#chronic wound symptoms

[grimaldiapologist]

This isn't an urgen concern or something that's coming out of a present situation of feeling the worst ever,

but like, with chronic illness, how are you supposed to know when something's an actual emergency? There's a new "this is the worst I've ever felt" with frightening symptoms of impending doom at least three times a year, and it's never anything. It's never anything and going to the urgent care for it just wastes everyone's time.

How the fuck are you supposed to know which "feeling the worst you've ever felt" is the one?

[kbkhospitals]

treatment for chronic wounds in hyderabad

Effective Care for Chronic Wounds at KBK Multi Speciality Hospitals offers top-notch treatment for chronic wounds. Heal faster with our expert care.

[baby-yongbok]

Remedies

OT8 x Reader

Genre - Comfort WC - 746

Summary - These are ways that I think the boys would help you to get over your mental and/or physical struggles Content Warning - Themes of mental and physical illness/struggles, mention of hospitals, mentions of medications/needles, mentions of food

A/N - I wrote this on my living room floor just now because I’m sick of being sick. I’m sick of being chronically ill, and I needed some comfort, so I thought I’d share it for anyone else who could use some comfort, too. I based these off of my experiences with my illnesses/disabilities. If you can relate then I just wanna say that i see you and you're strong. Keep fighting 💕+ I tried to write this to be gender neutral, I think I nailed it

✧ Masterlist ✧

Hugs from Jisung when your panic attacks have subsided. He whispers sweet praises of “You're okay” and “You're so strong” while he rocks you in his lap. You're still on the floor where he found you. His shirt soaks up every tear and his soft kisses on your forehead bandage every wound. You tell him that he can go, you apologize for causing a commotion, but he just holds you closer.

Laughing with Changbin while he tries to distract you from your symptoms flaring up. He's loud and silly on the couch with you. He's careful not to go overboard, he watches you to make sure that you're still comfortable while he makes silly voices and dances around for you. He's not ready to watch you cry yourself to sleep from the pain but he'll be ready to make you laugh again when you need it most.

Kisses from Chan while you're at your doctor's appointment. Your leg is shaking and he's soothing gentle circles into your back while he kisses your knuckles. He knows that you're scared, he is too. You have no idea what the doctor will say but he knows one thing for sure, no matter what the results are he'll be right by your side. He'll fight with you every single day and he'll kiss the pain away.

Adventures with Hyunjin when he realizes that you're avoiding going outside again. He knows that you get paranoid. He knows that every corner that you turn feels unsafe so he holds your hand. He skips across streets with you and dances on the white lines of the cross walks. He pulls you into shops that you've been too scared to visit yourself and buys you everything that you touch. He molds new memories with you with his bare hands. He'll do it everyday if he has to.

Cooking with Minho when he sees that you've been watching your diet too closely. He's gentle with you. You taste test everything together, he feeds you with silver spoons and kisses your nose with every hesitant swallow. He stands behind you while you stir the contents in the pots and plucks flour at you to see that pretty smile that he loves so much. He feeds you from his fork and he wipes away the mess. He makes it feel like it all goes down easy.

Reading with Seungmin when he comes to visit you in the hospital. He knows that you feel like you're going mad in here. He knows that you want to get up out of bed and walk out of here with him, that's what he wants too. Instead he holds your hand while you rest your head on his shoulder. He reads you each word with a softness that somehow drowns out the beeping of your monitors and the commotion on the other side of the curtain. He transports you to a place where you aren't sick. To a place where it's just you and him.

Cuddling with Jeongin when you feel that dark cloud consuming you again. He knew what was wrong when you let your alarms ring on for the third day in a row. You're huddled under blankets together, unmoving and quiet. His arms circle your waist and he pulls you closer. He weighs you down to reality. He makes you feel something besides the bubbling emptiness in your chest. He hums to you when the tears start to fall. He hums and holds you tighter. He won't let you drift away.

Singing with Felix while he helps you with your medication. There's so many to take that you've been overwhelmed with it all so he puts on a playlist and grabs all your pills. He lays them out and organizes them just how you need them. He uses the TV remote as a microphone, passing it to you when he sees you staring at the medicine littering the tabletop. He has you sing for him when he gives you your injections. He makes them as quick and painless as he can, always joining you for a high note as he sticks the band-aid on for you. He spins and hugs you once you're done for the day. He doesn't have to give you any praise, you can feel the love in his touch. You can hear it in his voice and see it in his actions. He's always going to be there to make it all feel easier.

If you liked this and wanna see more of this content let me know!

Thank You For Reading! Please Reblog or Comment to let me know how you liked it! It makes my day! 💕

Perm. Tag List:

@kayleefriedchicken

@compersian @kibs-and-bits @lixiluvs @armystay89 @lghtdarling

@teddy-stay , @baconcupcakes123, @moonchild9350 ,

@krayzieestay, @soulsbbg , @stay-bi , @yzsqu , @gho-ster , @lghtdarling

[macgyvermedical]

Reference Guide to Writing Drug Withdrawal

So your character has a substance use disorder (or physical dependence to a substance for another reason). This post will tell you how to write a scene (or story) in which they go through withdrawal.

NOTE: THIS POST DOES NOT INTEND TO COVER ANYTHING EXCEPT WITHDRAWAL, WHICH IS A VERY SMALL PART OF SUBSTANCE USE DISORDER AND PHYSICAL DEPENDENCE.

Substance Use Disorders and Physical Dependence:

Substance use disorders are chronic illnesses in which a person continues to use a substance (commonly nicotine, alcohol, cocaine, opioids like heroin or fentanyl, benzodiazepines, etc...) even when acquiring or using the substance can be dangerous or cause significant problems in their life (such as problems with money, safety, law enforcement, job security, child services involvement, or physical problems like wounds, infections, side effects, hangovers, and withdrawal). Substance use disorders are a common cause of physical dependence.

Physical dependence is also it's own problem and can occur for other reasons too. For example, many people take prescription medications that they would go through withdrawal from if stopped abruptly (say, because the pharmacy couldn't fill it in time and they ran out). Assuming that the medication is being taken as prescribed, physical dependence in itself does not mean someone has a substance use disorder.

So what is withdrawal? Withdrawal (sometimes called "detox") is the process by which a body stops being physically dependent on a substance. Generally speaking, it is unpleasant. This is because when a body is exposed to a substance repeatedly, it changes how it functions to accommodate that substance. When the substance is removed, there is a period of time where the body has to re-adjust to not having the substance.

For example, alcohol is very similar to the neurotransmitter (brain chemical) GABA. If you drink a lot of alcohol (more than about 4 drinks per day) for longer than about a month, the body decreases the amount of GABA it makes naturally to accommodate the "fake" GABA from the alcohol. If the alcohol is suddenly removed, the body doesn't have enough GABA, and the effects of not having enough GABA result in withdrawal symptoms.

The difference being, someone taking a medication they no longer want to take can slowly reduce the dose to minimize withdrawal symptoms. Someone with a substance use disorder usually finds cutting back nearly impossible. Because of this, managing physical dependence in someone with substance use disorder generally means giving them a similar substance which they get from a pharmacy and take continuously (methadone, buprenorphine), or a similar substance they can then taper off of in a controlled way (benzodiazepines, gabapentin).

Specific Withdrawal Syndromes:

Alcohol/Benzodiazepines:

These are the only two substances that result in a potentially life-threatening withdrawal syndrome, and it's essentially the same syndrome. As stated above, when taken for either 2 weeks for benzodiazepines or 4 weeks for alcohol, the body decreases the amount of GABA it produces naturally. GABA is the "brake pedal" in the brain, slowing things down and decreasing the amount of activity. If you don't have enough GABA, you get too much activity, which can result in severe anxiety, insomnia, seizures, hallucinations, high blood pressure, temperature, and pulse rate, heart arrhythmias, and confusion.

6-12 hours after a person's last drink, they will experience insomnia, anxiety, tremors, and headache.

12-24 hours after a person's last drink, if untreated with benzodiazepines or gabapentin, they may start to experience hallucinations (they typically know they are hallucinating at this point).

24-48 hours after a person's last drink, if untreated, they may start to experience seizures.

48-72 hours after a person's last drink, if untreated, they may start to experience a severe symptom known as delerium tremens. This is a state where they are hallucinating severely and they don't know they are hallucinating anymore. This is also a state where the person has heart rhythm problems that could result in death. This is the most dangerous period during withdrawal.

If a person makes it through 72 hours, they are usually in the clear as far as life threatening symptoms go, though they may experience mild symptoms like headaches and insomnia for long periods afterwards.

Note that medication for alcohol or benzodiazepine withdrawal like other benzodiazepines, phenobarbital, and gabapentin are given only for the first 5 days of withdrawal, tapering to lower doses each day. This gets the person through the dangerous part hopefully with no life threatening symptoms. It does not mean all symptoms are controlled, but they are hopefully kept on the milder end while the brain learns to make it's own GABA again.

Opioids:

Opioids include a range of drugs including prescription medications like oxycodone, hydromorphone, and morphine, as well as street drugs like heroin. Today, the street drug supply in many places is heavily adulterated. Many samples of heroin (and even "pressed pills" made to look like prescription opioids) contain the much stronger opioid fentanyl (which increases risk of overdose) and the sedative xylazine (which causes wounds) in addition to the expected heroin or oxycodone.

Opioids work by pretending to be endorphins- another neurotransmitter usually used by the body to reduce pain and stress. Similarly to GABA in alcohol use, the body reacts to having sustained high amounts of fake endorphins by decreasing the amount of endorphins it makes itself. This means, when the opioids are no longer present, the body can't make itself feel good or recover from pain.

There are many parts of the body that endorphins work in, including the brain, gut, nerves, and spine. When they are removed, symptoms include:

Nausea and vomiting.

Diarrhea.

Insomnia.

Anxiety.

Increased body temperature.

Racing heart.

Muscle and bone pain.

Sweating.

Chills.

High blood pressure.

There is not really a universal timeline for these symptoms like there is with alcohol. For someone who primarily uses short-acting opioids, withdrawal begins 8-24 hours after the last use (though anxiety and cravings can start much sooner). For people who primarily use long-acting opioids, withdrawal can take up to 36 hours to begin following the last use. Generally, symptoms peak within 1-3 days after they start, and acute symptoms last 10-14 days.

Unfortunately, someone who has an opioid use disorder will frequently experience cravings for very long periods of time (potentially the rest of their life) after they stop use. For this reason, people do significantly better at reducing or stopping use over the long haul if they are taking an opioid replacement drug like methadone or buprenorphine.

Methadone and buprenorphine are prescription medications that a person goes somewhere each day to get (methadone) or picks up each day from the pharmacy (buprenorphine). The drugs essentially make it so the person won't go into withdrawal and will have significantly fewer cravings for as long as they take the drug.

The management of opioid withdrawal is usually done by switching the person from a street drug to one of these opioid replacement drugs. However, it is important to note that methadone doesn't work immediately (usually it takes about 2-5 days of titrating it up to get it to a high enough dose to work, longer if the person has a very high tolerance). Buprenorphine requires a certain amount of time in withdrawal (usually a day or two) before it can be given, or it can make withdrawal worse instead of better (something called precipitated withdrawal).

Once someone is on one of these medications, they can choose to stay on them (recommended) or taper off (nice to be off meds in theory, but high rates of return-to-use).

Cocaine/Amphetamines:

Instead of pretending to be a neurotransmitter, stimulants like cocaine and amphetamines prevent the body from re-absorbing the neurotransmitter dopamine, leading to a whole bunch of it hanging out in the brain. This increases concentration and energy and boosts mood. However, taken over long periods of time, the brain kind of burns out and fails to respond to the high levels of dopamine.

You may have heard that amphetamines and cocaine don't have withdrawal states. That would be a myth. People who use stimulants repeatedly for long periods frequently have a withdrawal that is essentially the opposite of the effects of stimulants- they feel very tired, have trouble focusing, and feel depressed because their brains can't use dopamine the same way they did before the drug use. This may last for weeks after cessation of stimulants.

Unfortunately, unlike with alcohol and opioids, there's not a ton that can be done for this withdrawal. There have been several studies, including testing medications like the antidepressant mertazapine, the migraine medicine topiramate, as well as naltrexone and buproprion (also an antidepressant).

In Conclusion:

There is so much more to drug use, substance use disorder, and physical dependence than I am covering in this post. I am just covering a small part of physical dependence, however the cause, by discussing the effects and common treatments for withdrawal.

Thank you all for reading this far! I hope you learned something and will use it in your writing!

[darkficsyouneveraskedfor]

The Pain of Living 1

Warnings: non/dubcon, chronic pain, blood/violence, perversion, and other dark elements. Not all kinks or triggers are tagged. My username actually says you never asked for any of this.

My warnings are not exhaustive but be aware this is a dark fic and may include potentially triggering topics. Please use your common sense when consuming content. I am not responsible for your decisions.

Summary: You deal with pain every day, but a new source of pain lands on your front step.

Note: I know I shouldn't.

As usual, I would appreciate any and all feedback. I’m happy to once more go on this adventure with all of you! Thank you in advance for your comments and for reblogging.

You can’t sleep. That’s nothing new. Your fatigue is more than just a symptom of your condition. It’s a purgatory. Much like the pain that often adds to your restlessness. Funny how you know moving hurts, yet you hate to be still. 

You sit up and groan at the stiffness in your neck and shoulders. It isn’t just in the mornings. It follows you through the day. You fall asleep with the same tension wound into your muscles. 

You stand, dragging your feet as you try to shake out the tingling in your arms. Your thumb twitches. You yawn, long and loud, and wade through the early dim. You made it almost to three in the morning. That shouldn’t be a great feat. 

You grab a sweatshirt from your closet and leave the small bedroom. The place is tiny. One-floor; a kitchen, a bedroom, a front room, and bathroom. Detached and lonely but affordable. You don’t go out anyway, not where there are people. And you don’t have friends. 

You slip into your shoes and open the front door. There’s a bench at the edge of the property. Ten steps. That’s it. Sometimes they’re easy to count. Other times, it feels like Everest. You get there and you’re out of breath and the way back feels tenfold. 

You can’t stay inside. You feel claustrophobic in your own body, holing up in the house, only makes it worse. The air is cool and damp as dew settles on the grass. Your slips clap on the narrow pavement path.  

...Two, three, four, five... 

You slow and squint at the bench. There’s something on it. At first, you think someone left a bag of rubbish there again, but then you notice the way something dangles over the edge. It’s a man. 

You stop and turn back, looking at the front door, but then you think better of it. He could be hurt. Likely, only drunk. 

Six, seven, eight, nine, ten. 

You stop beside the bench and look down at the figure. He’s breathing. You can hear each painful wheeze as he sucks it in. He’s face down, one arm and one leg hanging over the side. His head droops down as well, he’s too tall for the slats. 

More startlingly, there’s a slick patch of red across his left shoulder. His shirt is torn around the gaping wound and blood smears across the fabric and his neck. There are even stains in his hair that seep past the buzzed strands into his scalp. 

You’re weak at the sight of him. You reach to the back of the bench to keep from collapsing. He’s in rough shape. What do you do? 

You stare at him then at the house. Ten steps. What do you? Do you go back and grab your phone, call for help? You try to get him up? Then what? You’re certainly in no state to help him. 

You lean back on your heel. Something wraps around your ankle and you yelp. You look down as the man clings to you. You try to shake him off and he grumbles. 

“Don’t leave,” he rasps, another breath rattling from his chest. 

“I... sorry,” you try to twist your ankle free. “I can’t--” 

“Dammit,” his breath whistles from him. “Don’t.” 

He squeezes even tighter and you whine. 

“Sir? I can call someone.” 

“Fuck... no,” he sneers. 

He releases your angle, raising his hand up your leg, dragging along the loose fabric of your pajamas. He reaches up, waggling his fingers. All three of them. You’re sickened at the sight of his bloodied and stubbed ring and pinkie fingers. 

You take his wrist and latch on as firmly as you can. He grunts as he pulls himself up and angles to sit against the back of the bench. His feet hit the ground heavily and he puffs out a tortured huff. 

“Fuckkkkkkk me,” he groans as he hugs his ribs. More blood across the front. 

You stare, dumbfounded. 

“I’ll get my phone.” 

“Don’t you fucking list--” He coughs and bends forward, keeping his arm around his middle as he hacks. He spits a reddened wad onto the ground and growls. “No. No calls. Get me inside.” 

“Inside?” 

“You keep making me repeat myself and I’m going to drown in my own fucking blood,” he reaches for you again, “come on, honey bun, I just need a boost.” 

You wave and once more peek at the house. He snarls and drops his arm. You glance back as he folds over again and reaches under his pant leg. He sits up with a pain roar and extends his arm in your direction. Your eyes nearly cross at the sight of the short barrel. 

“Get me off this fucking bench before you’re in worse shape than me. Got it, tater tot?” 

Your blood runs cold. You’ve never had a gun aimed at you. You’ve never even seen one up close. Only water pistols. 

You don’t think of arguing. You don’t even try to explain that you’re not very strong and that you hurt all over and you really don’t think you can get him that far. You don’t because you don’t feel any of it. Adrenaline overflows and drowns out all your doubts. 

You put your hands up and sway, “I’ll help. Please put it way.” 

He sighs and drops his arm. He leans forward and raises his other, waving you closer as he dips his chin. You move in front of him and grab his elbow. He rocks slightly, “on three.” He pushes back and forward, “one, two, three.” 

He uses his momentum to stand and whittles out a brittle breath as he hunches over. He stretches his arm over your shoulders and you fight not to wilt under his weight or the scent of blood radiating from him. You move cautiously, measuring each step as you work to keep from tipping over. 

You turn him back down the path. Should you really bring in a man with a gun? You don’t have much of a choice. Even as your bones ache and your muscles burn. 

He sounds awful. Like he’s dying. He could be. If he is, you’d hate to leave outside to do so but you’re not sure him doing so inside is much better. 

“Fucking Christ, move a little slower,” he drones. 

You don’t say anything. You can’t. You’re scared and in agony. You get him over the single step onto the porch and manage to push him through the door. The effort of your last surge has his arm sliding from your shoulders and he keels over onto the floor with a terrible thump and groan. You stand over him as he rolls onto his back. 

“Balls,” he croaks as he sprawls on the rug. “For the love of my dick, get some fucking towels before I bleed out.” 

You blink as you register his command. You don’t hesitate. You can’t. You hope he knows what to do because you sure don’t. 

You turn and go as fast as you can to get the towels, too distracted by his blood to worry about him staining your them or the floor. 

[opal-kitty333]

So, I like Horror Sans, and being a nerd, I've been thinking about him a lot during my recovery with brain damage. A lot of people treat his wounds like brain damage, giving him memory problems, chronic headaches/migraines, speaking difficulties, fugue states, just issues collecting his thoughts. All understandable and reasonable symptoms, but there's something about just what truly horrific, completely life altering, brain damage to such an extent can do to a person that hasn't been explored very much. Yes, he doesn’t technically have a brain, but considering someone with head trauma like him would be in a comatose like start for weeks to a month, we can choke up him taking that hit like he did and being able to walk and talk to that. Plus, we can take inspiration from real injury and science and have wiggle room for it to not be 100% accurate. Anyway-

This is Phineas Gage.

It is one of the earliest extreme cases of brain damage where the patient survived while psychology as a scientific practice was getting on it's feet. If you've taken a psychology class, you've heard of him. He was a railroad worker foreman who had a rod blown through his skull in an accident, destroy most of his frontal lobe.

If you don’t know what the frontal lobe is it's where your ability to reason and make decisions, the ability to control your muscles voluntarily, and your ability to process knew information and recall old information. It's well known for being the part of your brain that inputs logic, the part gives you the ability to remember what happened last time you picked a fight with someone, so instead you choose to walk away despite how much your want to punch them for being a prick.

As I stated before, this man was a foreman, well known for keeping a level head, being responsible, and hard working. After the injury, that completely changed. Everyone agreed he was barely recognizable as himself. He was impulsive, prone to extreme mood swings, impatient, making massive plans only to almost immediately abandon them, and generally seemed to have no control over his desires or ability to distinguish between a want or a need.

Now, let's look at Horror.

I'd say it's safe to say his frontal lobe but also part of his parietal lobe would be utterly fucked. Your parietal lobe controls your ability to process sensory information (mostly touch) and to understand not only where you and your body is, but to process the world around you. You see a massive enough tent, some clowns running around, the right music, and your parietal lobe is what does the work to label that as a circus.

To have these two structures damaged, or the closest equivalent in a monster, would radically alter Sans' personality, his ability to move, his understanding of the context around him, and connect with others.

He'd become rather self centered on his own desires and beliefs, struggling to even have the patients let alone the want to give other people the time of day. His actions would be impulsive, made on his emotions in the present moment and with little concerns other than the immediate consequences. He'd be prone to loud outbursts, not just rage, but any other emotions like sadness or glee with little ability to realize how he's acting may be overblown or inappropriate. Not only could his ability to put his thoughts into words be a struggle, but his ability to say those words could be affected as well. He'd be very present focused, with pass relations or responsibility mattering little as he keeps marching to the beat of his own drum.

That is, if he could march. He'd not only struggle to know where his limbs are or what he's touching, but his sense of balance would be awful. He'd likely have a constant wobble, having to go slowly and potentially hold onto or lean on things if he wanted to move quickly. God forbid how much he'd bump into furniture or trip and struggle actually grab onto something to catch himself. It's entirely possible he'd have difficulty reading and writing or confusing his left and right regularly. He'd need more time to process a situation and could very easily misidentify what's actually going on could likely lead to him acting even more unpredictable as the world around him is so much more dangerous and he's struggling to fully understand what everyone is doing and trying to keep two steps ahead of everyone around him.

But here's the thing. The brain is also incredibly adaptable in ways your wouldn't believe. Phineas Gage slowly recovered over time. He died twelve years after the incident from epilepsy but over time he slowly regaining his social skills and general functionality. He picked up a job as a stage coach four years after the indecent even. He was never quite the same person he was before, but he wasn't doomed to be what he first was after the indecent.

Imagine what this kind of thing could mean for Sans. Not only would the betrayal cut deep enough and the world falling apart put him through trauma that would shred the soul, but people he trust literally damaged his ability to think logically and control his impulses. Of course he's going to lash out, focus on doing anything he can to survive with little respect for what anyone else thinks. Even forcing his brother to do things and refusing to listen to him unless given no other option. All while he thinks the biggest problems after the indecent is how much his head hurts, how his memory is shot, that it's harder or even down right painful to think, and how he's struggling to cling to his independence while never having the patience or resources to give himself the ability to heal. He doesn't even realize how much he's changed. If you point it out Sans would likely get defensive and aggressive, or brush it off as everyone underground being awful people out to eat each other alive.

But then he gets out to the surface. He gets stable food, a safe place to live. His brother is recovering and as the years pass his mind can finally start pulling itself together and healing, finally. Sans begins to regain his ability to think critically on his own actions and others, his emotional outburst and vindictive behavior start to wind down and fade. He's able to think and start sifting through all the shit he remembers.

The guilt of what he did, the people he hurt for no reason other than pettiness. The stupid decisions he made that hurt himself and/or Papyrus in the long run. All the hindsight he has now. Imagine how much he would bury those memories and thoughts. Justifying everything he could and insisting he had reasons, or that it's just how it was and that everyone was as awful and cruel he was. Or just accepting that what Undyne had done to him and the famine after had ruined him, broken and rotted all the good he had and left him vile and malicious. That he'll never have a chance to truly be who he was before.

[covid-safer-hotties]

Also preserved in our archive

By Betsy Ladyzhets

Since early in the pandemic, people with Long COVID have faced challenges in applying for disability benefits, including from their employers, insurance providers, and the U.S. Social Security Administration. Applications often take a long time and are denied even for people who clearly have debilitating symptoms, leading to years-long, arduous appeals processes. The same has been true decades prior to 2020 for people with other infection-associated chronic diseases.

To learn more about the disability insurance system, Betsy Ladyzhets spoke to Barbara Comerford, a long-time disability lawyer based in New Jersey who specializes in these cases. Comerford has represented people with myalgic encephalomyelitis (ME, also known as chronic fatigue syndrome or CFS), for more than 30 years, including high-profile cases like that of journalist Brian Vastag.

Comerford discussed how the process works, her advice for putting together applications and appeals, how Long COVID has impacted her practice, and more. This interview has been lightly edited and condensed for clarity.

Comerford’s tips for disability benefit applications:

Comerford recommends that people applying for benefits extensively document their symptoms. Medical tests such as neuropsychiatric testing and cardiopulmonary exercise testing are her recommended method for documentation, though she acknowledges that these tests can be expensive. Comerford suggests that applicants should be careful to find lawyers and medical providers who have experience with these cases and won’t dismiss their symptoms. During the appeals process, Comerford recommends requesting a company’s administrative record and combing through it for any evidence that they abused judgement, cherry-picked evidence, or made other errors in assessing the case. Make sure to follow deadlines for filing appeals, as cases are closed if documents are not submitted on time.

Barbara Comerford: Should we focus on disability insurance, or do you want to focus on social security disability, or both?

Betsy Ladyzhets: Both, because people [with Long COVID] are applying for both.

BC: Right. And often, people think they should only apply for one, [but they should apply for both.]

Most of the disability plans that people have are often through their employer. Those plans are known as ERISA plans, that refers to Employee Retirement Income Security Act. It was created in the 1970s… Congress created this regulatory scheme, and then immediately created a zillion loopholes that corporations can drive a truck through. Later, ERISA covered all employee benefits in general.

Insurance companies wound up selling policies to corporations saying, “You can get the best people if you offer incentives.” And what’s a better incentive than, if someone gets sick, they can collect a substantial percentage of their salary until full retirement age? These are the sorts of perks that… People think, “If something happens to me, I’ll be protected.” The promise of these policies is that they will give people, usually, between 50% and 80% of their pre-disability income if they satisfy the requirements. Well, that’s a big if.

I’ve been doing this for 38 years. And I can tell you that 38 years ago, these [disability claims] were not problem cases. I used to do them for free for my litigation clients… But over the years, and really starting after 2001 with September 11, all hell broke loose. They [insurance companies] began to get very aggressive. Every time there is an economic downfall, whatever it is, they get extremely aggressive. So you can imagine, with the onset of the pandemic, they knew what was coming.

I did, for many years, advocacy for ME/CFS cases. I represented thousands of people… A lot of my colleagues say, “Long COVID social security cases are almost impossible,” because they don’t know what to do with them. My office hasn’t found that to be the case. I think the difference is, you have to document these cases with as much objective documentation of symptoms that people have… Get neuropsych testing, cardiopulmonary exercise testing, and other tests.

I started doing webinars and seminars [about disability benefit applications] in 2020, because I knew this was coming. At that point, they weren’t calling it Long COVID, they were just saying, some people with COVID weren’t getting better. But I knew it was going to turn into another ME/CFS disaster.

BL: How have you found the rise of Long COVID has impacted your practice? Do you find you’re more in demand now?

BC: We’ve always had a high volume of cases. Quite a few of them were ME/CFS cases. We did a case, Vastag v. Prudential, in 2018. Brian Vastag, who was a science writer for The Washington Post, was my client, and I could not get over how aggressively Prudential was just dismissing him because it was an ME/CFS case.

And the same is happening with Long COVID. We do cases all over the country on Long COVID and ME/CFS. It’s my livelihood, so it’s important for me, but it also makes me a little crazy that people get treated the way they do and that they have to hire people like me.

One of the things that people get upset about is that they have to spend money to medically document their symptoms. And worse than that… I see these Long COVID clinics, with doctors who are completely ignorant on Long COVID, who surreptitiously write notes in the chart that they think it’s a psychiatric case. I don’t know how familiar you are with this.

BL: Unfortunately, I’m very familiar.

BC: It’s awful. Not only is it really hard on my clients… It triggers them to read things that might not be what they said or might not be pleasant. And the number of times that I have seen that and it has sabotaged cases! I have to reconstruct the cases and have the clients contact the clinic [and get them to make corrections].

Mental/nervous limitations exist in all of these [insurance] policies… They can limit someone’s payments to two years if the case is a psychiatric case or mental/nervous limitation with a DSM diagnosis.

BL: I wanted to ask also — there’s been a lot of research on Long COVID at this point, and there was a report this summer from the National Academies specifically in response to a request from the Social Security Administration about Long COVID as a disability, in which they found that this disease can result in inability to work, poor quality of life, all that stuff. Have you seen that report, or other research, like the growing body of research on these diseases, have an impact?

BC: I was asked to comment on that [report]. Part of the problem with Social Security’s initiatives in this regard is that every social security case goes through what they call “sequential evaluation process.” You have to go through five steps to determine whether or not someone’s disabled. And among those steps is [matching people to a “medical listing of impairments,” but the list doesn’t include major symptoms for ME/CFS and similar diseases].

Years ago, there was a ME/CFS ruling called 99-2p. It offered guidelines [for ME/CFS cases that don’t fit the typical Social Security process]. After that, I was asked to present to the national association of Social Security judges, there were 500 judges in the audience. And I asked, “By show of hands, how many of you are familiar with 99-2p?” Two hands went up.

Despite the guidelines, in practice, [the judges aren’t familiar with these diseases]. Until there is a time when we can come up with a firm diagnostic criteria for Long COVID, and we can say, “This is what you have to document for this illness.” … And it can’t just be a positive COVID test, because many people got sick before testing was prevalent or they got sick after people stopped documenting that they were positive.

The other problem for Long COVID cases is it’s not like cancer or a broken leg or herniated disc or something that people are accustomed to. Those people are not told they’re crazy. Those people are not told they’re imagining it. Those people are not told, “Well, we just don’t buy it.” This is what happens with [Long COVID] and ME/CFS. The psych component that they try to pigeonhole these cases into is really a master stroke by the insurance industry that spends billions of dollars trying to persuade people that anyone who files for these benefits is a crook or fraud.

BL: It’s infuriating, especially when you see how deeply people’s quality of life is impacted by these diseases.

BC: Yes, every part of their life is impacted.

BL: I see what you’re saying about needing diagnostic criteria. In this time where we don’t have that yet, what would you want to see the Social Security Administration or other government agencies do to make it easier for all these people who are applying for benefits with Long COVID and ME/CFS?

BC: They should [reevaluate] the sequential evaluation process, which has been there forever, and look at medically determinable impairment in the context of Long COVID and ME/CFS. These diseases can be documented by things like neuropsych testing.

I’ll quickly go through the five-step sequential evaluation process. The first step is, “Is the person engaged in substantial gainful activity?” That is something you can do predictably, something that will last at least 12 months, and something that leads to gainful work, where you get paid and you can report for a job either part-time or full-time. In Long COVID cases… you have to document that this person is not engaged in substantial gainful activity because they don’t know tomorrow if they’re going to be able to get up and get out of bed and take shower, never mind report for work.

If you satisfy step one, they go to step two. There, they ask, “Do you have the ability, in light of your disability, to perform basic work-related activity?” Sitting, standing, reaching, pushing, pulling, reading, concentrating, things of that nature. And, “Does the disability negatively impact your ability to do these things?” [You need medical evidence, which can come from] a physician’s evaluation from a Long COVID clinic, for example.

If you have that, you go to step three, which is where that horrible “medically determinable impairment” crap comes in. There isn’t {a specific listing} yet for Long COVID, although they’re talking about it. Frankly, we’re still waiting for them to do one for ME/CFS, so I’m not holding my breath. That’s the only step in the process where, if they don’t satisfy it, you can still move on to the next step.

The fourth step is, “Is this person capable of performing the work that they performed for the last five years?” Until June of this year, it was the last 15 years… So we go through each job they had, all their symptoms and limitations and why they can’t do [the job anymore]. If we document successfully that they can’t perform their past relevant work for the last five years as a result of their disability, we can then go to step five.

Step five, the burden shifts to the Social Security Administration. Social Security has to document that, in light of a person’s age, education, and work experience, that there is no work in the national economy that they could perform. [To do this], Social Security has a big graph called the “medical vocational guidelines.” And essentially, the younger you are, the more skills you have, the more education you have, and the more skills that are transferable, generally you are found not disabled. But the graph is not supposed to be used for cases that involve what we call non-exertional and exertional complaints together. Pain, fatigue, things of that nature are all part of the non-exertional limitation.

That is how we lift ME/CFS and Long COVID cases out of that graph. Despite the fact that many of our clients are very young, many of them are highly educated, many of them have developed skills that are not only transferable, but are also in high demand in the national economy — [we say that] because they can’t predictably perform sustained work of any kind, the grid should not be used to find them not disabled. But with all of this, every one of these cases, medical documentation of limitations is crucial. I can’t emphasize that enough.

BL: I know a lot of people in Long COVID community, they’ve already sent in their applications, and then it gets denied, and then they have to appeal. What is that process like, and how would you suggest people go about finding someone like you?

BC: It’s really important to do some research. You want to know if the doctor or attorney you’re dealing with has experience in these cases… I do [webinars and one-on-one education] for lawyers all the time, because I’d rather them hear what has to be done, and understand what happens if they don’t do it.

If I’m giving people advice on appeals… If it’s coming from a United States employer, you’re going to be governed by ERISA. That’s important because people might file a claim without knowing the exact company policy. Despite the fact that federal regulations require employers to give that information to employees, when someone gets sick and files a [short-term] disability claim, they are immediately cut off from the employee benefits portal [that has all the exact policy information]. So then I’ve got to write a letter to the employers, and fight to get that information.

You can’t even get discovery in these cases… Sometimes they will award benefits, and then six months in they’ll say, “We no longer believe you’re disabled.” Under ERISA, [employers and insurance companies] get all the advantages.

BL: It seems like people should know, if you’re filing against an employer, to save that policy information before you lose access to it.

BC: When you get the notice of a denial, you can request a complete copy of the administrative record. You are entitled to see everything that the insurance company had on the case, and under federal regulations, they have 30 days to produce it.

And then you have 180 days to appeal that [denial]. People say that’s a long time. It’s really not. Because you’ve got to go through thousands of pages of documents. You’ve got to document where they abuse their discretion. It’s not enough to have medical evidence… [The standard you have to push back on is that] the insurance company or the employer has a “reason” to deny the claim.

The lawyer’s job or the claimant’s job is to show all the examples they found in the administrative record that show [mistakes or poor judgement on the part of the insurance company or employer]… Sometimes, you will see reports of experts that they’ve retained to review the case, and the expert will say, “I think it’s a payable claim.” And then the next thing you find is them looking for another doctor who’s a little more receptive to their suggestions. If we see they’ve ignored the opinion of one of their experts, that’s an example of abuse of discretion and arbitrary, capricious conduct. Cherry picking the evidence is another thing you often see in these cases.

BL: So it’s not just sending your own medical records, you have to show that the company has messed up.

BC: The insurance company or the employer, whoever is paying, you have to show that they abused their discretion.

BL: Is there anything else, any other advice or resources you would give people?

BC: This is really important. If it’s an ERISA case and they do not get that appeal in within 180 days, they’re foreclosed from pursuing it any further… [It’s a big mistake] if you blow those time deadlines.

All articles by The Sick Times are available for other outlets to republish free of charge. We request that you credit us and link back to our website.

[scientia-rex]

I got home from work today sneezing my head off with a right eye that won’t stop watering, took a hot shower, climbed into bed, and I haven’t climbed out since. I’m grumpy and I have a headache and if I’m not testing positive for COVID or debilitated by symptoms tomorrow I’ll still need to go to work because that’s twenty patient visits that would need to be rescheduled, usually with someone else, and that’s twenty people I’m letting down. Today I did one of my patented 45-second Pap smears (if it takes longer than that, your doctor needs to get better!) for someone with vaginal atrophy from menopause (it is both very common and very treatable) and she was in disbelief. (This time it was more like 30 seconds.) I saw a suicidally depressed patient who’s clinging to life with both hands and I changed their meds last week and I am not making them wait to see me. I cleaned a wound no one else gave a shit about and I saw a bitter pissy Republican Party bigwig who has terrible anxiety and depression she doesn’t tell anyone about, who’s alienated everyone but who I can still convince to try treatment.

I do my job on hard mode on purpose. I like being important—who doesn’t? I like being legendary, I like that when people move to town and ask for doctor recommendations on Facebook so many people mention me that other patients feel compelled to tell me about it. I got nominated for best doctor in our local region last year. (I didn’t win, out of 5 nominees.) But when I’m sick, when I’m the kind of sick that can be hidden easily, the kind of sick I was always expected to go to school and rotations and residency with, it’s so hard. I hate exposing patients, even to a cold, but the benefits of receiving care are probably enough to outweigh the chance of transmission. I wrestle with myself: if I call in, it starts a ripple effect. Can they get a per diem from their “pool” (of three) to come in? Can they reschedule my patients with me? I don’t have any open spots for five weeks. Can they open same days? None available for three weeks. Can they open blocked spots? That’s going to make my life hell when I come back from being sick. That’s clinic staff calling twenty patients, trying to reach them. That’s twenty patients who feel abandoned. They can know intellectually that doctors get sick too, but they don’t believe it. They take it personally. I have seen this over and over again, until I had to believe it.

It is so EASY for people who don’t do this job to tell me how I’m doing it wrong. “Just stay home!” Oh, okay, you want to tell the person whose chronic opioids I’m supposed to write for that I can’t? You want to put the nurses through getting the on-call to write a bridge prescription? I write more ADHD meds than most of my peers—usually a lot more. You want to tell my colleagues to write meds they’re uncomfortable with? How about tell my suicidal patients (which is a lot of them!) that the provider they know and trust after months or years will be replaced today by a 70-year-old white man who still thinks they should pull themselves up by their bootstraps? Tell my queer patients that they have to wait until I’m better and back to get their hormones and their STI screenings, reschedule a Pap someone was dreading. Every day is a kaleidoscope of opportunities to make a real connection with “difficult” patients. I’m good at it. I may be the best at it at my clinic.

I don’t hate calling in sick just because the clinic manager is a judgy bitch, though that doesn’t help. I hate it because of what it does to my patients. And it’s not simple. Pretending it is does all of us a disservice. I am not a widget. I am not easily replaceable. You can’t plug any of our per diems (all men, 2/3 white, 2/3 old, 1/3 a Bitcoin bro) into my place and call it an equivalent, and my schedule is already so packed that if I call in sick, patients will be guilt-tripping me about it for months. I’m not kidding. That happens every single time.

Christ alive, I wish it was true that doctors never got sick.

[elicathebunny]

learning to let go of lingering negative emotions + Entering a calm state and regulating emotions.

(@anitalenia for the divider ౨ৎ)

Holding Grudges and struggling to let go.

Holding a grudge can affect you in many different ways ...

✦ Mentally:

Increased Stress: Constantly thinking about past experiences can keep your body at high-stress levels, leading to high cortisol and other stress hormones. Over time, this can contribute to anxiety.

Heightened Anxiety: Holding onto a grudge can lead to feelings of anxiety, as you may constantly worry about encountering the person you're resentful towards or replaying the situation in your mind. This can create a cycle of rumination and distress.

Negative Mood: Resentment and anger are negative emotions that can change your perception of the world and affect your mood. Holding a grudge can lead to feelings of bitterness, hostility, and general negativity, making it difficult to experience joy or contentment.

Impaired Relationships: Grudges can strain relationships, both with the person you're holding a grudge against and with others in your life. It can lead to communication breakdowns, conflict, and social withdrawal, which can further bring up feelings of isolation and loneliness.

Impact on Self-Esteem: Holding a grudge can also impact your self-esteem and self-worth. It may lead you to question your own value, especially if the grudge is related to mistreatment.

✦ Physically:

Increased Risk of Cardiovascular Problems: Chronic stress and negative emotions can contribute to high blood pressure, heart disease, and other cardiovascular issues. Holding onto a grudge can keep the body in a constant state of stress, leading to high levels of stress hormones like cortisol, which can negatively impact the heart and blood vessels.

Weakened Immune System: Prolonged stress and negative emotions can weaken the immune system, making you more prone to infections and illness. Holding a grudge can activate the body's stress response, leading to chronic inflammation and a weakened immune response.

Digestive Problems: Stress and negative emotions can also affect the digestive system, leading to issues like stomach pain, indigestion, and irritable bowel syndrome (IBS). Holding a grudge can increase these symptoms by keeping the body in a heightened state of stress, which can mess with normal digestive processes.

Sleep Disturbances: Negative emotions and stress can interfere with sleep quality and quantity, leading to problems like insomnia or disrupted sleep patterns. Holding onto a grudge can keep the mind racing with negative thoughts, making it difficult to relax and fall asleep.

Pain and Tension: Emotional stress and tension can manifest physically as muscle tension, headaches, and other bodily aches and pains. Holding a grudge can increase these symptoms by keeping the body in heightened tension.

Why might we struggle to let these feelings go?

Emotional Attachment: Negative emotions, like anger and hurt, can be intense and create a strong emotional attachment to the incident.

Need for Justice: We often feel the need for fairness or justice, and holding onto a grudge can feel like a way of ensuring the other person is held accountable.

Fear of Vulnerability: Letting go of a grudge might require forgiving someone, which makes us feel vulnerable and exposed.

Identity and Ego: Sometimes, grudges become part of our identity. Letting go can feel like losing a part of ourselves or admitting we were wrong.

Lack of Closure: Not having a clear resolution or apology can make it harder to move on, as the issue feels unresolved.

Recurrent Triggers: Frequent reminders of the event or person can continuously reopen the emotional wound, making it harder to let go.

Negative Reinforcement: Replaying the event in our minds can reinforce negative feelings and make them harder to release.

Low Self-Esteem: When we feel bad about ourselves, we might cling to grudges to deflect attention from our insecurities.

How can we try to overcome grudges?

Acknowledge Your Feelings: Recognise that you're holding a grudge and understand why. Reflect on what happened and how it made you feel.

Express Yourself: If possible, talk to the person you're holding a grudge against. Express your feelings calmly and honestly without being confrontational.

Empathy: Try to see things from the other person's perspective. Understanding their point of view can help you feel more compassionate and less resentful.

Forgiveness: Remember that forgiving someone is more for your peace of mind than theirs. It doesn't mean you condone their behaviour; it just means you're ready to move on.

Focus on the Present: Let go of the past and focus on the present moment. Holding onto grudges keeps you stuck in the past.

Self-Care: Take care of your mental and physical health. Exercise, meditate, or engage in activities that make you happy and relaxed.

Set Boundaries: If someone continually hurts you, it’s okay to set boundaries. Protecting yourself can help you let go of grudges while maintaining your well-being.

Seek Help: If you’re struggling to let go, consider talking to a therapist or counsellor. They can provide professional guidance and support.

How to enter a calm state.

Mediation: When we pay attention to our breath, we are learning how to return to, and remain in, the present moment—to anchor ourselves in the here and now on purpose, without judgment. This increased awareness allows you to recognise and understand your emotions as they arise, rather than reacting impulsively. Regular meditation trains your mind to stay calm and composed. This practice helps in regulating emotions and reducing the intensity of negative feelings like anger, anxiety, and sadness. As you become more skilled at meditation, you'll find it easier to maintain emotional balance and respond to situations in a more thoughtful and measured way.

Here are five reasons to meditate: 1. Understanding your pain 2. Lower your stress 3. Connect better 4. Improve focus 5. Reduce brain chatter

Journalling:

Emotional Expression: Journaling provides a safe space to express and process emotions. Writing about feelings, experiences, and challenges can help individuals acknowledge and make sense of their emotions, leading to increased emotional awareness and regulation.

Stress Reduction: Writing about stressful events or worries can act as a form of stress relief. By putting thoughts onto paper, individuals can release pent-up emotions and gain a sense of control over their circumstances, thereby reducing stress levels.

Problem Solving: Journaling encourages reflection and introspection, allowing individuals to gain insights into their thoughts and behaviors. This process can help identify patterns, triggers, and potential solutions to problems, fostering personal growth and resilience.

Self-Discovery: Regular journaling promotes self-discovery and self-awareness. Through writing, individuals can explore their values, beliefs, strengths, and weaknesses, leading to a deeper understanding of themselves and their identity.

Physical Exercise: Regular exercise can help reduce stress and improve your mood. Activities like yoga, walking, or swimming can be particularly calming. Stretching is often associated with physical benefits like improved flexibility and reduced muscle tension, but it also offers numerous mental benefits. It helps to release physical tension in the muscles, which is closely linked to reducing mental stress. As your body relaxes, so does your mind, leading to a calmer state of being. Stretching enhances your awareness of your body and its movements. This increased body awareness can help you become more in tune with how stress and emotions affect your physical state, allowing you to manage your mental health more effectively.

Watch what you consume: Put down the phone and silence any distractions. Purposefully make your environment peaceful enough for you to have a clear mind. Don't disrupt your session, stay in this calm moment for as long as you need to to properly reflect on yourself and make a difference to your emotions.

Allow yourself to dig deeper into your emotions without rejecting any ideas:

Really ask questions to make the most of the state you are in. Don't reject or suppress any feelings that come up, accept them and use those thoughts to understand yourself better. This will help you let go or work out anything that is bothering you. Understand your triggers and why you feel this way by prodding yourself with more and more specific questions. This may be an uncomfortable process but by understanding what is blocking you from being completely at peace within yourself then it must be done.

example: I feel like this -> why do I feel like this? Well, because this happened -> Why does this make me upset? Because it reminds me of this -> Why can't I let it go? and so on.

[miffy-junot]

Junot's head injuries

You're all probably aware that Junot received many head injuries throughout the course of his career, and that these contributed to his eventual descent into insanity. But there's not much awareness for the actual effects of brain injuries and how they work, so I'd like to make a post (using information from some medical manuals of head injuries and their effects) to outline how these injuries may have effected Junot.

!! Disclaimer 1: I am not a doctor and have no medical qualifications, I simply know more about this topic than the average person and want to share that knowledge

!! Disclaimer 2: obviously it is impossible to discover the exact health issues that a man who died 200 years ago dealt with. It is known that he suffered many head injuries, but the exact parts of the brain affected and to what extent are unknown. Therefore I'll just be describing the potential effects of head injuries like the ones that Junot suffered, but it's up to the reader to interpret how many of these symptoms he truly dealt with.

Without further ado, let's get started:

Part 1: what type of head injuries did Junot suffer, and why does this matter? (tw for detailed description of injuries - skip to part 2 if you're sensitive about this)

Wounds caused by bullets or sabres (so the type of wound that Junot suffered) are categorised as 'open injuries'. While other forms of head injuries can cause damage to the whole brain, open injuries can be more localised, only affecting certain functions rather than everything.

However, open injuries also involve the skull being broken, which can cause further issues. This makes the affected part of the skull more fragile in the future, making it easier to break if another blow is suffered in the same area (which I'll get onto in the next bullet point!). In modern day, surgery can repair the skull and prevent complications, but as far as I'm aware these surgeries did not exist in Junot's time. Complications can arise from skull damage, such as chronic headaches, brain bleeds, and seizures.

Junot suffered multiple head injuries, which makes matters even more serious. A head injury makes both the brain and skull more susceptible to damage from future injuries, creating a sort of snowball effect. If the brain is already a damaged, a seemingly small injury can cause disproportionate harm.

It's most likely that Junot suffered injuries to the front of the brain rather than the back. With all head injuries but specifically open injuries, the part of the brain that gets damaged is crucial with determining the effects. In general, injuries to the front impair cognitive function, and injuries to the back impair physical function. Often injuries to the back of the brain cause symptoms like impaired spatial awareness, loss of control over limbs, or impaired vision. (to give an example from the Napoleonic era - Marshal Andre Massena was shot in the head during a hunting accident, leaving him blind in one eye. This is a localised injury to the back of the brain, impairing a physical function but leaving the mind unaffected). Junot showed no signs of physical disability, so it's clear that his injuries caused no serious damage to the back of the brain. However, the symptoms he did express (which I will get onto later in this post) are consistent with those of an injury to the front of the brain, specifically the frontal lobe which controls what we think of as the mind - emotions, behaviour, personality, problem solving skills, social skills, etc.

Unlike injuries to most parts of the body, brain damage is usually permanent. The brain can create new "pathways" to make up for the damaged areas, but those areas cannot be regrown.

Part 2: what are the symptoms of brain damage?

As covered in part 1, I will only be focusing on the cognitive side of things, since that's the part of the brain that Junot's injuries affected

For the following list of symptoms, I'll put a green tick next to the ones that Junot certainly suffered from, although many of them are up to interpretation

Fatigue

Chronic headaches ✔

Frequent nightmares ✔ (an example is the intense nightmares he suffered after an assassination attempt on Napoleon)

Difficulty starting/completing tasks ✔ (this seems apparent in his career)

Reduced concentration span

Reduced problem solving ability ✔ (again, this seems apparent in his career)

Impaired reasoning and judgement ✔

Unrealistic view of oneself and others ✔ (particularly in his blind faith in his own abilities and in Napoleon)

Intense mood swings (including rapidly changing between experiencing emotions very strongly or appearing cold and emotionless) ✔ (very evident in his relationship with Laure)

Depression ✔

Anxiety

Impulsive behaviour ✔

Reduced ability to tell what's appropriate in social interactions (including sexually inappropriate behaviour) ✔

Lack of insight ✔

Irritability and aggression ✔

Obsessive behaviour ✔ (particularly in his devotion to Napoleon and obsession with becoming a marshal)

Reduced capacity for memories (usually this only affects memories made after the injury - the person may be able to recall events many years ago but have little memory of yesterday) ✔ (this is shown in Junot's poor memory at the end of his life)

Part 3: in connection with other factors in Junot's life

Overuse of drugs and alcohol already cause mild brain damage, and will make any head injuries much worse. Additionally, it makes recovery more difficult.

Complete recovery from a brain injury is impossible, but rehabilitation can help the person to lead a fairly normal life afterwards. But unfortunately rehabilitation, particularly to the extent that Junot clearly needed, did not exist in the 19th century. Even with the best efforts of Junot's family, he could not have received all the support that he needed.

Many people with head injuries are able to regulate themselves more around strangers, but will show symptoms more intensely around trusted people. I believe this is shown somewhat in Junot's interactions with others.

Often when somebody in a long term romantic relationship gets a head injury, this causes the relationship to become less romantic and more platonic. Similarly, Junot's mental condition worsening and his relationship with Laure cooling off happened around the same time.

Part 4: so what does all this mean?

Honestly, it means whatever you want it to. Junot's behaviour matches many of the symptoms of an open injury to the front of the brain, but you could either interpret this as being cause-and-effect or merely coincidental.

Whether you love or hate Junot, I hope this gives you at least some insight into why he was the way he was, and the possible issues he was dealing with.

[chocodile]

Query; how much would Hyden taking proper medication and treatment for his real physical + mental ailments ACTUALLY do for his overall well-being?

That's a good question! There certainly are things that hypothetically could help him, but it would depend on whether we're talking modern medicine or not. He's already getting the "best" treatment his time period can offer (a few magical charms, dozens of folk remedy tonics, some of which contain mercury, opium, and unicorn blood). I imagine he has a whole shelf of tonics, tinctures, and other oddball cures he's tried and discarded over the years.

Unfortunately, his most significant problems can't be treated with the medical knowledge of his time period. (Even magic doesn't help that much: Healing magic is somewhat primitive and falls more under "speed up rate at which a wound closes" rather than "cure chronic conditions, fix nerve damage, and stop a magic crystal from burrowing its roots into your frontal lobe".) So all Hyden can really do is (poorly) manage symptoms.

In a more modern setting: He would have many more options. Depending on how "modern" we're talking, he might be able to get his gigantism treated in childhood. His abnormal height meant a lifetime of joint and muscle issues, among other things, and early-onset osteoarthritis in his early 40s. Stopping him from growing so tall would prevent a lot of pain and inconvenience in his future. Other than that, physical therapy and a marginally less sedentary lifestyle could also help, if he stuck with it. However, even with modern medicine, his two primary non-magic-brain-crystal-related physical ailments (osteoarthritis and nerve damage) cannot be cured, only managed.

In terms of mental health, he'd be a very difficult person to treat. If he lived in a modern-ish time period, I do think he might get (mis)diagnosed as bipolar, and mood stabilizers probably would help with taming some of his most extreme and impulsive behavior. The problem is that he'd be really bad about taking medication as prescribed. For example: stopping a med cold turkey when he "feels fine" and suddenly starting it again during a "I'm so fucked up, there's something wrong with me" spiral after a wild manic bender lands him in trouble.

As he got older and his reckless behavior slowed down, he'd probably wind up with a regular prescription including an antipsychotic, antidepressant [of dubious effectiveness], painkiller, and a bunch of common middle aged person medications for blood pressure and the like. They might not fix him, but they'd certainly leave him feeling better than the sketchy medieval folk remedies he canonically takes, at least.

[cripplecharacters]

I have a character with chronic pain as a result of resurrecting her friend. She feels the pain her friend experienced when he was fatally stabbed, while he only has a scar and no pain. The character's chronic pain isn't a punishment, it's the expected side effect of using resurrection magic.

She doesn't regret bringing her friend to life, and does what she can to relieve the pain, like using ice packs. Medicine is ineffective since she doesn't have any physical or mental source of pain to treat, and medicine can't treat magic-related symptoms.

Am I overlooking problems with this character? Also, should her chronic pain be based on any real-world conditions? Currently it isn't.

Hi!

I think this is an interesting premise!

Her being aware of the pain being a consequence of what she did is helpful to avoid the "disability as punishment" trope. I wouldn't say that it should be based on any real-life condition as "having a knife in you Forever" isn't really a thing. It's not even like the injury was transferred to her either, she just feels the magic side effect of it. I think you're doing fine!

For some suggestions that you could consider if you want;

when the friend got stabbed, did he have any other injuries? I think it could be interesting to have him be Alive and Not Experience the Fatal Wound (obviously), but have some of the non-fatal wound effects stay. So depending on where he was stabbed, some of his organs like kidneys or liver could be affected. For abdominal injuries there are also some symptoms that can activate months after the initial wound.

Adding a second character with non-magical chronic pain. Just to be safe, plus I really enjoy stories that have a range of disabilities shown (even across the same kind of disability)! They don't have to be a major character by any means. I think it could also be a nice way for a disabled community moment, or to have her get some advice on how to cope with the pain mentally.

I would only advise you to not make her into a saint-martyr for "choosing" to have a disability. It's fine for the character that she saved to think of her very highly for that (reasonable reaction to have), but I would be cautious around the narrative itself!

I hope this helps! :-)

mod Sasza

[kbkhospitals]

Understanding Chronic Wounds: Symptoms, Causes, Treatment, and Recovery Tips

Chronic wounds are injuries that do not heal within the usual timeframe, often lasting weeks or months. These wounds can severely impact a person's quality of life, making early detection and treatment essential

Symptoms of Chronic Wounds:

Persistent pain, redness, or swelling.

Slow healing or wounds that remain open for over four weeks.

Signs of infection like pus, foul odor, or warmth.

Discoloration of the surrounding skin.

Causes of Chronic Wounds:

Poor Circulation: Conditions like diabetes or venous insufficiency hinder blood flow.

Infections: Bacterial or fungal infections can delay healing.

Pressure: Long-term pressure, especially in bedridden patients, can cause ulcers.

Underlying Health Conditions: Diabetes, obesity, and weakened immunity contribute to chronic wounds.

Treatment for Chronic Wounds:

Debridement: Removing dead tissue to promote healing.

Advanced Dressings: Special dressings to maintain moisture and prevent infection.

Medications: Topical antibiotics or antiseptics.

Hyperbaric Oxygen Therapy: Increases oxygen delivery for faster healing.

Recovery Tips for chronic wounds

Keep wounds clean and follow medical advice.

Eat a balanced diet rich in vitamins and proteins.

Manage underlying conditions like diabetes.

Regularly change dressings as directed.

Watch for signs of infection and seek medical help if needed.

Proper care and early treatment are vital for managing chronic wounds and ensuring a successful recovery.

KBK Multi Speciality Hospital provides advanced, non-invasive treatments for chronic wounds, using cutting-edge technology like hyperbaric oxygen therapy and specialized dressings. We focus on early intervention and personalized care, addressing underlying conditions to promote faster healing and improve patients' quality of life.

[astrobiscuits]

Chiron: where is our physical (and mental) wound?

I'm currently reading a book about Chiron (did you know it's actually half asteroid, half comet? me neither), which inspired me to make this post. I'm in no way an expert in medical astrology, just a curious owl that wants to learn more about every branch of astrology out there (my Sag Venus loves it!!🤭)

DISCLAIMER!!! I'm not a doctor. If you've been feeling any symptoms described here, TALK WITH YOUR DOCTOR, NOT WITH ME

Observation: Before we dive in, i'd like to mention that the position of Chiron in the houses is important. Not every house placement suggests having a poor physical condition. The most prominent Chiron placements when it comes to having a medical condition are: Chiron in 1st house (house of self, visible illnesses), Chiron in 5th house (illnesses since birth/early childhood), Chiron in 6th house (house of health, if Saturn is also sitting there it points to chronic illnesses), Chiron in 8th house (house of death, may point to severe diseases or poor reproductive health) and Chiron in 12th house (house of the unconscious, deals with mental illnesses)

Honorable mention to Chiron in 3rd house and Chiron in 9th house as they represent accidents while travelling. If Chiron is heavily afflicted in these houses (unless it's also conjuncting Jupiter), it may point to...let's just say you're gonna be in a hospital bed in a vegetative state, but remember, nothing has a 100% possibility of happening, you're just more susceptible to it happening. I suggest checking the position of Chiron in Solar Return charts for the possible timing of it happening (look for Chiron in 3rd house/Chiron in 9th house as it activates your natal Chiron)

Without further do, let's dive in⚕️

Chiron in Aries: frequent headaches, frequent nose bleeds, teeth problems (sensitive teeth, tooth decay), deafness, skull fractures, cerebral anemia, brain tumours, hemophilia, epilepsy, BPD

Chiron in Taurus: frequent colds, frequent voice loss, thyroid problems (goiter, hyperthyroidism, hypothyroidis, etc.), tonsilitis, OCD

Chiron in Gemini: lung problems (asthma, tuberculosis, pneumonia, etc.), speech problems (stuttering, cluttering, mutism), alzheimer's disease, ADHD, OCD

Chiron in Cancer: frequent stomach pain, prone to lactose intolerance, (for girls) breast lumps, breast cysts, breast infections, nipple discharge, depression, anxiety

Chiron in Leo: prone to insolation, frequent heart palpitations, chest pain, hypertension, hypotension, arteriosclerosis, scoliosis, kyphosis

Chiron in Virgo: frequent bloating, prone to gluten intolerance, chronic allergies, diabetes, rabies, autism, ADHD, OCD

Chiron in Libra: prone to acne, frequent lower back pain, disc herniation, spondylolisthesis, chronic kidney disease, kidney stones

Chiron in Scorpio: frequent pain down there, chlamydia, gonorrhea, syphilis, HIV/AIDS, depression

Chiron in Sagittarius: frequent pain in the hips, prone to hips dislocation, cirrhosis, sciatica

Chiron in Capricorn: prone to knees dislocation, osteoarthritis, bone problems (osteopenia, osteoporosis), gout, depression

Chiron in Aquarius: electrical injuries, shin splints, osteofibrous dysplasia, ankle sprain, ankle fractures, poor blood circulation, schizophrenia

Chiron in Pisces: prone to break toes, athlete's foot, bunions, addison's disease, hormonal deregulation, aphantasia, psychosis, schizophrenia, anxiety

Yes, i'm aware of the fact that it's a generational planet and it moves very slowly through signs

BONUS: It's important to take into consideration all planets that conjunct, square or opposite Chiron (regardless if they're personal or generational) + the Ascendant for additional info about our illnesses

Ex. Let's take me as an example. My Chiron is in my 10th house in Capricorn squaring Saturn in 4th house (so double Capricorn energy) and Aries Ascendant. Guess what? I've got TMJ (basically a jaw disorder affecting the joints) and i've got it from my fam -_- (Saturn rules tradition i love my fam)

I also believe that having a heavy afflicted Chiron in general makes someone prone to having a medical condition, even if it's not in the houses mentioned previously (like in my case). However, these people are more focused on the main meaning of the house, not their health problems. They tend to ignore their health problems or they just don't care

I hope you enjoyed my post and found it insightful :)

What's your wound? Lmk in the comments your placements and your illnesses

Kisses xoxo

[insipid-drivel]

Endometriosis, Fat Doctors, And Bellybuttons: What They Don't Teach You In Health Class

Woo another rambling TED talk, but I just got home from a meeting with a doctor specializing in wound care that I really feel a lot of you should hear:

Firstly, I've been having mysterious pains in my bellybutton area since... probably last Autumn? But I've had menorrhagia (extremely heavy, painful, and even dangerous periods that can cause spontaneous hemorrhaging) since I was 13 years old. Since my menorrhagia became active, I've been begging for a hysterectomy. I'm moving into my 20 year anniversary of Living With A Uterus That Hates Me As Much As I Hate It.

Being trans (agender) also really incentivizes the whole "yeet the uterus" thing, too, but that doesn't really have anything to do with why I wanna talk to y'all about endometriosis and bellybuttons.

Anyway, as of this year, I've had a lot of issues with my bellybutton region. Random infections, inflammation, pain, trips in and out of the ER; the works. My doctor has been so confused by my bizarre constellation of symptoms that he hasn't been sure of what's going on or what the best course of action is, aside from referring me for more tests and prescribing comfort measures in the meantime.

Until today. My desperate track for a diagnosis began over a week ago when my symptoms became alarmingly sepsis-like, but my test results came back with nothing but signs of an elevated white blood cell count. My doctor has been rushing me from specialist to specialist, and today was a wound care doctor that specializes in treating bariatric, hospice, and disabled patients that can't necessarily follow conventional wound-care advice meant for young, abled, and thin people.

I didn't expect much. Maybe some magnifiers, swabs, and a biopsy at worst, followed by antibiotics and whatever else, but definitely nothing that would help me solve this latest scary health mystery. While the worst of the pain I had that landed me in the ER went away on its own enough that I can get by with mobility aids, I still haven't had a diagnosis.

Until Awesome Fat Doctor.

Awesome Fat Doctor I celebrate. I live for this man. He literally gave me a reason to keep on trying and not give up. I was so scared of the appointment I'd gone nonverbal (not weird for me these days), but I got my voice back after I spent a while with him and his nurse (who was also fantastic). Even though I only met him for a few minutes and he forgot to introduce himself so I can't remember his name right now, Awesome Fat Doctor was a rock star. He was in his later middle age, scruffy, unshaven, and fat - enough that I could imagine the reason he specializes as a wound care doctor is because he may have gotten fed up of other doctors blaming his own health problems on his weight and life choices.

AFD gave no fucks. Along with being a big guy, he carried himself with the gruff no-nonsense of a man that's probably beaten up his ableist colleagues overdiagnosing fibromyalgia in the back of a Wendy's parking lot. He had been informed of my autism and my own needs for a wheelchair due to my own long-term chronic pain and other health issues, as well as my troubles speaking, and treated me like a little cousin that was having a rough go of things like he'd had.

He was compassionate and a straight-shooter with me. He was respectful of my boundaries, talked to me as casually as if I could respond like anybody else with working vocal cords (which I was eventually able to), and generally had all the bedside manner of someone that has worked with patients with special needs of all kinds. He looked at the trouble area and my records and history, told me that he was gonna do his best to get things straightened out, and then went quiet as he studied the timeline of my issues.

"Do you have endometriosis?" he asked, while studying a photo my mom had taken of a... skin infection over my lower abdomen, which had spread from my bellybutton.

I was confused.

"Not that I know of," I answered. I'd found my voice already when he and his nurse both helped put me at ease and showed me I was respected, safe, and seen. I've been tested a few times in my life for endometriosis and had my fair share of ultrasounds (the most common way to diagnose endo), and nobody had found anything unusual. But I have menorrhagia, am always in pain from my reproductive organs, and am desperate to get them removed. I'm on a 24/7 regimen of 2x normal birth control pills just to keep me from menstruating for my own safety. It sucks.

"My wife once had to get emergency surgery for what we thought was appendicitis. Do you know what it turned out she had?" he asked me, very suddenly, and like he had an idea.

"Ectopic pregnancy?" was my first guess, because women have died in the past to ectopic pregnancies that were mistaken for appendicitis.

AFD shook his head. "It was her menstrual cycle, and she had endometrial tissue bleeding into the space beside her appendix. I think you may have endometrial tissue in your bellybutton, and every time your hormones try to cycle in spite of your birth control pills, it bleeds and infects."

I was gobsmacked. Endometriosis and PCOS run in my family as reliably as eye and hair color, but I'd never really thought of how pernicious endometrial tissue could actually be. When I picture endometrial tissue, I picture overgrowths inside of reproductive tissue, or clinging to the outside; not growing randomly within the abdominal cavity or emerging out of my fucking skin like a turkey pop-up timer of doom.

AFD slowly nodded. "And the only way we'd be able to see the endometrial tissue is if you had it tested while you were menstruating and the tissue itself was inflamed and bleeding. Otherwise, it won't show up as anything different to the normal, healthy tissues surrounding it. A biopsy isn't reliable, either, because we have to know exactly where the tissue is before we test it. You have to have your hormones triggering the tissue to inflame and behave differently so it can be diagnosed if there are no big deposits of tissue to see."

After a long time of my ears ringing, I asked him, "Do you think it's possible that the ultrasounds were showing false negatives? Like, I have endometriosis and had it all along, but the tissue is too small to see or were being looked at at the wrong time?"

As it turns out, that's exactly what may be going on.

I see my doctor tomorrow, and meet with my surgeon at the beginning of next month.

Listen to your bodies, y'all. I am so thankful to that doctor, who wound up diverting into a very colorfully-worded rant about how much he hates the American medical system immediately after that. He gave me hope that I was just having new issues with old problems and was right all along about what my body really needed, and that my symptoms now are just showing what happens when doctors neglect their patients' needs.

I did wind up asking if he specialized with wound care because of how other doctors responded to his weight, and he said that it was a mix of reasons beginning with Yes: Both so he could have a safe space from fatphobia and ableism for himself and his patients, but also so his wife - who, while I hadn't seen her, he explained was about as big as he was - would have her own pain taken more seriously, being both fat and female. As he'd already explained, she hadn't been successfully diagnosed with endometriosis until she was symptomatic of full-blown appendicitis-levels of pain as an adult and her doctors were forced to stop blaming her pain on her weight.

Now, as I sit here reflecting... It's hard to believe that, thanks to this doctor's theory, I may finally be free from pain and dysphoria sooner than I imagined. It just took a doctor who could empathize with me to see me, and choose to take the scarier hill to fight on with me.

[jmtorres]

Hi, this is random, but would you mind sharing more about your gut issues/long covid? (I.e. diagnosis, treatment). I have chronic fatigue, and gut issues that are definitely linked to that, but all of my doctors are being extremely useless about it. (No worries if this is not the kind of info you want to share with a total stranger on the internet)

(This is in reference to my comment on this post)

@reptilerex I appreciate you recognizing the sensitivity of this ask, I am going to go ahead and answer it because I feel like the likelihood that you or someone you know (or even others of my readers) are struggling with long covid and finding adequate medical help vastly outweighs the minuscule probability that you've hacked into HIPAA records and are planning to dox me lol

so in the immediate aftermath of my first bout of covid (despite vaxxing and masking regularly, I'm up to two now 😭) my obvious symptoms were fatigue – going to the grocery store would wear me out for 2+ days – and a 20 year-old scar from a car accident reopened, which sounds like some scurvy ass bullshit, and I do wonder if the fact that my friend @niqaeli, who knew that long covid symptoms are highly correlated with MCAS symptoms and was encouraging me to start MCAS otc treatments like vitamin C supplements, helped. (worth noting that while I didn't hear anything about old scars reopening as a covid/post covid thing before it happened to me, but when I told people about it, they were like "oh yeah, that happened to me or someone I know" SO often) My doctor sent me to a wound specialist for that, and they kept poking it trying to figure out if there was some embedded shrapnel that they hadn't realized was in there originally, but ultimately it just healed back over much redder and angrier than the first time.

so then, the fatigue. My doctor had me wait three months because it wasn't officially long covid until three months. obnoxious as hell. I found out the DMV accepts long covid for a disability placard reason and got my doctor to write me a DMV form about how I couldn't walk hardly any distance. she was willing to do that before the three month mark.

I was Johnny on the spot coming back three months after, the first thing she did was send me for a chest x-ray because the obvious/expected reason for fatigue is you're not getting enough O2 in your blood. There was nothing wrong with my lungs and we were kind of at a dead end until I presented my doctor with more options.

I mean, I was kind of like, my PCP is being useless, I have a PPO, why can't I just go directly to a specialist, but it turns out specialist won't take you without a referral because reasons. I had heard rheumatologist is as good at figuring out weird vague shit so I tried to book there but when I told them long covid, they said that wasn't their department. They said I needed to go see an immunologist which sounded wrong to me, but there was a pretty good HIV specialist immunologist in the area that I tried to book with who said no that's not what long covid is. someone recommended a Long Covid Specialty clinic in a city that is 2 to 5 hours away depending on traffic and I knew I wasn't making that drive in my current condition so was like somebody local gotta help me.

so I went back to my PCP and said to her that I had learned from disability communities online that sometimes a rheumatologist can be helpful. And she said OK we can do some blood tests for inflammation markers to see if I can justify a referral to a rheumatologist. (and I thought of my weird scar issue and thought gee I better have some weird inflammation markers)

So I had some inflammation markers pop and I got a referral to a rheumatologist, and they were actually willing to see me. The rheumatologist ordered so many tests, like an unbelievable number of tests. I think they drew like eight vials of blood. Plus other samples. The rheumatologist was basically like let's look for anything and everything.

I had a borderline response on Calprotectin. To quote from the explainer in the test notes:

Calprotectin in Crohn's disease and ulcerative colitis can be five to several thousand times above the reference population (50 mcg/g or less). Levels are usually 50 mcg/g or less in healthy patients and with irritable bowel syndrome.

so I wasn't high enough to qualify for IBD outright from that test results, but I was high enough that it flagged to the rheumatologist, and I had reported a family history (brother has IBD), so he said that was enough to diagnose and started prescribing me for that.

The thing is, rheumatology is an ass backwards way to get an IBD diagnosis and I was having another symptom that I hadn't reported because I was a dumbass and this is the apocryphal frog boiling slowly thing. I was having fairly regular loose stool/diarrhea. if I had told my PCP that could I have gotten a referral to a gastroenterologist and gotten a less ass backwards diagnosis?

I hadn't told my PCP about loose stools for two reasons:

I didn't think it was relevant to the fatigue, and in fact, I still didn't think it was relevant when the rheumatologist called it, and I was really surprised when taking medication for IBD did actually turn out to help the fatigue

I knew I was lactose intolerant, so I thought it was already explained. However, the rheumatologist and I had this exchange:

Him: so do you still drink regular milk or just Lactaid?

Me: Lactaid

Him: then you shouldn't still be having diarrhea

Me:…

I can't remember the first med he started me on because I was only on it for a couple of weeks before we had to switch. (it helped a lot when I could tolerate it but about every three days I had to throw up and then I felt awful and didn't take the med for a couple of days and you can guess how that went.) the one that I went on long-term that actually worked without side effects for me was mesalamine/lialda. I also started experimenting with some dietary changes, the low FODMAP diet is intended for IBS not IBD, but you are still expected to have IBD triggers so I was playing around with that.

for a few weeks, I had incredible improving energy. It was crazy.

then I made what I can only now think of as a mistake in trying to be proactive about my care. because I had stumbled ass backwards into an IBD diagnosis and I felt like I should have gastroenterologist confirm it, and I went to go see my brother's gastroenterologist. he wanted to do a colonoscopy and he asked me to go off the mesalamine for six weeks so that he could see what my colon was like without treatment and it was the worst fucking six weeks of my life. Hated it. colonoscopy results: he didn't see anything fucking wrong and would not diagnose IBD or prescribe mesalamine based on what he found. I said, but the mesalamine improves my symptoms, what does that mean? He said, it means keep seeing your rheumatologist.

I went back to the rheumatologist and told him about the whole debacle with the gastroenterologist and he was like "so how did he explain your inflammation readings?" like CHECKMATE. And he concluded that any lesions I had must be in the small intestine, not the large intestine and so were not seen by colonoscopy.

I kept taking mesalamine. My improvement was slower after the break from it which sucks but I did get back to normal lab work within six months, hallelujah.

Follow up: MORE stuff that might have been avoided if I had gastroenterologist regularly, had gotten an IBD diagnosis from a gastroenterologist, or had mentioned my shitty symptoms in the immediate: the gallbladder bullshit this summer

I had my second round of covid in May and I didn't notice a lot of fatigue coming out of it, though I was more cautious with myself the second time around, but I was sort of holding my breath for what horrible nonsense is going to come out of this now? so then I had what I thought was a really bad case of Gerd that didn't go away for two weeks even though my Gerd usually resolves in like a day. I went to my PCP twice during this period and then ultimately ended up at the ER when I realized my pain was in my side not central anymore and I was worried about appendicitis. It wasn't appendicitis. It was my gallbladder. and it came out that night. overall, I am very happy with how the hospital handled the emergency for instance, I didn't realize until two weeks later that I seriously could've died because they were so calm about it the whole time but like they don't do same-day surgery unless death is on the line, let's be real.

but here's things that could have been helped if I had better gastroenterology care:

I didn't find this out until I was researching gallstones after the fact, and I would like to think a gastroenterologist would have warned me whereas the rheumatologist wasn't super aware of it but: IBD can lead to gallstones because one of the ways a cholesterol gallstone forms is, if you get an imbalance of bile and cholesterol in your gallbladder; your body wants to recycle bile by reabsorbing it at the end of your small intestine, but if you have IBD, sometimes it loses the bile instead of reabsorbing it, and then you get an overabundance of cholesterol, turning into a gallstone the size of a golf ball

I told my PCP it was a case of Gerd that wouldn't go away, but I didn't tell her I was also having diarrhea. Diarrhea is not a Gerd symptom. Maybe if I had just fucking told her she might've recognized or could've sent me to somebody who would have recognized it as a gallbladder symptom before it turned into an immediate emergency

tl;dr don't hide your gut symptoms from your doctor because you "think" you know what's wrong with your guts or that it's not related to your other problems or you're embarrassed or what the fuck ever just tell them that you're shitting yourself because it might turn out to be important