#especially if you don't have health insurance

[butts-bouncing-on-the-beltway]

I come from a family riddled with chronic and congenital health issues, which wasn't THE ONLY reason I went into healthcare and public health policy, but it **helped**

Throughout my own chronic health journey two things have struck me over and over again as part of this issue are

1) medical doctors from more traditional specialties have a history of starting out *at best* vaguely compassionate, and steadily cruising through "confused and irritated" all the way into "actively coordinating with other medical providers to medically neglect you". This means that often, the only doctors who have been both compassionate, sure they could help, and willing to keep trying for YEARS on end without hesitation or frustration, WERE CONMEN

They could afford to be all of those things. Because all they needed was for me to keep showing up at their door to pay my invoices. Meanwhile, actual doctors are accountable to licensing boards, health insurance companies, and a dozen other entities for why they're spending time and money on me, and the longer they have to do those things, the more of a problem they have.

2) there comes a day, a threshold of desperation, where you just need someone to make anything even a little bit better, and if they can do that, they might as well be your god now. Everyone's threshold is different. I hit mine in my late 20s, after over 15 years of increasingly despondant care-seeking, but I know others hit it faster or slower. When this moment comes, it is very easy for a conman to roll up, do something batshit, and manage to make you feel just better enough to be willing to try whatever batshit thing they suggest next. And it doesn't hurt that these are also the only people to act like they believe me when I described the things that were happening, whereas a lot of doctors and nurses I've seen just nod and smile and cruise past it, like the ER doctor the other day who was repeatedly informed that I was having an episode of an orthostatic heart condition and A) didn't run a tilt table, B) didn't even bother to take my heart rate in more than one position, C) DIDN'T EVALUATE MY **HEART** AT ALL BECAUSE HE FOCUSED ON MY NECK AND BRAIN WHERE PAIN WAS MANIFESTING INSTEAD OF MY HEART WHICH HE WAS REPEATEDLY INFORMED WAS CAUSING THE PAIN, and D) didn't treat my dehydration AT ALL despite this being a severe flag for further episodes, and further episodes being a high head-trauma risk for me.

The cons who have "treated" me all ran the kinds of tests that my future doctors simply REFUSE to order, but are happy to hear the results from when I pass them on! Even helped me get them paid for when I couldn't afford things like genetic counseling or complex blood tests. They have all been *weirdly helpful* even when I can see how much bullshit they're also saying.

But it's taken me having multiple degrees in related specialties to be able to parse (MOSTLY) the bullshit from the valuable ideas. And the whole point of having doctors is that not everyone should HAVE to be a medical professional just to get medical care!

I don't know that I have solutions here or especially helpful observations, but I think part of the fear I've been developing about all this is "the medical system is failing so many people so often that even KNOWING someone is a quack isn't enough to stop patients from seeing them if they're a quack who can produce what looks like results"

It feels like the line between "alternative medicine scams" and legit medical info is crumbling apart and it scares the hell out of me.

I was on youtube looking up some stuff for my friend, to see what unreliable stuff they might have to watch out for, and there are a lot of scams being pushed by people who are using academic-sounding terminology and appear to the uneducated outsider (me) to actually have an understanding of the science. A lot of these people either are medical doctors or are posing as medical doctors using a sketchy bullshit degree from some obscure illegitimate institution.

What's more, there's a lot of content creators enabling this by building their channels around vague, essentially benign claims that are too unspecific to be labeled misinformation, like "Avoiding these foods could help with this condition!"

Like yeah, in the broadest sense, maybe eating less "refined sugars" could make you feel better, but once you watch this video, the algorithm immediately starts pushing other videos with similar titles making similar claims, except those claims are "Refined sugars cause disabilities and cancer," and that will bring you to "Sugar is a drug more addictive than cocaine and you can detox by eating only raw beef and butter."

I got recommended a Jordan Peterson video within 3 clicks of simply putting the name of a chronic illness into youtube search.

[littletrumpetcat]

i got my wisdom teeth out (abridged version, i was not put under, i babysat a half hour later. long story) and i am in PAIN. also taking out the bloody mess of a gauze every hour fucking sucks. i almost yakked every time i pulled it out of my mouth. the worst part? every time i burp i taste remnants of paper towel. i need to know if anyone else can relate. this is so gross. im tired

[bearsinpotatosacks]

you know you're in deep in top gun special interest when you're doing quizzes to find out if Carole would be eligible for medicare and tricare. And you're british, so don't have to deal with healthcare

[flightyalrighty]

FIRST | PREVIOUS | NEXT CH 1 PG 36

Infested will return on June 27th. --- Thank you to the following Ascended supporters: @chaogongoozles, @fiiresiidefrfr, @elizard4227, @grogar, Ezzoh, @susivoi, @calculuscacophony, Eros, @ivycorp, @summersdale @borrelia, @mizukiz, @sanicdetails, @combinegrunt-echo-1, Pica, @veeceear, @quackenburt, ItsmeMonarch, @memendoemori, @trans-girl-sonic, & savarsenic

Content Warnings | Store | Ko-Fi (Discord!) | Read On Comic Fury! DISCLAIMER: "Infested" is a horror comic ft. content not suitable for those under the age of 17.

A long-winded looking back on things below the cut:

The first few pages of Infested were uploaded to this blog on March 2nd, 2023 -- Over a whole year ago! I was so busy, too, that I completely missed its birthday (Sorry Infested). Looking even further back than that, the original story was was something I began writing on December 25th, 2022 (Merry Christmas).

It took two years to get to this point.

And hey, not to toot my own horn about it, but completing even one chapter of a webcomic is a big deal. Especially for me. My first webcomic, Fight/Flight, didn't get very far. I completed the prologue, started Chapter 1, and then had to drop it for a number of reasons (I didn't really agree with what baby-me had to say, politically, anymore).

This comic was born from a lot of intense feelings. The story, itself, too. Some good. Some bad.

I had been forced to move away from my hometown, and with that move, I lost the physical connection that I had to all of my friends. I lost the familiarity of a place I'd known for most of my life. I'm now stuck somewhere... Worse. It felt like a cage. Still does. Disconnected from the life I thought I would be living after college. I didn't have health insurance, either -- Got kicked off of it because of the move -- And as a result, I was off my antidepressants.

So there I was, at a pretty low point in my life. I miserable and lonely and every single day dragged on. And on. And on. And I felt so disappointed in myself. That disappointment became self-loathing, and it all kinda spiraled.

Have I mentioned that I'm a huge Sonic fan? I don't think I need to. I'd say it's pretty obvious. But for the sake of this story, I'll say it again: I'm a HUGE Sonic fan. I've been that way since 2003 with Sonic Heroes. The franchise has been in my life for over two decades. I had a monthly mail subscription to Archie's Sonic the Hedgehog. Sonic the Hedgehog was something that I truly loved more than any other piece of media. It brought me endless joy. Until I didn't.

I had dropped Sonic after Lost World was... Itself. I had already felt pretty irritated with the Meta Era, and Lost World was the final straw. The last bit of hope that the series could recover was snuffed out when Forces was released. It was over. I was done. If Sonic was truly that embarrassed by itself, if they had truly lost touch with what made the series so great, then I wouldn't waste my time any longer. I was so sure that I had to just... Grieve and move on. My beloved childhood game series was dead. Long live the king or whatever. I'd just bitterly read IDW Sonic and think about what could've been. I was lucky to have that comic, at least. Archie had been canceled, too, after all. I was lucky to have my scraps.

Then Sonic Frontiers came out. And it changed everything.

And my god, it was everything. It was everything to me. Flaws be damned, it was everything. To. Me. The spectacle. The serious tone. The vastly improved writing. Kellin Fucking Quinn. It was FUN! It was actually FUN to PLAY. He was back. I was back. Sonic pulled me by my hand out of the ocean of misery I'd fallen into, and he looked me in my eye and he said;

"Hey. You're gonna be alright."

Metaphorically speaking. Sonic The Hedgehog didn't actually literally speak to me -- And sure, okay, maybe it's a little dramatic to describe a game as this great Depression Annihilator but I'm dead serious when I say that, for that time, before I was able to get back on my meds, I was self-medicating with Sonic.

Sonic was all I was thinking about. I reread the Unleashed arc in Archie Sonic, which got me sorta realizing something, and which led to my post where I said something along the lines of "Sonic would hide a zombie bite."

Archie Sonic would, at least. Because he basically did do that in the Unleashed arc of that comic. He let that problem fester until it became an even bigger problem because, ironically, he didn't want to be a problem.

So one thing led to another. I thought more about Sonic becoming a zombie. Bada-bing, bada-boom, Infested was born.

I didn't expect it to get the attention that it did. I felt lucky when the first page I drew Rouge on (Page 6 I think?) blew up. The right people saw it at the right time. I'm extremely grateful for that.

I'm extremely grateful for all of you.

So yeah, one chapter. Woo! Here's to many more.

[tf2heritageposts]

tips for runaways of abusive families

from one who did that

note: this assumes you are 18+ or will be 18+ upon escaping, and also american, sorry

BEFORE YOU LEAVE:

get your insurance information, ESPECIALLY YOUR HEALTH INSURANCE. you can use it until you're 26

have your ssn memorized

make sure you have a decent amount of money saved up, dependent on your situation

have your method of transportation figured out beforehand. are you leaving the city? state? general area? country? get it planned out

if you are planning on taking your pet with you, make sure you have food stocked up with you and bottles of water. i would also reccomend bringing a 1ml kids syringe if you have the type of pet that will stop eating/drinking in stress situations. also bring a form of cover like an extra shirt or towel if it is an easily stressed pet. also make sure you have a carrier, and if you're going on a plane, make sure it is up to the standard of your plane, as well as making s ure your type of pet is allowed on the plane, especially if its an "exotic" pet, aka anything thats not a cat or dog

i also may recommend stocking up some food but depending on your situation this may not be needed

stock up on any medications you may have/need

don't give your family any form of information they could use to track you down in the future, especially if theyre the crazier types

make sure to change your passwords on any technology you may be leaving form and log out completely on them. make sure you have no files they could use to find you

DURING:

leave at a time where you're 100% sure nobody will catch you. if you have a family member that comes home late from work, know when they'll be back and asleep

turn off ANY location services you have after you're already away from the house, even if it alarms them. you don't want them to figire out where you are

wear a jacket with pockets, especially deep ones

make sure you have your wallet, forms of id, etc

get ready to run as fast as you can

if you're leaving the state, especially via plane, DO NOT IMMEDIATLY GO TO THE AIRPORT, THEY WILL CHECK THERE FIRST! go to a hotel and spend 1-3 days there while they exhaust their time and figure you already left. THEN you can go

stay calm while you're in the process of leaving. the moment you hit the air, they legally can't do anything

keep any critter you have calm, especially if they can suffer health problems from stress

have your hotels booked in advance

AFTER:

dont give your family your address if they try to talk to you

if you can really, cut them off entirely. chances are theyre not gonna change

get an air mattress as soon as you can, we used doordash for one

figure out how you will be paying finances. if you're living with someone, great, if not, you may have to post donation posts on social media until you can get a job

be happy you escaped, good job! most people won't be able to do this so im proud you were

[so-i-did-this-thing]

How it's going as a trans person in Florida: Planned Parenthood, 26Health, and Spektrum Health have announced they have paused all gender affirming care.

To recap, DeSantis signed several anti-trans bills into law this week. Care is banned for minors, care is all but banned for adults, Don't Say Gay has been extended, children can be kidnapped from affirming parents by non-affirming family, and there is a bathroom bill that subjects trans folks to arrest for using government owned facilities, such as those in courthouses, airports, many stadiums and parks.

The adult effective ban was felt immediately. The main elements are:

signing at every visit an in-person informed consent form created by the state

all care come from physicians instead of nurse practitioners

no telemed for gender-affirming care

Currently, it is unknown if existing HRT prescriptions written by NPs will be honored by pharmacies. I personally know one person who was able to pick up testosterone yesterday, but I have also read many reports of folks being denied. I myself don't have a refill ready for another 10 days and will report back after I try my own pickup.

What's additionally dangerous is those of us, myself included, who get non-HRT prescriptions from our gender clinics now face the uncertainty of continuing of *all* of our medical care. Our health clinics are at risk of shuttering permanently as they lose major income, and many of us will lose STD meds, depression meds, heart meds, etc, etc.

When we say "this will kill us," it goes beyond suicide risk from forced detransition.

"But you can still get HRT from a physician."

So many suck or are outright hostile and the demand outstrips the supply. Before I found my NP-run clinic, one physician just decided to not call in my Rx, another was so shit at reading lab results, he thought I had hepatitis, and the third I had to threaten to kick in the teeth for trying to force too large a speculum in me.

Also, the state-required consent form has not been finalized and distributed yet, so at this point, everything has pretty much ground to a halt.

It was estimated that 80% of trans adults would lose their healthcare because of how many use providers like Planned Parenthood, but the impact seems even greater now.

"You can get your non-gender care elsewhere still."

DeSantis recently signed a bill that allows healthcare professionals to discriminate against trans people.

Sure, we can try to find care elsewhere, but it will be a slow and expensive process, with no guarantees. It took me over 20 years to get my heart condition treated because of transphobic doctors.

What can I do as a trans Floridian?

Stay in communication with your clinic - many are working on getting physicians added to the roster to prescribe HRT. Lawsuits are being filed and it's possible the changes to adult care can be rolled back.

Continue to try to pick up your meds, but begin looking for care elsewhere, though. Inside and outside the state.

Remember that while telemed for gender affirming care has been banned, you can still cross state lines for care. See Erin's map of informed consent clinics.

Many people will turn to DIY, but be sure you are aware of the risks here, especially if on testosterone, which is a controlled substance.

What should I be worried about next as a trans Floridian?

I worry about the following next steps towards genocide:

Banning getting care out of state. This is from the anti-abortion playbook. They will likely start with kids again, but we've seen how quickly adult care gets axed.

Being declared mentally incompetent or a risk in some way. This could be anything from being barred from gun ownership to not being allowed to work for the government.

Being declared a de facto predator. This has already happened with the latest bathroom law (cis people can eject trans people from government owned single-gender facilities, with arrest as a penalty), so watch out for it being applied to privately-owned facilities. Watch for discussions of official lists of trans people.

Gender presentation enforcement laws, essentially banning "cross dressing". Laws that block or rollback documentation changes.

These all have historic precedence and are huge "I'm in danger" red flags.

What can I do as a cis person?

Amplify all this news. Talk frankly about how this is genocide. And donate what you can to trans mutual aid campaigns so people can travel to get healthcare or even leave the state.

Here's some articles to get started on building awareness:

Take care, everyone, of yourself and each other.

[thedisablednaturalist]

Literally all the shit rich people have turned into luxuries are stuff many disabled people need (or would need to manage their pain but can't afford it)

Comfy ergonomic chairs

Indoor pool/hot tub (therapy bath)

Massages on the regular

Aides (rich people call them servants)

Yea even a cook who makes you special meals (perfect for people with special dietary needs and for those with severe allergies, as well as people who are in too much pain or are otherwise unable to cook)

Elevators in your house (even small ones just for groceries, my rich aunt has one in her beach house!)

Rich people don't buy these for fun I hope but custom powerchairs are obscenely expensive. It pisses me off when I see another person invent "the wheelchair of the future!" Which then is literally never fucking used because none of us can afford it (and insurance definitely won't pay)

Indoor gyms or even personal exercise equipment. Hard to go out to a gym somewhere else when you're disabled, especially if you are immunocompromised

Outdoor spaces to relax in. It's literally vital for your mental health to at least see the outdoors. I'd rather be bedridden in a sunroom (with retractable blinds) than a shitty apartment with one tiny window.

There's even freaking health retreats these people go to regularly. There's a fibromyalgia retreat in new york where they basically take care of all your needs while trying different treatments and seeing which ones help. Either it's heaven or making money off of scamming desperate people who are able to scrape the money together to go.

Private planes, which I honestly think shouldn't exist, but one that specifically catered to people with disabilities (spaces for wheelchairs/other mobility devices, accessible handicapped airplane bathroom, anxiety reducing tools, trained medical personnel and care team)

Also customized cars, except instead of making gas guzzling racecars to joyride in while everyone else is trying to get to work, cars with electric ramps, lifts, doors, cars customized for someone with limb differences. Those cars where you can roll your wheelchair right up to the wheel. Fuck even self driving cars once they are no longer deathtraps.

Skincare products that are safe for sensitive skin like eczema but also actually work

Nice-looking clothes customized to fit limb differences, access points, look good in wheelchairs, colostomy bags, etc. while also being comfortable and not fast fashion.

Dental care!!! What the fuck why is this shit so expensive!! I don't want my teeth to fall out!! (Disabled people usually need more dental care bc we have a harder time keeping up maintenance)

Rich people go and splurge on all of these even though they don't need them while calling disabled people selfish for begging their insurance for even one of these.

[happy74827]

The Perfect Gift of Appreciation

[Rudy Cooper (technically) x Female!Reader]

Synopsis: Being severely injured with zero money to back up your bills, you decide to take an emergency visit to the only doctor you personally know.

WC: 2897

Category: Hurt/Comfort, Slight Fluff,

A lot of you actually liked my Brian fic (love y’all), so I wanted to make another for you guys. I’m sad that there’s still none 😔😔

『••✎••』

He was absolutely pissed. Granted, he didn’t actually tell you, but the way his face fell into utter disappointment when he finally answered his door was all the information you needed. You couldn’t help but frown, your hand moving to cover your poorly bandaged arm as you watched him.

It made sense; the man had just come home from his shift, and his outfit was still intact with his suit and lab coat, with exhaustion weighing on his eyes. The man looked downright miserable, and with you looking like a wet rat from the rain and the blood seeping from your wound, he couldn't imagine a less welcome sight.

You both just stood there staring at one another, the rain pounding against the umbrella over your head. The wind was picking up, and you knew it was going to storm harder. You really couldn’t stand the look he was giving you.

"Hey, Rudy," You managed out, swallowing hard as the pain began to seep into your voice. You endured quite a lot to get here, and you weren’t about to let your pride show now.

The man before you let out a tired sigh, leaning against the doorframe as he closed his eyes.

"You do realize what time it is, don't you?" He questioned the usual cheerfulness of his voice, which was replaced with annoyance. It hurt a bit to hear, but you didn't blame him. It’s quite rude to show up unannounced, and it was even worse considering you showed up after 2 am.

Your eyes averted downwards, feeling ashamed for even showing up here. The last thing you wanted was to bother him, especially at a time like this.

Yet, you couldn’t go anywhere else. Money wasn’t quite flowing well in your area, and it was bad enough to where you had no insurance. You were a simple college student, working odd jobs here and there while balancing school and the like.

The job you had recently obtained was a janitor position for a nearby grocery store, and things seemed pretty good for a bit. It was not enough to pay those outrageous health bills, but it was getting you by.

"I need a favor... I know it's not exactly the best time to be asking, but please, just listen—" You began, the words spilling out of your mouth just as you’ve rehearsed them a million times.

Before you could continue, Rudy opened his eyes and looked down at you with a small frown. He already noticed the way you held your arm and the way you kept glancing at it. He knew what this was about; he knew the moment he opened the door and saw the desperation in your eyes.

Your name fell from his lips, drained and tired as he rubbed his forehead. He was silent for a bit, just as you were, and when he finally looked back up, his frown grew deeper.

"You seriously can’t afford to get simple treatment? How do you even know if I have the right supplies to fix something like this up, huh?"

You didn’t reply, merely biting down on your lip as you looked away. It was true, you weren't sure. Yet, Rudy had always been so kind to you, always willing to offer his help and support when you needed it.

The man sighed, closing his eyes as he ran his fingers through his hair. He couldn’t believe he was doing this; he had to wake up in a few hours, and now he had to deal with this.

The only thing keeping him from saying no was the look you gave him.

You weren’t one to beg or ask for help. You usually dealt with things on your own, and when you couldn’t, you were willing to work it off. He admired that about you, how you weren't the type to depend on others.

The fact that you were even here, soaked to the bone and asking for his help, proved to him just how serious the situation was.

You had no other choice, and he knew that.

So, without a word, Rudy stepped aside and gestured for you to enter. The relief was immediate, and before he could blink, you were inside, the sound of the rain slowly fading behind you.

The warmth of his home was a great contrast from the outside, and you couldn’t help but sigh contently as he threw his coat off and led you down the hall.

His duffel was still beside the couch, a sign that he had just returned moments before. Somehow, it made you feel worse, knowing that you interrupted his much-needed rest.

You followed Rudy through the living room, landing in the kitchen where the door to his basement was. You were about to follow him downwards, side-stepping past him, but a hand slammed against the doorframe just before you could.

Startled, you looked up at Rudy, a brow raised at the sudden stop. He was staring at you, his expression unreadable, and it made you grow uncomfortable.

"Stay here. I’ll be up in a minute, okay?" His voice changed slightly, sounding far more awake than before.

"Can’t you just do it down there? I mean, that’s where all your stuff is, right?"

Why go through all the trouble of bringing everything upstairs?

He shook his head, his lips pulling into a tight line. It looked like he was thinking something over, and when he finally spoke, he seemed hesitant.

"Just trust me, okay? Just wait here. I promise I won't be long."

You frowned, wanting to question him, but Rudy was already moving down the stairs. The door shut behind him, and the next thing you knew, you were left alone in the kitchen.

Confused, you couldn't help but stare at the door.

Why didn’t he want you down there? That was pretty odd behavior for someone who loved to brag about his work. You couldn’t recall a time when Rudy wasn’t so open about what he did.

So why the sudden change?

You didn’t want to question it, and instead, you hummed and sat down in the chair. You could hear his footsteps echo downstairs, and you waited patiently for him to return.

The sound of the basement door opening was almost instant, and when Rudy entered, you noticed the big medical box in his arms. You couldn’t help but watch the man walk around his kitchen, his movements slow and calculated as he made his way over to you.

Rudy placed the box onto the table, popped it open, and began to pull out the gloves, rubbing alcohol, and gauze. The man grabbed a chair and pulled it across from you, and as he did, he glanced up at you and smiled.

Your mind, however, was still elsewhere.

"Hiding a body down there, or something? You were taking forever, know..." You mumbled, your gaze shifting from the box to Rudy.

He chortled at the comment, glancing up momentarily to give you a small smile before resuming his task of pulling out the medical supplies.

He didn’t say anything other than the comments about your wound. How’d you get it? If it hurt, how long ago did it happen…

You know, the typical doctor questions.

Rudy took your arm in his, his hold gentle as he carefully removed the cloth that was once your makeshift bandage. You winced, hissing as the material peeled away some of the dried blood, and it caused Rudy to glance up at you apologetically.

As the cloth finally came off, Rudy didn’t make any type of comment. He didn't react to the deep cut on your arm other than the occasional flicker of his eyes. To you, it was absolutely jarring. It looked so much worse than you expected, and you couldn’t help but glance away as the man poured the alcohol onto the gauze.

He must’ve been used to this kind of thing, considering he didn’t so much as bat an eye.

The alcohol felt cold against your skin, and you bit your tongue to prevent the pain from escaping. Rudy didn't say a word as he cleaned up the wound, and you took the time to glance at the man.

Rudy was focused, his eyes narrowed as he concentrated on your wound. He was careful but quick, and his actions were precise and methodical. The way he moved was almost fascinating, and before you knew it, he was done with that part.

Rudy tossed the now bloodied gauze into the trash can that was temporarily beside the table and then reached for the next item.

The numbing shot.

The man paused, his gaze lifting from the supplies and up to your face. Rudy, the sweet and caring guy, had a very different face whenever he worked. He had his usual soft and comforting smile, but the way he constantly looked at your arm was so… cold.

He almost looked bored.

You blinked, and suddenly, he was staring at you, his brows raised.

You stared, unable to find the words, but the moment he spoke, the spell was broken.

Rudy gave you a sheepish smile, gesturing the shot in his hands. He warned you about the small prickle, gesturing to the shot in his hands, the prickle that’s never just a prick of the skin. It’s always quite painful.

The needle was tiny, but the feeling of the sensation entering your body was enough to make you grit your teeth. You felt your face grow warm, the embarrassment washing over you as the pain became a dull ache.

It didn't last long, and soon Rudy was shaking it around, supposedly making the numbing effect act faster.

Then, the waiting game. He told you around five to ten minutes, depending on your tolerance, and that's how you both ended up sitting across from one another in silence.

Rudy was tapping his fingers against the table, the only sound filling the air. You couldn’t help but notice the dark circles under his eyes, the way his shoulders sagged, and the occasional yawn that escaped him.

"I’m sorry," You said, finally breaking the silence. His facial expression didn’t help you feel better, the frown on his lips growing deeper as he shook his head.

"Don’t be sorry." He mumbled, his eyes closing briefly as he inhaled sharply. "Truth be told, I actually despise apologies. And it's not like you did this to yourself on purpose, anyways…"

That was true, you supposed. Still, the guilt wouldn't leave you alone.

When the man didn’t receive a reply, Rudy looked at you with a tired smile. His hands moved over the medical box, and with a slight push, it was out of the way and no longer between you.

Rudy then leaned forward, placing his elbows against the table, and folded his hands beneath his chin.

"You know, I miss this."

You blinked, tilting your head at him as a soft smile formed on your lips. "Me being clumsy and annoying?"

He chuckled, a sound that brought warmth to your heart, and the exhaustion was temporarily forgotten.

Rudy shook his head, and as he did, his smile faded and was replaced with something a little more sad. "Skin. The human body. Blood. The life force. I just miss it, I guess... I love what I do, don't get me wrong, but it can be a little boring at times.. It gets repetitive. The smiles are nice, the gratitude of those I treat, but sometimes I can't help but think about other things. More exciting things, y'know?"

"Suturing my arm is exciting to you? That's pretty weird, Rudy, and that's coming from me…"

You were only half-joking, and Rudy was aware. The man was silent for a moment, his gaze averted as his smile slowly returned.

A soft chuckle left him, and he leaned back against the chair, crossing his arms against his chest.

His eyes closed, and the smile on his face grew.

It wasn’t a sad smile, nor was it happy. It was a smile that said many things but nothing at all.

When his eyes finally opened, they were different. The smile was gone, and so was the warmth in his expression.

The smile he wore now was a familiar one, and the glint in his eyes was one you knew too well.

The box was moved back in front of him, and with a swift movement, the scissors and tweezers were in his hands.

Then, the conversation was over, and so was the waiting period. He did check to see if it was numb, but the moment you confirmed that it was, he went right back to work.

It was silent for the most part; you felt no pain, and Rudy was careful as he did his job. It was going by rather quickly, and with the silence that fell between the two of you, you couldn’t help but look down at your arm.

He was already halfway done. The numbing was working like a charm, and with how quickly Rudy was going, it was almost like a superpower. For a man not in his element, he seemed like he was pretty damn well in his element.

Maybe he did have a body hidden downstairs. Give him some practice.

Rudy stopped for a moment, the sudden pause causing you to lift your gaze and look at him. He was holding a new needle in his hand, a black string-like material in the other.

He was staring at your arm, the concentration on his face strong as he held the items up. It was a rather odd sight, and you couldn't help but lean closer to get a better look.

Rudy blinked, his focus snapping up at you, and he gave you a lopsided grin.

You watched him for a moment, the man simply staring back at you with the same grin, and after a moment of silence, he put the tools down.

"And, presto." He said, his grin widening, and before you knew it, he was packing up the box.

Damn, that was fast.

He wrapped the wound in an actual bandage, moving at the speed of light, and before you could even comprehend what was happening, Rudy was already finished.

The man got up, stretching out his back as he did, and he glanced down at you with a soft smile.

"I don’t keep any antibiotics around here, but a simple store trip can fix that. You don’t need anything fancy, just a simple infection control, and you should be good to go. It doesn't seem to be too bad, and if it gets any worse, then we can look into that later... at the ER."

"Right." You mumbled, not having the energy to protest. The sarcasm, the jokes, the humor... everything was gone. You were drained, and now that the whole ordeal was over, you felt yourself slouching against the chair.

You looked up at Rudy, and before you could speak, he was already talking.

"Don’t worry about it. I’ll drop you home tomorrow morning before I go in. I’m seconds away from passing out, and you look like you're about to fall over."

You nodded, a silent thank you falling from your lips. Rudy gave you a nod in response and then gestured towards the hallway.

It wasn’t too long after that you found yourself walking down the hallway with a spare pillow and blanket. The guest bedroom was empty, and when you entered, the lights were off.

You didn’t question it, and instead, you set the pillow and blanket on the bed and made yourself comfortable. He said he used this room a lot, but somehow, it looked so untouched. It wasn’t dusty, but the way the room was set up proved that it wasn't often used.

Still, you were far too exhausted to give it a second thought.

Rudy walked past the doorway, a pair of keys in his hands as he waved them around. You heard him mention something about locking up and going to sleep, and after he left, the hall was silent.

And then, after a few minutes, the house was silent.

As you lay there, a wave of exhaustion washed over you. Your arm was still numb, and you felt nothing as you gently placed your hand against the bandage.

There was no pain, no nothing. It was just ugly, and yet you were grateful.

You didn’t even know Rudy for that long. A mutual friend introduced you to one another, and ever since then, it has been a whirlwind of events.

Especially due to your overbearing clumsiness.

But tonight? What a true blessing.

You couldn’t thank him enough. Maybe you could make him breakfast in the morning. That sounded like a decent enough gift.

Unless you happened to break his kitchen or yourself, you’d have to see how things played out.

And with that, you rolled over, your eyes slowly drifting shut.

You were out within a minute. And fortunately for Rudy, so were his neighbors.

It was a rather quiet night, after all, and with his soundproof walls, no one could hear a thing.

Even with the preparation for the next present for his precious Ken, the perfect gift of appreciation, no one could hear the sounds of his true work.

Well, no one except you.

[@ghostheartbeat, @numetalnerd2007] Here’s your tag, besties! Go wild! ☺️☺️

I hope you guys liked the "realistic" approach I took here lmao. I felt really devious about this plot 😈

[cy-cyborg]

Writing and drawing amputee characters: Not every amputee wears prosthetics (and that's ok)

Not every amputee wears prosthetics, and not doing so is not a sign that they've "given up".

It's a bit of a trope that I've noticed that when an amputee, leg amputees in particular, don't wear prosthetics in media its often used as a sign that they've given up hope/stopped trying/ are depressed etc. If/when they start feeling better, they'll start wearing their prosthetics again, usually accompanied by triumphant or inspiring music (if it's a movie). The most famous example of this is in Forest Gump, Where Dan spends most of the movie after loosing his legs wishing he'd died instead. He does eventually come around, and him finally moving from his wheelchair to prosthetics is meant to highlight this.

The thing is, it's not that it's unrealistic - in fact my last major mental health spiral was started because one of my prosthetics was being a shit and wouldn't go on properly, despite fitting perfectly at the prosthetist's the day before. I'm not going to use my legs when I'm not in a good headspace, but the problem is, this is the only time non-prosthetic using amputees ever get representation: to show how sad they are. Even if that's not what the creator/writer necessarily intended, audiences will often make that assumption on their own unless you're very careful and intentional about how you frame it, because it's what existing media has taught them to expect.

But there are lots of reasons why someone might not use prosthetics:

they might not need them: this is more common in arm amputees because of how difficult it can be to use arm prosthetic, especially above-elbow prosthetics. Most folks learn how to get on without them pretty well. In fact, most of the arm amputees I know don't have prosthetics, or only have them for specific tasks (e.g. I knew a girl who had a prosthetic hand made specifically for rowing, but that's all she used it for).

Other mobility aids just work better for them: for me, I'm faster, more manoeuvrable and can be out for longer when I'm in my wheelchair than I ever could on my prosthetics. Youtube/tik tok creator Josh Sundquist has said the same thing about his crutches, he just feels better using them than his prosthetic. This isn't the case for everyone of course, but it is for some of us. Especially people with above-knee prosthetics, in my experience.

Other disabilities make them harder to use: Some people are unable to use prosthetics due to other disabilities, or even other amputations. Yeah, as it turns out, a lot of prosthetics are only really designed for single-limb amputees. While they're usable for multi-limb amps, they're much harder to use or they might not be able to access every feature. For example, the prosthetic knee I have has the ability to monitor the walk cycle of the other leg and match it as close as possible - but that only works if you have a full leg on the other side. Likewise, my nan didn't like using her prosthetic, as she had limited movement in her shoulders that meant she physically couldn't move her arms in the right way to get her leg on without help.

Prosthetics are expensive in some parts of the world: not everyone can afford a prosthetic. My left prosthetic costs around $5,000 Australian dollars, but my right one (the above knee) cost $125,000AUD. It's the most expensive thing I own that I only got because my country pays for medical equipment for disabled folks. Some places subsidise the cost, but paying 10% of $125,000 is still $12,500. Then in some places, if you don't have insurance, you have to pay for that all by yourself. Even with insurance you still have to pay some of it depending on your cover. Arm prosthetics are even more expensive. Sure, both arms and legs do have cheaper options available, but they're often extremely difficult to use. You get what you pay for.

they aren't suitable for every type of environment: Prosthetics can be finicky and modern ones can be kind of sensitive to the elements. My home town was in a coastal lowland - this means lots of beaches and lots of swamp filled with salty/brackish water. The metals used in prosthetics don't hold up well in those conditions, and so they would rust quicker, I needed to clean them more, I needed to empty sand out of my foot ALL THE TIME (there always seemed to be more. It was like a bag of holding but it was just sand). Some prosthetics can't get wet at all. There were a few amputees who moved to the area when I was older who just didn't bother lol. It wasn't worth the extra effort needed for the maintenance.

People have allergies to the prosthetic material: This is less of a problem in the modern day, but some people are allergic to the materials their prosthetics are made from. You can usually find an alternative but depending on the type of allergy, some people are allergic to the replacements too.

Some people just don't like them.

There's nothing wrong with choosing to go without a prosthetic. There's nothing wrong with deciding they aren't for you. It doesn't make you a failure or sad or anything else. Using or not using prosthetics is a completely morally neutral thing.

Please, if you're writing amputees, consider if a prosthetic really is the best mobility aid for your character and consider having your characters go without, or at least mix it up a bit.

For example, Xari, one of the main characters in my comic, uses prosthetics unsupported and with crutches, and uses a wheelchair. They alternate between them throughout the story.

[cardentist]

"yes trans mascs experience transphobia, but there's no such thing as trans mascs experiencing bigotry Specifically Related to them being men/from being related to men"

my mom, after some time sorting her feelings and sifting through trans resources, was accepting of my being a trans person. it took work, but it happened. she sought out trans media from trans people, she took initiative to inform other family members and put herself between me and them.

and she completely refused to even start the process of Maybe getting me on testosterone for 10 years, until I aged out of being covered by her health insurance and couldn't afford to do it myself.

Specifically And Entirely because she was terrified that testosterone was going to make me an angry, violent person. that it was going to, in her own word, "give me roid rage."

for years she made vague pantomimes about eventually seeing about transitioning, but That reasoning would still come up no matter how I tried to explain it to her otherwise.

I am not a particularly violent person, if maybe stubborn. but that didn't matter. what Mattered is that my mother had a preconceived notion of what testosterone does, what Masculinity Does, and that notion was an inherently negative, scary one.

and Because Of That I was denied access to resources That I Need for Years. something that has carried over into the rest of my adult life.

and I see sentiments like hers online, even and sometimes Especially in trans spaces, all the time.

this vision of men as inherently violent, of masculinity as inherently dangerous, and the onus placed in the laps of Trans Men (and often, on Trans Boys) to diminish and shrink themselves to Prove that they're non-threatening enough to be tolerated.

and it bares pointing out that this Isn't just something that affects trans men. trans Women are just as affected by this association with maleness as an inherently corrupting factor. and so to are butch women and nonbinary people presented as violent and scary.

likewise, I see Similar sentiments pushed at butches and trans mascs that it's their job to Protect other people within the queer community, that image of violence and anger filtered through a softer light designating their Use. you're Allowed to be a Scary Masculine Creature as long as you dedicate yourself to protecting the weaker frailer other (which is, you know. Sexist And Weird).

but it's like. people don't Want to think about different kinds of trans and gnc people having overlapping experiences, so instead people like to decide which Kind of people are allowed to have this experience and cut other sorts of people out of those conversations.

it's not about what a particular person's gender or presentation Is, it's how that person Is Perceived and the way that they're treated Because Of that perception. sometimes this transphobia that fears masculinity looks like a perception of scary men trying to pretend to be women, sometimes it looks like a perception of women Becoming scary men, and everything that lies in between (with combinations therein).

finding a term that is used to describe this is Useful not just for giving trans mascs a way to talk about their experiences without encroaching on other conversations about transness. but Also in giving us words to describe a specific phenomenon that Can affect All trans people (and gnc people, and genderqueer people, etc), but that is difficult for us to recognize as a shared experience because people seem to think that sharing experiences is either impossible or a bad thing.

[tinystepsforward]

automattic vs wp engine mastterpost

adrienne's GitHub recap is probably the best place to see a comprehensive timeline of what's going down. it's been kept up to date. my (very out of date) previous writeup is here.

what's happened/other links

Matt has not logged off, just switched platforms, so there's lots on X/Twitter, Reddit, and Hacker News. it's really not worth wading through.

WP Engine actually filed suit.

the complaint includes some truly remarkable screenshots of Matt trying to blackmail the CEO of WP Engine.

which... personally i would not happily work for someone who just blackmailed me while not even my boss, but that's just me. he hasn't denied this at all, in fact confirming on Hacker News:

I haven't doxxed any private texts from other parties like they have. [source]

and, notably,

I even invited her to my 40th birthday on Jan 11, another text message she decided not to share. [source]

this gives me the creeps. in the context of the rest of the way he's talking to her, and the ways in which he's interacted with women in general, it's. not great.

also he slid into an ex-employee (also a woman)'s DMs asking why she was being mean to him bc he'd never been nothing but nice to her, while also making legal threats. so y'know, pattern of behaviour.

a good writeup of the social side of things

if you don't care so much about the open-source stuff, Steph Lundberg's writeup is, like her previous one on Matt's Tumblr meltdown, pretty solid and people-focused.

Mullenweg has already demonstrated egregious lapses in judgment and abuses of power, it’s just that up until now he’s wielded his power against vulnerable populations without access to high-powered lawyers and their own massive platforms.

a more technical writeup

this one is melodramatic in the same ways Matt was (uses war terminology), which i don't agree with, and which led to some... internal arguments at Automattic. that part's not my story to tell, but a little more on that later. it's a solid writeup of the actual WordPress side of things. there's some seriously dodgy trademark behaviour going on here.

of note: this blogger locked comments on his post:

and then Matt, uh, found a way around that:

wild!

10% of Automattic leaves

that's a link to Matt's blog post. here's an Internet Archive link.

in short, staff were offered a severance deal of the higher of $30k or six months' salary. while that's very generous, it's still very risky in today's tech market, especially (for the same reasons i mentioned when Matt was melting down on here) for people outside the US, people who need the health insurance, or people with young kids. despite that, 10% decided with very little notice (they had two days to decide) to leave.

However now, I feel much lighter. I’m grateful and thankful for all the people who took the offer, and even more excited to work with those who turned down $126M to stay. As the kids say, LFG!

i'm thrilled to see some of my ex-colleagues make it out. i'm keeping the rest who have stayed on in my thoughts. i don't know anyone who's wholesale shilling for Matt.

Matt's been pressuring staff to post in support of him, @-ing the entire company to vote on Twitter polls in his favor, and so on. many of the people who stayed have written blog posts about it, all starting with "I stayed". people on social media have pointed out the very clear pattern of Automatticians jumping into discourse to defend Matt, and it doesn't look good.

i don't have a lot to say about those posts, except to highlight Jeffrey Zeldman, whose "I stayed" post is perhaps one of the more honest ones. (his Rodney King reference was in poor taste, and he... i don't like his role at automattic, tbc) but like. he's nearly 70. he helped shape the modern internet and develop its accessibility standards. he has often put his neck on the line for disabled staff who don't have as much clout as he does. given the financial troubles he talks about and the state of this market and how old he is, i personally have read between the lines of what he's saying in a particular way.

fuck, man. i'm sad. i'm sad for all my friends who are creaking under the strain and watching others leave but who can't do that. i'm sad that many of them are left in teams which are half-empty or divisions where significant senior leadership are just gone, with no time to document what they had in progress.

i'm sad for Josepha Haden Chomphosy, the former executive director of the WordPress Foundation, who was dealing with a personal emergency and ended up having to miss WordCamp US (where Matt started publicly starting shit with WPE). she came back from that to a gigantic fire in the community she's invested a decade of careful, Matt-negotiating, stewardship to, and decided to take the severance offer. she deserved better.

other things Matt's been up to

mostly linking to comments or posts which compile things here, bc it's too scattered otherwise.

blocking people from the official WordPress X account if they disapprove of his actions.

publicly talking about a vulnerability in ACF, a plugin WPE maintains, which could put thousands of sites at risk. this is not normal, and he met with so much horror even from current staff that he deleted his post.

saying he comes across badly because he's "a little ASD", which is driving me personally up the fucking wall. he's never once said it before and he really is turning into Temu Elon.

generally bragging that he still has more planned. jesus fucking christ

continually saying that WPE's suit is against WordPress.org and the community, which is not true. on which note, his pinned tweet is certainly something:

his choice of lawyer is uh. the kind of guy to defend nestle against literal child slaves.

as always, while i think WordPress crumbling will disproportionately affect websites in poorer parts of the world, there are certainly tyrants who are causing much more immediate and potent suffering. if you've read this far, please do send anything you have spare to gazafunds.com.

[femmefatalevibe]

Any tips on saving money?

Track your income/expenses. Knowing your monthly cash flow + essential and discretionary spending is the only sound starting point toward setting your financial goals.

Evaluate your non-essential spending habits. Consider where this money is going, and whether these expenses add value/are necessary to your life (pleasure or peace of mind is an acceptable "necessity" if you're living within your means to be clear!).

Determine the money you have left over after you cover your essential expenses and most fulfill discretionary expenses. This amount is your "saving/investment" money.

Divide your leftover amount into 3 categories: Emergency fund, goal-oriented savings (like buying a desired luxury item/furniture, a down payment on a house, a vacation, etc.), and investments.

Put your savings in a high-yield savings account. If possible, have different accounts for each purpose, especially your emergency fund and savings for future purposes. You can also get a CD for a long-term savings goal.

Put your investments (in the USA at least) in the following buckets: Roth IRA (max it out), ALWAYS take your employer's full 401k match, HSA (if you have a high-deductible health insurance plan), and S&P 500 index funds/other evergreen mutual funds + blue-chip stocks.

Purchase fewer, higher-quality items. Know the sales seasons for each product category and shop around this calendar (down to the produce items in season). If possible, rent items when it makes sense.

Only say "yes" to plans/financial obligations that add value/pleasure to your life. Don't let yourself feel shortchanged financially or emotionally. It's never worth it, honestly.

Invest in your physical, mental, and financial health first. This can mean something different for everyone but it's important!

**I'm not a professional, just another young woman on the internet, so please take this advice accordingly. Please meet with a financial advisor/CPA for formal advice and personal financial planning.

Hope this helps xx

[genderqueerdykes]

Testosterone HRT Overview, Guide & Information for All People Seeking It

Hello, we're a genderqueer person who's been taking testosterone HRT since 2015. I've also worked in a pharmacy and we've seen a lot of the roadblocks that comes with people trying to start HRT. Nobody really explains how difficult it can be, even when you get your prescription. Because testosterone is a controlled substance in many places, it creates hurdles. There can be a lot going on, and some folks become very disheartened if their T isn't covered by insurance. i get that. We wanted to create a relatively easy to digest and succinct post detailing some common hurdles people have to face on the doctor/prescriber and insurance level, as well as after getting their hormones. *please note that a lot of this information is United States centric as that's where i live, i can't give information for a country i've never lived in, unfortunately.*

The estrogen HRT version of this post is here!

Doctors, Insurance & Getting Your Prescription

If your primary care provider is already familiar and comfortable with prescribing HRT, you can go through them, find an informed consent clinic, or seek an endocrinologist or gender affirming care specialist. Planned Parenthood is a good option for many people. If you don't have insurance, check to see if your area offers medicaid or other low income insurance plans, T can get pricey in some areas, especially for topical. if you can't access insurance please look into services like GoodRx that offer coupons and discounted rates for prescriptions.

Here is a list of informed consent clinics in the US for HRT.

Your provider will ask you some questions about your experience with gender, any dysphoria, why you want to seek medical transition, if you'd like to seek surgeries, assess your mental health, and then screen you for potential health problems or roadblocks. Your liver enzymes will be screened, as will your hormone levels, blood pressure, and some other things. Make sure your doctor knows to note that you are a transgender patient so that your blood tests are not discarded because your gender says "F" instead of "M" on the paperwork.

In some areas it is required to seek treatment with a therapist who specializes in transgender care to make sure this avenue is right for you. Not everywhere requires this step.

Make sure you talk to whoever is prescribing the testosterone to you about insurance, and if they are aware that testosterone is a controlled substance. A controlled substance is a substance that has been restricted by your country's government or governing medical organization and has to be monitored carefully. You need what's called a "prior authorization" from your doctor in order to get your insurance to give you your hormones in most states. Talk to your doctor and pharmacy about prior authorizations for your testosterone and syringes if you need them.

Currently, the only forms of testosterone available for masculinizing HRT are testosterone cypionate (injectable), topical gel, and patches. Topical forms are usually applied daily, injections can be done once or twice a week, or even more or less frequently if a person needs it. There is no pill option available for masculinizing HRT currently.

Do NOT become disheartened if you do not see the effects you want to see right away. It can take several years for the full effects of certain aspects of medical transition to show themselves. Stay patient, talk with your provider, talk to other trans people!

Stay patient, Stay positive!

HRT and Administering Testosterone

When you get a prescription, how things go will depend on if you get your doses administered at the clinic, or if you choose to do them at home. If you are not comfortable self administering, ask if they will at the clinic. many places offer this service.

if you choose to administer at home, if you are using injectable T, note that pharmacies may give you the wrong gauges of needles because they don't often give out needles for HRT. You need two different sizes- a thicker, longer needle for drawing from the vial, as testosterone cypionate is thick. You will generally be given large 18g needle for drawing and a small 22 or 23g needle for injecting. Many people have preferences for different gauges so ymmv. Depending on if you are injecting intramuscularly or subcutaneously the gauge of the needle with vary. Sanitize your injection site and your hands, never using the same needle tips twice for any reason. Never use needles that have touched another surface, and get a sharps container.

Make sure you are injecting in different spots every time you inject. you do not want to inject into the same patches of skin every time, as this can cause tissue damage, tissue death (necrosis), and severe scarring after long periods of time of having to heal but being interrupted over and over again. inject into slightly different spots every time to make sure your skin and muscle tissue can heal.

Here is a guide on safely injecting your own testosterone, including steps on how to prepare your skin for the injection, hold the vial while drawing, change needles, and more.

Another guide for hormone injections.

Make sure to check with your provider to see what type of injection you are meant to do, many do intramuscular injections, but many opt for subcutaneous (just below the skin) injections because they are less painful and require less frequent injections.

If you receive topical testosterone like androgel or other alcohol based testosterone gels, make sure you read the informational packet that comes with it to ensure you are administering it in the correct areas- your exact formulation will need to be applied in a certain area, if you do not have the guide or packet that came with it, please read this page to figure out where you need to apply it. if your topical T isn't working you may be applying it in the wrong place.

When applying topical T, make sure you clean the skin before putting it on, and do not shower or go swimming for 2 - 5 hours after application. make sure you cover the skin with some kind of clothing. You want to make sure it doesn't rub off on other people, as other people can absorb it as well by touching you. Do not ever have someone else apply topical testosterone for you, even if they are also trans, as this can mess with their levels in a bad way.

After starting T you may have to adjust your dose over time to achieve desired effects. if so, you will start on a starter dose and then you can move up to higher doses as your body adjusts. This process is called titration.

No matter HOW tempting it is, NEVER TAKE MORE T THAN YOU ARE PRESCRIBED! It is processed through your liver, which can completely wreck it if you take more than it can handle. Slow and steady wins the race with HRT. If you take too much T at once, your body can also aromatize it, meaning your body will convert it and encourage the production of further estradiol, which will provide unwanted effects. Do not increase your dose without your doctor's advice or knowledge, and do not go any faster than advised.

Effects of Testosterone HRT

Growth and thickening of facial and body hair begins 3 - 6 months after treatment starts and the full effect happens within 3 - 5 years.

Menstruation (periods) stop. This occurs around 2 - 6 months within starting treatment, and is one of the most desired effects.

Voice deepens. The vocal cords thicken, which can cause uncomfortable sensations in the throat for a time, such as a scratchy feeling, dryness, tightness, pressure, and a 'sore' throat that isn't sore in an illness related way. This begins 3 - 6 months after treatment starts, and the full effect happens in 1 - 2 years.

Body fat redistribution begins 3 - 6 months after treatment starts and the full effect happens within 3 - 5 years.

Growth or enlargement of Adam's apple.

Clitoris grows larger, and vaginal lining can thin and become drier. Some experience vaginal atrophy and/or painful levels of dryness, while some maintain a healthy level of vaginal fluids without problem. This begins 3 - 12 months after treatment starts, and the full effect is usually seen within 1 - 2 years, though some experience growth over a long period of time if their dose is low.

Change in body odor and increased sweating occurs within 1 - 3 months of starting treatment.

Muscle mass and strength increase, this will begin within 6 - 12 months and the full effect will be seen within 2 - 5 years.

Possible libido increase, though some report no changes or even the inverse.

Potential but not guaranteed balding or receding hairline, which is treatable, and not seen in everyone.

Potential increase in energy in general, some report an almost antidepressant like effect.

Possible increase in red blood cell production leading to high blood pressure, which is treatable via medications and donating red blood cells when appropriate and safe.

There is not really a guide book to masculinizing HRT and medical transition, most of the information there is is passed along between each of us. We will continue to edit this post as we think of more important information.

[kieren-fucking-walker]

Hi everyone,

For those of you who don't know, my darling cat Sage was diagnosed with lymphoma last week, by Sunday he couldn't walk by himself and wasn't eating and so we made the decision to have him put to sleep. He passed peacefully at home in my arms, and is now buried with his sister who died last November. I miss them both, and his absence is really hard to get used to.

I was already off work with my mental health so not getting full pay, and due to the time it took us to work out what was wrong with him, the diagnostic tests, medication, and ultimately having him put to sleep I've spent just over £1200 in vets fees. Because of his age and pre-existing illnesses his insurance won't cover it, and while I'm doing my best to negotiate with them I don't think I'm going to get anything out of it.

If you are able and would like to help with vets fees, then we'd be very grateful, my PayPal is here and my ko-fi is here.

It isn't as time sensitive as my previous, especially now he's passed and failure to pay won't harm him, but I need to take care of my own disability needs too and not being at work on full pay leaves me in a worse situation than I otherwise would be in, so any help (only if you are able and willing) is greatly appreciated.

Thank you for reading, I'm sorry the news isn't happier, and any love sent our way will definitely be felt 💜

[mostlysignssomeportents]

The health industry’s invisible hand is a fist

On June 21, I'm doing an ONLINE READING for the LOCUS AWARDS at 16hPT. On June 22, I'll be in OAKLAND, CA for a panel and a keynote at the LOCUS AWARDS.

The US has the rich world's most expensive health care system, and that system delivers the worst health outcomes of any country in the rich world. Also, the US is unique in relying on market forces as the primary regulator of its health care system. All of these facts are related!

Capitalism's most dogmatic zealots have a mystical belief in the power of markets to "efficiently allocate" goods and services. For them, the process by which goods and services are offered and purchased performs a kind of vast, distributed computation that "discovers the price" of everything. Our decisions to accept or refuse prices are the data that feeds this distributed computer, and the signals these decisions send about our desires triggers investment decisions by sellers, which guides the whole system to "equilibrium" in which we are all better off.

There's some truth to this: when demand for something exceeds the supply, prices tend to go up. These higher prices tempt new sellers into the market, until demand is met and prices fall and production is stabilized at the level that meets demand.

But this elegant, self-regulating system rarely survives contact with reality. It's the kind of simplified model that works when we're hypothesizing about perfectly spherical cows of uniform density on a frictionless surface, but ceases to be useful when it encounters a messy world of imperfect rationality, imperfect information, monopolization, regulatory capture, and other unavoidable properties of reality.

For members of the "efficient market" cult, reality's stubborn refusal to behave the way it does in their thought experiments is a personal affront. Panged by cognitive dissonance, the cult members insist that any market failures in the real world are illusions caused by not doing capitalism hard enough. When deregulation and markets fail, the answer is always more deregulation and more markets.

That's the story of the American health industry in a nutshell. Rather than accepting that people won't shop for the best emergency room while unconscious in an ambulance, or that the "clearing price" of "not dying of cancer" is "infinity," the cult insists that America's worst-in-class, most expensive health system just needs more capitalism to turn it into a world leader.

In the 1980s, Reagan's court sorcerers decreed that they could fix health care with something called "Prospective Payment Systems," which would pay hospitals a lump sum for treating conditions, rather than reimbursing them for each procedure, using competition and profit motives to drive "efficiency." The hospital system responded by "upcoding' patients: if you showed up with a broken leg and a history of coronary disease, they would code you as a heart patient and someone who needed a cast. They'd collect both lump sums, slap a cast on you, and wheel you out the door:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195137/

As Robert Kuttner writes for The American Prospect, this kind of abuse was predictable from the outset, especially since Health and Human Services is starved of budget for auditors and can only hand out "slaps on the wrist" when they catch a hospital ripping off the system:

https://prospect.org/economy/2024-06-13-fantasyland-general/

Upcoding isn't limited to Medicare fraud, either. Hospitals and insurers are locked in a death-battle over payments, and hospitals' favorite scam is sending everyone to the ER, even when they don't have emergencies (some hospitals literally lock all the doors except for the ER entrance). That way, a normal, uncomplicated childbirth can be transformed into a "Level 5" emergency treatment (the highest severity of emergency) and generate a surprise bill of over $2,700:

https://pluralistic.net/2021/10/27/crossing-a-line/#zero-fucks-given

The US health industry is bad enough to generate a constant degree of political will for change, but the industry (and its captured politicians and regulators) is also canny enough to dream up an endless procession of useless gimmicks designed to temporarily bleed off the pressure for change. In 2018, HHS passed a rule requiring hospitals to publish their prices.

Hospitals responded to this with a shrewd gambit: they simply ignored the rule. So in 2021, HHS made another rule, creating penalties for ignoring the first rule:

https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/hospitals

The theory here was that publishing prices would create "market discipline." Again, this isn't wholly nonsensical. To the extent that patients have nonurgent conditions and the free time to shop around, being able to access prices will help them. Indeed, if the prices are in a standards-defined, machine-readable form, patients and their advocates could automatically import them, create price-comparison sites, leaderboards, etc. None of this addresses the core problem that health-care is a) a human right and b) not a discretionary expense, but it could help at the margins.

But there's another wrinkle here. The same people who claim that prices can solve all of our problems also insist that monopolies are impossible. They've presided over a decades-long assault on antitrust law that has seen hospitals, pharma companies, insurers, and a menagerie of obscure middlemen merge into gigantic companies that are too big to fail and too big to jail. When a single hospital system is responsible for the majority of care in a city or even a county, how much punishment can regulators realistically subject it to?

Not much, as it turns out. Kuttner describes how Mass Gen Brigham cornered the market on health-care in Boston, allowing it to flout the rules on pricing. In addition to standard tricks – like charging self-pay patients vastly more than insured payments (because individuals don't have the bargaining power of insurers), Mass Gen Brigham's price data is a sick joke.

See for yourself! The portal will send you giant, unstructured, ZIPped text files filled with cryptic garbage like:

ADJUSTABLE C TAPER NECK PLUS|1|UNITED HEALTHCARE [1016]|HB CH UNITED HMO / PPO / INDEMNITY [34]|UNITED HEALTHCARE HMO [101604]|75|Inv Loc: 1004203; from OR location 1004203|52.02|Inpatient PAF; 69.36% Billed|75|Inv Loc: 1004203; from OR location 1004203|56.87|Outpatient PAF; 75.83% Billed

https://www.massgeneralbrigham.org/en/patient-care/patient-visitor-information/billing/cms-required-hospital-charge-data

These files have tens of thousands of rows. As a patient, you are meant to parse through these in order to decide whether you're getting ripped off on that HIP STEM 16X203MM SIZE 4 FEMORAL PRESS FIT NEUTRAL REVISION TITANIUM you're in the market for (as it happens, I have two of these in my body).

Kuttner describes the surreal lengths he had to go through to prevent his mother from getting ripped off by Mass Gen through an upcoding hustle. By coding her as "admitted for observation," Mass Gen was able to turn her into an outpatient, with a 20% co-pay (this is down to a GW Bush policy that punishes hospitals that charge Medicare for inpatient care when they could be treated as outpatients – hospitals reflexively game the system to make every patient an outpatient, even if they have overnight hospital stays).

Kuttner's an expert on this: he was national policy correspondent for the New England Journal of Medicine and covers the health beat for the Prospect. Even so, it took him ten hours of phone calls to two doctors' offices and Blue Cross to resolve the discrepancy. The average person is not qualified to do this – indeed, the average person won't even know they've been upcoded.

Needless to say that people in other countries – countries where health care is cheaper and the outcomes are better – are baffled by this. Canadians, Britons, Australians, Germans, Finns, etc do not have to price-shop for their care. They don't have to hawkishly monitor their admission paperwork for sneaky upcodes. They don't have to spend ten hours on the phone arguing about esoteric billing practices.

In a rational world, we'd compare the American system to the rest of the world and say, "Well, they've figured it out, we should do what they're doing." But in good old U-S-A! U-S-A! U-S-A!, the answer to this is more prices, more commercialization, more market forces. Just rub some capitalism on it!

That's where companies like Multiplan come in: this is a middleman that serves other middlemen. Multiplan negotiates prices on behalf of insurers, and splits the difference between the list price and the negotiated price with them:

https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills.html

But – as the Arm and a Leg podcast points out – this provides the perverse incentive for Multiplan to drive list prices up. If the list price quintuples, and then Multiplan drives it back down to, say, double the old price, they collect more money. Meanwhile, your insurer sticks you with the bill, over and above your deductible and co-pay:

https://armandalegshow.com/episode/multiplan/

The Multiplan layer doesn't just allow insurers to rip you off (though boy does it allow insurers to rip you off), it also makes it literally impossible to know what the price is going to be before you get your procedure. As with any proposition bet, the added complexity is there to make it impossible for you to calculate the odds and figure out if you're getting robbed:

https://pluralistic.net/2022/05/04/house-always-wins/#are-you-on-drugs

Multiplan is the purest expression of market dynamics brainworms I've yet encountered: solving the inefficiencies created by the complexity of a system with too many middlemen by adding another middle-man who is even more complex.

No matter what the problem is with America's health industry, the answer is always the same: more markets! Are older voters getting pissed off at politicians for slashing Medicare? No problem: just create Medicare Advantage, where old people can surrender their right to government care and place themselves in the loving hands of a giant corporation that makes more money by denying them care.

The US health industry is a perfect parable about the dangers of trusting shareholder accountable markets to do the work of democratically accountable governments. Shareholders love monopolies, so they drove monopolization throughout the health supply chain. As David Dayen writes in his 2020 book Monopolized the pharma industry monopolized first, and put the screws to hospitals:

https://pluralistic.net/2021/01/29/fractal-bullshit/#dayenu

Hospitals formed regional monopolies to counter the seller power of consolidated Big Pharma. That's Mass Gen's story: tapping the capital markets to buy other hospitals in the region until it became too big to fail and too big to jail (and too big to care). Consolidated hospitals, in turn, put the screws to insurers, so they also consolidated, fighting Big Hospital's pricing power.

Monopoly at any point in a supply chain leads to monopoly throughout the supply chain. But patients can't consolidate (that's what governments are for – representing the diffuse interests of people). Neither can health workers (that's what unions are for). So the system screwed everyone: patients paid more for worse care. Health workers put in longer hours under worse conditions and got paid less.

Kuttner describes how his eye doctor races from patient to patient "as if he was on roller skates." When Kuttner wrote him a letter questioning the quality of care, the eye doctor answered that he understood that he was giving his patients short shrift, but explained that he had to, because his pay was half what he needed, relegating him to a small apartment and an old car. The hospital – which skims the payments he gets for care – sets his caseload, and he can't turn down patients.

The answers to this are obvious: get markets out of health care. Unionize health workers. Give regulators the budgets and power to hold health corporations to account.

But for market cultists, all of that can't work. Instead, we have to create more esoteric middlemen like "pharmacy benefit managers" and Multiplan. We need more prices to shovel into the market computer's data-hopper. If we just capitalism hard enough, surely the system will finally work…someday.

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/06/13/a-punch-in-the-guts/#hayek-pilled

[intheholler]

On Appalachian and Southern Stereotypes

After seeing some people leap at the opportunity to insult and further harm us under my posts, even by obviously leftist accounts, I wanted to address some of the most popular stereotypes of our region.

Not as an excuse. There are many negative, violent and otherwise harmful features of the American South. We have a horrific history especially in terms of the violence we inflicted and continue to inflict upon the Black community that cannot be forgotten, and, as a culture, we do need to pay our dues.

But maybe this will help y’all apply some nuance to the situation and understand that we aren’t all your enemy.

Stereotype 1: Everyone is a Republican Racist

Absolute horse shit, my friends. There are people like me all over the south and in the hollers. We just get drowned out by the fascists, and it is all by design. 

In my home state of North Carolina alone, they are working tirelessly to make it impossible for young, often liberal (if not outright leftist) voices to be heard. They specifically target regions with heavy POC populations.

As recently as May of this year, the North Carolina Supreme Court overturned their own previous ruling which once made gerrymandering illegal. This allows Republicans free range to draw their congressional lines wherever benefits them most. 

Meanwhile, Roy Cooper, our Democratic governor, has been in office since 2017.

Gerrymandering is a real problem, and it reflects the worst of us. But it does not reflect all of us.

We are a working class, pro-union people.

We are coal miners and mill workers and farmers.

We took up arms against the government and fought for our labor rights during the Coal Wars as recently as the 1920s.

We bled for labor rights at the Battle of Blair Mountain.

It’s a myth that you keep perpetuating that we are all closed minded, bigoted regressionists. It diminishes the efforts of everyone from the coal miners to people like me while we try to make the region a better place.

It actually only worsens what you say that you wish you could “saw off into the ocean.” 

That's my home you're talking about.

Stereotype 2: Everyone is Obese

36.3% of the overall population of the Southeast is obese. This is true.

Have you considered why that may be? For starters, Southerners are more likely to be uninsured compared to individuals living in the rest of the country.

"Among the total nonelderly population, 15% of individuals in the South are uninsured compared to 10% of individuals in the rest of the country."

Partially because they didn't even expand the same Medicaid benefits to us. and partially because we are just so fucking poor. 

17% of the American South is below the poverty line, compared to 13% in the Midwest, 13% in the West, and 13% in the Northeast.

Percentages under 5% may not seem like much, but when you consider 1% of the total United States population is around 3,140,000 people, yeah, that adds up real quick.

How does this relate? Well...

Mississippi has 19.58% of its residents below the poverty line, and a 39.1% obesity rate.

West Virginia has 17.10% of its residents below the poverty line, and a 40.6 % obesity rate.

Kentucky has 16.61% of its residents below the poverty line, and a 40.4% obesity rate.

Are you seeing the trend?

We, generally speaking, are more likely to be unable to afford to feed ourselves wholesome foods, and we are less likely to be able to afford medical insurance--two things that are obviously important to maintaing good health and a "healthy" weight.

By the same token... 

Stereotype #3: We're All Uneducated 

The South and Appalachia are some of the lowest ranked in terms of educational funding and spending per pupil in the entire country. We don't even break the top 30 on the list, y'all.

49. Tennessee at $8,324 per pupil 47. Mississippi at $8,919 per pupil 45. Alabama at $9,636 per pupil 42. Kentucky at $10,010 per pupil 36. North Carolina at $10,613 per pupil 35. South Carolina at  $10,719 per pupil 33. Georgia at $10,893 per pupil 32. West Virginia at $10,984 per pupil

The top three best-funded states, by comparison, receive between $18k and $20k per pupil.

In terms of higher education, student loans are a death sentence for everyone but especially impoverished kids just looking for a way out. It just isn't feasible for most of us. And that's if we even tested well after going to shitty schools our whole lives. If we had better education, we'd have better literacy in all things, including critical thinking, allowing us to better see through the bullshit we are taught. But we don't. And you aren't helping the ones who are trying in spite of that.

Stereotype 4: Bad Teeth

Quickly going to touch on this one--when we consider a lack of access to affordable, healthy food, shitty medical insurance in general and our poverty rate, this one is kind of obvious. Even so:

“Dental coverage was significantly lower than the national average in the South Atlantic (45.6%), East South Central (45.6%), West South Central (45.9%), and Pacific (48.0%) regions.”

Every time you make a toothless hillbilly joke, ask if poverty is really the butt of the joke you want to be making.

These are just the most pervasive of them, imo. And they can all be underlined by extreme poverty which is absolutely by design.

It also contributes to why it isn’t so easy to “just leave” as we are so often dismissively told to do. Moving is expensive.

And why should we have to, anyway? Why should we have to flee our homes?

Why, for those who feel safe enough and/or have no other choice, should we not stay and fight to better the region?

And why can’t you other leftists get behind us and help us in our fight instead of perpetuating harmful stereotypes? We're your people, too.

Just some food for thought. And I hope some of y’all take a big ol bite.