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carpenterswife · 6 months ago

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ALL MY GHOSTS (ix)

series masterlist

- summary: Finally, you and Beau begin opening up to one another, sharing details of your pasts you hadn’t been willing to before. One thing leads to another, and you take a new step.

- word count: 4523

- warnings: 18+!!!!! descriptions of domestic abuse, descriptions of inhumane treatment, mentions of abortion, smut (🎉).

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“Hey.” Beau pushed a hand through his hair, as you stumbled over to the small kitchen. Coffee in hand, he watched you from over the top of his mug. “How’d ya sleep?”

You tried your best to tame your hair, simultaneously pressing random buttons on the coffee machine, hoping one would make it start. Beau smiled in amusement, watching you. He reached over, putting your mug into the machine and pressing a button on the front. The coffee machine whirred to life.

“Thanks.” You leant back against the counter. “Your sofa is uncomfortable.”

Beau chuckled. “It’s not meant for sleepin’ on.” He sipped his coffee, eyeing you. “Why don’t y’take my bed tonight? I’ll take the sofa.”

“I told you—“

“Uh-huh, an’ I’m not listening’ no more.” Beau interrupted you, with a smile pulling at the corner of his mouth. “You’re injured. Y’should be comfortable. Take the bed. It ain’t nothin’ off my back.”

Huffing, not pleased with Beau’s decision, you reluctantly nodded in agreement. His smile brightened, pleased with your compliance.

He stared at you. “Now, be honest.” He lean back against the kitchen counter beside you, in the small hallway that substituted as a makeshift kitchen. “How did ya actually sleep? No bullshittin’.”

Grabbing your coffee as the machine beeped, you took a small sip, making a face as the liquid burnt your tongue. “Fine.” You smacked your lips.

“Really now?” He hummed, very obviously not believing you. For a few beats, he just stared. “‘Cause I could swear I ‘eard y’walkin’ around at 4am.” He stared at you knowingly. Asshole.

“Just a bad dream, is all.” You flashed him a smile.

He hummed, unconvinced, but not pushing. “Aight.” He sipped his coffee, peering at through dark lashes. “Hey, if ya get one tonight, come to me, yeah? I’ll help.”

You stared back at him, a small tick in your jaw. “I’m not a kid, Beau.”

“And I ain’t saying you are.” He held his hands up in surrender. “Just sayin’, everyone needs a little help sometimes.”

You shrugged off his kind offer. “Don’t need it.”

Beau stared at you, analytical. Silently, he set down his coffee, taking a few steps past you. Your eyes were focused in on him as he opened up a closet in the hallway, rummaging for a few moments. When he emerged, he was holding a newspaper clipping.

Brows furrowing, you stared in confusion. Beau seemed to hesitate, eyes distant, and then he handed it to you.

Confused, you set down your own coffee and took it.

‘COP MOURNS MURDERED PARTNER’.

Your brows furrowed deeper, eyes landing on the picture of Beau on the clipping. Your eyes skimmed over the words, teeth biting down on the inside of your cheek with every word you read.

Randy.

Five Houston Police Officers.

Hatcher Bar & Grill.

Drug bust.

Miscommunication.

Mishap.

Shot dead.

Sergeant Beau Arlen set to retire.

“Jesus, Beau.” Breathless, you looked up at him, taken aback. “This is your old partner?” He nodded, silent, observing your reaction. Your eyes turned back down to the words on the newspaper clipping, digesting it all. “Fucking hell. I’m— Jesus, I’m so sorry.”

“Randy.” He nodded. “Good guy. Hell, he was the closest friend I’d had on the force.” Your eyes returned to his face, drinking in his nostalgic expression.

You set down the clipping and stepped closer to him, wanting to offer comfort.

“We went to take in a cartel. Me, Randy, an’ three others.” He looked to you, eyes meeting yours. “Somethin’ went wrong. They knew we were comin’. It was bad policin’ on my part. Bad leadership. Bad— bad everythin’. I sent him one way,” he shook his head, “and watched a bullet go through his skull.”

“Fuck. Beau.” You laid a hand on his arm, squeezing.

“I was a wreck.” He muttered, crossing his arms over his chest. “Drank myself half t’ death every night. Carla dragged me out of bars an’ picked me off floors. I clocked out.” Your eyes were burdened with sadness as you stared at him. “I wasn’t there. For— for her, for Em. I drank, and I— I fought with ‘er, and I— I was a god terrible husband. An even worse father. ‘m still surprised Carla lasted as long as she did.”

Your thumb brushed up and down his arm, offering him comfort and reassurance.

“I don’t blame her for divorcin’ me. I can’t. I deserved it.” He laughed dryly to himself, sad and self-loathing.

“You didn’t deserve that, Beau.” You whispered, eyes staring up at his. He looked down at you, lips pressed together, silent. “You deserved to have someone there to support you. You were grieving. You— you needed help, therapy, support.“

“I was a shithead, Y/N.” He whispered back, shaky.

You shook your head. “I’m sure you were. And, yeah, Carla didn’t deserve that. She did what she thought was best for her and for Em, and that’s fair on her. She prioritised herself and her kid.” You squeezed his arm. “But you can’t deny that you needed help.”

He just stared off past you, not responding. He knew it was true. What he’d needed was support from his wife. He’d needed that push to get help. But that wasn’t on her. Carla shouldn’t have had to do that for him. That was his job, to look after himself. She shouldn’t of had to have that on her shoulders.

His internal argument was interrupted when you wrapped your arms around his neck, guiding him in for a gentle hug. His arms came up to wrap around your waist, pulling you closer to him, until you were pressed up against his front.

Inhaling shakily, Beau put his chin down on the top of your head, enjoying the feeling of having you in his arms. He cracked a small smile. “Thank you.” He whispered.

Your response was to hold onto him tighter.

God, Beau could stay like this all day. With you holding onto him so tight, as he cradled you against his chest. He could feel strands of your hair tickling his hair with every breath, your small hands pressed against his shoulderblades.

You’d been through so much in the last few weeks. Beau held you tighter at the memory of what your ex had put you through.

With you in his arms, Beau swore to himself that he’d ensure you weren’t ever hurt again.

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Beau grinned in amusement as he watched you try, and fail, to keep the fire alive. He set his plate of dinner aside, gently putting his hand over yours to take the fire iron from you. “I got it.” He murmured, taking over the job at tending to the fire.

You smiled sheepishly, sitting back in your chair. Beau chuckled at your expression, setting down the fire iron as the flames grew once more, providing you both with a wave of heat.

Silence settled between the pair of you as you ate the dinner you’d cooked together.

Beau’s camper was nice. You liked it here. It was serene and pretty. You’d had a gorgeous view of the sunset, that you’d enjoyed with a cup of coffee and horrible country music Beau had insisted on putting on. There was an overlooking view of Helena, of the lights and the buildings.

It was beautiful up here. Surrounded by nature, and movie-like views in every direction.

You glanced at him, remembering what he’d told you about earlier. He’d been so open and vulnerable with you, recalling every detail of what’d happened to Randy. He’d told you stories of his old friend over a bottle of beer, the two of you laughing, and Beau occasionally tearing up, as he recalled his best memories from Houston.

It hit you that you were the only person in Helena that’d ever got the privilege of seeing him like that.

And the words you spoke came out abruptly and without much thought. “Jack wasn’t always abusive.”

His head whipped around to look at you, mouth full of his dinner. “Wha’?” He spoke around his mouthful. You couldn’t help but laugh at the adorable sight; him, frozen, chipmunk cheeks full of food.

“Jack wasn’t always abusive.” You repeated yourself. “For the first year, he was… charming, funny. A gentleman, really.” Your expression scrunched together at the memory. “That was the man I fell in love with.”

Beau swallowed his mouthful of food. “What happened?” He asked gently, careful with his words.

“As soon as he put a ring on my finger… he changed.” You brows furrowed, hand tensing around your fork. “My sister warned me. Said it was odd, that he’d proposed after only a year. But, I was 25, and I thought I’d met the love of my life.”

Beau smiled sadly. He’d heard too many of these kinds of stories. Women lured in by men who seemed like fairytales, only for their true colours to be revealed after the women were stuck.

“It started small. He got mean.” You spun your fork. “Started calling me a bitch, a whore. Things like that. He told me I needed to quit my job, become a stay at home wife. That he wanted dinner on the table every night when he got home. That I belonged to him — he owned me.”

He cringed. “Jesus.” He muttered.

You sighed deeply. “He started punching walls, throwing things. Then, he started throwing things at me. Started punching the walls beside my head.” You shook your head, looking up at Beau. “Before I realised what was happening, I was stuck and already covered in bruises. He’d cut me off from my friends and family, convinced me they were bad for me.”

Beau reached over, grasping your hand within his bigger one. He offered you a comforting smile.

You squeezed his hand. “The abuse got worse and worse overtime, until I started going to the hospital. They started questioning me. And then he stopped letting me go.” Your eyes went vacant. “He got me pregnant on our 2nd anniversary.”

His eyes widened a little at this information. He put the pieces together. “You didn’t keep it?” He asked softly, not the slightest bit of judgment in his voice.

“No.” You confessed. “I kept it from him. Got an abortion. When he found out…” your hand tightened around Beau’s instinctively, “he beat me so bad I couldn’t walk for three days.”

“Fuckin’ hell.” Beau grit his teeth. “I’m gon’ kill that bastard. I swear to you, when I find him, I’m gon’ beat his ass.”

You laughed softly at his words. “He started locking me up after that. In the bedroom, in the closet. Anywhere he could. He’d lock me up when he ‘wasn’t bothered to deal with me’.”

Beau cradled your hand in both of his tightly, brows furrowing.

“When he was at work one day, I left.” You whispered. “Packed half of my stuff, put it in my car, and just drove. Ended up in Montana with a flat tire.” You cracked a smile. “You know how it went after that. I ended up here. And just… stayed.”

He squeezed your hand. “I’m proud of you.” He whispered, smiling softly at you. “That must have taken a lot of bravery. To up an’ leave like that.” Beau stared at you with soft and caring eyes. “You’re an amazin’ woman, y’know that?”

You smiled warmly back at him.

“An’ I promise,” Beau brought your hand towards him and held it to his chest, cradling it, “I will catch this bastard before he even touches you again.”

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Beau was woken up by the sound of your heavy breathing from the bedroom. Confused, he sat up, groggy, ears straining to focus on the sound. With concern growing in his chest, he got to his feet, stumbling about for a moment.

He made his way to the bedroom, digging his knuckles into his eyes to wake himself up. “Y/N?” He called out, voice hoarse and scratchy with sleep. “Y’good?”

Your head shot up as he peeped into the bedroom, the concern heavy despite his heavy eyelids. “Fine.” Your breaths were still ragged. It did nothing to convince him. “Just another bad dream.” He hummed and stepped over, sitting down on the edge of the bed by your feet. “Really, Beau, I’m okay.”

“You’re shakin’ like a leaf. Don’t look alright to me.” Beau stared at you worriedly. “C’mon, ‘s just me, honey. Talk to me.”

You refused to look at him.

Beau shifted closer. His finger curled under your chin, nudging your head up. Your eyes locked with his, breath stolen from your lungs. He gave you a comforting smile, his expression so soft and caring. “Please.” He murmured. “Talk to me.”

Something churned in your gut. The way he was looking at you. The way he was speaking. Your entire body got hot.

Without even considering the consequences, you lurched forward, catching his lips in an eager kiss. You’d wanted this for so damn long.

He didn’t move.

God, why wasn’t he moving?

You quickly realised your mistake and separated from him.

Beau was frozen still, absolutely flabbergasted. He didn’t even look like he was breathing.

“I’m so sorry.” You breathed out, horrified. You’d just fucked this up. He’d been nothing but kind and sweet and caring. An incredible friend. And you’d fucked all of it. “Beau, I am so sorry. I shouldn’t have—“

He interrupts you, hands grabbing onto your cheeks and pulling your face towards his. His lips mets yours fiercely, in a kiss that said everything he was too scared to.

It felt better than you’d ever expected it to. He was good at this. His hands tilted your head, giving him the opportunity to deepen the kiss. Your stomach whirled and danced and fluttered, as you allowed him to take the lead, parting your lips as his tongue prodded for access.

You’d been dreaming of this moment. But you’d never dreamt it’d be this good. Your hands latched onto his sleep shirt, kissing him back with equal vigour. It felt like everything clicking into place. His hands left your face, venturing down your body until they grasped onto your waist. This was good. This was right.

He pulled back, just an inch, gasping in air. “Jesus christ.” He whispered breathlessly. He moved forwards again and reconnected your lips. Beau shifted himself, settling further on the bed.

Without disconnecting your lips, he gently laid you down on the bed, loving and careful with every movement he made with you. He hovered above you, your head caged by his hands. You shifted to accommodate his position on top of you.

For a moment, he pulled back, eyes fluttering open. They were dark; darker than you’d ever seen. Full of heat and need and desire. “Do you want this?” He whispered, eyes drinking in your expression.

“Yes.” You breathed out in response. Your hands tugged on his shirt, bringing him down close to you. “I want you.”

He physically shuddered at those words. “You’re sure?”

You nodded immediately, twitching with eagerness. “100%.” You whispered to him, eyes big as they stared up at him.

Beau smiled softly, and leant down to kiss you again. It was gentler this time, and one of his hands began to roam your curves. He took his time to explore every inch, every curve, every dip. Eventually, his hand met the hem of your shirt. He sat up onto his knees, gently pushing your shirt up.

You helped him strip your shirt off your body, watching in amusement as he blindly flung it away. Underneath your sleep shirt, you were bare, leaving your top half fully exposed to him.

His eyes took the sight in, swallowing thickly. “God. You’re so pretty.” He whispered, desire shining in his eyes. He leant down over you again, pressing wet, open-mouthed kisses down your neck, leaving spots of saliva shining on your skin.

Instinctively, your head tilted back, allowing him easier access to the sensitive skin.

He smiled against your neck at that action, peppering kisses over the column of your throat, occasionally nipping, making you giggle. His smile grew, travelling downwards to your chest. Your hands explored his clothed back, as his lips kissed down the valley of your breasts.

Breath hitching, you reached for his shirt, eagerly tugging at it. Beau chuckled quietly at your eagerness, sitting up so you could pull his shirt off over his head.

He watched you, with amusement, as you almost drooled at the sight of his bare chest. Your hands explored the defined muscles, which tensed under your soft hands. Beau smiled at you, admiration in his eyes as he leant back down, catching your lips in a steamy kiss. He departed, and his lips attached to your breast instead.

Your breath stuttered and caught in your throat. “Beau.” You whispered softly, his tongue swirling around the hardened bud. Your hands travelled up his back, palms brushing his shoulder blades, and up into his hair.

His hand came up to palm at the other breast, giving it equal attention. He twirled and pinched your nipple, your soft breaths and noises making his pants strain. He moved on from your breasts, trailing kisses down your stomach, giving every inch of your body the attention it deserved. He looked up at you as his hands hovered over the waistband of your sweatpants, searching for consent before he undressed you further.

Immediately, you nodded, eager for his touch.

Beau grinned and hooked his thumbs on the waistband, pulling them down. His eyes drank in the sight of you clad in merely panties as he tossed the sweatpants aside.

You gasped, hips bucking unexpectedly, as his fingers brushed past your wet spot of arousal.

His grin became mischievous. “Look at you.” He murmured, his admiration of you clear. “How long have you been waitin’ for me, huh?” He chuckled, hands gripping onto your hips. “All I’ve done is touch you, an’ you’re soaked.”

You gave him a glare, huffing, squirming under him. “Don’t tease, Arlen.” He laughed quietly. “Like you’re any better.” To prove your point, you reached down, hand cupping the tent in his pants.

He gasped. “Fuck— baby.” His fingers dug into your hips at the unexpected touch from you. His eyes darkened further, and he wasted no more time in tugging down your underwear, letting them join the haphazard pile of clothes skewed on his bedroom floor. He groaned softly, looking down at you, all laid out, eager and needy for him, completely naked and exposed underneath him. “You’re so hot.”

You giggled quietly, hands combing through his hair. Your hips squirmed a little, searching for his touch.

He obliged, kissing his way down your body, until he was at your thighs. His hand brushed you, deft fingers quickly getting to work. He parted your folds, grinning at the sight of your pussy glistening wet.

“Beau.” You whimpered, needy. Your hands blindly found his hair, hips bucking up into his hand.

Chuckling softly, Beau gathered your wetness, fingers easily locating your clit. The moan of pleasure you let out went straight to his dick. He remained there for a few moments, listening to your noises of pleasure as he toyed with your sensitive nerves.

Looking up at you, he watched your reactions, as he slid two fingers inside of you. You moaned, a sweet sound that spurred him on more. He pumped his fingers into you, attentively listening to your noises, quickly learning and adhering to the movements and locations that set you off the most.

Your walls fluttered around his fingers, and he groaned at the tight grip your cunt had on his digits. His dick twitched at the feeling.

Walls clenched and tightened, making Beau aware of your oncoming release. As your soft noises became louder and higher-pitched, he pumped into you a little deeper, knuckle-deep inside of your pussy. He pressed his thumb against your clit with ease, flicking and playing with it, the extra stimulation sending you over the edge.

His deft fingers worked you through your orgasm, leaving you writhing and moaning under him. He pulled his fingers out, leaning back up, catching your lips in another heated kiss. His hands grabbed your thighs, one of them leaving a sticky mess on your skin.

“Fuck, you’re good at that.” You whispered against his lips.

Beau laughed at your praise, lifting his head and grinning down at you. “I could tell.” When you rolled your eyes, he laughed again. He lifted his hips a bit as you tugged at his waistband, pushing his sweatpants down. He shimmied them off his feet, letting them fall by the end of the bed.

You groaned at the sight of him on top of you, naked and hard, erection already leaking. “God, Beau.” You hooked one leg around his hips and tugged him, making his tip brush against your pussy. You both moaned in tandem. “I want you so bad. I’ve wanted you for so long.”

He smiled softly down at you. One hand cradled your sweaty face, pushing hair off your cheeks. “Me too, baby.” He whispered, loving. “Been dreamin’ ‘bout being inside of you for a year.”

Arms curling around his neck, you smiled up at him, breathless. Your other leg wrapped around his hips. “Condom?”

“Top drawer.” He chuckled.

Grinning, you turned your head and reached for the drawer, yanking it open. Blindly, you patted around the drawer, until you located a square packet that crinkled under your fingers. You pulled it out. “Mmm, size large.” You teased him, ripping the corner of the packet.

Beau hung his head down and laughed, eyes scrunching. “Shut up, you.”

You giggled, expert hands retrieving the condom from inside the packet.

He watched you eagerly, breath hitching in his throat as you rolled it down his cock. “Fuck.” He hissed, struggling to remain still under the gentle touch. His hips twitched a little, especially when you playfully twisted your hand. “Shit— don’t do that.”

You just laughed at his gasp of pleasure, pulling your hands of him, and winding your arms around his neck again.

Beau smiled at you, catching his breath. “You ready?” He whispered. When you nodded in response, Beau shifted closer to you, pressing his tip against your entrance. Your breath hitched, turning to a moan when he pushed in. “Shit, baby.” He moaned, dropping his forehead down onto your shoulder. He pushed deeper slowly, bottoming out, hips stuttering.

“Beau.” You moaned his name quietly, right in his ear. He groaned softly at the sound. His cock stretched you exquisitely. The fit was snug and tight, and he loved it.

Carefully, he began moving inside of you, strokes gentle and steady. He lifted his head up to look down at you, his elbows caging your head. He let one hand tangle in your hair, hips meeting yours as he pulled out halfway, and then pushed back in fully. “You feel so good.” He whispered breathlessly, his other fist clenching, controlling the urge to thrust faster. “God, you’re so fuckin’ tight, baby. So pretty. So perfect for me.”

You moaned under his praise, walls fluttering. Your grip on his hair tightened, one hand falling down onto his shoulder.

He chuckled at your reaction, noting that down. You liked praise. He wouldn’t be forgetting that anytime soon. After a few more thrusts, he began to quicken his pace. His cock twitched inside of you, as he thrust in and out.

Your foot pressed against his ass, guiding him in deeper and faster.

He moaned softly, but did as you insisted. His hips hit yours a bit harder, pulling out all the way and then pushing right back in incessantly. You cried out in ecstasy at the pleasurable, fast intrusion. The pace was steady and just the right speed, as his cock hit the sweet spots inside of you. He pressed a kiss to your forehead, lingering, as he fucked you sweetly and lovingly.

“So pretty.” He murmured against your skin. “Don’t know why I waited so long for you.”

You felt the band in your stomach tighten, like it was being pulled and stretched.

Beau felt your walls clench around him, squeezing his cock. He hissed in pleasure, his thrusts becoming jerky for a few moments. He reached down, adding extra stimulation by working your clit. He felt you tighten more and more around him, fluttering and tensing in the most perfect way.

That was enough to make the band snap.

Your head tilted back as you moaned, cumming for a second time. Your release coated over his covered cock, and it sent him over the edge, spilling inside his condom with a grunt and moan. He fucked you through your orgasm, your tight grip on his cock milking him dry.

As you came down, reaching the end of your release, Beau slowed his thrusts. He grunted quietly, breathless as he looked down at you, admiring your fucked-out expression.

He pulled out, the feeling sending another jolt through you. With shaky breaths, he took off his condom, tying it and disposing it in the trash can. He’d empty that when it wasn’t 4am. He turned over and faced you, hand soothing over your hair. “You okay, baby?”

Rolling over to face him, your expression was full of content and admiration. “Better than okay.” You laid a hand on his bearded cheek, thumb stroking his sweaty cheekbone. “You have no idea how long I’ve wanted that to happen.”

Beau chuckled, hand finding your waist and pulling you towards him, your breasts brushing his chest with the close proximity. “I’ve wanted you for so long.” He whispered. “If I’d known you’d felt the same… I would have done that a long fuckin’ time ago.”

Smiling, your thumb traced a line from freckle to freckle on his cheek. “Did we— I mean… is this gonna ruin anything?”

“No.” He whispered, certain. “No.” He repeated. His hand tucked hair behind your ear, brushing it all off of your face. “I don’t regret this. Do you?” You immediately shook your head in repulse. His smile grew. “How ‘bout this? Tomorrow, I’ll take you on a proper date. You, me, Pedro, and a nice dinner.”

Your nose scrunches playfully. “Do we have to take Pedro?”

Beau gasped in mock offence. “Ey!” He swatted your shoulder gently, playful. “I told ya already. Don’t y’be talkin’ ‘bout Pedro like that. He can hear you.” Your giggles made his heart flutter, biting back a loving smile as he just watched you.

This was so right.

“Shower?” He grinned at you.

You grinned back. “Round two?”

He’d intended aftercare — wash you up, make sure you felt okay and clean. But, he guessed that worked too. He could do both, after all. He barked a laugh. “I can work with that.” He sat up and slid off the bed.

You squealed with laughter as he scooped you up bridal-style, carrying you off to the shower.

Yeah, this was how it was meant to be.

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a/n: double update as an apology for the slow updates recently. they finally did it. yippee!!! had so much fun writing this one + adventuring their relationship. if the smut is bad, ignore it - i’ve never properly written it before :(

taglist: @yvonneeeee @deans-spinster-witch @fanfic-n-tabulous @dwonfilm @foxyjwls007

@just-levyy @i-love-ptv @hobby27 @zepskies

#beau arlen #beau arlen x reader #beau arlen x you #all my ghosts #jensen ackles #jensen ackles x reader #beau arlen x female reader

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posttexasstressdisorder · 11 months ago

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And a touching word from Bob Lefsetz:

https://lefsetz.com/wordpress/2023/12/12/jeffrey-foskett/

Jeffrey Foskett

He was a really good guy. And I’m not just saying that because he died.

I knew who Jeffrey was before I knew him. He was the guy on stage with Brian Wilson, the one hitting the high notes, the one who turned his big red guitar around during the show so we could see where it was painted “Smile.”

But I don’t remember exactly how we met. Maybe over e-mail. I could comb the archives but I don’t want to, I’m too creeped out that he died.

He was sick. Diagnosed and originally treated in the Bay Area he went to MD Anderson in Houston and they kept him alive, year after year. He’d check in on a regular basis, apropos of nothing. Tell me he was getting treatment, asking how I was and really wanting to know.

Before that we’d connect at shows. I remember when he took me to meet Brian on the tour bus. Prepping me regarding what to expect.

And the last time I saw him was with Mike Love, a few years back at the Vilar in Beaver Creek. He introduced me to Mike Love and Bruce Johnston and we all had a very interesting hang in the dressing room.

And Jeffrey was not a typical musician, he was clean, and always was, no dope and no drink. And a believer, as in religion. But you wouldn’t know all this if he didn’t tell you. And he’d had bariatric surgery, he used to weigh over 300 pounds, he’d reference this now and again. That was the funny thing about Jeffrey, he held nothing back, either about himself or those around him. He would testify not in a gossipy way, but an honest way, as if you were buddies since second grade.

And then he had to go off the road, because of his treatment, but then he went back out, even though he could no longer sing.

Let’s see…

Jeffrey checked in on February 11th, and that was the subject of his e-mail, “Checking in”.

And then again on March 3rd.

And on March 20th he said:

“I am praying for your health. Interestingly, my pre infusion drugs are Tylenol, Benadryl and Pepcid. Benadryl must be the key to no nausea.

I hope your pemphigus is under control and that you are comfortable.

Thank You for supplying me with interesting reading in the LL.

Stay Healthy. God Bless You

Jeffrey”

And on June 20th:

“Just checking in after reading ‘The Infusion’. Is your pemphigus at least under control to where you are comfortable to sleep, walk, drive, etc.?

I am doing great. For me, there is no better place than MD A. They are keeping me thriving

I’m still praying for you my friend

Love and Blessings – Jeffrey”

And on July 24th, regarding antisemitism:

“Hi Bob,

I am a Stone Christian. Jesus Christ is my Lord and Savior. Are these emails for real? I am so thoroughly disgusted that I want to crawl into a hole. From our private email exchanges, You know that I pray for you and your ongoing health situation on a daily basis. The person that wrote this garbage is a stain to all of humanity. On one hand I am grateful that you published them on the other, it literally sickens me. What happened to the world? I guess I have been so caught up in healing that I have ignored other truly important aspects of my surrounds.

I am sorry for the personal attacks on you and your Religion. It is disgraceful. My heart literally hurts

God Bless You – Jeffrey”

Where do you find friends like that? Believe me, they’re rare. And when one is that genuine, thinking of you, regularly checking in, you have an ethereal bond that goes beyond regular friendship.

When I heard of Jeffrey’s passing I thought I’d heard from him more recently, in October or so, I was surprised to find his last missive was in July. Which makes me think he had a rough time of it. And one thing they don’t tell you about cancer is it’s painful. But Jeffrey had such belief in MD Anderson that he convinced me, after years of treatment on a regular basis, that he’d be here for years to come.

But he’s not.

And many people have no idea who Jeffrey Foskett is. But those he touched, they’ll never forget him, because he was genuine, because he was a good guy. Fake was not in his bones.

What angers me most is he can’t read this, he can’t know how much he meant to me, how he touched me.

I don’t know what to do with this empty feeling. My contemporaries are dying on a regular basis. It used to be a rare event, usually through misadventure, but now… You can’t metabolize these passings. Some before their time, like Jeffrey, at 67, others like Christine McVie, who didn’t make it to 80, never mind Jeff Beck. And then Ryan O’Neal. We bonded over having CML. He was a funny guy, he lived in the present, if he brought up the past it was like you’d been there together. He was honest about his son, he had to show me his Tesla Model X, and now he’s gone at 82. That might seem old to some, but if you’re a boomer, if you’re past Medicare age, that’s scary. You count on those years, you think you’ll be active until sometime shy of 90, and then you won’t be so great, but you’ll continue to enjoy TV and a good meal and music, if you can still hear. We keep pushing finality into the distance, But one by one team members are falling by the wayside. They might be gone, but their legend lives on, even if they were not famous.

So if you’ve been to a Brian Wilson show, if you’ve seen the Beach Boys in the past decade, you experienced Jeffrey Foskett. He was the glue that held it all together. The utility man who provided what the legends no longer could. And he didn’t want notice, he was glad to be the midwife for some of the greatest music of all time.

Yes, first and foremost Jeffrey Foskett was a Beach Boys fan. The fact that he got to play with his idols?

You can’t ask for much more than that.

He was cut down before his time, but he exceeded his dream.

May he live in an endless summer ever after."

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beardedmrbean · 4 months ago

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HOUSTON - According to the U.S. Attorney's Office, Sanjay Kumar was indicted by a federal grand jury for selling and shipping counterfeit cancer drugs worth tens of thousands of dollars into the United States.

Court documents state the 43-year-old from Bihar, India, along with his co-conspirators, allegedly orchestrated the sale and shipment of fake cancer treatment drugs, including counterfeit versions of Keytruda, to unsuspecting individuals in the U.S.

Keytruda is a genuine cancer immunotherapy and was approved in the U.S. for 19 different indications, treating various forms of cancer such as melanoma, lung cancer, and breast cancer. The exclusive right to manufacture and distribute Keytruda in the U.S. belongs to Merck Sharp & Dohme LLC.

Kumar was arrested on June 26 in Houston while in the U.S. to negotiate further deals aimed at expanding his illicit business of selling fake Keytruda in the American market.

Kumar faces several charges, including one count of conspiracy to traffic counterfeit drugs and four counts of trafficking counterfeit drugs.

If convicted, he could be sentenced to up to 20 years in prison for each count and fined up to $2 million.

#nunyas news

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paladinnether · 2 years ago

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hatchetfield characters as arctic monkeys songs

to celebrate getting NPMD crumbs, i've compiled a list of arctic monkeys songs that i think fit a few of my fav hatchetfield characters. because why not.

zoey chambers: arabella

"it's much less picturesque without her catching the light. the horizon tries, but it's just not as kind on the eyes."

pete spankoffski: bigger boys and stolen sweethearts

"there's always somebody taller, with more of a wit, he's equipped to enthrall her, and her friends think he's fit. and you just can't measure up, no, you don't have a prayer."

ethan green: 505

"but i crumble completely when you cry, it seems like once again you've had to greet me with goodbye.”

tom houston: love is a laserquest

"when i'm not being honest, i pretend that you were just some lover."

professor hidgens: star treatment

"i'm a big name in deep space, ask your mates. but golden boy's in bad shape."

stephanie lauter : fluorescent adolescent

"discarded all the naughty nights for niceness, landed in a very common crisis."

lex foster: only ones who know

"and i bet she told a million people that she'll stay in touch, but all the little promises, they don't mean much."

grace chasity: honestly, she’d think listening to them would be a sin since 90% of their popular songs are about women, drugs, or sex- but if i had to pick one, i’d say tranquility base hotel and casino. only because they talk about jesus in the opening line.

#starkid #hatchetfield #arctic monkeys #zoey chambers #pete spankoffski #ethan green #tom houston #professor hidgens #lex foster #grace chasity

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pessimisticsarc · 2 years ago

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BACKSTORY

Warning: Contains spoilers for HBO’s True Detective Season 1 as well as mentions of death, drugs, murder, and more.

Rustin Cohle was born in June 1964 to Travis Cohle and Barbara Campbell. Travis was on leave from the army, and Barbara was a sex worker. She chose to keep him even though conceiving him was an accident.

In 1966, his father returned from the war and was greeted with the news of the birth of his son, who was then two years old. Despite his mother’s protests, Travis took him with him and moved to Alaska.

Between 1967 and 1982, Rustin and Travis lived in a secluded cabin on Pilot Point, living a survivalist lifestyle.

Rustin was tens of miles from the nearest school and was never able to receive a proper education. However, he was an avid reader and read every book his father had and everything he could find on his trips to the city. Whether or not he paid for said books is up for debate.

In 1981, Travis Cohle was diagnosed with acute lymphoblastic leukemia and chose not to undergo treatment. He passed away in May of the following year.

Two months after his father’s death, Rustin packed up most of his things and drove to Texas in his father’s Ford. The three-day trip took him more than four weeks, having stopped in almost every major city.

Rustin lived in a motel in Houston, Texas, for three months while studying for his GEDs, which he passed.

From 1982 to 1984, Rustin attended college and worked various jobs to support himself, including being a dog walker, a grocery store and gas station cashier, and a car wash attendant. He received an associate’s degree in criminal justice.

In 1984, Rustin enrolled in the Houston Police Academy. Ten weeks later, he graduated and became a patrol officer with the Houston Police Department.

In 1987, Rustin was promoted to Junior Detective in the Robbery Division. That same year he met Claire Morgan, whom he married five months later. In November of that year, Rustin’s daughter, Sophia Cohle, was born.

In 1989, Rustin was transferred to the Houston Police Narcotics Division. That same year, Sophia passed away in a tragic car accident on the front porch of their home.

Due to the death of his daughter and his work with narcotics, Rust quickly became an addict, scamming couriers to keep his addiction going.

In 1990, Claire filed for divorce. The divorce was finalized two months later. She kept the house while Rust got the car.

That same year, during a house raid, Rust came across an addict injecting his infant daughter with methamphetamine. He shot and killed the man in a passionate rage.

As punishment for his actions, the state attorney gave Rustin a choice between going to jail for first-degree murder or going undercover for an unspecified period. He chose the latter.

From 1990 to 1994, he was forced to work undercover, infiltrating gangs and cartels under the command of whoever needed someone in his position.

In mid-1994, in a deal gone wrong, he killed three cartel members and was shot three times with a .25-caliber handgun.

During his recovery, he was admitted to Northshore Psychiatric Hospital in Lubbock, Texas, where he stayed for four months. Upon his release, he was offered retirement with a pension, but he chose to continue working and requested to be transferred to a Homicide division.

In October 1994, he moved to Lafayette, Louisiana, to fill a vacancy in his division of choice and was partnered with Martin Hart.

In January 1995, Dora Lange was murdered, and Rustin and Martin took on the case. Ten weeks later, they found the suspected killer in a meth shack in an isolated area and planned to arrest him, but Martin ultimately killed him with a headshot in a series of unfortunate events.

From 1995 to 2002, Rustin and Martin worked on various cases and became friends. They spent time together, and Martin’s wife, Margaret Hart, often set Rustin up for blind dates. In 1999, he met Laurie Spencer, and they remained a couple for three years.

In 2002, Rustin reopened the Dora Lange case for further investigation after a tip from a criminal he was instigating. His actions in this regard got him suspended.

Later, he had a fallout with Martin, which led him to resign from the police force and flee Louisiana.

From 2003 to 2010, little is known about Rustin’s whereabouts or if he continued working on the case.

In 2010, he returned to Louisiana to conduct reconnaissance related to the Lange case.

In 2012, the Lake Charles murder occurred. Rustin and Martin are brought in for questioning and later reunited to work on the case together.

They eventually discovered Erroll Childress, responsible for both murders and possibly many others. They found his house and followed him to “Carcosa,” a series of nearby tunnels filled with Cajun traps, children’s clothing, and a shrine dedicated to the “Yellow King.”

Rustin and Martin confronted Errol, who stabbed Rustin with a butcher knife and wounded Martin. As Errol attacked Martin, Rustin managed to kill him with a headshot.

Laid on the ground, Rustin pulled out the knife, spending his last conscious moments being tended to by Martin.

Rustin woke up a week later at Lafayette General Hospital and was expected to make a full recovery. His only visitors were Laurie, who was now head of Trauma Surgery, and Martin, whom he later convinced to help him escape.

From 2012 to 2013, he lived with Martin, who helped him heal.

After recovering, Rustin decided to stay in Louisiana, moving to his own apartment and helping Martin with his private investigator business, “Hart Investigative Solutions” (later renamed “Hart & Cohle Investigative Solutions”).

He lives and works there to this day.

#re: backstory.#pinned.

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nddtreatmentclearlake · 1 month ago

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New Dimensions Day Treatment Centers Clear Lake offers cutting-edge drug rehab services in area. Our experienced clinicians specialize in treating addiction through evidence-based therapies, helping patients reclaim their lives and rebuild healthy, drug-free lifestyles. Our programs include intensive day treatment, family counseling, and relapse prevention strategies. Our Clear Lake facility provides a safe and welcoming environment where patients can focus on their recovery journey. If you or a loved one is seeking drug rehab in Clear Lake Texas, New Dimensions is here to help.

New Dimensions Day Treatment Centers Clear Lake 1345 Space Park Dr., Ste. C, Houston, TX 77058 (800) 685–9796

My Official Website: https://nddtreatment.com/locations/clear-lake/ Google Plus Listing: https://www.google.com/maps?cid=4943720892447346514

Service We Offer:

Dual Diagnosis Treatment Partial Hospitalization Program Intensive Outpatient Program Outpatient Rehab Mental Health Treatment Depression Treatment Anxiety Treatment Psychological Testing Drug Rehab Panic Attack Treatment Suicidal Treatment

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#drug rehab Clear Lake Texas #Outpatient Rehab Center In Clear Lake Texas #mental health treatment Clear Lake Texas #dual diagnosis treatment center Clear Lake Texas

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epic-pain · 3 months ago

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Effective Pain Management in Texas: Solutions and Resources

Pain management is a critical concern for many Texans, given the diverse causes of chronic pain and its significant impact on quality of life. From back pain and arthritis to post-surgical recovery, effective management strategies are essential for improving daily functioning and overall well-being. Fortunately, Texas offers a range of resources and approaches to address this pressing issue.

Comprehensive Pain Management Approaches

Pain management is not a one-size-fits-all solution; it often requires a multi-faceted approach tailored to the individual’s needs. In Texas, patients have access to a variety of treatment options that can be categorized into several primary approaches:

Medical Treatments:

Medications: Prescription medications, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and anticonvulsants, play a significant role in managing pain. Texas physicians often work to balance pain relief with minimizing potential side effects and avoiding dependence.

Injections and Nerve Blocks: Procedures like epidural steroid injections and nerve blocks can provide targeted relief for specific pain sources. These treatments are typically performed by specialists such as pain management physicians or anesthesiologists.

Physical Therapy and Rehabilitation:

Physical therapy is a cornerstone of pain management, especially for musculoskeletal conditions. Texas offers numerous rehabilitation centers where patients can receive tailored exercise regimens, manual therapy, and other modalities designed to alleviate pain and improve mobility.

Occupational therapy and ergonomic adjustments can also be beneficial for those experiencing pain related to daily activities or work-related injuries.

Alternative Therapies:

Acupuncture: This traditional Chinese practice involves inserting fine needles into specific points on the body to relieve pain and improve function. Many Texans have found relief through acupuncture, which is often integrated with conventional treatments.

Chiropractic Care: Chiropractors in Texas offer spinal adjustments and other techniques aimed at addressing misalignments that contribute to pain, particularly in the back and neck.

Psychological and Behavioral Approaches:

Chronic pain often has psychological components, including stress and depression. Cognitive-behavioral therapy (CBT) and other counseling methods can help patients manage the emotional and mental aspects of pain.

Mindfulness and relaxation techniques, such as meditation and biofeedback, are also used to help patients cope with the stress and discomfort associated with chronic pain.

Accessing Pain Management Services in Texas

Texas has a robust healthcare system with numerous facilities and specialists dedicated to pain management. Major cities like Houston, Dallas, and Austin have a wide range of clinics and hospitals offering specialized pain management services. Additionally, rural areas benefit from telemedicine options, allowing patients to consult with pain management experts remotely.

For those seeking pain management services, it’s essential to start with a comprehensive evaluation by a healthcare provider. This initial assessment helps determine the underlying causes of pain and outlines a personalized treatment plan. Referrals to specialists, such as pain management doctors or physical therapists, may follow.

Navigating Insurance and Costs

Understanding insurance coverage for pain management can be complex. Many Texas healthcare providers work with insurance companies to ensure that treatments are covered, but patients should verify their specific plan details. Some services, especially alternative therapies, may not be fully covered by insurance, so it’s important to discuss costs and payment options upfront.

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pain management in texas

epic pain management

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sa7abnews · 3 months ago

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'I feel a migraine coming on, what can I do right away?': Ask a doctor

New Post has been published on https://sa7ab.info/2024/08/16/i-feel-a-migraine-coming-on-what-can-i-do-right-away-ask-a-doctor/

'I feel a migraine coming on, what can I do right away?': Ask a doctor

People who suffer from migraines — one out of every seven people globally, statistics show — know that time is of the essence.When the first signs and symptoms appear, taking quick action can help stop the headache in its tracks — while failing to take those steps can result in a potentially debilitating episode.People who live with migraines often suffer from daily anxiety about when the next migraine will hit, or whether it will interrupt work or other plans, noted Dr. Robert Cuyler, a psychologist in Houston, Texas, who specializes in chronic headaches.RED WINE HEADACHES COULD BE CAUSED BY THIS INTRIGUING CULPRIT, STUDY FINDS”That anxiety can actually lead to worsened symptoms for people whose migraines are accelerated by heightened stress levels,” he said. Experts agree that finding a calm, quiet and dark environment can be helpful.”This can help reduce the sensory overload, especially visual, that is often associated with migraine onset,” said Dr. Robert Cuyler, a psychologist in Houston, Texas, who specializes in chronic headache.HEADS UP ON MIGRAINES AS EXPERT REVEALS TIPS FOR FINDING RELIEF FROM ‘DEBILITATING’ HEADACHESBreathwork can also be helpful, he advised. “Calming breathing exercises can be particularly beneficial in quieting the anxiety that frequently accompanies migraine pain,” said Cuyler, who is also chief clinical officer of Freespira, a Washington company that makes an FDA-cleared treatment for panic attacks and PTSD symptoms.”This not only helps in immediate symptom management, but it can also have a direct impact on future situations.”Other potentially helpful actions include applying temperature therapy with hot or cold compresses or sipping a caffeinated drink, according to Mayo Clinic.ASK A DOCTOR: ‘IS IT DANGEROUS TO CRACK MY NECK OR BACK?’While some people find relief in medications — including over-the-counter pain relievers and prescription drugs — Cuyler emphasized the power of the mind-body connection in controlling migraines.”When a migraine strikes, people understandably run to the medicine cabinet — but it’s also essential to consider the emotional load of chronic headaches,” he said.”Addressing the psychological aspects of migraines is an often overlooked tool that can greatly help a person’s ability to cope with and potentially reduce the toll of these debilitating headaches.”It can also be helpful to remind yourself that it’s just a temporary condition, according to Cuyler.”The pain will eventually pass, and ordinary life will be possible again,” he said. “This approach can help reduce that anxiety and promote a sense of control, which is vital when dealing with the often unpredictable nature of migraines.”CLICK HERE TO SIGN UP FOR OUR HEALTH NEWSLETTERCuyler also recommended reflecting on the positive events or situations you’ve avoided out of fear of a migraine.”We know that avoidance can ‘shrink’ your life and increase isolation, loneliness and eventually even depression.”It can also be helpful to keep a migraine diary, recording any potential triggers when headaches occur.For more Health articles, visit www.foxnews/healthAnyone who suffers from severe or frequent migraines should contact a health care professional for diagnosis and treatment recommendations, experts noted.

#e9721541-bc9f-5ae5-ab95-9080f9e1f43b

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mikeo56 · 4 months ago

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Despite their small size, gut bacteria wield large influence over the effectiveness of certain cancer drugs. Researchers have now found that the ratio of specific microbial communities in the gut can help to predict who will respond to next-generation drugs for treating some kinds of cancer1.

The findings will also help to identify healthy volunteers who could donate faecal bacteria to transfer into the intestines of people who do not respond to these drugs, a procedure known as faecal microbiome transplantation, study co-author Laurence Zitvogel, an immunologist and oncologist at the Gustave Roussy Cancer Campus in Villejuif, France, wrote in an e-mail to Nature.

The work “is a breakthrough from a diagnostic point of view”, says Fabio Grassi, an immunologist at the Institute for Research in Biomedicine in Bellinzona, Switzerland. The findings, he says, also highlight how the delicate balance of gut microbial species can affect the success of high-stakes therapies, such as immune checkpoint inhibitors. This treatment helps the immune system to recognize and attack cancer cells and is the focus of the new research. The findings were published today in Cell.

Search for helper bacteria

Over the past decade, Zitvogel and others have investigated how gut microbes interact with these cancer treatments in ways that activate the immune system. “Everyone was looking for that single bug that [could] improve response to immunotherapy across cancer types — and it was elusive,” says Jennifer Wargo, a physician-scientist at the University of Texas MD Anderson Cancer Center in Houston. In 2018, Wargo published a study2 — alongside similar ones by Zitvogel3 and a third team4 — that linked specific gut bacteria to positive clinical outcomes following immunotherapy treatment in mice and people with cancer. But there was little agreement on which microbial species were associated with treatment response.

Wargo says that Zitvogel’s latest research helps to answer why the search for a single gut microbe that could boost responses to cancer immunotherapy was so challenging. Instead of focusing on individual microbial species, the work shows that the overall make-up of microbial communities in the gut influences a person’s response. “It’s all about the community structure,” Wargo says.Why are so many young people getting cancer? What the data say

Zitvogel and her colleagues analysed faecal samples from 245 people with lung cancer and identified two groups of microbial species: group one contained 37 microbes, such as Veillonella species, that are linked to resistance to immune checkpoint inhibitors; group two included 45 bacterial species associated with positive responses. People with lung cancer with response-associated bacteria lived longer than did those with resistance-associated bacteria.

Next, the researchers developed a person-specific score based on the ratio between group one and group two. The score also included quantification of Akkermansia muciniphila, a microbe that has gained attention owing to its potential role in influencing immune responses.

When tested on hundreds of people with various types of cancer, including kidney cancer, the score could predict in most cases who was likely to respond to treatment with immune checkpoint inhibitors. The score will soon be transformed into a diagnostic assay, Zitvogel wrote.

Possible predictive tool

The tool could help to identify people with cancer who might need microbiome-targeting therapies to boost their response to immunotherapy, but it requires further validation before it can be used in the clinic, says Francesca Gazzaniga, a biologist at Massachusetts General Hospital in Boston.

She also notes that the study focused on participants in Canada and France, so the score might not be as predictive in populations living in different areas and eating different diets, Gazzaniga says. “This is a good start, and if we understand more about the underlying mechanisms — why these sets of bacteria are important — we might be able to get better targeted therapies.”

Research on the role of microbiota in the response to immunotherapy began years ago, yet there have been no tangible benefits for patients so far, says Maria Rescigno, an immunologist at Humanitas University in Milan, Italy. All the same, Rescigno anticipates that doctors will integrate the tool developed by Zitvogel and her team into practice. “If clinicians adopt this, it could lead to a significant change for the patients.”

#gut microbiome #cancer #life saving therapy

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selectedbenefits · 5 months ago

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Houston Group Health Insurance for Businesses Ensuring Employee Well being and Company Success

In the vibrant city of Houston, Texas, businesses thrive in a competitive landscape where attracting and retaining top talent is crucial for success. One of the key factors in achieving this goal is offering comprehensive group health insurance plans to employees. These plans not only enhance the overall well-being of the workforce but also contribute significantly to the company’s growth and stability.

Importance of Group Health Insurance

Group health insurance serves as a cornerstone of employee benefits packages for businesses in Houston. It provides employees with access to essential healthcare services, including preventive care, medical treatments, and emergency services. By offering robust health insurance coverage, employers demonstrate their commitment to the health and welfare of their workforce, thereby fostering loyalty and job satisfaction among employees.

Advantages for Businesses

For businesses in Houston, investing in group health insurance offers several strategic advantages:

Attracting and Retaining Talent: In a competitive job market, offering comprehensive health benefits can make a significant difference in attracting talented professionals to your company. Moreover, it helps retain valuable employees who are looking for stability and security in their employment.

Improved Productivity: Employees who have access to healthcare services through employer-sponsored insurance are more likely to prioritize their health needs, leading to fewer sick days and increased productivity. Healthy employees are also more engaged and motivated at work.

Cost-Effective Coverage: Group health insurance plans often provide more affordable premiums and better coverage options compared to individual health plans. This affordability is advantageous for both employers and employees, as it reduces out-of-pocket expenses and ensures access to quality healthcare services.

Tax Benefits: Employers can benefit from tax incentives by offering group health insurance plans. Contributions made towards employee premiums are typically tax-deductible for businesses, making it a cost-effective investment in employee welfare.

Choosing the Right Plan

Selecting the right group health insurance plan requires careful consideration of several factors:

Coverage Options: Evaluate the scope of coverage offered, including medical services, prescription drugs, and mental health services.

Provider Network: Ensure the insurance plan includes a broad network of healthcare providers and facilities in the Houston area to give employees access to quality care.

Cost-Sharing: Consider the balance between premiums, deductibles, and co-payments to find a plan that is affordable for both the company and its employees.

Additional Benefits: Some insurance plans offer extras such as wellness programs, telemedicine options, and dental or vision coverage, which can enhance the overall value of the plan.

group health insurance plays a pivotal role in the success of businesses in Houston by promoting employee health, well-being, and job satisfaction. By offering comprehensive health benefits, companies can attract top talent, reduce turnover rates, and foster a productive work environment. Moreover, investing in employee health through group insurance demonstrates a commitment to corporate social responsibility and enhances the overall reputation of the company in the competitive marketplace of Houston.

As businesses continue to evolve and adapt to changing economic landscapes, prioritizing employee welfare through robust health insurance coverage remains a cornerstone of sustainable growth and long-term success. By partnering with reputable insurers and understanding the unique healthcare needs of their workforce, businesses in Houston can build a thriving organizational culture where employees feel valued, supported, and empowered to achieve both personal and professional goals.

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xtruss · 5 months ago

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To Pee or Not To Pee? That Is A Question For The Bladder — And The Brain 🧠

— 12 June 2024 | ✍️ Emily Underwood | Source: Knowable Magazine

Credit: Esther Aarts

You’re driving somewhere, eyes on the road, when you start to feel a tingling sensation in your lower abdomen. That extra-large Coke you drank an hour ago has made its way through your kidneys into your bladder. “Time to pull over,” you think, scanning for an exit ramp.

To most people, pulling into a highway rest stop is a profoundly mundane experience. But not to neuroscientist Rita Valentino, who has studied how the brain senses, interprets and acts on the bladder’s signals. She’s fascinated by the brain’s ability to take in sensations from the bladder, combine them with signals from outside of the body, like the sights and sounds of the road, then use that information to act — in this scenario, to find a safe, socially appropriate place to pee. “To me, it’s really an example of one of the beautiful things that the brain does,” she says.

Scientists used to think that our bladders were ruled by a relatively straightforward reflex — an “on-off” switch between storing urine and letting it go. “Now we realize it’s much more complex than that,” says Valentino, now director of the division of neuroscience and behavior at the National Institute of Drug Abuse. An intricate network of brain regions that contribute to functions like decision-making, social interactions and awareness of our body’s internal state, also called interoception, participates in making the call.

In addition to being mind-bogglingly complex, the system is also delicate. Scientists estimate, for example, that more than one in 10 adults have overactive bladder syndrome — a common constellation of symptoms that includes urinary urgency (the sensation of needing to pee even when the bladder isn’t full), nocturia (the need for frequent nightly bathroom visits) and incontinence. Although existing treatments can improve symptoms for some, they don’t work for many people, says Martin Michel, a pharmacologist at Johannes Gutenberg University in Mainz, Germany, who researches therapies for bladder disorders. Developing better drugs has proven so challenging that all major pharmaceutical companies have abandoned the effort, he adds.

Recently, however, a surge of new research is opening the field to fresh hypotheses and treatment approaches. Although therapies for bladder disorders have historically focused on the bladder itself, the new studies point to the brain as another potential target, says Valentino. Combined with studies aimed at explaining why certain groups, such as post-menopausal women, are more prone to bladder problems, the research suggests that we shouldn’t simply accept symptoms like incontinence as inevitable, says Indira Mysorekar, a microbiologist at Baylor College of Medicine in Houston. We’re often told such problems are just part of getting old, particularly for women — “and that’s true to some extent,” she says. But many common issues are avoidable and can be treated successfully, she says: “We don’t have to live with pain or discomfort.”

A Delicate Balance

The human bladder is, at the most basic level, a stretchy bag. To fill to capacity — a volume of 400 to 500 milliliters (about 2 cups) of urine in most healthy adults — it must undergo one of the most extreme expansions of any organ in the human body, expanding roughly sixfold from its wrinkled, empty state.

To stretch that far, the smooth muscle wall that wraps around the bladder, called the detrusor, must relax. Simultaneously, sphincter muscles that surround the bladder’s lower opening, or urethra, must contract, in what scientists call the guarding reflex.

It’s not just sensory neurons (purple) that can detect stretch, pressure, pain and other sensations in the bladder. Other types of cells, like the umbrella-shaped cells that form the urothelium’s barrier against urine, can also sense and respond to mechanical forces — for example, by releasing chemical signaling molecules such as adenosine triphosphate (ATP) as the organ expands to fill with urine. Source: Reporting By E. Underwood, Knowable Magazine

The Multi-Layered Bladder

Each of the bladder's layers plays a role in sensing when we need to pee. The urothelium, the innermost layer, is a stretchy, leak-proof barrier with sensors for stretch, pain and inflammation. The lamina propria, rich in blood vessels, nerves and immune cells, also detects fullness and pain. The detrusor muscle, controlled by nerves from the spinal cord, stores and expels urine and signals fullness and the urge to urinate.

Filling or full, the bladder spends more than 95% of its time in storage mode, allowing us to carry out our daily activities without leaks. At some point — ideally, when we decide it’s time to pee — the organ switches from storage to release mode. For this, the detrusor muscle must contract forcefully to expel urine, while the sphincter muscles surrounding the urethra simultaneously relax to let urine flow out.

For a century, physiologists have puzzled over how the body coordinates the switch between storage and release. In the 1920s, a surgeon named Frederick Barrington, of University College London, went looking for the on-off switch in the brainstem, the lowermost part of the brain that connects with the spinal cord.

Working with sedated cats, Barrington used an electrified needle to damage slightly different areas in the pons, part of the brainstem that handles vital functions like sleeping and breathing. When the cats recovered, Barrington noticed that some demonstrated a desire to urinate — by scratching, circling or squatting — but were unable to voluntarily go. Meanwhile, cats with lesions in a different part of the pons seemed to have lost any awareness of the need to urinate, peeing at random times and appearing startled whenever it happened. Clearly, the pons served as an important command center for urinary function, telling the bladder when to release urine.

Beyond Barrington’s Nucleus

Barrington’s work laid the foundation for our current understanding of the neural circuitry of bladder control. But we now know there’s much more than the pons involved.

As the bladder fills with urine, stretch-sensing cells in the detrusor, as well as in inner layers of the bladder wall, send signals of fullness up the spinal cord to a part of the brainstem called the periaqueductal gray. The signals then travel to a region called the insula, which acts as a kind of sensor: The fuller the bladder becomes, the more neurons in the insula fire off tiny electrical pulses called action potentials.

Next, a region of the brain that’s responsible for planning and making decisions — the prefrontal cortex — calculates whether it’s a socially acceptable moment to urinate. If the answer is yes, it sends a signal back to the periaqueductal gray, which in turn sends an all-clear signal to that part of the pons Barrington identified in cats — now aptly called Barrington’s nucleus. The signal goes back down to the bladder, and voila, urination occurs.

How The Brain Detects — And Relieves — A Full Bladder

A simplified representation of some of the nerve pathways and brain regions that allow most healthy people to detect when the bladder is filling or full, predict how long they can wait to urinate, and successfully carry out a plan to “hold it” or “go.” Disruptions at any level of this complex, two-way system of neuronal communication can lead to bladder disorders, as millions of people worldwide know firsthand. Source: Reporting By E. Underwood, Knowable Magazine

Over the past decade, super-precise tools for mapping how different brain regions connect and interact have made the picture even more elaborate.

Valentino and her team have used a technique that can monitor and analyze the electrical activity of neurons across multiple sites within the brain simultaneously to show that neurons located in a part of the brainstem called the locus coeruleus start to fire in a steady, rhythmic pattern when the bladder reaches a certain level of fullness. Wavelike, this activity spreads to the brain’s outer layer, the cortex, and rouses the brain to a more alert state about 30 seconds before urination occurs. Valentino hopes that observations like this could inform treatments for common problems like nocturia and bedwetting, but they also may help to explain something basic that most people have encountered.

“I think that’s one of one of the major reasons you wake up when you have to urinate,” Valentino says. “The locus is saying, ‘Stop what you’re doing and focus on this.’”

Learning To Hold It

Control over when and where we pee takes time to develop, as anyone who has potty-trained a toddler can attest. At birth, urination is governed not by the brain, but by a spinal reflex that springs into action when the bladder reaches a certain capacity. Only at around age three or four do the brain regions that govern functions like social awareness and decision-making override the reflex, says Hanneke Verstegen, a neuroscientist at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.

It’s not possible to watch how this process unfolds in the brainstems of human infants. But Verstegen and her colleagues are studying a similar process in baby lab mice, which gain voluntary control over urination by about three to five weeks. At that point, the baby mice start to pee in a designated corner — a behavior that’s not unlike that of toilet-trained toddlers, she says. Interestingly, the more primitive, automatic spinal reflex we have as infants never completely disappears: When a spinal cord injury damages the nerves that carry signals between the bladder and brain, the reflex can reemerge, often causing incontinence or other problems that require using a catheter.

Spinal cord injuries are just one of the many ways that brain-bladder communication can go awry. As the brain ages, the long, spindly neuronal projections that transmit messages in and between regions that control urination can also lose their integrity and derail normal bladder function — a process that’s often accelerated in Parkinson’s and Alzheimer’s disease.

Medical physicist Becky Clarkson of the University of Pittsburgh and her colleagues are using neuroimaging tools such as functional magnetic resonance imaging (fMRI), which looks at fluctuations in blood oxygen levels to indicate which parts of the brain are active, to understand how the elegant brain mechanisms governing urination break down. “We’re trying out work out what pathways maybe have damage,” she says. “How does the brain normally control the bladder? How does it fail to control the bladder?”

When the bladder is empty or partially full, it is full of folds and wrinkles (shown here in an artificially colored cross-section of a mouse bladder wall). In humans, this extra tissue allows the organ to increase its volume fivefold or sixfold, one of the biggest expansions of any organ in the body. Courtesy of Patapoutian Lab / Scripps Researcher Institute, La Jolla, CA

Most of the participants in Clarkson’s studies are women over 60, the group of people that has the highest rate of overactive bladder syndrome. Roughly 11% of the general population has overactive bladder, but more than 45% of post-menopausal women report symptoms.

Scientists aren’t sure what causes overactive bladder syndrome, or why it’s so common in older women. Some point to changes in the bladder itself. Mysorekar, for one, has found that during menopause, a proliferation of immune cells form tiny lumps resembling lymph nodes on the female bladder lining. These lesions increase the bladder’s sensitivity to even nominal levels of E. coli, the bacterium that causes most urinary tract infections, she says, causing chronic bladder pain or overactive bladder syndrome.

Another major contributor to overactive bladder syndrome in both women and men is detrusor overactivity — erratic contractions of the bladder muscle that send false signals of fullness to the brain. Nearly all existing treatments aim to quiet these spasms: The most prescribed class of medications, antimuscarinic drugs, blocks the activity of acetylcholine, a nerve-signaling chemical that triggers detrusor contractions, for example.

If medications don’t work, clinicians often recommend dosing the detrusor with shots of botulinum toxin, also known as Botox, so it doesn’t contract as much. Sometimes, they’ll also deliver electrical current to nerves in the spinal cord through a surgical implant or electrodes placed on the skin, attempting to restore normal activity in the spinal nerves that control the bladder muscle.

“How Does The Brain Normally Control The Bladder? How Does It Fail To Control The Bladder?”

— Becky Clarkson

The problem with all these detrusor-taming treatments is that they can have unwanted side effects — including, in rare cases, impairing the ability to release urine, says Michel. “It’s a very thin line you’re walking — if you do too much, you can no longer expel; if you do too little, you have problems with storage.” Antimuscarinic drugs have been linked to symptoms of cognitive decline, particularly in older people, raising safety concerns. And not everyone with overactive bladder syndrome has an overactive detrusor muscle, prompting some scientists to ask if the problem for some patients lies elsewhere in the body, such as inside the brain.

Home Safe

If you’ve ever come home after a long day at work, and — just as you unlocked the front door — felt a sudden, even overwhelming urge to go, you’ve experienced the tight link that scientists have long known exists between the brain and bladder. Called latchkey incontinence, this type of urge doesn’t have anything to do with how full your bladder is. (It’s also different from a physical inability to hold urine in when we sneeze, cough, or jump: That common problem, called stress incontinence, usually occurs due to weak pelvic floor muscles.)

Some scientists think that the urgent sensations that characterize overactive bladder syndrome may be conditioned responses like the ones that Russian physiologist Ivan Pavlov created in the 1890s when he trained dogs to associate food with the sound of a metronome. For some people, that conditioning could be years of waiting to get home to urinate so they can use their own bathrooms, Clarkson and her team hypothesize. For others, it might arise from a variety of situations and triggers, like the sound of running water. It’s normal if such intense sensations happen occasionally, but if they happen a lot, researchers consider it a potentially worrisome symptom.

Women with overactive bladders often have unusual patterns of brain activity, Clarkson and other groups have found. In a typical experiment in Clarkson’s lab, study participants lie flat in an fMRI machine while a catheter infuses fluid into the bladder until they say they are feeling full. A technician removes some fluid, then replaces it, repeating the process multiple times.

Using this approach, Clarkson and other researchers have built a model of how the brain controls the bladder, involving regions such as the insula, which processes fullness signals from the bladder, and the prefrontal cortex, which helps determine if it’s an appropriate time and place to pee. Two additional regions, the supplementary motor area and the anterior cingulate cortex, appear to work together to gauge just how urgent the need to urinate is and execute the pelvic floor muscle contractions that help us hold it until a bathroom is found. These areas tend to be more active in some people with overactive bladder syndrome, possibly contributing to the overwhelming sense of urgency even when their bladders are only partly full. “We think that’s almost like a panic station,” Clarkson says. “When you have urgency, you gotta go.”

"To Me, It's Really An Example of One of The Beautiful Things That The Brain Does.”

— Rita Valentino

A few years ago, one of Clarkson’s colleagues noted that the intense urges in overactive bladder syndrome are similar to the cravings former smokers feel in certain situations, like a bar where they used to smoke. Intrigued, Clarkson teamed up with smoking-cessation researcher Cynthia Conklin from the University of Pittsburgh, adapting a method from smoking studies to investigate how women with overactive bladder respond to personal triggers. The women were shown photographs of the places that triggered their own urgency, like their front doors or in one case, the entrance to a Target supermarket. Viewing these triggers increased activity in brain regions associated with attention, decision-making and bladder control, compared to “safe” photos.

Certain behavioral therapies seem to help women with overactive bladder syndrome respond more calmly to their urgency triggers, Clarkson says. For example, her team’s preliminary data suggest that mindfulness techniques like a body-scan meditation, which prompts participants to relax from head to toe, can reduce the intensity of the bladder sensations. They also found that a noninvasive form of brain stimulation called transcranial direct current stimulation, or tDCS, could ease urgency.

Clarkson and her team have also explored how brain activity differs between women who do and don’t respond to treatment with botulinum toxin and pelvic floor muscle therapy, and they are currently investigating whether taking commonly prescribed bladder medications results in changes to the brain.

Many older women — and men — are already taking multiple anticholinergic medications, which include the most-prescribed class of bladder drugs, antimuscarinics, by the time they seek treatment for overactive bladder. Given the concerns that taking too many such medications can cause cognitive problems, Clarkson hopes to add non-pharmaceutical treatment options to the menu. “If we can keep people off the drugs, that would be great,” she says.

One of several types of force-sensing protein channels found in the bladder, this three-pronged, propeller-shaped Piezo2 channel sits in the cell membrane. It opens in response to mechanical forces such as stretch and pressure. Recently, researchers have shown that both people and mice with genetic mutations that affect Piezo2 function have urinary deficits. These include a diminished ability to sense when the bladder is filling or full. Goultard59/Wikimedia Commons

Causes of Overactive Bladder

Most researchers agree that the main obstacle to finding more effective treatments for overactive bladder syndrome is that the diagnosis is so muddy: Rather than a single disorder, it’s a loose group of symptoms that can be caused by many different conditions, from Parkinson’s disease to spinal cord injury to diabetes to none of the above. But the cases often get lumped together and talked about as if they were all the same condition, says neuroscientist Aaron Mickle of the Medical College of Wisconsin.

Mickle is studying how different conditions affect the bladder lining, the urothelium — a soft, self-renewing layer of tissue that can stretch and flatten to accommodate changes in bladder volume. Although scientists once considered the urothelium a passive barrier that renders the bladder walls leakproof, it’s now clear that it plays a key role in signaling the stretch of the bladder as it fills.

One reason that the urothelium is so sensitive is that many of its cells contain multiple types of mechanically activated ion channels — proteins that sit in cell membranes and are literally channels into the cell. When the cell membrane gets stretched, pushed or otherwise deformed, these channels open, allowing positively charged ions to flow inside the cell, explains Kate Poole, a physiologist at the University of New South Wales in Australia and author of a 2022 article in the Annual Review of Physiology on mechanically activated ion channels in mammals.

Sensory neurons that extend into the urothelium contain these force-sensing channels; when the influx of positive ions reaches a certain threshold in these nerves, they communicate directly with nerves in the spine and brain through electrical impulses. Intriguingly, however, non-neuronal cells in the urothelium also contain a variety of mechanically activated ion channels, suggesting that they, too, can signal bladder fullness.

In 2023, Mickle used optogenetics — in which the zap of a laser beam remotely activates or deactivates selected cells in animals — to selectively stimulate some of these non-neuronal urothelial cells. That was enough to activate sensory neurons and trigger bladder contractions, the first time this had been done. Eventually, Mickle hopes to develop a wireless optogenetic system that continuously monitors and modifies the activity of specific types of bladder cells in people. (Although the optogenetics technique has so far been used mainly in lab animals, researchers are now exploring its use in humans.)

iStock, Gleb Kosarenko

Other groups are investigating as drug targets the force-sensing channels in bladder cells, as well as other channels that open in response to various nerve-signaling chemicals and hormones. These include a group of force-sensing propeller-shaped proteins called Piezo channels that play an important role in bladder sensation. In 2020, a study published in Nature showed that in addition to other profound deficits, such as difficulty walking, people with a rare mutation that affects one type of these channels, called Piezo2, struggle to sense their bladders filling. Some must pee on a set schedule or physically push down on their bladders to urinate.

Some scientists hope to target Piezo2 channels to treat a variety of bladder disorders. One advantage of targeting such channels, says Poole, is that they’re “inherently druggable,” meaning that researchers can often find small molecules that will switch them on or off even if they normally respond to mechanical stimuli.

But there’s also a downside: Like other ion channels that researchers have tried to target in the bladder, Piezo2 channels can be found all over the body, including in the lungs, joints and heart. Consequently, any drug that affects the channels in the bladder will likely hit other parts of the body, causing safety issues. Michel points to a clinical trial for a drug that worked on another type of ion channels in the bladder — ones that let potassium ions into cells — but had to be discontinued because it turned out to cause liver problems.

There is at least one way to overcome that obstacle, at least in theory: gene therapies that specifically target bladder tissue because they’ve been directly injected into the detrusor muscle or have been infused via catheter into the urethra. In 2023, scientists published preliminary but encouraging data from a clinical trial with 67 patients of a genetic therapy that targets the bladder’s potassium channels.

Although scientists who focus on the bladder and urinary tract have traditionally worked separately from those researching the spinal cord and brain, these long-siloed fields are starting to link up and collaborate, putting more pieces of the brain-bladder puzzle together. Mickle, for example, has recently teamed up with a neuroimaging lab that will help him observe how a mouse’s brain responds to optogenetic stimulation of its urothelial cells.

In the past, “we never focused on the brain,” Valentino says. But the new research, she says, “is allowing us to think more about these other targets.”

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