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kurooskitten · 5 years ago

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All Eyes on Me. [Kuroo Tetsurou]

A/N: i got inspiration for this while finishing my biochem hw packet 😗 and like, kuroo’s canonically really good at biochemistry so it works out

Summary: Kuroo sees you need a little more encouragement to get your work done.

18+ content ahead!

“Stressed” was an understatement.

You felt like you were being completely and utterly destroyed by your classes at the moment, and the fact that you had procrastinated so much on your biochemistry homework packet and didn’t pay much attention in class didn’t help either.

You had answered everything that you could with your note packet you had gotten in class, but as for anything the packet didn’t mention? You were stumped. Swamped.

As a last resort, you called your boyfriend.

“Yoww!” The greeting that could’ve usually made you giggle elicited no reaction from you.

“Hey, Kuroo? Can you come over?”

You hear shuffling on the other end of the line.

“Uhhh, practice just finished up. I can head over after everything’s taken care of back here if you’d like.”

You sighed in relief. “Please. I really need your help with this damned biochem homework.”

He chuckled. You were positive he was grinning on the other end. “Oh? Is my Kitten having trouble in class?”

You groan, sliding your hand down your face. “Oh, put a lid on it. I have other classes I’ve been worrying about, you know. Not everybody just ‘gets it’ like you do.”

“I’m only teasing you.” You hear more shuffling and a sigh escape from his lips. “Alright, you big baby, I’m on my way. Don’t give up till I get there, alright? I’m not doing the whole thing for you.”

“I know, I know. Just— hurry up, okay?”

He chuckled. “Alright. See you in a few. I love you.”

“I love you, too. See you soon.”

With that, the call came to an end, with you resting your head on your arms; a sound of distress escaping from your lips.

“Oh my goddddddd!”

——

If you were being completely honest, by the time the door bell rang, you’d only gotten about 5 more questions done.

‘It’s been half an hour and I barely scratched the surface!’ You groaned internally and dragged yourself to the door, looking up exasperatedly at your amber-eyed boyfriend.

“Who pissed in your cheerios?”

“The fucking science teacher.”

He let out a hardy laugh at your retort as he followed behind you back to where you set up shop in your living room; your textbook opened with others stacked beside it, your folder, an open notebook with a pen on it, highlighters, and the thick, 5 page packet you were currently working out of.

“At least you’re organized.”

You scoff and sat down next to the coffee table where you were seated, Kuroo sitting next to you and taking out his own supplies.

The tomcat was a lot more organized than people would give him credit for. His handwriting was neat and pleasing to the eye, his books were color coded, and he never forgot a single material needed to complete his work that night. His set up was much more minimalistic than yours, but contained the essentials nonetheless.

“I will never be able to get over how nice your handwriting is, Tetsu.”

He chuckled, grinning at you. “Stop gawking and get to work, you fiend.”

You huffed and turned to your packet, but couldn’t find the motivation or will to even pick the damn thing up. You could feel Kuroo's eyes flicker from the packet to your face multiple times before he sighed and shifted where he sat.

"You're gonna need some motivation, aren't you Kitten?"

You felt your cheeks heat up at the pet name he gave you, setting your face in your hands in an attempt to cool off your warming face. "I have no motivation to work right now, Tetsurou."

In response, he grinned. "How about we play a game, hm?"

You raise an eyebrow.

Kuroo says nothing, but instead pulls you to sit between his legs where his arms quickly found themselves around your waist and his face in the crook of your neck. You let out a little squeak as his breath tickled the shell of your ear when he spoke.

“For every question you answer, I’ll reward you.”

One of his hands leaves the clasp of his other that sat at your waist to slip underneath your t-shirt and rub the skin that it hid. You felt yourself swallow a lump that was forming in your throat. “And if I get it wrong?”

“Doesn’t matter. We’ll go through and correct them later. For now, all that matters is that you start writing, Kitten.”

You nod shakily and inhale deeply to calm your nerves before sliding your packet over and grabbing your pen.

“What are the four types of organic compounds?”

‘Oh,’ you thought. ‘This is easy!’

As you wrote down your answer you couldn’t help but think of how much Kuroo’s presence (and his proposition) both motivated and calmed your nerves. ‘Boom. Carbohydrates, lipids, nucleus acids, and proteins.’

“Nicely done, Kitten.”

You feel the hand that had slipped underneath the edge of your top slide higher up, tracing where the underwire of your bra met your skin. The lips that were hovering above your ear began placing soft kisses in a trail all the way from behind it to the dip in your shoulder.

You felt yourself instinctively fall back into his touch, your head rolling to the side to give him more room to work, but he just chuckled against your skin and went to whisper in your ear again.

“Nuh-uh-uh, Kitten. You have to work.”

You let out a frustrated huff (which was borderline a whine) and attempt to collect yourself. ‘Okay,’ you thought. ‘’Explain the differences between a monosaccharide, disaccharide, and polysaccharide sugar.’’

You smiled slightly. You’ve seen all this material before. This was more review than anything. Why were you so stressed before?

You wrote down your answer.

‘Monosaccharides all have the formula C12H22O6 and a single ring structure. Disaccharides are double sugars with the formula C12H22O11. Polysaccharides are formed out of three or more simple sugar units.’

You feel yourself smile once again, however, it’s short lived as your boyfriend hums against your neck and begins groping your breast through the fabric of your bra. The hand that held you still in his lap abandoned its idle state to pop open the buttons of your jeans.

“Hahh ..”

“Get back to work, Kitten.”

You muster the best nod you can, and read the next quest from behind lidded eyes. “Explain two factors that can denature enzymes.”

You try to open your eyes wider so you don’t mess up writing. ‘Extreme pH values and extremely high temperatures.’

Kuroo doesn’t make a noise of approval this time, but instead slips his hand into your panties, rubbing circles onto your clit.

You find yourself gripping at his arm for support (even though you’re sitting down, laying against his built figure), as if letting go meant certain death.

His other hand busies itself with undoing your bra clasp, sliding the cups underneath your breasts and pinching your nipples.

“Oh my god—“

He licks a long stripe from the juncture of your neck to the middle of your ear, biting down on the cartilage.

“One more, babygirl. All I want is one more.”

You could feel your face flush an even deeper shade of red at his words and the feeling of his own arousal pressing against your back. You struggled to form your next words.

“I— I can’t, fuck-“

The sound he lets out at your whine is scarily similar to that of a cat purring. “I know you can. C’mon. One. More.”

As some extra encouragement, he speeds up his fingers on your clit, adding an extra to slide down and push at your entrance ever-so-slightly.

You inhale shakily, and grip your pen with a deathly tight grip, hoping it will keep you from dropping it mid-sentence. You knew Kuroo would stop if you didn’t give him one more answer, and you wouldn’t let that happen.

You could barely make out the question on the paper. “List the major functions of proteins in the body.”

‘Easy enough,’ you thought to yourself, your very own thoughts barely coherent as your mind fogged up with pleasure like a mirror in a bathroom when the shower was running.

‘Growth, repair, energy formation, and to act as a buffer to help keep the body’s pH constant.’

You felt Kuroo grin against your neck one more as he muttered a good job and pushed the lingering finger into you, slowly pumping itself in and out of your body. You whine quietly at the feeling, knowing that last question you answered was your ticket to bliss.

“Take off your shirt for me, baby.”

You sit up slightly, trying not to dislodge the finger inside of you and shed your shirt; tossing it haphazardly to some forgotten corner of the room. Your bra soon follows, sliding the straps off your shoulders to bare your chest to your lover.

He gently gropes your mounds before sliding that calloused hand up your chest to grip your jaw softly, turning your face to his. He stares into your eyes for a moment, those amber eyes now molten pools of gold— both glazed and brimming with lust and desire.

He lowers his face to yours, kissing your lips hungrily as his ministrations on both your breasts and clit become quicker. The finger inside your walls becomes more accurate, and you can’t help but spreading your legs more in a way to let your boyfriend reach further inside of you.

All of your cries and moans were swallowed eagerly by the raven haired tomcat of a boy who was intent on kissing and biting your lips swollen and raw. He neglected his own erection to reward you for you hard work— your own satisfaction more important than his own.

A second finger was added, stretching you out deliciously as you clenched around it in earnest. You pulled away from Kuroo to let out an embarrassingly loud moan, and he just grinned that cheshire grin of his before taking to your neck to leave a large hickey where no one would be able to see but you and him.

Your pants grew labored and your moans increased in volume as Kuroo carried you towards release, shutting your eyes and letting the tingly sensation of the build up envelope your body.

Kuroo pulled away from your neck to growl into your ear huskily.

“Go on, cum for me, Kitten. Cum on my hand. I know you want, too. You deserve it.”

You found yourself gripping his arm a little tighter this time around, your nails digging crescent moons into his bicep as you bit your puffy and red lips to try to stifle the noise, the effort ultimately failing as your jaw dropped open to let the noise of pleasure out from the depths of your throat.

“Look at me, Kitten. Let me see your face.”

You turned your head best you could as your eyes fluttered shut, although you were able to catch the predatory look that lingered in his eyes. You heard Kuroo groan as you spasmed around his fingers— your moan catching in your throat and turning into a broken whine. He never let up in the motion of his hand while you came, determined to help you ride out your high to the fullest.

When you finally stopped squirming in his grasp, he pulled his fingers out from your panties and removed his hand from your swollen breasts. You opened your eyes to meet your boyfriend’s who quickly slipped the digits still covered in your slick into his mouth, keeping eye contact all the while. You felt yourself involuntarily whining at the sight and he just chuckled.

“Now, how about we get you cleaned up and then finish this packet, yeah? I think you’re motivated enough now.”

You can’t help but roll your eyes at him. God, did you love this man.

#haikyuu!!#kuroo tetsurou #haikyuu kuroo #not sfw #writing

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aflower-exe · 5 years ago

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The one in which you get stuck in a closet with Baekhyun

[ 3:27pm ] A group project? Really? You look around the room at the faces of your classmates. Of course you would have to complete a group project in the one class that you have no friends in. “The assignment is simple. I want you and your partner to build a 3D diagram of your assigned biomolecule. The partners will be posted on the board. When the bell rings please move in an orderly fashion”

Your class definitely did not move in an orderly fashion. In fact one might say it was a downright bloodbath. Your classmates were pushing and shoving their way to the board as if it was the last piece of food during an apocalypse. You roll your eyes and take your time packing up. You were clearly in no hurry to see who your partner was. You actually kind of dreaded the thought. I mean there were some pretty bad options. You could be with Nayeon the ditzy popular girl who you swear has never not worn her bright pink blazer, or maybe Johnny the know it all who thinks speaking more than one language is a personality trait, or even worse you could have Irene who’s stare is said to be so cold that the temperature around her actually drops.

As the crowd dissipates, you walk up to the board. Your heart was pounding out of your chest as you glided your finger across the board in search of your name. “Y/N (Phospho)Lipid-” Lipids? Easy. You could draw a lipid molecule in your sleep. With a deep breath you move your finger over to see the name of your partner. “B A E ” Bae… Bae Suzy? You think that’s the pretty girl that always humming behind you but you’re not entirely sure. Either way you could’ve done a lot worse. “K” what? That’s not the next letter of bae suzy. Wait...It couldn’t be... “Looks like you and me are partners” You feel a long slender arm wrapping around your shoulder. Of all the people... you think, cursing silently. You throw Baekhyun’s arm off of you, giving him the space to maneuver himself in fromt of you. “Consider yourself lucky. It’s not everyday a girl like you gets to be partnered with someone like me” He smirks. You take a deep breath to suppress the rage building inside of you. “Lucky me” You reply between gritted teeth. You push pass Baekhyun and make your way through the halls, desperate to get home. “Hey wait up!” Baekhyun calls, he starts running to catch up, “Seriously for someone with such short legs you sure do walk fast.” You clench your fist and walk faster, hoping he’ll give up. “Hey, ____, slow down we need to talk” “Don’t worry about it. I’ll do the project myself and write your name on it, just leave me alone” you call over your shoulder, making sure you maintain your speedy pace. “No wait that’s not—” Baekhyun sighs and grabs your arm, stopping you from running away, then pulls you into a dark closet.

“What the hell!!” You scream, pulling away. “What is wrong with you?” “You weren’t listening,” He pants “and you walk so goddamn fast”. You squint your eyes but you can barely see his figure in the darkness. “Where even are we?” You ask. “I don’t know i thought this would be a classroom” You feel around for a light switch, patting down everything near you. Suddenly, you feel something… strange. It’s soft and warm and… damp. “Baekhyun… please tell me I’m touching your very sweaty arm” “... That’s not me” Baekhyun stutters. You feel your stomach start to drop, but before you could let out the scream that had been building inside of you, the lights flicker on. “A janitor's closet?With the way our class always looks i assumed we had no janitors” He frowns. “If that wasn’t you then what was—” You slowly turn your head to the large, moldy sponge that your hand was resting on. You gag and pull away, wiping the slime off of your hands and onto the wall. You reach your hand for the door and twist the doorknob gingerly, but it doesn’t open. “Baekhyun… it’s stuck” You twist on the knob again, this time with both hands but the door doesn’t budge. “Step aside…” Baek sighs. He moves your hand and pulls on the doorknob, twisting it with two hands. “____… I don’t know how to say this, but I think we’re stuck” You bang on the door and scream for help, but all the students and faculty are long gone. Baekhyun joins in, banging on the door, so ahrd you’re sure it’ll break. “This is all your fault. I offered to do the entire project by myself but you just had to stop me. Now we’ll never get it done.” “Hey, i was just asking you to slow down. As far as I’m concerned it was your unbridled bitchyness that got us into this mess.” “Oh fuck you” You say rolling your eyes in annoyance. “Wouldn’t you like to” You sigh pull your arms in close to your chest, scared of what might happen if you leave your fist unattended.

You and Baekhyun slouch onto the floor, making sure to keep as much space between the two of you. After a while the tense silence becomes peaceful, and you find yourself growing tired. You watch Baekhyun as he rests his head on the metal shelf behind him. Just when you think he’s fallen asleep, he starts to sing a soft tune. His voice is like honey, warm, smooth, and sickeningly sweet. No matter how much you despise him, you couldn’t help but feel soothed by his voice. You soon find it impossible to keep your eyes open, and before you know it, you’re asleep.

[ 7:45pm ] What a terrible dream… you think. You stretch your arms out and yawn loudly. Imagine being partnered with Baekhyun… god that would be terrible… “Good morning princess,” you have got to be kidding me “or evening. I don’t actually know what time it is my phone’s been dead for hours” You sigh loudly and Massage your temples, his presence already an annoyance, “Y’know I actually thought this was all a bad dream… i wish it was a bad dream” “Nice to know you’re dreaming about me” He smirks, a mischievous look gleaming in his eyes. “You are… infuriating… to say the least. I don’t care how cute you are I don’t know how girls put up with you” “So you admit that I’m cute?” You feel your face flush. You open your mouth to respond but you know the bright blush that shrouded your face was all the answer he needed.

The two of you find yoruself sitting in an awkward silence for what seems like forever. “So… do you have any plans tonight” Baek says, his voice smooth and confident. “Excuse me?” You say, a dark, angry blush rising to your cheeks. Baekhyun chuckles, “The project. We’re partners, remember?” “Pfft, duh! obviously! i mean what else would you have meant by that” You chuckle nervously. What else would he have meant? Did you expect him to ask you out? Did you want him to ask you out? Now it was Baekhyun’s turn to blush, but unlike you he looked you dead in the eye. “Stop looking at me like that” you say, avoiding his gaze. “Can I ask you a question” He says, his voice suddenly serious. You narrow your eyes at him, scanning his face for any sign of mockery, “Shoot” “Why do you hate me?” Woah. You were not expecting that. “What?” you stutter. “I’ve always been nice to you and yet you’ve always hated me.” He’s right. He may be egotistical and arrogant, but he was always nice to you. Why did you hate him? Was it his perfect voice or his perfect hair? Was it his effortless charm and gracefulness? Or maybe it was his smile that you could just spend eternity getting lost in. “You’re just so… perfect. All the girls like you, all the teachers like you, you drive a nice car and wear nice clothes. And you’re so nice to me! I go out of my way to be bitchy to you and you’re still nice. I just—” Baekhyun cuts you off by colliding his lips with yours. Of course, the kiss is perfect.His lips are soft and plush as they melt into yours. He tastes like piña colada lip balm and mountain dew, a strangely addicting combination.

When he pulls away his hand is still resting on your cheek. Before you can think, you reach your hand up and punch him dead in the face. The sound of your fist colliding with his nose seemingly amplified in the tiny closet. “What the fuck!” He screams, his hands holding his now less than perfect nose. “Why the hell did you kiss me?” You ask. You actually didn’t mind him kissing you. In fact, you wanted him to do it again. But you couldn’t let him know that. You’d never hear the end of it. “Why the hell did you break my goddamn nose?” “Hello? Is someone in there?” You hear a voice calling out from the hall. You stand up and move towards the door “He-” “SHHHH,” Baekhyun whispers, covering your mouth with his hand, “Do you want someone to come in and see that you broke my nose?” You push his hand away and turn to him, “Don’t you wanna get out of here???” Baekhyun pouts. He seems conflicted. “Yeah, but—” “Oh my god. You’re embarrassed that i broke your nose. Do you want me to lie to protect your delicate emotions?” “Oh fuck off—” Before you even get the chance to respond, the janitor door opens and you are greeted by the familiar fluorescent light of the hallway. In front of you stands a middle aged teacher who you’ve never seen before. “What are you two doing in here, school ended 4 hours ago. And why is he bleeding?” “Because he’s an idiot” The teacher squints her eyes at you, eyeing you up and down. “I didn’t know that idiocy caused people to start spontaneously bleeding from their nose” “I think it’s a new phenomenon. It’s chronic, very serious in fact i should be taking him to the hospital now”

You grab Baekhyun by the hand and hurry out of the school, “Thanks for saving us” you yell, not bothering to wait and hear the teacher response. Once the two of you are out of the door Baekhyun pulls away from you and stares. “Aren’t you gonna apologize?” “For what” “For breaking my nose!” Baekhyun huffs. He still has a hand covering his nose. “Sorry” You mutter “You are? You’re actually sorry” You press your lips together in an attempt to seal in the laugh that was threatening to erupt out of you. “No, not really” Baekhyun looks at you. For a moment it looks like he’s ready to scold you. His eyes look stern and he presses his mouth into a straight line. Then he starts laughing. His laugh is infectious.It’s light and airy and joyful and you can’t help but join in. As you laugh you can’t help but think, maybe he’s not so bad after all.

[ a/n: idk why i had so much trouble coming up with an ending to this lmao. This is lowkey cute i hope better writers revamp this idea someday. I really like the whole enemies to lover idea with Baekhyun. Hope you enjoy this!! ]

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haxballfan-blog · 4 years ago

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When You're Sad, Your Skin Is Sad

Correlation doesn't prove causation, but I can't help but notice that both times I’ve lived in my teenage bedroom I’ve felt especially sad. In high school, it was an angry sadness that sought attention. But when I came back to my parents house in March to ride out COVID, the sadness became deep and dull—about everything and nothing. I go to bed dreading the next day like it holds a big test I haven’t studied for. In the morning, I alternately jolt awake while it’s still dark, or tether myself to my comforter well into the workday. I’ve been very privileged in the ways I’ve experienced the past few months, but also very anxious. And actually, the CDC estimates that 40-percent of adults exhibit symptoms of anxiety or depressive disorders as of this past July. (In 2019, that number was 11-percent.) So, yes, I’m crying a lot more than usual; maybe you are too. I’m also breaking out more than usual—and you?

“Yes, stress causes you to break out,” says Dr. Amy Wechsler, who, as one of only a handful of doctors in the US board-certified in both dermatology and psychiatry, is uniquely qualified to answer questions about this kind of stuff—she even wrote the book on it. Dr. Wechsler cites a well-known study done on a college campus during exam week, where researchers found a strong correlation between stress and the severity of acne. “But exam period is like two weeks long, and when the exams go away the breakouts go away. Imagine if you had exam period for five months, you know? That’s like what we’re going through right now.”

According to Dr. Wechsler, the root of stress acne lies in a molecule called cortisol. Cortisol is a hormone that’s pumped out by the body to fight illness, control blood sugar levels, regulate metabolism, and influence memory formation. In general it’s anti-inflammatory, but when you’re stressed, your body responds by producing more cortisol than it would normally as part of the fight-or-flight response meant to keep you alert when you need to be. If that stress is prolonged, and you don’t have the proper coping mechanisms to deal with it, cortisol starts to act very inflammatory.

“Inflammation is the root cause of acne, and eczema, and psoriasis,” says Dr. Wechsler, who also adds that high levels of cortisol over a long period of time will break down collagen, the molecule in your skin that keeps it looking plump. “That’s why when people are really stressed out for a while, they look like they aged overnight.” For a good, obvious example of this phenomenon, take a look at a photo of President Obama in his first year as president compared to his last. Cortisol also weakens your skin’s natural barrier, so you’ll start to experience more transepidermal water loss. Several months of anxiety may leave you with a totally different skin type: even if your skin is normally oily, it will start to dry out and get more sensitive. Dr. Wechsler notes that when your barrier is compromised, your skin is more likely to react to something that normally wouldn’t cause a problem. “That’s when people say things like, ‘I’ve been using the same product forever, they haven’t changed their ingredients, but now I can’t tolerate it.’”

The tricky part about cortisol is that once levels are high, it can be difficult to bring them down on your own. At minimum, you need to make sure you’re getting an adequate amount of sleep each night, which can be difficult when you’re feeling anxious. “Cortisol is at its lowest for everybody during sleep, and healing molecules like beta-endorphins, growth hormones, and oxytocin,” a mood enhancer, “are always at their highest,” says Dr. Wechsler, who compares the molecules’ relationship to a see-saw. If you’re not getting much sleep, you’re not giving the anti-inflammatories a chance to catch up to the cortisol.

During the daytime, you can sort of hack your body chemicals by engaging in activities that directly trigger a release of those happy molecules. Completing your skincare routine floods your brain with dopamine, otherwise known as the “feel-good neurotransmitter.” So would cooking a complicated dinner, or organizing your bedroom, or finishing a book. A workout can help balance too-low endorphins, a fact I always felt was fallacy until I experienced my first runner’s high a few months ago. Not into exercise? Pop on a John Mulaney stand up special—any will do!—for a rush of endorphins you don’t have to sweat for. And to raise your oxytocin levels, turn down the lights and grab your vibrator. Sex drive can lower when you’re depressed, but each time you orgasm your body releases cortisol-lowering, calm-inducing oxytocin.

Of course, these things won’t stop you from feeling anxious, but they might help you feel a little bit better on the day-to-day, and you also may see a difference in your skin. “When people are very anxious, they feel this loss of control over what’s going on in their lives, and normal routines fall by the wayside because they feel unimportant,” Dr. Wechsler explains. “A skincare routine gives you back a little control,” she adds, conceding that, at the very least, 10 minutes of caring for yourself will feel better than reading the news, or scrolling through Instagram.

The absolute easiest, low-effort way to help balance cortisol? For a sad person at least, it’s crying. Scientists aren’t quite sure how or why, but studies show that a good crying session decreases cortisol levels. It was once widely believed that tears were a way to expel excess stress hormones, but now, most researchers think that the benefits of crying have to do with social signaling: just getting out the message that you’re in distress seems to help alleviate some of that distress. And, if you’re crying to somebody, they’re likely to give you a hug, rub your back, or stroke your hair—all triggers for oxytocin.

But while crying is good for the skin internally, it can leave your face feeling… not so great. Which is the reason I called Dr. Wechsler in the first place—I wear my recent crying obviously, and am left frantically icing my face before morning meetings and check-ins with family. Beyond how I look, my post-crying face hurts. My eyes get incredibly puffy, and I often find myself stuck between a rock and a hard place when I cry at night. It happens, without fail, after I do my skincare routine, and I wasn’t sure whether the salty tears left on my skin were further contributing to breakouts. To make my outsides match my insides after a solid catharsis, I wanted to figure out a post-crying best practice—a sad girl beauty routine, if you will.

What I’d learn is that your eyes work overtime to produce tears, which draws an abundance of blood to the surface of your eyelids. If you cry at night, that blood doesn’t have anywhere to go—it pools in your face when you’re lying flat. “If you’re crying during the day and you’re standing up and walking around, gravity will take the swelling from your eyelids, bring it down your face, and flush it out,” adds Dr. Wechsler. For those particularly concerned about morning puffiness, you can stay upright until the swelling subsides, or try Dr. Weschler’s favorite method. “Put a teaspoon in a glass of ice water, let it get really cold, and then take the back of the teaspoon and put it on your eyelid with a little bit of pressure. Both the cold and the pressure really help those blood vessels calm back down,” says Dr. Wechsler, who learned the tip from one of her model patients. Doing that right away will probably help prevent morning puffiness, but if you aren’t feeling up to it, just go to sleep and try to keep your head elevated with an extra pillow. You can always try the spoon trick (and some vertical action) in the morning.

As for the tears themselves, Dr. Wechsler recommends rinsing them off to abate dryness. If you’ve cried within a half hour of doing your skincare routine, you can rinse with a gentle cleanser (or water, if you think another wash will be too drying) and re-apply your skincare products. Otherwise, just rinse and moisturize again.

Remember how I mentioned cortisol is difficult to lower on your own? If you’re experiencing symptoms of anxiety and depression, you might also consider seeking out the help of a trained therapist. While it’s easy to ruminate on how we look on the outside, it’s important to emphasize that this skin issue is indicative of a larger, internal problem. Aside from the auxiliary benefit of helping balance your skin, talking to someone can help alleviate the feelings of loneliness, grief, and uncertainty you might be feeling right now. Therapy for Black Girls, the National Queer & Trans Therapists of Color Network, and Open Path Collective all offer remote therapy options at accessible price points. You might also check out Psychology Today’s list of therapists, which is quite comprehensive—you can filter results by things like specialty, sexuality, and race. If you’re a Black woman, you can also apply for a grant from The Loveland Foundation to subsidize your sessions.

Knowing that my skin is feeling as vulnerable as I am right now, I’ve been taking it easy with my skincare. And the benefit is twofold: nixing breakout treatments lets my skin actually heal, and using fewer products means I’m more likely to actually do my routine (even when I don’t feel like it). I’ve noticed new pimples subsiding after fortifying my compromised skin barrier with products rich in ceramides, natural moisturizing factors, and lipids. I’ve also been chasing opportunities to feel good as often as I can, masked and tiptoeing around the border of my own shrunken comfort zone. Still the breakouts, and the tears, come in waves. But then again, they always have.

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mcatmemoranda · 5 years ago

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Second-generation antipsychotics (SGAs), also known as atypical antipsychotics, generally have lower risk of extrapyramidal side effects and tardive dyskinesia compared with first-generation antipsychotics (FGAs).

FGAs and SGAs have comparable efficacy. The SGA, clozapine, has the best efficacy, but due to its adverse effects, it is used for schizophrenia that is treatment- refractory.

Antipsychotics work by blocking the postsynaptic D2 receptor. Aripiprazole and brexpiprazole are partial D2 receptor agonists. Cariprazine is a D2/D3 receptor partial agonist, with preference for D3. Pimavanserin is a serotonin 5HT2A inverse agonist and antagonist with no dopamine D2 affinity. Antipsychotics have to bind 65% of dopamine receptors to have antipsychotic efficacy in functional imaging studies.

Unlike FGAs, SGAs also bind 5HT2 receptors, which may be part of the reason why SGAs have lower risk for EPS. SGAs may also bind more loosely to D2 receptors and preferentially block receptors in the limbic and cortical regions rather than in the striatal areas. SGAs also bind muscarinic, alpha-adrenergic, and histaminic receptors, which causes their side effects.

In urgent situations, rapidly absorbed antipsychotics are used. Sublingual asenapine is the most rapidly absorbed, with a one-hour time to peak serum concentration, followed closely by lurasidone and the immediate-release formulation of quetiapine.

Drugs that are absorbed more slowly such as olanzepine, ziprasidone, and extended release quetiapine, are better tolerated. Lurasidone and ziprasidone should be taken with a meal, as this enhances bioavailability. A high fat meal increases absorption of quetiapine by 50%. It’s recommended not to take quetiapine with a high fat meal.

Most antipsychotics are metabolized through the cytochrome P450 system in the liver. Paliperidone (the active metabolite of risperidone) is mostly excreted unchanged by the kidneys, so dose adjustment is not required in pts with liver impairment. But of course, dose adjustment of paliperidone is required in pts with kidney dysfunction; and palliperidone is C/I in pts with renal impairment.

People with CYP2D6 polymorphisms may be slow or fast metabolizers of certain antipsychotics, which is why serum levels of drugs are assessed if poor or extensive metabolism is suspected.

In poor metabolizers, dose reductions of 50 percent have been recommended for aripiprazole, brexpiprazole, and iloperidone; dose reduction is also recommended for poor metabolizers of clozapine.

Because aripiprazole is a partial agonist of D2 receptors, it may counteract the effects of other SGAs that primarily block the D2 receptor. So you may see a paradoxical decrease in antipsychotic effect as the dose of aripiprazole is increased when switching from an antipsychotic with D2 receptor blockade effect. Abilify is metabolized by CYP 2D6 and 3A4. So dose adjustments should be made when the pt is concurrently taking drugs that either inhibit or increase activity of these enzymes. The manufacturer recommends a twofold dose increase of Abilify in the presence of metabolic inducers such as carbamazepine and a 50 percent reduction in dose with inhibitors such as fluoxetine, quinidine, or ketoconazole.

CYP3A4 inducers, such as rifampin, decrease the levels of brexpiprazole and aripiprazole.

Clozapine is metabolized via CYP1A2, 2D6, and 3A4. Fluvoxamine and ciprofloxacin inhibit CYP1A2 and thus require reduced dosing of clozapine if the pt is on these medications concurrently.

Clozapine can cause agranulocytosis. It also causes strong anticholinergic, sedative, cardiac, and hypotensive effects, so drugs with the same side effects should not be combined with clozapine.

Olanzepine is metabolized by CYP 1A2 and has fewer drug-drug interactions, but of course drugs that induce or inhibit CYP1A2 should be avoided with olanzepine use.

Polycyclic aromatic hydrocarbons in tobacco smoke may induce CYP1A2, so olanzepine dose may need to be adjusted in smokers when they’re in non-smoking facilities and when they are outpatient.

Pimavanserin is metabolized by CYP3A4 and should be avoided with drugs that prolong the QT interval.

Quetiapine is metabolized by CYP 3A4, and the manufacturer recommends up to a fivefold increase in dose with inducers such as carbamazepine and a reduction to one-sixth the dose with strong CYP3A4 inhibitors such as voriconazole or ritonavir.

Side effects may worsen when the drug is combined with other agents that cause sedation, anticholinergic effects, hypotension, or weight gain.

Risperidone serum levels are increased by strong CYP2D6 inhibitors such as fluoxetine and paroxetine, and to a lesser degree by bupropion.

Ziprasidone is metabolized via glutathione and aldehyde oxidase, with a minor contribution from CYP 3A4. It can cause prolonged QT interval, especially when combined with other medications that prolong the QT interval.

Aripiprazole, asenapine, clozapine, olanzapine, and risperidone are available in oral disintegrating tablets, which are useful in pts who cheek their medications or in those with dysphagia.

For emergent situations, rapid release olanzepine and ziprasidone can be given intramuscularly. No SGAs can be given intravenously. In a previous presentation on antipsychotics, I think there was a question about that. So remember that olanzepine and ziprasidone can be given IM.

Long-acting, injectable antipsychotics are used to treat patients unable to adhere to daily regimens. Long-acting versions of aripiprazole, olanzapine, paliperidone, and risperidone may be administered by injection at two-week to three-month intervals.

Oral dosing of SGAs with standard or orally disintegrating tablets is the preferred route of administration in most patients. These formulations have equivalent dosing, absorption, and clearance.

Dosing at bedtime is generally preferred because of the sedation associated with many of these drugs, but exceptions are common and the medications work equally well irrespective of the time of the dose.

Common side effects associated with second-generation antipsychotics (SGAs) include weight gain and related metabolic effects, hypotension, sedation, anticholinergic symptoms, hyperprolactinemia, extrapyramidal symptoms (EPS), cardiac effects, cardiomyopathies, cataracts, and sexual dysfunction.

Take into account pt medical conditions when choosing an antipsychotic to use. For example:

●A patient whose symptoms include insomnia may benefit from a sedating antipsychotic. What antipsychotic causes sedation? Answer: quetiapine (seroquel).

●A patient with diabetes should avoid medications with a high risk of weight gain and metabolic effects. What antipsychotic is known for causing metabolic syndrome? Answer: olanzepine.

●A patient with a known cardiac problem or taking medications that prolong QT interval should preferentially receive an antipsychotic with a more favorable cardiac profile. What antipsychotic prolongs the QT interval? Answer: ziprasidone.

●A patient with essential hypertension may do well with an antipsychotic with hypotensive effects.

Rare but serious side effects include tardive dyskinesia, neuroleptic malignant syndrome, seizures, agranulocytosis, hypersensitivity reactions, and an increased risk of mortality from all causes, especially in older adult patients with dementia-related psychosis.

Weight gain, diabetes, and dyslipidemia are the components of metabolic syndrome usually associated with SGAs, along with the consequent risks of diabetic ketoacidosis and cardiovascular disease.

Clozapine and olanzapine carry significantly higher risk for metabolic syndrome than other antipsychotics, whereas aripiprazole, lurasidone, pimavanserin, and ziprasidone are associated with the lowest risk.

The potential morbidity of these symptoms has led to recommendations for routine short- and long-term monitoring of weight, waist circumference, blood pressure, fasting glucose, and lipid profile of patients taking any of the antipsychotic drugs.

Anticholinergic effects of antipsychotics include dry mouth, constipation, blurred vision, and urinary retention. Clozapine causes sialorrhea. Otherwise, it has the strongest anticholinergic effects.

regular inquiries regarding urinary retention, blurred vision, and especially constipation should be made. Aggressive treatment of constipation, often including prophylactic agents, may be required to avoid serious side effects, such as fecal impaction or bowel perforation.

Sources:

https://www.ncbi.nlm.nih.gov/pubmed/10427467

https://www.uptodate.com/contents/second-generation-antipsychotic-medications-pharmacology-administration-and-side-effects?search=antipsychotics&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

#antipsychotics

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paleorecipecookbook · 6 years ago

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The Carnivore Diet: Is It Really Healthy?

In my recent debate on the Joe Rogan Experience with Dr. Joel Kahn, I touched briefly on the carnivore diet. I’m a huge believer that meat is an essential part of a healthy diet, but eating an all-meat diet is an entirely different subject, and I think we need to be very careful about assuming that an intervention that works well in the short term will also be safe and effective in the long term.

In this article, I’ll discuss the diets of ancestral populations, how the carnivore diet affects the body, my concerns about the potential consequences of such a restrictive diet in the long term, and alternative dietary approaches that might offer the same benefits without having to go pure carnivore.

Are you considering going carnivore? The all-meat diet is trending, but completely dropping plant-based food off your plate could have a significant impact on your health. Check out this article for a breakdown on the strengths and weaknesses of the carnivore diet. #chriskresser

What Is the Carnivore Diet?

The carnivore diet is pretty straightforward: eat only animal foods and stay away from all plant foods. This means that you are primarily getting your energy from protein and fat and are consuming close to zero carbohydrates.

Many people who have adopted the carnivore diet report faster weight loss, improved mental clarity, healthier digestion, and even improved athletic performance. I certainly don’t doubt the anecdotal reports of people that have found remarkable relief from debilitating chronic health problems with this diet. For many of these people, nothing else they had tried worked.

However, when considering the health of a dietary or lifestyle intervention, I’ve long believed that we should look at the big picture: historical evidence from other populations, plausible mechanisms that explain its effect on our bodies, and scientific data regarding outcomes.

Were Any Ancestral Populations Carnivores?

Let’s start with a brief look at the diets of some supposedly “carnivorous” ancestral populations. Indeed, many ancestral groups thrived on large quantities of animal products. However, every single one of these groups also took advantage of plant foods when they were available:

The nomads of Mongolia nourished themselves on meat and dairy products, but also gained nutrients from their consumption of wild onions and garlic, tubers and roots, seeds, and berries. (1)

Gaucho Brazilians consumed mostly beef, but they supplemented their diet with yerba mate, an herbal infusion rich in vitamins, minerals, and phytonutrients. (2)

The Maasai, Rendille, and Samburu from East Africa primarily ate meat, milk, and blood. Young men almost exclusively ate these animal products but also occasionally consumed herbs and tree barks. Women and older men consumed fruit, tubers, and honey. (3)

The Russian Arctic Chukotka subsisted on fish, caribou, and marine animals but always ate them with local roots, leafy greens, berries, or seaweed. (4)

The Sioux of South Dakota ate great amounts of buffalo meat, but they also ate wild fruit, nuts, and seeds that they found as they followed the buffalo herds. (5)

The Canadian Inuit lived primarily on walrus, whale meat, seal, and fish, but they also went to great lengths to forage wild berries, lichens, and sea vegetables. They even fermented some of these plant foods as a way of preserving them. (6)

Every culture we know of that has been studied ate some combination of animal and plant foods. This does not necessarily mean that animal or plant foods are required to remain healthy, but it does speak to the ancestral wisdom of these cultures.

Five Reasons Why the Carnivore Diet Works

When any diet, drug, or other intervention “works,” it’s important to try to understand the mechanism behind it. In the case of the carnivore diet, there are several reasons that might explain the benefits people report.

1. The Carnivore Diet Can Restrict Calories and Mimics Fasting

Ever felt stuffed after you ate a huge steak? Protein is very satiating, meaning it fills you up and sends signals to your brain that you’ve consumed enough food. It’s no surprise that people report not feeling very hungry and start eating less frequently when they adopt an all-meat diet.

Food habituation may also play a role here. When you eat the same thing day after day, your brain doesn’t get as much reward value from food, so you start to eat less food overall—even if the food is usually something you find rewarding, like a big juicy steak.

The ultimate result is unintentional caloric restriction. Caloric restriction sets off a number of changes. When caloric intake drops, the concentration of insulin, insulin-like growth factor 1 (IGF-1), and growth hormone are significantly reduced. This condition triggers autophagy, which literally means “self-eating”—an internal process of cleaning up old cells and repairing damaged ones. Autophagy is also induced during fasting.

This may be why caloric restriction is so effective at reducing inflammation and alleviating symptoms of autoimmune disease. (7) Of course, caloric restriction also results in weight loss. These are arguably the two primary reasons that people seem to be drawn to the carnivore way of eating, but these effects might also be achieved through simple caloric restriction.

2. The Carnivore Diet Is a Low-Residue Diet

“Residue” is essentially undigested food that makes up stool. A low-residue diet is a diet that limits high-fiber foods like whole grains, nuts, seeds, fruits, and vegetables. It is often prescribed for people with inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS) to alleviate symptoms like diarrhea, bloating, gas, and abdominal pain. (8)

Meat is made primarily of protein and fat, which are absorbed high up in the GI tract, leaving little residue leftover to irritate or inflame the gut. In other words, an all-meat diet is effectively a very low-residue diet and gives the gut a rest.

3. The Carnivore Diet Is Often Ketogenic

If you’re eating large amounts of meat but are only eating once or twice a day and adding extra fat to the meat, your diet is likely ketogenic. A ketogenic diet is a high-fat, moderate-protein diet, with:

60 to 70 percent of energy from fat

20 to 30 percent of energy from protein

5 to 10 percent of energy from carbohydrates

While the carnivore diet has no such macronutrient ratios, it’s likely that some of the benefits that come with eating meat alone are due to the body being in a state of ketosis.

Ketogenic diets have been shown to be helpful for a wide variety of conditions, including multiple sclerosis, diabetes, and neurological conditions like Parkinson’s disease and Alzheimer’s. (9, 10)

4. The Carnivore Diet Changes the Gut Microbiota

Switching to an all-meat diet can also rapidly alter the gut microbiota. A 2014 study found that putting healthy human volunteers on an animal-based diet resulted in significant changes to the gut microbiota in less than 48 hours. (11) The animal-based diet increased the abundance of bile-tolerant organisms and decreased the levels of microbes known to metabolize different plant fibers.

The gut microbiota has been linked to virtually every chronic inflammatory disease that has been studied, so it’s no surprise that an intervention that drastically changes the gut microbiota could have significant implications for health. (12)

The Biggest Potential Problem with This Diet: Nutrient Deficiencies

Now that we’ve established some of the mechanisms involved, the big question is: is the carnivore diet safe?

The short answer is that we really don’t know, since there are no long-term studies that have tracked large groups of individuals on carnivore diets for any significant length of time. One of my chief concerns about it is that it lacks several nutrients that are crucial for health.

There are four micronutrients that are especially difficult to obtain on a meat-only diet. Based on a typical carnivore diet and the Dietary Reference Intakes (DRIs) established by the Institute of Medicine, these include:

Vitamin C: An antioxidant that boosts immune cell function and is important for stimulating collagen synthesis

Vitamin E: An antioxidant that prevents the oxidation of lipids and lipoproteins

Vitamin K2: A fat-soluble vitamin that reduces the calcification of blood vessels

Calcium: A mineral required for healthy bones, muscle contraction, and nerve transmission

If dairy is included in the diet, this will cover vitamin K2 and calcium. However, if you don’t like organ meats, the number of potential micronutrient deficiencies increases significantly. In that case, you can add to the list:

Vitamin A: A fat-soluble vitamin important for proper vision and maintaining immune defenses

Folate: A B vitamin important for cell growth, metabolism, and methylation

Manganese: A trace mineral needed for the proper function of the nervous system, collagen formation, and protection against oxidative stress

Magnesium: A mineral that supports more than 300 biochemical reactions, including energy production, DNA repair, and muscle contraction

It’s also important to note that vitamin C is extremely heat sensitive, so only fresh or very gently cooked organ meats will have appreciable amounts.

Many carnivore dieters claim that the nutrient requirements for the general population simply don’t apply to them. Anecdotally, I know of several individuals who have consumed a carnivore diet for three or more years without any overt signs of nutrient deficiencies.

Still, we’re lacking data. Currently, the DRIs are the best we have to go off of, and I don’t think we have enough evidence to unequivocally say that this diet has no risk of producing nutrient deficiencies in the general population.

Should We Be Aiming Higher Than the Daily Recommended Intake?

Even if the carnivore diet were sufficient to prevent outright deficiency, we should also consider metabolic reserve. Metabolic reserve is the capacity of cells, tissues, and organ systems to withstand repeated changes to physiological needs. In other words, it’s having enough nutrients “in the bank” to be able to deal with a major stressor, injury, or environmental exposure. (13) So if an all-meat dieter manages to meet a recommended nutrient intake, it still may not be enough for optimal health.

Other Reasons an All-Meat Diet May Not Be Healthy

It Lacks Beneficial Phytonutrients

Phytonutrients are chemicals that are produced by plants to protect against environmental threats, such as attacks from insects and disease. They can also have major benefits for our health. Curcumin, beta-carotene, quercetin, and resveratrol are all examples of common phytonutrients.

Some proponents of the carnivore diet suggest that phytonutrients are toxic to humans, and that it’s best to eliminate them completely from our diet. However, many of these “toxins” act as acute stressors that actually make us stronger through a process called hormesis.

Much like resistance training is an acute stressor that leads our muscles to adapt and get stronger, exposure to small amounts of phytonutrients is a hormetic stressor that activates several different pathways in the body, ultimately serving to reduce inflammation, enhance immunity, improve cellular communication, repair DNA damage, and even detoxify potential carcinogens. (14, 15)

It Might Affect Hormones, Fertility, and Thyroid Function

We have zero long-term data about how an all-meat diet impacts hormones, thyroid function, and fertility. I have written before about why carbohydrates are particularly important for female fertility and why very-low-carb diets may not be the best choice during pregnancy.

Carbohydrates are particularly important for supporting thyroid function since insulin stimulates the conversion of inactive thyroid hormone T4 to active T3. In fact, traditional cultures that ate largely animal products and had little access to plant foods often went to great lengths to support fertility, including eating the thyroid glands of the animals they hunted. (16)

My guess is that most modern “carnivores” are not consuming the thyroid glands of animals and are therefore at risk for suboptimal thyroid function and (at least temporary) infertility.

It Could Overtax Your Liver (If You’re Eating Lean Meat)

When you don’t eat sufficient carbohydrates and fat, your liver can make glucose from protein via a process called gluconeogenesis. This process creates nitrogen waste, which must be converted to urea and disposed of through the kidneys.

While this is a normal process that occurs in every human being, there is a limit to how much protein the liver can cope with safely. More than 35 to 40 percent of total calories as protein can overwhelm the urea cycle, leading to nausea, diarrhea, wasting, and, potentially, death. For pregnant women, this threshold may be as low as 25 percent of total calories. (17)

Interestingly, anthropological evidence suggests that hunters throughout history avoided consuming excess protein, even discarding animals low in fat when food was scarce. (18)

In short: When eating meat, it’s important to have a good amount of healthy fats or quality carbohydrates as well.

Is the Carnivore Diet the Ideal Human Diet?

In the last section, I outlined several potential concerns with the carnivore diet. But this leads me to another important question: even if the carnivore diet is safe, is it really the best diet for optimal health?

While you might be able to get away with a vegetarian or carnivorous diet for a short while, the evidence suggests that the ideal diet includes both animal and plant foods. Dr. Sarah Ballantyne broke this down in part three of her series “The Diet We’re Meant to Eat: How Much Meat versus Veggies.”

While you can theoretically get all of your nutrients from one group alone (and potentially supplement with any missing nutrients from the other group), we need both sets of nutrients to be optimally healthy, and consuming animal and plant foods in their whole form is the best way to accomplish this.

Five Alternatives to the Carnivore Diet

Here are some options that might provide the same therapeutic benefits that the carnivore diet can offer—but without as much potential risk.

1. A Low-Carb Paleo Diet

Some people trying a carnivore diet are going straight from the Standard American Diet to pure carnivore. Oftentimes, a low-carbohydrate Paleo template might provide some of the same benefits, including weight loss, improved insulin sensitivity, and an alleviation in autoimmune symptoms. (19, 20, 21)

2. A Fasting Mimicking Diet

A fasting mimicking diet can reverse type 1 and type 2 diabetes, alleviate age-dependent impairments in cognitive performance, and protect against cancer and aging in mice. (22, 23, 24) In humans, the fasting mimicking diet was found to significantly reduce body weight, improve cardiovascular risk markers, lower inflammation, and potentially improve symptoms of multiple sclerosis. (25, 26)

3. Periodic Prolonged Fasting

Undergoing a 72-hour fasting once every few months could also achieve many of the benefits boasted by the carnivore diet. Prolonged fasting causes organs to shrink and then be rejuvenated as damaged cells are cleared out and stem cell pathways are activated. (27)

4. A Ketogenic Diet

The ketogenic diet has been very well studied and has documented benefits for epilepsy, neurodegenerative disease, and autoimmune disease. Ketones themselves are potent anti-inflammatories. (28, 29)

5. Addressing Gut Pathologies

If a healthy lifestyle coupled with the dietary approaches above is insufficient to control your symptoms, consider working with a Functional Medicine practitioner who is knowledgeable about gut health. If you’re thinking about becoming a strict carnivore because you’re experiencing adverse reactions to even very small amounts of plant foods, that’s likely a sign of an underlying gut infection that should be addressed.

Share this with friends and family who might be considering an all-meat diet, and be sure to leave your thoughts in the comments below.

The post The Carnivore Diet: Is It Really Healthy? appeared first on Chris Kresser.

Source: http://chriskresser.com February 06, 2019 at 01:31AM

#paleo #recipe #food #delicious #healthy #yum #diet

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celestialpotat0 · 3 years ago

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I just wanted to say that I’m proud of myself, because I definitely don’t tell myself that enough. I’ve been really tough on myself, hating myself for what I perceived as my flaws, feeling like I was not good enough.

I trained a new shift, the TPN shift, at work Mon-Wed last week, then have been staffing it solo ever since (I had my seventh solo TPN shift today.)

I had dosed TPN per Pharmacy throughout my internship and residency so felt very comfortable with writing adult PNs. But the TPN shift at my current job in a pediatric hospital is completely different. The major difference being that prior to my first day of training this shift, I had never written a pediatric PN before. And now I am clinically assessing (and in some cases, writing) PNs for patients who are 1 day old and born very prematurely to patients who are big teenagers. There were 43 patients on PN in our hospital today. This shift is responsible for verifying PNs and modifying orders, coordinating the compounding/checking/packaging/delivery of the PNs, answering the dedicated phone line for any provider with questions about PNs, troubleshooting any compounding issues that arose, managing the prepacking of lipids with this severe shortage going on, etc. Essentially making sure that all 43 PNs are clinically optimal and reach the patients. This is a demanding shift and I had been intimidated by how tough it seemed.

I studied a good amount for it in the weeks leading up to my training, in my hotel room while I was on vacation, on the plane back from vacation, trying to get some reading in in bed before sleeping. On my first day of training, it took me like an hour or maybe even more than an hour to assess one PN order. It was hard for me to fathom how I was supposed to reach that point where I was going to be able to staff solo. But I kept practicing and studying and by the end of the last day of training, I felt ready to take on my solo shifts. I had to stay overtime on a number of my solo days, and I couldn’t help but feel like a failure. I criticized myself for not being able to finish the workload by the scheduled end time of my shift.

Today, I actually got a lot of phone calls and messages from providers with questions and issues. I was able to answer them and provide my recommendations. That slowed me down a lot, but I also was still able to do the other work faster so that I reached the goal number of PNs to verify, despite a number of them being new patients and initiations. I also finished assessing the last order maybe around 4:45pm or so (when I was training I was finishing that around 6pm).

I didn’t treat myself the best these past two weeks. I’ve focused more on the work than taking any breaks. This morning before my alarm rang, I had already woken up out of anxiety 3 hours before I had to be at work and immediately went to my computer to check one of my patient’s labs out of fear that I might have made a mistake on dosing this 5-week-old infant’s PN. I was extremely relieved to see all of her labs were within normal limits, because I had been picturing the terrible things that could have happened if I had accidentally made a mistake. It’s been exhausting. But honestly, it feels like it was all worth it after how today went and I noticed that I’ve grown so much since training. What seemed daunting before became something that I could manage.

I had also trained and staffed other shifts, and I have been really negative and toxic to myself, focusing on things I didn’t know, ways I wasn’t good enough. But I wanted to take a moment for once to focus on my growth. I have an even more intimidating shift I’ll be training next week; I think what will make it tough is the patient and order load, the large number of med errors in the orders (many providers are learners), and all of the clinical question phone calls I’ll get. But I now believe that I CAN do it, like how I learned so much for this TPN shift. Not only can I do it, but the whole process and journey is SO rewarding precisely because I once struggled and then I got to a point when I realized I’m actually comfortable with the shift and can handle dilemmas the shift throws at me.

I spent my years as a student and resident building confidence in my clinical knowledge and skills, all for adult patients. I knew the answers and I felt competent (except for when the attending physician grilled me during my last rotation when I had had two hours of sleep the night before and didn’t get to study that topic ahead of time, but that’s a whole ‘nother story). Since I started working at a pediatric hospital last year, that confidence was replaced with... just feeling like I know so little. Pediatrics is a whole different world, so I feel like I’m starting from scratch again. I’m a student again learning everything for the first time, and I don’t like the feeling of insecurity in my lack of experience with pediatric patients. But I’ve also always sought being out of my comfort zone, so I feel very fulfilled too. I am learning so much, which is exactly what I wanted. I don’t like feeling like I don’t know the answers. I’m used to being comfortable with clinical shifts and answering drug info questions from providers. Now I need to continue to channel my discomfort of feeling inexperienced in pediatrics to studying hard and working really hard to become a better pediatric clinician. If I hate this feeling of lacking, then I’d better work harder. Again, I want to remind myself that how I did today is proof to myself that I am capable.

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your-dietician · 3 years ago

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Diet change, exercise may help

New Post has been published on https://depression-md.com/diet-change-exercise-may-help/

Diet change, exercise may help

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Can lifestyle changes help with resistant hypertension? stockstudioX/Getty Images

Researchers recently investigated whether lifestyle changes could reduce blood pressure among people with resistant hypertension.

Resistant hypertension refers to high blood pressure that does not respond well to medical treatments.

Their results suggest that supervised lifestyle changes, including dietary changes, group counseling, and a cardiac rehabilitation exercise program, provide similar results as medications in reducing blood pressure.

The researchers hope that their results will encourage policymakers to consider cardiac rehabilitation as a new treatment for resistant hypertension.

The World Health Organization (WHO) estimates that 1.28 billion adults worldwide aged 30–79 have high blood pressure, or hypertension.

Over time, high blood pressure can damage blood vessels and organs. It can lead to potentially life-threatening events, such as stroke, heart attack, and organ damage.

Several medications exist to manage hypertension. However, around 20% of people with the condition have resistant hypertension, which means that medications do not bring their blood pressure into the healthy range.

Resistant hypertension has links to an increased risk of organ damage and a 50% greater risk of adverse cardiovascular events, compared with people who have treatable hypertension.

Some preliminary evidence suggests that diet and physical activity can lower blood pressure among those with resistant hypertension. However, to date, there is a lack of high-quality studies.

In a recent study, researchers from Duke University School of Medicine in Durham, NC, conducted a randomized clinical trial called ‘Treating Resistant Hypertension Using Lifestyle Modification to Promote Health’ (TRIUMPH) to examine the link between lifestyle changes and resistant hypertension.

They investigated how a 4-month combined diet and exercise intervention delivered in a cardiac rehabilitation setting compared with a single educational session providing the same lifestyle prescription in reducing blood pressure.

“Our findings indicate that lifestyle modifications in patients with resistant hypertension […] can successfully lose weight, increase their physical activity, and as a result, lower blood pressure and potentially reduce their risk of experiencing a heart attack or stroke due to their high blood pressure,” James A. Blumenthal Ph.D. told Medical News Today.

Blumenthal is the first and senior author of the study and J.P. Gibbons Professor of Psychiatry and Behavioral Sciences at Duke University School of Medicine.

The study appears in Circulation.

The researchers recruited 140 people with resistant hypertension and an average age of 63 years. Overall, 48% of patients were female, 59% were black, 31% had diabetes, and 21% had chronic kidney disease.

All participants had a body mass index (BMI) of 25 kilograms per square meter or higher at the start of the study and did not engage in regular moderate or vigorous physical activity.

Participants, on average, were taking 3.5 prescribed blood pressure-lowering medications.

The researchers randomized the participants into one of two 4-month treatment groups. The first group of 90 participants received instructions from a nutritionist about the DASH diet alongside caloric and sodium reductions.

The DASH diet is a flexible eating plan that reduces sugar and saturated fat intake and increases consumption of vegetables, fruits, whole grains, fish, poultry, and legumes.

Participants in the first group exercised at a cardiac rehabilitation facility three times each week for 30-45 minutes and underwent weekly group counseling sessions to support their lifestyle changes.

The second group of 50 participants received a 1-hour educational session on blood pressure management delivered by a health educator alongside a workbook outlining an individualized diet and exercise program. The workbook included information on the DASH diet, caloric restriction, and the same exercise program as those in the other group.

The researchers recorded participants’ blood pressure before, during, and after the 4-month intervention. They also kept track of participants’ diet, weight, and cardiovascular fitness. Participants were encouraged to continue taking any pre-existing hypertensive medications throughout the trial as instructed by their doctor.

After the 4-month program, the supervised group saw a 12-point drop in resting systolic blood pressure compared with 7 points in the self-guided group. Systolic blood pressure refers to the pressure the blood exerts on the artery walls as the heart beats.

The supervised group also saw their 24-hour systolic blood pressure readings drop by 7 points, while the self-guided group saw no changes in their 24-hour blood pressure readings.

Participants in the supervised group performed well on other markers, too. They lost an average of 15.3 pounds (lbs) in weight over the study period, compared with 8.5 lbs in the self-guided group. That is around 7 kilograms (kg) and 4 kg, respectively.

They also increased their oxygen uptake by 14.8%, compared with 3.4% in the control group. Increased oxygen uptake is a positive indicator for cardiorespiratory function.

“Being a randomized control trial (RCT), the study is considered high in the pyramid of scientific evidence,” José M. Ordovás, Ph.D., Director of Nutrition and Genomics at Tufts University, MA, who was not involved in the study, told MNT.

“Obviously, more significant numbers and extended length would have made the study better and answered additional questions. However, I consider this an excellent first step towards bigger and longer studies. Another beauty of the study was its simplicity, which may have facilitated its clear answer,” he added.

Scientists have already shown that elements of the lifestyle changes in the study, such as reduced salt intake, weight loss, and exercise, can lower blood pressure. Which of these plays the most significant part in reducing blood pressure, however, remains unclear.

“We were unable to determine which aspects of the intervention were primarily responsible for the blood-pressure-lowering effects — whether it was the improved aerobic fitness, weight loss, greater consumption of certain nutritional components of the DASH eating plan, salt restriction, or other aspects of the intervention,” said Dr. Blumenthal.

“We believe that for the lifestyle program to be maximally effective, all components of the intervention need to be provided. There is any number of potential physiologic mechanisms that could have affected our results, which we hope to examine in the future,” he added.

“Based on the results presented, things did not work through traditional [cardiovascular disease] biochemical markers (inflammation, lipids, glucose),” said Dr. Ordovás

“Obviously, it did not work through the pathways involved in response to antihypertensive drugs because they were resistant to them. The most obvious element here may be weight loss. […] It would be interesting to see if there was a correlation between blood pressure and weight changes,” he continued.

The researchers concluded that people could best accomplish lifestyle changes when assisted by a multidisciplinary team of health professionals in a cardiac rehabilitation setting.

“While some individuals can make the changes on their own, a structured program of supervised exercise and dietary modification conducted by a multidisciplinary team of physicians, psychologists, nutritionists, and physical therapists/exercise physiologists found in cardiac rehabilitation programs throughout the country is likely to be more effective,”

– Dr. Blumenthal.

The researchers note that only five study participants had systolic blood pressure above 160 millimeters of mercury. Hence, the efficacy of lifestyle intervention among those with more severe hypertension remains uncertain.

“Sometimes, the limitations in many of these studies are their generalizability, “Dr. Ordovás told MNT, “Still, in this case, there was a good representation of minorities and gender. But, the overall environment was similar, and this needs to be replicated in other geographical and cultural areas.”

“The other obvious limitation is that it was not directed to respond to precision medicine or precision nutrition. Therefore, whereas the means showed a benefit towards the group undergoing the more intense intervention, this study does not reveal who benefited and did not,” he added.

“All patients with hypertension should be following appropriate diet and exercise recommendations, but doing this is hard,” Dr. Edo Paz told MNT, “In my experience, lifestyle changes are rarely enough to treat even simple hypertension.”

Dr. Paz, who was not involved in the study, is vice president of medical at K Health and a cardiologist at White Plains Hospital, NY, part of the Montefiore Health System.

“Overall, the results are not surprising. Cardiac rehabilitation has already been shown to be effective in preventing heart issues and death. We use it in people with certain severe cardiac conditions, like people recovering from a heart attack or people hospitalized with congestive heart failure,” he added.

“Unfortunately, only 1 in 4 eligible patients participate. Given what we know about cardiac rehab and the results of this study, we should use this tool more broadly, including referring more patients and making sure that referred patients participate,”

– Dr. Paz

“Results of the TRIUMPH study suggest that policymakers should consider resistant hypertension as a new indication for cardiac rehabilitation with appropriate coverage by governmental agencies and private insurers,” Dr. Blumenthal said to MNT.

“Importantly, we also need to determine if such lifestyle changes can be sustained — and, if not, patients may need ‘booster’ sessions to ensure that they can maintain the healthy lifestyle choices over time,” he concluded.

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jessicalorenzin · 4 years ago

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Cannabis Coach Review As Well As Comprehensive Overview On Quitting Weed Completely

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carterrollins96 · 4 years ago

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Grow Taller 19 Years Old Stupefying Tricks

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#Grow Taller 19 Years Old Stupefying Tricks #Grow 4 Inches Taller Exercise

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maldonadohoward · 4 years ago

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Can Fish Oil Increase Height Wonderful Tricks

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#Can Fish Oil Increase Height Wonderful Tricks #How To Get Taller In Just Your Legs

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bhuwank · 4 years ago

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TESTING THE HEART

Heart care has become an industry. A number of heart institutes are being opened every day worth crores of rupees, in one or the other part of the country. The main aim of these institutions is to make money by performing as many bypass surgeries or angioplasties, because these operations only can earn astronomical amount of money. Estimations of Rs. 3 Lacs to Rs. 5 Lacs for one such operation are not uncommon. Some of the hospitals still perform these operations for as low as 65000, if they are in a small city like Coimbatore or Varanasi!

In these hospitals, necessary and unnecessary investigations or tests are also performed as a secondary source of revenue. Every cardiologist sends for a battery of investigations. Blood samples are drawn several times from the patients in a day in these hospitals. Many of these investigations are also done for the outdoor (OPD) patients also. The other day one of my patients told me that for tests only he has spent about Rs, 50000 in a heart hospital and then told him to bring another 3 lacs for the angioplasty. Mostly these patients are not explained what these tests are, why were they necessary and what are the interpretations.

In this issue we thought we should inform our readers about some of the investigations that are possible for a heart patient and their meanings. Some of the tests are almost compulsory to perform in a suspected heart patient or a confirmed heart patient. Some of them are to be performed on special occasions. In this issue we shall find out about some of the tests, in whom they should be done and what the results would mean.

Another disturbing thing that I found in heart hospitals is that they perform another battery of tests, which may be only necessary in case patient wants to opt for an operation and they prescribe these tests without telling the patients that they are performing these tests to prepare for the heart operation. These tests are HIV tests, Hepatitis test, X ray chest, Total blood count and differential count, kidney function tests, liver function tests, Blood grouping and serum Electrolytes. Most of these tests have no bearing with the treatment of heart disease, do not perform the most needed lipid profile test, which will inform the patient about the cause of the disease.

Angiography is the most invasive of all the tests described in the this issue but the results are unreliable and approximate. I do not recommend this test mostly. It should be done only when the patient is very keen to undergo bypass surgery or angioplasty.

THE BLOOD TESTS

Lipid Profile

The lipid profile is a group of tests that are often ordered together to determine risk of coronary heart disease. The tests that make up a lipid profile are tests that have been shown to be good indicators of whether someone is likely to have a heart attack or stroke caused by blockage of blood vessels (hardening of the arteries).

The lipid profile includes total cholesterol, HDL-cholesterol (often called good cholesterol), LDL cholesterol (often called bad cholesterol) and triglycerides. Sometimes the report will include additional calculated values such as HDL/ Cholesterol ratio or a risk score based on lipid profile results, age, sex, and other risk factors.

The lipid profile is used to guide providers in deciding how a person at risk should be treated. The results of the lipid profile are considered along with other known risk factors of heart disease to develop a plan of treatment and follow-up.

Blood Glucose

Blood glucose is the correct and scientific term. But in colloquial language people, even the doctors , use the term “blood sugar” for blood glucose. A conventional sugar test would mean testing for fasting and post prandial (PP) i.e. after meal. A good control would mean a fasting sugar of less than 100 mg/dl and a PP sugar of 140 mg/dl.

Serum Glycosylated Haemoglobin

Blood glucose estimation on a particular date can only tell about the control of diabetes on that date. But there is a blood test, which can instantly give us an idea about control of blood glucose over the past three months. This test can help in avoiding frequent blood testing and needle pricking. This test is called glycosylated haemoglobin (HbA1C). In a normal person with normal blood sugar the reading is about 6%. A diabetic with the worst of control will have a reading of about 12%. Saaol expects a figure of 7% or below. The principal behind the test is that it measures the glucose tagged haemoglobin percentage in blood. Haemoglobin (Hb) is produced in our body continuously. But on the day the blood glucose is high the haemoglobin would get tagged with glucose. Thus, the increase in the high glucose period will be associated with higher glycosylated haemoglobin.

Cardiac Enzymes

Cardiac Enzymes are protein molecules released into the blood stream from heart muscle damaged by a blocked artery. This is known as a heart attack. When someone is admitted to the hospital with a clear cut heart attack, these enzymes are measured to get an idea of how much muscle was damaged.

Many people are admitted to the hospital with apparent heart symptoms but other tests such as the ECG are inconclusive about whether a heart attack (i.e. damage to the heart muscle) actually occurred. In these cases, the cardiac enzymes are used to determine if this was a heart attack as opposed to a bad episode of angina or perhaps symptoms unrelated to the heart altogether.

The enzymes most commonly measured these days are creatine phosphokinase (CPK) (also known as creatine kinase (CK)) and Troponin.

These enzymes have a characteristic rise and fall pattern after a heart attack. It may take 4 hours or more after the onset of symptoms for the test to become abnormal and upto 24 hours for the level to peak. Consequently, blood test are taken from the patient several times. A normal blood test upon arrival in the emergency room does not mean a heart attack has not occurred. Eventually, the levels in the blood fall back to normal.

Troponin T&I

These are contractile proteins of the myofibril (heart muscle). The cardiac isoforms are very specific for cardiac injury and are not present in serum from healthy people. Troponin I is the form frequently assessed. There is new form (Troponin L) which may be detected earlier.

Rises 4-6 hours after injury

Peaks in 12-16 hours stays elevated for up to 10 days.

Electrocardiogram (ECG)

The ECG is the most commonly performed cardiac test. This is because the ECG is a useful screening tool for a variety of cardiac abnormalities; ECG machines are readily available in medical facilities; and the test is simple to perform, risk free and inexpensive.

How is the ECG performed?

The patient lies on an examination table, and 10 electrodes (or leads) are attached to the patients arms, legs and chest.

The electrodes detect the electrical impulses generated by the heart, and transmit them to the ECG machine. The ECG machine produces a graph (the ECG tracing) of those cardiac electrical impulses. The electrodes are then removed. The test takes less than 5 minutes to perform.

What information can be gained from the ECG?

From the ECG tracing, the following information can be determined:

· The heart rate

· The heart rhythm

· Whether there are “conduction abnormalities” (abnormalities in how the electrical impulse spreads across the heart).

· Whether there has been a prior heart attack

· Whether there may be coronary artery disease

· Whether the heart muscle has become abnormally thickened.

All of these features are potentially important. If the ECG indicates a heart attack or possible coronary artery disease, further testing is often done to completely define the nature of the problem and decide on the optimal therapy.

The Echocardiogram

The echocardiogram is an extremely useful test for studying the heart’s anatomy. It is non-invasive and entirely safe, and when interpreted by well-trained cardiologists, is very accurate.

How is the echocardiogram performed?

The patient lies on a bed or examination table, and the echo technician places a transducer (a device that resembles a computer mouse) over the chest wall. The transducer is moved back and forth across the chest wall, collecting several “views” of the heart.

The Stress Test

Some forms of cardiac disease are easily missed when the patient is at rest, because at rest the patient’s physical examination and ECG are often entirely normal. In these cases, cardiac abnormalities may become apparent only when the heart is asked to perform at increased workloads.

The stress test is used to evaluate the heart and vascular system during exercise. It helps to answer two general questions: 1) Is there occult underlying heart disease that only becomes apparent when the heart is stressed by exercise? 2) If there is underlying heart disease, how severe is it?

How is a stress test performed?

The patient is attached to an ECG machine, and a blood pressure cuff is placed on one arm. Sometimes a clothespin-like sensor is attached to the finger to measure the amount of oxygen in the blood. After a baseline ECG is obtained, the patient begins to perform a low level of exercise , either by walking on a treadmill, or pedaling a stationary bicycle. The exercise is “graded”- that is every three minutes, the level of exercise is increased. At each stage of exercise the pulse, blood pressure and ECG are recorded, along with any symptoms the patient may be experiencing.

With a “maximal” stress test, the level of exercise is gradually increased until the patient cannot keep up any longer because of fatigue, or until symptoms (chest pain, shortness of breath, or lightheadedness) prevent further exercise, or until changes on the ECG indicate a cardiac problem. Maximal stress tests should be performed when the goal is to diagnose the presence or absence of coronary artery disease.

After the test, the patient remains monitored until any symptoms disappear, and until the pulse, blood pressure and ECG return to baseline.

Hope you liked this article!

This article is written by Dr. Bimal Chajjer (Heart Care Specialist)

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economicplus · 5 years ago

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USA We've been flooded with thousands of reader questions on coronavirus. We're answering them.

USA CLOSE

An epidemiologist answers the biggest questions she's getting about coronavirus. Wochit As the coronavirus pandemic continues to shut down daily life across the globe, thousands of our readers across the nation have asked us questions about COVID-19. And we're answering them. For basic facts about the virus – what it is, how it spreads and where it's located – you can get caught up by reading our in-depth explainer here. We've also debunked some viral coronavirus myths. But you're curious and continue to ask important questions via our newsletter, Coronavirus Watch. (Not a newsletter subscriber? Sign up for it here!) So below, you can find answers to questions such as: Is it OK to be outside? How old are people who are dying in the U.S.? Is it safe to get carry-out food? If you don't see an answer you're looking for, check out our newest Q&A where we talk about UV radiation, antibodies, cats and more. What else would you like to know? Ask us by filling out the form you can find here.

USA Can UV radiation from the sun kill the virus?

– Charlie from Dade City, Florida Experts have advised against using concentrated UV light to prevent or treat the coronavirus and do not recommend going in the sunlight to kill the virus. Only levels of concentration of UV light much higher than what is found in sunlight can kill viruses, the experts note, and the levels that are able to kill viruses can cause irritation to human skin and should be avoided. Neither sunlight or UV light is listed as a preventative measure on the websites of the World Health Organization or the U.S. Centers for Disease Control and Prevention. Fact check: Sunlight does not kill the new coronavirus

USA My primary income is from rentals. If my tenants are unable to pay their rent, what kind of relief is available to me?

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USA Is it true that everyone who is on unemployment due to COVID-19 will receive an additional $600 a week as part of the stimulus package?

– Hannah from Canton, Ohio The stimulus package expands unemployment insurance benefits. If you've lost your job because of the outbreak, you will see your weekly state insurance benefits – which average about $400 – increased by $600 for four months. And if you are still unemployed after state benefits end, you could get an additional 13 weeks of help.

USA What are the results so far with the tests of the Z-Pak and malaria med, hydroxychloroquine?

– Pat from Alexandria, Virginia There are no approved therapies or drugs to treat COVID-19. Anecdotal reports suggest that a known anti-malarial (hydroxychloroquine) combined with a common antibiotic (azithromycin, sold as Zithromax and Z-Pak) may offer some benefit in the treatment of hospitalized COVID-19 patients. A very small study in France of just a couple dozen patients found some evidence that the combination was effective in fighting COVID-19. A subsequent study of 80 patients in France found clinical improvement in all but one. Studies in China have suggested similar results. Researchers have warned that the drugs can have risky side effects and could cause subtle heart changes and increase a person's risk of developing arrhythmia. Clinical trials of the drug combination began in New York on March 24, and the FDA on March 29 granted emergency use of hydroxychloroquine by hospitals. Several other clinical trials are in the works, according to ClinicalTrials.gov. But it's still too early to say whether the drugs are effective.

USA How many people have recovered from the virus?

– Stephanie from Mt Pleasant, South Carolina More than 191,000 people worldwide have recovered from the virus as of Wednesday, according to data from Johns Hopkins University. Most of the recoveries have been in China, followed by Spain, Germany, Italy and Iran. Of the more than 203,000 confirmed cases in the U.S., more than 8,000 have recovered.

USA Will families who receive food stamps be eligible for the stimulus check?

– Renda from Miami, Florida Yes, families who receive food stamps are eligible to receive a stimulus check! The $2 trillion stimulus plan includes one-time payments of $1,200 per adult and $500 per child, $367 billion for small businesses, $500 billion for loans to larger industries, $100 billion for hospitals and the health care system, and $600 more per week in unemployment benefits for those out of work. Here's how you can calculate the amount of stimulus money your household can expect.

USA Is the virus a DNA molecule protected by a thin layer of fat that will disintegrate if that fat layer is removed outside your body?

– Rita in Las Vegas, Nevada SARS-CoV-2 particles are spherical bundles of genetic material (RNA) surrounded by a fatty outer layer (lipids) with proteins called spikes protruding from the surface. These spikes latch onto receptor proteins on human cells in the lungs and other tissues and change the structure of those human cells, allowing the viral genes to enter the host cell to be copied, producing more viruses. Viruses need a host to "survive," and the fat layer breaks down when it is out on its own in the environment. Preliminary researc h suggests that the virus is stable outside the body for different periods of time, depending on the climate and surface. You can "kill" the virus using soap, extreme heat and ultraviolet light, and each attacks a different part of this virus structure. Soap breaks up the fatty outer layer. Heat breaks up the protein spikes. And UV light breaks up the genes inside.

USA Has anyone with preexisting conditions gotten the coronavirus and survived?

– Dee from Arlington, Texas Yes, many people have. While the risk for serious disease and death from COVID-19 is higher in people who are older or who have certain preexisting conditions, thousands have survived. Data from the CDC published Tuesday found that, as of March 28, the U.S. reported 2,692 patients who had one or more underlying health conditions. Of those patients, 173 died. This limited data suggests that thousands of people who have one or more underlying health conditions have not died. Moreover, a February WHO study of more than 70,000 coronavirus patients in China found that people with preexisting conditions had higher fatality rates than those without preexisting conditions: 13.2% for those with cardiovascular disease, 9.2% for diabetes, 8.4% for hypertension, 8.0% for chronic respiratory disease, and 7.6% for cancer. However, those figures suggest that large percentages of people with preexisting conditions survived.

USA Can coronavirus be transmittedthrough secondhand smoke?

– David from Columbus, Georgia "It’s not the main mode of transmission. There's probably some component of airborne, but I don’t think secondhand smoke would be a compounding factor," said Tania Elliott, clinical instructor of infectious diseases at NYU Langone. If the smoke irritates your lungs and causes you to cough, that poses a greater risk of transmission since the virus is thought to mainly spread through respiratory droplets when someone coughs or sneezes, Elliot said. Smokers are likely to be more vulnerable to COVID-19 as the act of smoking means that fingers and possibly dirty cigarettes are in contact with lips, according to the WHO. Smokers may also already have lung disease or reduced lung capacity which would greatly increase risk of serious illness, the WHO says. While data is still evolving about how long the virus may remain alive, a recent study found that viable virus could be detected up to three hours later in the air.

USA Is cross-country road travel advisable to destinations outside of COVID-19 'hot spots'?

– Roland from Albuquerque, New Mexico The White House is asking Americans to stay home as much as possible to slow the spread of the virus, and some states and local governments have issued "stay home" and "shelter-in-place" orders. "I don’t think now’s the time to do it," Elliott said. "If you have a house somewhere else, that's fine. But I wouldn’t recommend being in hotels or crowded public settings. If you want take a road trip and go camping, there's risk associated with that."

USA Can you catch the virus from people who've died?

– Nikki from Albany, Georgia The main way the virus is thought to spread is through respiratory droplets produced when an infected person coughs or sneezes, and this is not a concern after death, according to the CDC. But people should consider not touching the body of someone who has died of COVID-19, the CDC says. There is no known risk associated with being in the same room at a funeral or visitation service with the body of someone who died of COVID-19, the CDC says. Kissing, washing and shrouding should be avoided before, during and after the body has been prepared, if possible. But holding the hand or hugging after the body has been prepared for viewing may pose less of a risk, the CDC says. CLOSE

Reviewed editor-in-chief David Kender shares creative ways to keep your kids engaged while you're stuck at home. USA TODAY

USA What is the value of testing for the coronavirus if there is currently no treatment?

– Linda from Brevard County, Florida There is value to getting tested because there are many reasons why someone would seek medical care for their symptoms, and ruling out the coronavirus is helpful in seeking other causes, said Jason Christie, chief of pulmonary medicine at Penn Medicine. "The biggest problem is we don’t have a quick and reliable test right now. Without that, we have to be smart and ration the testing to those people that need them most. So don’t go out and get tested right now unless you’re sick," Christie said. Testing also helps health officials figure out how prevalent and contagious a virus is.

USA Is it safe to get groceries during senior shopping hour?

– Pamela from Wellsville, Pennsylvania Acknowledging that older adults and persons with underlying health conditions are more susceptible to COVID-19, a growing number of stores are dedicating time or opening earlier for senior shoppers and other at-risk groups. But Elliott says she doesn't advise it. "That gives a false sense of security," she said. "By encouraging older people with chronic diseases to go out at a dedicated time, you're still exposing them to a bunch of other people, and if one person in that crowd is infected, then the virus will spread." Elliott said she'd rather see stores limiting the number of people who can enter during a given time period so that there are fewer people in the store. She also encourages healthy people to do the shopping.

USA Can the virus be transmitted through the mail? Should I stop sending greeting cards?

– Pam from Seven Lakes, North Carolina The chances of transmission through your mail is very low, Elliott says. "Parts of the virus can fall on surfaces and survive on surfaces for up to 72 hours. But you have to have pretty good conditions for that to happen. So the likelihood would be very small, even with no precautions," she said. Elliott advises people to put their mail down on a plastic plate instead of directly on a counter top or table, to use a letter opener, and to wash hands thoroughly after touching the mail. Research on how long a virus may live on surfaces is evolving. The CDC has said there is likely very low risk of transmission of COVID-19 from products or packaging that are shipped over a period of days or weeks "because of poor survivability of these coronaviruses on surfaces." A recent study found that viable virus could be detected up to three hours later in the air, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel. But a subsequent report from the CDC found that genetic material from the virus can live on surfaces for more than two weeks.

USA Are plastic grocery bags considered the plastic that you have to wait hours to touch?

– Elizabeth from Greenfield, Indiana You should take precaution with any containers, Elliott says. "The plastic grocery bags I’d throw out right away, wash your hands and then clean your food. Chances (of infection) are low," she said. "But better yet, bring your own bags! It’s better for the environment anyway."

USA They keep saying stay isolated for two weeks. But what happens after the two weeks?

– Al from Topeka, Kansas Officials suggest self-quarantining for two weeks if you've had exposure to somebody with the virus and might be infected. It's a way to monitor if symptoms develop and, at the same time, avoid any possible spread to others. Since the incubation period for the virus is up to 14 days, you're "cleared" for the virus after two weeks, Elliott said. After that, you still need to practice social distancing.

USA Is it advantageous for a younger healthy person to get the coronavirus to build immunity to it?

– Danny from Sundance, Wyoming No, for several reasons, says Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. While a protective antibody is generated in those who are infected, scientists are not yet sure whether that immunity will last for a short period of time, for years or for life. Some say the possibility of reinfection is very likely. Moreover, a new federal health report says Americans of all ages have faced serious health complications amid the outbreak. Data from the CDC show that among the roughly 12% of COVID-19 cases in the U.S. known to need hospitalizations, about 1 in 5 were among people ages 20 to 44. Anywhere from 14% to 21% of adults ages 20 to 44 with COVID-19 have been hospitalized, the CDC data estimates. Two to 4% of cases led to ICU admissions, and less than 1% were fatal. Finally, it's important to avoid getting and spreading the virus. While the young may not be the most at risk, they're carrying the disease to those who are more vulnerable, such as older people and those with underlying conditions. Dr. Deborah Birx, a member of the White House coronavirus task force, on Wednesday urged "the millennial generation" to take special precautions. "You have the potential to spread it," she said.

USA Does getting��pneumonia shots given to elderly people help if you get this virus?

– Linda from Hendersonville, Tennessee Vaccines against pneumonia, such as pneumococcal vaccine and Haemophilus influenzae type B vaccine, do not provide protection against the new coronavirus, according to the World Health Organization. The vaccines simply guard against those specific bacterial infections. The COVID-19 virus can, in fact, cause pneumonia, but the vaccines cannot prevent this pneumonia.

USA I see people in my neighborhood out running, riding bikes and walking their dogs. Is that OK?

– Patti from Carmel, Indiana Yes, that's OK! Just be sure to maintain distance from other people. The CDC recommends a distance of about 6 feet. Even in states and counties where residents are being asked to stay home or "shelter in place," it's still fine to go for a run, hike or do other outdoor activities, as long as proper social distancing is observed. Just don't be like Chicago, where city officials closed trails and parks after crowds of hundreds of people were seen congregating along the city’s lakefront. Remember: The White House recommends that you should avoid social gatherings involving more than 10 people, as well as all non-essential travel, shopping trips and social visits. Social distancing: Why it's so important to stopping the spread of coronavirus CLOSE

Social distancing matters. Here is how to do it and how it can help curb the COVID-19 pandemic. USA TODAY

USA Are there any projections to estimate the spread of COVID-19 and a timeline of its passing?

– Dennis from Las Vegas Yes, there are many projections, but scientists say they all hinge on how people behave. That's why it's essential to social distance and do what you can to prevent spread. A conservative USA TODAY analysis based on data from the American Hospital Association, U.S. Census, CDC and WHO estimates that 23.8 million Americans could contract COVID-19, leaving almost six seriously ill patients for every existing hospital bed. Another analysis finds that America’s trajectory of community spread is trending toward Italy’s, where circumstances are dire. One researcher at the Global Center for Health Security estimated last month that as many as 96 million Americans could be infected. The U.S. population on March 27 is estimated at 329 million. The Johns Hopkins Center for Health Security estimated that 38 million Americans will need medical care for COVID-19. The CDC's worst-case-scenario is that about 160 million to 210 million Americans will be infected by December. Under this forecast, 21 million people would need hospitalization and 200,000 to 1.7 million could die by the end of the year. Outside the U.S., leaked British documents projected that a coronavirus outbreak could rage until spring 2021. German Chancellor Angela Merkel said 60% to 70% of her country's population could eventually become infected. USA TODAY analysis: America's coronavirus 'curve' may be at its most dangerous point

USA Is it safe to get carry-out food?

– Debby from Omena, Michigan The CDC and WHO have not issued formal guidance on carry-out food. While the CDC says that there is no evidence to support transmission associated with food, a person may get COVID-19 by touching a surface or object that has the virus on it and then touching their own face. The virus can, for example, survive on cardboard up to 24 hours, according to a recent study. The issue of carry-out food also raises concerns about the risk couriers are facing by interacting with customers during their shifts. That's why some companies are now offering "contactless" delivery options that help people maintain social distancing by allowing couriers to ring the doorbell and leave the package outside. Study finds: Coronavirus can live in the air for hours and on surfaces for days CLOSE

It's vital to clean surfaces you touch every day amid the coronavirus outbreak. Here are mistakes to avoid. USA TODAY

USA How soon after exposure can you test positive?

– Pam from Easton, Maryland There's no specific data on this question yet, according to Gregory Poland, director of the Mayo Clinic’s Vaccine Research Group. However, we do know that someone infected with the virus may begin showing symptoms anywhere between one and 14 days after catching the virus, most commonly around five days, according to the WHO. "The peak viral shedding occurs during the first five days after the onset of symptoms. My guess is that within a few days of being exposed, these patients are beginning to shed virus," Poland said. A recent report from the CDC studying an outbreak at a care home in Washington State found that among 23 residents who tested positive for the virus, 13 were asymptomatic. Within a week, 10 of those 13 developed symptoms, with onset at 3 days.

USA Do the symptoms for COVID-19 come together or can you have separate symptoms showing up at different times?

– Carlos from Los Angeles The most common symptoms are fever, tiredness and dry cough, according to the WHO. Shortness of breath is also among the most common symptoms, according to the CDC. In most cases where symptoms present, those symptoms come together, Hotez said. "Usually it presents with fever and cough, or fever, cough, and shortness of breath," he said. "It might present with one of those symptoms first, but then it rapidly progresses to the others." Some patients also have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. Some people do not have symptoms at all. A New York neurosurgeon is warning people against looking out for fever as the first tell-tale symptom of the virus. His symptoms began with a little bit of congestion and only later progressed to a fever, body aches and chills. More on testing: Coronavirus test swabs aren't your standard Q-tips, and they're running out as testing ramps up

USA How do you actually die from the coronavirus? What happens?

– Catherine from Carson City, Nevada In some cases, the virus ultimately damages tiny air sacs in the lungs, restricting oxygen to the bloodstream and depriving other major organs – including the liver, kidney and brain – of oxygen. Severe cases of coronavirus: Some result in brain damage, inability to walk In a small number of severe cases, that can develop into acute respiratory distress syndrome (ARDS), which requires a patient be placed on a ventilator to supply oxygen. However, if too much of the lung is damaged and not enough oxygen is supplied to the rest of the body, respiratory failure could lead to organ failure and death. Here's what that looks like inside the body.

USA What is the age range of U.S. deaths from COVID-19?

– Becky from Bentonville, Arkansas In the U.S., ages range from an infant less than one year old to people in their 90s, according to state and local health departments. The Illinois Department of Public Health said Saturday that an infant coronavirus patient younger than one year old in Chicago had died. An investigation was underway to determine the cause of death. "There has never before been a death associated with COVID-19 in an infant," department Director Dr. Ngozi Ezike said. This week health officials also reported that a 17-year-old teen in New Orleans died after contracting the virus. And a 2-month-old in Nashville who tested positive for the virus could be the youngest patient in the nation, officials say. However, this range is not conclusive because health officials have not released the specific ages of several other patients, and new deaths are being reported each day.

USA If a person is sick with the coronavirus and gets tested for the flu, would the flu test be positive?

– Antonio from Patchogue, New York No, the presence of the coronavirus would not turn a flu test positive. However, it's possible to have both the coronavirus and the flu at the same time. In that case, the flu test would be positive. The opposite is also true: Presence of the flu would not result in a positive coronavirus test. It's important to note that, even if someone tests negative for the coronavirus, they still may be infected with the coronavirus. CLOSE

We answer the often searched question: "What are the symptoms of coronavirus versus the flu?" USA TODAY

USA I was told I should be tested if I could not easily inhale a large breath and hold it for at least 10 seconds. Is this good advice?

–Ted from Scottsdale, Arizona No. While shortness of breath is among the most common symptoms of the virus, according to the CDC, that diagnosis does not necessarily involve holding a large breath for 10 seconds. Medically known as dyspnea, shortness of breath is often described as "an intense tightening in the chest, air hunger, difficulty breathing, breathlessness or a feeling of suffocation," according to the Mayo Clinic. If you think you may be sick, call your doctor and follow CDC guidance.

USA Can masks be reused by an infected person or used only once?

– Debra from Dayton, Ohio The longer a mask is used and the more damp it becomes, the less effective it is, Poland said. "But it is definitely better than the alternative of no mask!" Contributing: Molly Stellino, Adrianna Rodriguez, Dalvin Brown, Marco della Cava, Jayme Fraser and Matt Wynn Follow Grace Hauck on Twitter @grace_hauck Autoplay Show Thumbnails Show Captions Last SlideNext Slide Read or Share this story: https://www.usatoday.com/story/news/health/2020/03/19/coronavirus-reader-questions-death-age-flu-symptoms-food-timeline/2863776001/ Read the full article

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arielleyoga-blog1 · 5 years ago

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Dusty Marie

If you know me, or follow me on instagram, then you know I am the type of dog mom that truly believes she couldn’t possibly love her future human children as much as she loves her pug.

Dusty and my journey started out a little bumpy: I was 7 days into grieving the sudden and traumatic loss of my 10month old puppy when I came home and found my mom on the couch with this tiny pug face looking out at me. Y’all...most of you probably would have been SO happy. But I was SO heartbroken and in the middle of deep grief...that was NOT what I wanted at that time. I did not bond with her, I didn’t even love her at first, and if I’m being totally honest: I tried to see if we could give her back. But then this little part of me knew I was being horrible and this sweet little baby didn’t know about my loss, it wasn’t her fault. So, I decided to make her as different from Cosette as possible, and bring her by my side as my buddy. I don’t know how or when, but she went from my buddy to my baby, and I mean it when I say I don’t know where my soul begins and where her’s ends. I don’t know what life was before her, and I start to completely sob if I consider that there could be life after her.

For all the joy she brings me, all the joy her sweet face and cute little pug butt brings others: she deserves to feel as good as she can. To be doted upon, to get snuggles and treats, and to live a healthy long life. She has come with a fair share of health issues over her lifetime, and so I have done EXTENSIVE research on things she can take regularly to help with the chronic issues she has, as well as any that may arise as she is about to turn 10.

Just like I take supplements and use Arbonne, just like I give my husband vitamins every day. Just like I personally ensure I’m putting pure things in and on my body: I feel the same for my little girl!

I find a lot of other dog parents struggle with some of the same issues, or don’t realize something will be an issue later on: and so I wanted to write a post with what Dusty gets every day, and why!

1. RAW FOOD

Now, first let me say she does get 1/4 cup of dry kibble we order through Chewey.com from our vet. But I hated the idea of her on some crap kibble through Science Diet, so I decided to do a lot of digging and find a happy medium. The reason she has the 1/4 cup of the vet prescribed food is because when she was a puppy we discovered her body doesn’t break down fat well: and causes extreme digestive distress, which as a baby made her bleed while she went #2 and THERE IS NOTHING MORE UPSETTING THAN YOUR TINY BABY PUPPY LOOKING AT YOU WITH SAD PUG EYES POOPING BLOOD! So, after speaking with our vet: we put her on this kibble and it helped IMMEDIATELY. She has a VERY sensitive digestive system (someday my husband will figure that out and stop sharing his whipped cream with her lol) and because of that, I make sure what she eats and the supplements she gets with her meals are things that help keep her digestive system functioning properly. (Quick shout out because I care about my pug’s gut health as much as my own and my client’s which is why I think every human needs to do my 28 day detox program!)

I tried companies that like MAKE FOOD FOR YOUR DOG, and I even tried making food myself: but listen, mama works...mama can’t be like having customized meals sent to the house. Plus: some of the stuff used isn’t best for HER. And so, the kibble she has benefitted the most from I get at The Healthy Spot and it’s Primal Pronto. Every time time she’s out I switch flavors. We stick to Chicken or Turkey and Sardine because she had responses to the other ones that were’t favorable: again, she’s sensitive like her mama. But they say to swap each time because it helps their body function better. And I agree!

It wasn’t hard for me to decide on raw food being the majority of her diet: I mean, she’s a dog...they can’t cook unfortunately, and kibble is human-made. Just like I don’t eat spam or other weird processed stuff: Dusty shouldn’t either! PLUS Primal raw food is free of antibiotics, steroids, preservatives and added hormones AND their stuff is responsibly sourced from sustainable ranchers in the United States, New Zealand, Australia and Europe.

She has benefited greatly since going on the raw diet: so I highly suggest that to all pet parents.

2. Apple Cider Vinegar

Originally, I started adding just a capful to her breakfast because ACV actually helps dogs when they have diarrhea OR when they’re constipated. Again, always been obsessed with my dog’s gut health! But then I started doing even more research and the benefits are insane: It’s a natural flea and tic repellant, it aids with hot spots, helps arthritis by breaking down calcium deposits that form around older dog’s joints, and literally so much more!

Dusty, and most pugs, have VERY sensitive skin. And so one thing I didn’t want to do was constantly have to give her little steroid pills or get shots to help with the itching she would experience with seasonal changes or heat waves. Now that she’s 9, the benefits ACV has for joints and a plethora of other issues is what keeps me giving it to her every single morning with her breakfast. And no...she doesn’t mind the. Sweet little Dusty Marie is a pug...she eats so fast I don’t think she can even taste her food!

3. Goat’s Milk

That sensitive skin, again! It was recommended to me to try goat’s milk to help her with the reactions she kept having on her skin years ago. AND it also turns out, goats milk helps with digestion! Talk about two birds with one stone! Just like with ACV, there are A TON of benefits of Goat’s milk for dogs. Again, I shop regularly at The Healthy Spot: they’re a fantastic store and they have so many locations. We were suggested A+ Answers Goat’s Milk, and used that for a while. THEN! Pronto came out with one and so I tried that one...and she threw up more than she’s ever thrown up in her ENTIRE life. So, Healthy Spot took it back no problem and let me know this probably means she’s allergic to turmeric as that’s the only difference in ingredients. There was a period of time that she was off of goats milk: and the itchy skin returned with a vengeance. I went to get a supplement to help, and upon talking to the staff they urged me to first get her back on the goats milk before spending tons of money on more supplements/powders and the such. And guess what? Within 2 days she was back to normal! So, I make sure we NEVER run out!

4. Juvinate K9

This I got within the last year because for a few days I noticed her randomly limping, sometimes it was subtle, and a few times it was really dramatic. And I FREAKED OUT! I did hours of online research and found this supplement that she now gets with breakfast and dinner.

It is a unique supplement for dogs containing the state-of-the-art Ayurvedic extract blend Crominex® 3+ for the support of healthy joints, circulatory support and weight management. It supports healthy circulation, which is important for the delivery of nutrients throughout the body, and can be an important supplement for overweight dogs, supporting healthy blood glucose and a healthy lipid profile. The reviews were nothing but positive: and since starting her on Juvinate K9, I haven’t seen her limp more than twice: and it’s been over 6 months!

5. Dope Dog CBD

CBD is ALL the rage now a days, and since I have experienced TONS of benefits from it: why not Dusty!? There are so many brands out there, but I found Dope Dog to be the highest quality and they’re a company that truly CARES about dogs! Dusty get’s their CBD drops at both meals, and gets their CBD treats when she’s extra cute ;)

CBD has endless benefits, but as I mentioned above: I got this specifically for the limping. She’s approaching 10 and I plan on her living to 83 human years because I truly cannot even fathom what life would be without her.

The other benefit of this product: is it is SO clean and high quality you can use it too! Sometimes I throw a little in my Arbonne breakfast smoothie :)

She also gets their treats as rewards when she’s extra good...or when she’s extra cute and I feel guilty cuz I have to leave for clients or a class lol

6. Fish Oil

This is a supplement I haven’t been as consistent about giving her: again, it’s benefits for skin and joints are amazing. And it also is helpful for her circulatory system. I notice her coat instantly benefits when I squeeze a little in her breakfast! You can 100% go to a pet store and get a fish oil for dogs. OR what I like to do is go to Trader Joes, get their Salmon Oil, pierce a capsule and squeeze it in her food. Sometimes I miss, so never wear a shirt you like because a little fish oil can really mess up your morning. But knowing she’s getting a high quality fish oil with breakfast versus spending MORE on a “dog” fish oil keeps me from getting too upset when I get a little salmon oil on my PJs.

Let me know if you have any questions! This is what a day in the life of Dusty Marie’s food bowl looks like: Breakfast:

Kibble: dry and Pronto raw

1 capful ACV

1 scoop Juvinate

1 capsule salmon oil

.25 Dope Dog

Dinner:

Kibble: dry and Pronto raw

1 scoop Juvinate

.25 Dope Dog

1/4 ish cup A+ Answers Goat’s Milk

#livewellwitharielle arielleyoga dustymarie pugmom pughealth doghealth dog petparent pugs wellnessfordogs wellness holisticremedy

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