#not to be too negative but like. sometimes i wish we had a functioning healthcare system

[lazy-toad]

The thing about being trans in the UK is just accepting the fact that I may just straight up never be able to medically transition

[dashiel-sky]

LFRP: Dashiel Sky

Stats

Full Name: Dashiel Sky.

Pronunciation: Dash-ee-el Sky.

Alias(es)/Nickname(s): Dash.

Age: 20.

Gender: Male.

Race: Hyur, Midlander.

Name Day: 13th Sun of the 5th Umbral Moon

Birthplace: Limsa Lominsa.

Guardian: Menphina, the Lover.

Residence: Living in a renovated room at the Drunken Moogle.

Sexual Preference: Bisexual, very heavy male lean.

Relationship Status: Single.

Alignment: Neutral Good.

Physical Appearance

Height: 5 Fulm 6 Ilm

Weight: 126 Ponze

Eyes: Dark Purple

Hair: Bright white

Skin: Tanned

Build: Lithe, semi-androgynous

Scars: None

Tattoos/Marks: Arcanism matrices covering both arms, from wrist to shoulder

 Traits

Extroverted / Introverted / In-between

Disorganised / Organised / In-between

Close minded / Open minded / In-between

Calm / Anxious / In-between

Disagreeable / Agreeable / In-between

Cautious / Reckless / In-between

Patient / Impatient / In-between

Outspoken / Reserved / In-between

Leader / Follower / In-between

Empathetic / Unempathetic / In-between

Optimistic / Pessimistic / In-between

Traditional / Modern / In-between

Hard-working / Lazy / In-between

Cultured / Uncultured / In-between

Loyal / Disloyal / In-between

Faithful / Unfaithful / In-between

 Family

Saewynn Trinder – Mother – Status: Alive

Leowald Trinder – Father – Status: Deceased.

Mentality

Social level: Very good at public speaking, fairly good at one-to-one speaking. Easily flustered, though.

Optimistic View(s): Everyone deserves a chance. The world is an inherently good place. People are good.

Pessimistic View(s): Gil makes the world go round. Corruption is rife. The rich stand atop the poor, and it can’t be changed.

One Positive Personality Trait: Trusting.

One Negative Personality Trait: Naivety.

One Personality Warning: Submits to the will of others far too easily, thanks to his upbringing.

Random Quirk: Doesn’t appreciate the value of gil.

Hobbies: Researching and practicing warding and seals. Drawing and painting. Reading. Listening to music. People-watching.

Addictions: None, currently.

Habits: Plays with his hair, lip-biter.

Pleasures: Being paid attention to, being complimented, discussing his passion for magic.

Smoke: Never.

Drugs: Never; his bedroom was recently drugged with an aphrodisiac, however.

Alcohol: Rare, usually sweet drinks like cocktails.

(Up to) Five things they appreciate

Beauty. Dash appreciates beauty, almost regardless of race, and definitely regardless of gender.

Music. Dash was raised listening to fine, classical music; he loves hearing new types.

Expensive things. Being raised rich, Dash definitely appreciates expensive food, drink and clothing.

Company. Dash had a rather lonely upbringing, something that he seeks to remedy by meeting people from all walks of life.

People interested in magic. Someone to discuss his passion with, to listen to their experience, theories and own ideas. Wonderful!

(Up to) Five Things they Dislike

Abuse. Any form of physical abuse is something Dash hates to see.

Being likened to his family. Any links to his lineage he’s tried to sever, being reminded of where he’s from, or being likened to them really makes him angry.

Offensive smells. Raised as he was, Dash likes sweet smells, nice smells. Offensive smells make him feel nauseous.

Bad fashion. He’s a rich boy. Dress badly? He’ll be unable to fight off his urge to scowl.

(Up to) Five Strengths

Defensive-magic affinity. His ability to create, maintain and destroy wardings, barriers and seals is exemplary, especially considering he’s mostly self-taught.

Looks. He’s a very pretty boy. His family have bred for looks they can use as a weapon, and it definitely shows.

Wealth. He may have squirreled away only a fraction of his family’s worth, but it’s enough money for most people to live on for several generations.

Communication skills. Dash was raised and taught how to speak coherently and politely to all people.

(Up to) Five Weaknesses

Trusting. Despite his upbringing, Dash tends to trust almost all those around him. Something that is easily preyed upon.

Submissive nature. Dash was raised to submit to his mother’s will. And though he eventually rebelled and escaped her, his very nature is to submit to those of a stronger will.

Physical inability. Dash can’t use swords, or jump, or climb very well. He’s able to run at speed, but his build and upbringing don’t allow for much else.

Wealth. Although a strength, his inability to gauge how poor others are, as well as the coddled-nature of being rich is definitely a weakness, too.

Apathy. Dash was taught about the corruption of the world, how gil makes it function and it’s all that matters, such that he’s apathetic towards the plight of rich v poor. It’s just the way things are, to him.

(Up to) Five Fears

His mother. The source of his life’s torment, the main reason he fled his family���s dark history, and the reason for his suffered upbringing.

Poverty. Though less of a conscious fear, Dash wouldn’t know what to do without money.

Legacy. Becoming the next in a long line of vile, corrupt members of his family.

Possible RP Hooks

His past life. Were you a friend, family-friend or acquaintance Dash made before fleeing his mother? A political ally? Did you even /aid/ his escape somehow? Lots of ideas revolving around this, especially for those playing nobles/business-people from Limsa Lominsa or Ul’dah.

Magic. Interested mage? Bonus points for your interest to be in defensive spells, wards, seals and barriers. Likewise, are you curious about his tattoos? Their origin and abilities?

More magic. As opposed to mere theory, Dash wants to eventually begin using his abilities. Need a ward erecting or destroying? A seal being made or unmade? Let’s talk about it.

The past catches up. Perhaps you’ve been hired to look for him. A bounty hunter, perhaps, or some type of ‘fixer’ hired by the elite. (I have no desire for Dash to wind up ACTUALLY going back to his mother, so this angle only works if you’ll end up sympathizing with him, or potentially blackmailing him? Either way, he’s ICly not going back, and OOCly I won’t let him. :p)

Friendship. Dash has other interests, and just really likes to meet people. So, let’s be friends.

What I’m Seeking

Basically? People to write fun and interesting stories with. I’m quite happy to write mature themes, including injury, angst and eroticism; but I don’t really want these to be a /focus/, more of a thing that happens as our characters grow together, as their stories go on. I care for my RP partners, too, so I often consider the term in a friendly context. If we RP togethe, expect me to consider you my friend.

OOC Notes

You can call me Sarto (My main’s name). I’m a mid-20’s male from the UK. I’ve a long history of RP, though XIV is my first RP-MMO.  I like to think I’m approachable, I love meeting people and making friends. I’m happy to RP in-game or through Discord (Just ask me for it!). I work in healthcare, so if you’re sick expect me to worry and try to offer advice; it’s a sometimes-annoying side-effect, sorry. I’m almost always up for RP, though I do have both mental and physical health problems, and do have days where I don’t wish to do anything. Please don’t take it personally; it’s probably just a bad day.

I love asking and answering asks on Tumblr. (Follows come from Archmagesarto)

Otherwise I’m pretty boring and/or basic, so not much else to go here. Look forward to (hopefully) rp with you soon!

[simmer-for-hire-blog]

Why I haven’t been around.

Hoo boy, this is gonna be a Longpost™ so I’m probably gonna put it under a cut, just so you guys don’t have to look at the whole thing on your dash. But this is basically just gonna be me outlining why I haven’t been around on Tumblr, and more broadly just kinda everywhere. Also, there might be some darker themes and stuff, so I’ll make sure to put in the appropriate trigger warnings in the tags. And before any of you rush to judgments, no I’m not making this post to garner sympathy or for notes or anything like that. If anything I’m just trying to provide an explanation to those who follow me and are disappointed by my lack of posts, and potentially raise awareness for what I’m going through and provide some basic information. So hold on to your hats, because here we gooo! (There’s also gonna be some TMI in here about periods and stuff so if that kind of thing grosses you out then you probably shouldn’t read this tbh)

So I’ve had a few health problems - both physical and mental - that I’ve been trying to  overcome over the past couple of years or so. Most of my problems concern the endocrine (hormone) system and reproductive organs, so if this is TMI, then it might be better for you to not continue reading as I will probably go into some detail.

For about a year or so, I’ve had the official diagnosis of Polycystic Ovarian Syndrome, or PCOS, but I’ve been suffering from it for a good five years or so idk? For those of you who aren’t familiar with it, it is a condition that is related to abnormal hormone production in the body, which results in characteristics such as excess hair growth, weight gain, irregular or no periods and - the main focal point - fluid-filled sacs growing in the ovaries, which can cause a lot of pain if they burst. I’d just like to make a note here that I am in no way an expert, so the information here may not be completely accurate, so I urge you to do your own research on this if you wish to find out more, rather than taking what I say as fact. My personal experience with this has been less severe than a lot of cases, I would say. I first started showing symptoms around 2014/2015, when my periods became irregular, and eventually stopped altogether over the period of about 4 months. Naturally, I went to see a doctor, and had maybe the worst experience I’ve ever had with a medical professional. It took him two years (still with no periods) to finally admit that something was wrong, and I ended up having to enter each medical appointment with the attitude that I would need to fight tooth and nail to get him to admit that I could have a problem. But eventually he agreed to send me for an ultrasound, and there it was found that I had a borderline amount of cysts (not enough for a certain diagnosis, but too many to say that there was nothing wrong), leading to a diagnosis being given, as I had a lot of other symptoms. There is no treatment for PCOS, as it cannot be cured, so all the doctors can do is suggest options to manage the symptoms. One such option is the contraceptive pill, which they put me on. I had such a terrible reaction to this that I stopped taking them because it was impossible for me to function as a human being while I was on them, as they worsened the disorder that I will tell you about next. However, when I came off the pill, I actually started getting periods again, which seemed like a miraculous recovery, until something worse happened...

So I was thinking that everything would be magically better when I started having periods again. Unfortunately for me this was not the case. After coming off the contraceptive pill, I had regular (yet very light) periods again. So this meant that the cycle of hormones was continuing normally. For the week or so leading up to my period until a couple of days into the period, where people would often experience PMS, it’s like I became a different person. I’d have episodes where I’d be so sad that I couldn’t get out of bed, and would sometimes barely be able to move. Obviously this caused me to miss a lot of school. I think my attendance at the end of this school year must have been like 50% or something. I’d also experience fits of violent rage, and overwhelming thoughts of self-harm and suicide. In February of this year, it all became too much for me, and I was admitted to the hospital after a suicide attempt. Luckily for me and everyone around me, I survived and was discharged a couple of days afterwards. My memory of the event is terrible due to the nature of the attempt so I couldn’t really tell you very much about my experience. It was a very strange period of time, because about halfway through each period, these symptoms would fade away, and I’d be left wondering why I’d ever had these thoughts and feelings, because they wouldn’t even cross my mind when these ‘episodes’ weren’t going on. It was during this time that a family member sent me a link to an article. This article was about a woman who, like me, suffered an almost complete personality change for a few weeks per month, in a seemingly cyclical nature. Like me, this started when she first got her periods and didn’t affect her all the time. The only difference is that her periods were always regular, whereas I had barely had any due to the PCOS. This woman was diagnosed with a disorder called Pre-Menstrual Dysphoric Disorder, or PMDD. A lot of the information is on the website that I have linked, but feel free to do your own research if you’re curious. To summarise, it is a disorder caused by sensitivity to normal hormone fluctuations that causes extreme mood swings, depression, anxiety, bursts of rage etc. between ovulation and bleeding (which basically means the week or two leading up to your period). For me, this disorder is crippling, and has destroyed any chance of a life I could have had. I cannot continue any form of education, I cannot work (I had a job for about an hour before I couldn’t take it but that’s another story), so there’s not much to do with my life. Lately I have been thinking long and hard about some information that I’ve recently come across. According to the Equality Act of 2010 (this applies to me because I live in the UK, but it’ll be different in other countries), a disability is defined as ‘having a physical or mental impairment that has a substantial and long term negative effect on your ability to do normal day to day activities’. According to this definition, my PMDD is a disability, but I haven’t fully read up on the legislation, so I couldn’t whether legally it would count or anything like that. I also don’t know how I feel about being defined as ‘disabled’, because mental disorders aren’t typically seen as being disabling in our society and there’s a stigma around people with disabilities being ‘helpless’ and I’m certainly not that, and I don’t want to undermine people who suffer from physical disabilities by calling myself ‘disabled’, so there’s a whole host of reasons why I don’t want to jump to that.

Contrary to what I’ve been saying here, there is actually hope for me. PMDD and PCOS are not completely curable per se, but there are ways to manage and educe symptoms, so I can live a normal life (PMDD is more curable than PCOS however, which has been touched upon in the article I linked earlier, and I will briefly discuss in a second). However, so far my GP has been of absolutely no help, and I fully intend to complain officially because the way they have treated me is appalling and has basically ruined the current state of my life. That is why I decided to see a private specialist. I am so lucky that my family have the financial security needed to be able to afford a private healthcare consultation, because I received so much more help from them in the half hour consultation than I ever received from my GP in the four years that I have been going to them for help on these matters. The private doctor listened to the timeline of events that I laid out for her, and the full extent of what is currently going on, and recommended that I take vitamin supplements, as they have been proven to slightly manage PMDD symptoms, and prescribed a five-day contraceptive which would hopefully get my periods kick-started again, as I have missed the last four months with no sign of them returning. I’m currently on the last day of this contraceptive, and I’ve been suffering with really bad PMDD (didn’t really help that I was out drinking on friday which usually makes my symptoms worse, but oh well, it was a good night), so hopefully these will yield results within a couple of days. The consultant is also following up with a colleague in London who is an expert on this kind of thing, and will shoot me an email if she finds anything else out. Treatment options for PMDD can include inducing menopause early or even a hysterectomy (removal of the female reproductive organ), but I have been told that hopefully it will not come to that.

So yeah, that’s been my journey so far. During this time, it’s been difficult, even impossible, to keep up with this blog. I hope that you understand why I haven’t been able to update regularly. If you have any questions, please ask me, and I’ll try to the best of my ability to answer all of them. If you’ve read this far, thank you for sticking with me, and by the way, thank you for 738 followers! I really don’t deserve that much love and support considering I haven’t made a post in months, but it means a lot. I hope this post informed you all about what I’ve been dealing with and all that, and I’ll try to make some sort of recovery in order to keep posting here. I love you guys xx

[gabriella-lost-in-the-big-city]

And in her heart was a sea of darkness… Pt. 1

The choice I make to say what I have to say in the next post is a risky one. It may change how people view me or act around me entirely. I may be seen as a victim crying out for help (and maybe I am). However, despite the consequences of talking about this matter, the whole point of this blog was to be nothing but 100% honest with the people that read what I write and give my self the opportunity to say all the things I wish I could say or do or feel on a daily basis. So without any other further interruption, here I go…

My depression has been with me since the 6th grade, a time where my emotional intelligence grew and I became more secure with my sexuality. I felt such guilt and fear for being a male (at the time) who had sexual/romantic feelings for other men since I grew up in Raleigh, NC from 2005 to 2014. Feeling like I could confidently be out of the closet as a gay male (let alone being a trans woman) was not an option in the south. I was surrounded by so many narrow-minded people that knew nothing but the tobacco farms and cattle that surrounded them, that still thought racism was a politically correct thing, that God, Jesus, and whoever else from the nativity scene where the only “people” that were going to save you from burning in hell for your “sin”. There were no political activists, social justice warriors, or open-minded liberals, just white Republicans chewing tobacco and riding down the highway with confederate flags in tow. It was not always like this, but when these images crossed my path I knew that there was going to be backlash on being anything other than white straight and Christian. I knew I couldn’t tell many people around me, especially not my family (diluted Catholics from El Salvador), so I spent the next 4 years keeping who I really was a secret (something I would pick back up when I discovered I was actually trans this entire time in college) and that really tormented me mentally. I felt alone among even my closest friends. I felt like I couldn’t get too close to anyone at school or in the neighborhood to avoid having them find out I was gay and possibly hating me for being gay. I began to develop thoughts of suicide during this time in my life as my depression worsened over the years. I just kept having these thoughts that things were never going to get better, that I would have to live the rest of my life in secret from my family, that I would never be loved for being who I am, and that my feelings/thoughts/actions would always be seen as wrong. My thought process was if I just killed myself I wouldn’t have to feel the pain and agony of my depression, I didn’t have to live my life in fear – distant from the world around me. In hindsight, the emotional turmoil I endured with my transition into the woman was way more deserving of a desire to commit suicide then what I went through in middle/high school. Middle/High school is the common cold and what I have been going through during the past 3 years of college is like a stage 4 pressure injury infected with MRSA.  I never like talking about my life as a gay male (2007-2014) even if it is a brief background story because I always feel it’s such a cliché/diluted story of what I’ve been through.

Now that you know that I suddenly didn’t just start being depressed and suicidal when I moved to NYC for college, this is where the real fun begins. I don’t want to focus on how I discovered I was trans all along in this post, so I’ll just skip that part for now. As a trans woman, my depression began to worsen – I finally found the answer I had been looking for to explain why I never could relate to the guys in the neighborhood or why I felt “different” all my life, but now I became an even bigger monstrosity in society. For some reason, people can be ok with people being Gay, Lesbian, or Bisexual (which even that is something people can’t get their heads around, but I digress), but are not ok with people being trans. My parents, for the most part, had dealt with me being “gay” neutrally a.k.a. they never really mentioned it after I came out to them. However, I knew that being trans was a pill they would not be able to swallow (a thought that would come true soon enough). I chose to act on my desire to be a woman my freshman year of college in secret from my family – I would put on my E.L.F. makeup on and look like a total mess and occasionally wear an ill-fitting dress from F21 and super high heels that I knew I could not walk in (something I still have not mastered). Some of my closest friends called me Gabby (which in hindsight I am so grateful they took the initiative on), but for the most part, I was still Justin (GOD I FUCKING HATE HAVING TO SAY/SEE/THINK OF THAT NAME). Over the course of the past three years, It became increasingly harder to be seen and treated as “Justin” as I came close to becoming the woman I am today, but in those early years it was easier to still be “Justin” as I had already made up my mind that there was no way I could live ha happy life being trans. My family would never respect or accept me (which is mostly true in my current situation) and I would never be truly loved by a man (or a woman) as a transwoman (which I still think is true because my run-ins with online dating are terrible, but we will save that for another post). I think the hardest part was having to keep everything a secret, especially when I moved in with my grandma my sophomore year where I literally had to pack Gabriella in a box and be forced to only be her when I was in the bathroom. I worked so hard those four years of high school just to have the courage to come out the closet and be free, just to be thrown back in with no way out in sight. On the outside, I pretended everything was fine on the outside, but I the inside, the negative thoughts I had about myself just fermented inside of me. There is nothing healthy about bottling things inside because eventually the pressure becomes too much and you either have to begin to release the pressure little by little or wait for the bottle to eventually explode. My form of dealing with my emotional distress was nowhere near healthy – from my self-diagnosed binge eating disorder to the binging of alcohol at parties to numb the pain to my favorite, the burning of my wrist with a lit cigarette, There are a variety of ways to commit self-harm, some choose to cut or inflict physical pain on themselves, but I chose the delightful burn of a recently inhaled cigarette. I had an affinity for cigarettes when I first came to NYC for college, the warm smoke entering my lungs calmed my nerves and the burn from smashing the cigarettes onto my wrist riled the inner masochist in me right up. It only ever happened a handful of times during my freshman and sophomore year of college, but I still have the scares that I guess will haunt me for the rest of my life. Looking back over the years sometimes I wish I had the courage to drink a little more, to keep the cigarette on my body just a little while longer and fry my veins, maybe grab a blade and slit my wrists or cut through my carotid, maybe jump in front of an incoming train or into incoming traffic, or down a whole bottle of pills from the medicine cabinet. I never had to guts to do more than what I did to self-harm or actually kill myself despite wanting to do it so badly – a part of me was scared of surviving my suicide attempts and having to live with the consequences or I felt bad for how my suicide would affect the people around me. However, my fears of self-harm and suicide slowly diminished – the pain or the consequences didn’t seem so bad and I thought that my life was way too insignificant to actually make a lasting emotional impact on the people around me. People die all the time, and sure it’s hard, but we eventually moved on and they become nothing more than a stone on the ground or ashes in the wind. And I am sure you’re asking yourself if all of that is true, what is stopping you from going back to hurting yourself or killing yourself, and If I wasn’t asking myself that very question every day of my life I would have an answer for you. I guess what’s still keeping me alive is that little part of me that feels like I do have some value in this work, that my work and future ambitions in healthcare and public health matter and are important. However, at the same time, I can’t tell you that there is also a part of me that is willing to give up my value in this world just for the selfish desire to just end my life long-suffering. I know this may seem crazy that this is how I feel, that I would be willing to throw all the good things I have worked long and hard for - to be where I am today, a semi-successful, semi-confident, semi-functioning TLW on the path of bigger and better things one day. If could be worst, I could be physically sick, have cancer, have a stroke, have my leg amputated, need a major organ transplant, etc – but then again this is just siding with the whole “mental illnesses don’t matter as much as physical ones” debate.

I can’t tell you what would make me feel better. I can’t tell you what will make me value my life. I can’t tell you when or why I have these thoughts, only that they worsen when I find myself alone or I am not distracted by the world around me. I can’t promise you I’ll be safe, that this is something or someone to save me. I’m a wild card, I’m a ticking time bomb, I don’t know how long I will last. All I can tell you is that I’ve felt this way, every day, with varying intensities, for the past 12 years. I don’t know if it will ever end. I know a lot of you this is a lot to digest, things you never thought I go through on a daily basis. However, that’s the way I chose things to be. If I was outward and honest with these feeling with everyone around me, I wouldn’t have all the friend that I have, I wouldn’t have accomplished all the things I have, I wouldn’t be able to smoothly move through life like I have all these years. My façade, a happy/sarcastic/melodramatic woman, helps me get through every day if my life – and I don’t know if I will ever truly feel that being happy is no longer something I just pretend to feel. This is not everything I want to say on the matter or it is a complete representation of how I truly feel (and I don’t know if it is physically possible to convey such feelings and have you truly understand them through words on the screen). This is just an abridged version of what goes inside my little head, behind the scenes, behind closed doors where you never think to look and see.

 - G  

[otcsocialnetwork]

$PAOG – NWAV ROADTRIP REPORT & PICS 

NWAV ROADTRIP REPORT & PICS Hello all, First off, let me preface this with, I normally write code, not papers, so please forgive any spelling or grammar issues. Second, thanks everyone for a fun trip. I’m not just talking about Florida and Ohio. I’m talking about entrance into stocks. That’s correct. Not a stock pro here, first decent investment in a stock really. I got lucky with about 700 shares of OWCP when a buddy suggested that this might be right up my alley and pointed me towards it. Then I started looking for another stock since it was apparent 700 shares wasn’t going to do me anything in the near future that I wasn’t going to get in a pay check anyway. So backup… Who am I and why should you listen to me? Well, I’m more or less just a regular guy, for all intents and purposes, nobody. I do however happen to have a unique perspective that made this stock stand out to me as something to watch. Day to day I am a computer programmer, writing software to analyze various business functions ranging from marketing performance and employee efficiency to customer shopping patterns and inventory allotment. Since I’m also a big fan of money, I build websites on the side, primarily medical since doctors generally always pay. Lawyers are good to, but I digress… I live in Missouri and as we are bordered on three sides here by states with MMJ in some form or another in the works, and have a sad, sad, little program here ourselves, we all know MMJ is on the way. In Mo we currently have very restrictive legislation, only two companies allowed to produce CBD oil for epilepsy, and few neurologists willing to recommend it yet. I can’t blame the doctors, nobody wants to be the first and risk their career. Med school isn’t cheap! To have those loans and not be able to practice… No thank you! Keep that in mind when you think about these doctors working with PAO already… Pioneers. That being said, doctors don’t always make the best lawyers, marketers, or technical security experts. Trust me when I say as we web developer, I’m really glad these doctors are doctors, not web developers, or even designers for that matter. Nor should they be! They went to school to be doctors. Most know their limitations but sometimes they try to build their own site. They normally soon realize that when looking at time to dollars while comparing to overall website quality and shortened development time, it was best to just pay a developer/designer to do it, and everyone ends up happier and more successful. Similarly, I’m sure I could drill a hole or two in someone’s spine, pack it with Plexiglas, and call it a Kyphoplasty. I mean that is in essence, what the procedure is, but I make no claims that the patient would be in either less pain, or breathing at the end of the procedure. Having PAO to lean on for knowledge in areas doctors simply aren’t going to know as much about such as legal or make use of PAO’s online tech, will allow smaller practices to explode and larger ones to dominate in this emerging medical sector as it spreads across the country. While the MMJ aspect alone makes linking up with PAO attractive to doctors here in Mo who want to be in ahead of the curve, it is just a portion of the benefits. My most recent build was for a pain management surgeon who is already offering several alternative medical solutions offered by PAO and others that are not. After seeing how much business my client does on alternative medicine though, it is clear that MMJ, while massive, is only a part of this equation here. With our current healthcare system in a state of uncertainty, many patients are finding themselves weighing their options as the cost with insurance for many procedures is just as unaffordable as it is without. The Hormone and stem cell therapies alone are massive. As PAO grows and more doctors join, more ideas will spread, more solutions will be offered. One procedure my client offers now is Platelet Rich Plasma Injections. They cost the patient about $500 and are not covered by insurance despite showing overwhelming success rates. Like everything, as these procedures become more available, and better understood by the non-medical community, they become more affordable. Between the nightmare stories I’ve heard from clients and family, patients and doctors, everyone is ready for some options in healthcare. This isn’t news. Then you throw RSII in the mix, couple that with the fact that this company is not only growing its roots in two of the most conservative / restrictive states in the union and making it look easy. If their model works in Ohio and Florida, they can adapt to work in any virgin state as well as push into more saturated markets (once the low hanging fruit is gone). Seems to be a pretty good position to be in. At this point I’m sure I’ve got some people saying, “Making it look easy?!?!?!?! I keep hearing they are a scam?!?!?!”. Now I’ve learned if you even imply a negative motivation behind anyone’s actions on this board you are very likely to have your post removed, so I will simply ask. Why would someone you don’t know, who will never meet you, be hanging out in a stock gossip forum warning you “hey, don’t buy this it’s a scam”? I’d love to believe that everyone is my buddy, but have you played video games online? Have you seen what anonymity has done to behavior online? So without further delay, this is what I’ve got on NWAV… NWAV SUMMARY & REPORT (Part #2 – Ohio) So let’s start in Ohio. I was up there March 24, 2017. I started in Sandusky and then went down to Parma. The Sandusky office was exactly where it was supposed to me. This is one thing that had me dying laughing. We’re all sitting around here asking “Where is it? It’s not where it’s supposed to be!”, totally freaking out. Shoot, I took vacation days to drive up to Ohio because I wanted to make sure I wasn’t caught up in some Wolf of Wall Street pipe dream and thought we (the longs (the vocal ones at least, I’m learning here guys lol) on the board) had discovered some serious new info and I was gonna get proof. Just a couple days ago I’m looking at the PAO Facebook page. There is a sample ID they posted on Jan 20, 2017. It’s got the address on there, plain as day! Since Jan 20th! Even funnier, it’s been on this board at least that long too! They aren’t hiding info from us, they are busy working! Opening 6 locations and launching a website in a couple months is a daunting task. I made it up to Sandusky and found the clinic with no trouble. It is kind of tucked away in the back, not really easy to see unless you know where you’re going. No signage in the shopping center, but great signage at the entrance. To tell you the truth, I was a little disappointed in that at first, but later it all made more sense. I was able to talk to the neighbors in the unit closest to the street. They were telling me that they were really busy the previous week but were able to finish up moving everything in early and were “just waiting on the official go date”. I don’t remember exactly how I brought it up other than I was asking as a potential patient, not as an Investor, so there was zero reason to tell me a lie. That and the guy was very laid back, positive, and had sounded as if he believed it would be good for the community. When I was saying good bye I threw in there, “Man I wish these guys had stock, I would totally get some!” to which he said, “No kidding, I should ask if they do!” I hope he did. As far as what I could actually see, honestly not too much new. The signs were up and looking good. Everything was clean. Computers had some monitor glow at the desk in the lobby. I got there early in the morning and checked on it as soon as I got into town (about 1:30am… in the rain… lol… didn’t care, it was there!!!). I came back the next morning (where I talked to the neighbor) and the lights were out so it appeared someone had been there. The maintenance door was open between units but I’m getting too old to crawl through ceiling tiles and get trespassing charges, plus I had seen enough to feel good that things were on the up and up. I seriously considered it anyway, but thankfully I brought my fiancé, not my buddy, or I might have been writhing a much less complete report from a cell as I would rather have the stock than bail. Before heading down to Parma I checked out a few other things. I went to the Sandusky Wellness Center on 3703 Columbus Ave. This is where Dr. Greg(g) Winnestaffer, who will be at the Sandusky clinic, currently has an office. A nice building not too far away and after seeing how Florida is building out around Jacksonville, and talking to the staff of the medical complex where Dr. Bernard’s Friday office is, it would not seem farfetched to me that this location could serve as at least another referral source / satellite for PAO. This is just speculation on my part, but why not? I also checked out the Bank that was for lease in the same shopping center as the Sandusky clinic (1028 Cleveland Rd). There are no for rent signs on it anymore as seen in the Google Maps images. It looks unoccupied however there are some signs on the door that say “Lucky’s Entertainment” with little shamrocks. In the PR that came out Nov 3, 2016 it clearly said that they renegotiated the lease to get the bigger unit, but I still hold out hope that they grabbed the bank too and are saving it for Central Office / Dispensary / RSII Lab, but that is just me hoping. Couldn’t blame them for being quiet, I mean look at how we hound them for info, but think about a bank drive through with multiple lanes and a huge vault. How could a company like this, make use of a building like that? Next I went down to Parma to find the other clinic, but one thing first. I’m not from Ohio, never been to Ohio, didn’t know anything about the place. So when I read the PR talking about the opiate addiction problem in Ohio and saw some news clips about how they had the highest death rate from opiate overdose, I was like, “Yeah it’s bad stuff, got that problem here. Tons of meth too. Wanna talk murder rates, we all got problems, and what?” Ok, well maybe not that cold, but the point is I absolutely underestimated what was going on up there. In Sandusky there were some billboards, a few signs here and there, but more than at home. It was apparent that opioid addiction was a public concern, but by the time I got to Cleveland, parts of the city looked almost like a WWII “buy war bonds” news reals. There were signs everywhere warning about heroin and pills. Bus stops, trash cans, benches, everywhere! Once I made it down to Parma it was a little less apparent, but all that means is that it wasn’t smacking me in the face anymore. So the Parma office was a lot more viable than Sandusky, which makes sense. Folks in recovery aren’t really looking to be called out on it, or seen going in. Having a nice entrance in the back of the shopping center fitted the need up in Sandusky. Parma was the exact opposite. It’s positioned in a pretty nice medical building on the corner of a big intersection that is impossible to miss. Walk through the front doors, make a right and you’re there. The first 5 units facing the street are all AMCA. The office had easy to see professional signage, name and unit number in the buildings info board, and a mostly finished office visible from the mail slot and windows, and a note directing deliveries to go to the main door, not the other doors. This location was a win too! So Ohio looked great! Both of these are corporate locations, so revenues there will be all PAO! I almost convinced my fiancé to keep south and check out Florida on the way home, but there just were not enough hours left in the weekend to get back for work, so I would have to wait. We have since had the walkthrough of this location: https://www.facebook.com/PAOgroupinc/videos/611587985717486/ NWAV SUMMARY & REPORT (Part #3 – Florida) Let me start this part of the report with an apology to IR. Now that I’ve seen all the locations, talked to some people in person, and thought about all the work, and the timelines involved in businesses I’ve only to helped launch (not plan, and initiate)… in a single state… in much less volatile, history making sectors… and then compare to what you all have said you were doing to do, and have in fact done, in the time you have done it… I take back all the less than friendly messages I left over the last month or so when I didn’t understand, or misread the PR, or mistook something I saw. I even left a couple this weekend in Florida. I normally felt pretty dumb when I figured out what I was missing if that makes you feel better. While we’re being all forgiving, since I’m in part 3 of a report on a series of cross country road trips stalking your company, I would not trust me to keep quiet either, so totally forgive you for never calling me back LOL. At this point though, come on guys, drop the PR, make everyone happy, and let me get a real tour so I can say thanks in person! Ok, so I packed up the car and headed down to Orange Park. When I got there I was happy to see, much like Ohio, exactly what I expected to. Having AMCA logs on the door and windows was a great start. The parking lot was full, even around back. There even looked to be people waiting in their car in the lot next door because they were either early, didn’t feel like waiting inside, or maybe both. I walked in, looked around, saw that they were packed, and just looked lost and got out of there. After all this was a live working practice. I know how busy those offices can get and with a possibly overflowing waiting room, I didn’t want to interrupt and ask silly questions. Seeing there were 5 patients in the waiting room, 4 visible staff members moving quickly to get things done in the section of office behind the admittance window, and who knows how many of each I couldn’t see in the other 80% of the building, I didn’t need any more convincing that they were busy. Seemed to be everything I could hope for here. A few things to note about this location before moving on to the others… It is positioned wonderfully at an intersection, with a stop light, across from a large medical center. The number of patients a day that are going to leave that medical center and see the green cross in the windows here will be huge. There is also a pharmacy attached to the building. As of April 3rd 2017 Florida’s Senate has passed a new plan through its first hearing which is much less restrictive that the one from the house, allowing for edibles and vaping, just not smoking, along with all other treatment options. It also proposes increasing the number of dispensaries and independent labs testing the medical MJ treatments. Don’t we know a company that could benefit from that? Sure this is six months to a year away, so what do we do till then? I guess we work on registering more patients and give the lawmakers the numbers they need to put some weight behind what the people are saying they want. Wait a second, so you are telling me actions speak louder than words? So wait a second, by that logic, I guess I would rather have 5 verified locations and no PR, than a glowing PR full of promises. Now I mentioned leaving some unhappy messages with IR. That was because when I got to Jacksonville Beach I could not find the AMCA sticker anywhere and I didn’t want to go into random buildings asking about it. I called IR and left message and my phone number. Surprisingly, they didn’t call me back. Cooler heads prevailed and after I realized that I sure as heck wouldn’t call me back either, but I was already down there and couldn’t go home and leave it at that… I went in and played patient and turned up some good info though. So we have seen on the Pointe Medical website that 905 Beach is Dr. Bernard’s part time office. He is only there on Fridays. This of course was a big old red flag until I understood the business a little better. How can we count this as a clinic if the doctor is only there on Fridays? We’ll doctors having a couple offices is nothing new, they do it all the time. The problem is that Dr. Bernard is only one guy, so how can he be in two places at once and make use of two offices in a way we can really count as two clinics? That is the beauty of this model, with even just what we have seen of the altmedcenters.com page, the secure video referral system (MCVerify), and proper staffing, a doctor’s practice can rapidly scale up to multiple locations in short order. The software allows the doctor to be anywhere provided they have a location with staff such as a Physician’s Assistant or Nurse Practitioner to aid in the recommendation. Now all the sudden this location made more sense. Well, confirmation on that was the second thing that came out of the mouth of the very nice lady working at the desk. “Dr. Bernard hasn’t been at this location in a few weeks actually. ” My heart stopped. “I know he’s been out trying to hire some more staff. I know he needs at least a PA (Physician’s Assistant).” I vision came back into my left eye, then my right, followed by a heartbeat. More staff is good. The other lady chimed in, “Yeah I think he’s been working on getting a new location ready the past couple weeks.” I need to start playing poker. I politely said thanks and sorry for the confusion, I must be trying to get to his other office. Joked around for a minute since they were really friendly people and headed for Ft. Lauderdale. At this point not having had time to think it through and realize how good of news that was, but feeling better about all I had just heard. Now my next stop was Ft. Lauderdale since I only had so many business hours left in the trip, but first I’ll talk about St. Augustine. When it was announced that PAO Group got their lease at this location I was pretty happy. Unfortunately I was not able to figure out where it was, nor did they give a location. Seeing how this location is not too much further from Jacksonville Beach than orange park (in the greater scheme of things), with Green Cove Springs (another location mentioned in PR) almost between Orange Park and St. Augustine, it seems to make sense that Dr. Bernard will be in fact heading up multiple locations as we were told in his FB video with Robert Webber. Also, the St. Augustine location looked to be in overall good shape in the video, and seems to not need much more than paint and equipment as it was previously a doctor’s office. Having been 2 full weeks since they took possession, I would not be surprised if they were ready to open in short order and then we will have our first corporate location in Florida. Ok, on to Ft. Lauderdale. Well for starters… Man the turnpike can slow ya down! I didn’t get down there till after business hours and it was Friday so I was out of luck for catching anyone there. Just like you find looking online, there was Hollywood Hormone Therapy sign, just no AMCA. I was a little irritated. Left IR another real peach of a message, and sat there for a minute or ten. I was able to see through the windows in the front that the lobby looks just like its picture on the website, but the lights were out and the only picture I could get was more reflection of my phone than image of the lobby, so I didn’t bother taking a picture of it. Now at this point, despite overwhelming evidence that this is in fact everything promised, I’m sitting there seeing ready to pop actually thinking. Maybe they are right… Crazy talk I realize now, but I had been in a car for 20+ hours. Anything short of a grand opening parade was going to be a disappointment. I went back to the PRs to see what I had missed. Just like the freaking ID with the Sandusky location on it that sat in plain sight for months. When I talked with the staff in Jacksonville Beach, I mentioned Alternative Medical Center in the office next door when I was looking for Dr. Bernard’s office. Just like the people who called the phone numbers asking about the PAO group getting confused answers. Everyone there knew Dr. Bernard, only one of the neighbors knew that Alternative Medical Centers was, “that thing Dr. Bernard is working on”. Patients going to Hollywood Hormone Therapy are making appointments to see a doctor, not a physician’s group. In this case they want to see Dr. Michael Schmidt who also runs a family medicine practice a little further north in Deerfield Beach. Me getting hung up on the AMCA sticker not being in the window seems kinda silly now that I have had sleep and EVERYTHING else is where it was expected to be. Additionally, because of the scalability of this business model, I won’t be shocked if we see similar developments with Dr. Schmidt in the Ft. Lauderdale and easily drivable surrounding areas as we have seen in the Jacksonville area with Dr. Bernard and the northern Florida locations. NWAV SUMMARY & REPORT (Conclusion) So having time to get home and type everything out. More than ever, I like what I see here. If my biggest beef is that two satellite locations don’t have logos in the window, but everything else seems to be going pretty darn well… Things could be a lot worse. They seem to be meeting goals on time which is apparently unheard of in the OTC. We also look to have been building a very strong base over the last month investor wise and the PPS has had one of the smoothest stabilizations after initial discovery that I’ve been able to find going through other stock histories. Throw the fact that we have a PR due any day and 4/20 in two weeks where MJ is about to be national news on CNN and all the other news stations, like it is every year around 4/20, it would seem to me that great things are on the horizon. Good luck all! http://dlvr.it/Qvtt1W

[roxysbeachlife]

10 Important Symptoms of Depression

I am posting this article as a result of my unsuccessful attempt to get off anti-depressants after 30 years.  The holidays make depression worse, especially when you are alone.  After a MAJOR downward spiral I post this for awareness.  Clinical depression is not to be taken lightly.  That being said, here is the article in it’s entirety…

Axel F. Sigurdsson MD

Major depression affects more than 16 million American adults each year (1). It can occur to anyone, at any age. And, importantly, depression is not a personal weakness but a severe medical illness.

Of course, we all have times when our mood is low. Gloom, heartache, melancholy, woe, desolation. These are all parts of life’s journey and fortunately most often normal temporary reactions to daily events. But, at what stage should such feelings be defined as clinical depression? The British writer and poet, Giles Andreae who himself has battled depression once said: “Thinking you’ve had depression makes about as much sense as thinking you’ve been run over by a bus. Trust me – you know when you’ve got depression (2)” 

Although this is not entirely true, it emphasizes the difference between clinical depression and occasional episodes of low mood. However, unfortunately, too many people don’t acknowledge their depression or think it isn’t serious or even believe that it is some personal weakness.

Only about a third (35.3%) of those suffering from severe depression seek treatment from a mental health professional (3). Hence, it is estimated that as many as two-thirds of people with depression do not realize that they have a treatable illness and do not seek treatment.

According to The American Psychiatric Association, “depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and home” (4).

Hence, we might conclude that depression reflects long and persistent periods of low mood without reason? But, that’s a misinterpretation. The truth is that there is a reason. That reason is the disease we call depression.

The British actor and writer Stephen Fry has talked openly about his depression. He says: “Why should I be depressed? I’ve got enough money. I’ve got a job. People like me. There is no reason to be depressed. That’s as stupid as saying there is no reason to have asthma or there is no reason to have the measles. You know you’ve got it. It’s there. It’s not about reason.”

Depression is often considered to be a mood disorder. Fry says: “To me, mood is like the weather. Weather is real. It is absolutely real: when it rains, it rains – you get wet, there is no question about it. It is also true about weather that you can’t control it; you can’t say if I wish hard enough it won’t rain. It is equally true that if the weather is bad one day, it will get better and what I had to learn was to treat my moods like the weather.”

  1. Depressive Mood

Persistent sad, anxious or “empty” mood is an essential feature of major depression.

However, frequently those who have suffered from depression describe their depressive mood in a more specific manner. It is not just about feeling sad all the time. It is somewhat different and usually much worse.

In fact, people with depression not always feel sad. They may be able to speak with their friends and have a laugh. On the outside, it may look like there’s nothing wrong. But inside, there is something missing. There is an emptiness, so hard to describe and so hard to understand unless you have experienced it yourself.

Let me quote Stephen Fry again: “There comes a time when the blankness of the future is just so extreme, it’s like such a black wall of nothingness. Not of bad things like a cave full of monsters and so, you’re afraid of entering it. It’s just nothingness, the void, emptiness and it is just horrible.”

Fry even goes further and says: “It’s like contemplating a future-less future and so you just want to step out of it. The monstrosity of being alive overwhelms you.”

Some patients with depression express intense sadness and emotional distress whereas others have a sense of emotional numbness (“blahs”). Hence, the magnitude and nature of the depressive mood may vary between patients.

2. Anxiety

Depression is often associated with anxiety. Both are facilitated by stress, either recent or dating back to childhood (5). Up to 70 percent of patients with depression experience anxiety (6).

Anxiety may be described as a feeling of worry, nervousness, or unease about something with an uncertain outcome.

Today, many experts believe that depression and anxiety are not two disorders that coexist but two faces of one disorder (7).

Often, anxiety precedes depression, sometimes by several years. Typically the onset of anxiety is in late childhood or early adolescence. Depression usually begins a few years later with typical onset in the mid-20s (8). But, of course, depression may occur at any age.

One person suffering from depression and anxiety wrote (9): I’ve always lacked self-confidence, even before my anxiety disorder was identified. I try to mingle with the best of them, but at the same time on the inside, I’m an intolerable nervous wreck and always wish I was at home watching repeats of “Friends” with a slab of fudge cake, even when I’m socializing with my nearest and dearest. Sadly, I don’t think this will ever change. So when I’m at that point where I’m trying just to leave the house, let alone do anything adventurous, my fragile mind always says “But, why? Why bother? You’re going to fail at this anyway?”

In fact, isolation may become quite severe. Simple tasks such as going to the supermarket may become a major hurdle.

3. Loss of Interest or Pleasure in Activities Once Enjoyed (Anhedonia)

The word Anhedonia describes the inability to experience pleasure from activities usually found enjoyable, e.g., exercise, hobbies, and social interactions. In Greek, anhedonia directly translates to “without pleasure.”

Most patients with depression have anhedonia. It is a crucial feature of major depression. Events and activities we used to enjoy become less interesting or fun. We may even lose interest in our friends. Libido and interest in sex often decrease as well.

Some experts suggest that anhedonia comes not from a reduced capacity to experience pleasure, but instead from an inability to sustain good feelings over time. In other words, maybe pleasure is experienced fully, but only briefly, not long enough to sustain interest or involvement in life’s good things (10).

In anhedonia, the simple and satisfying sensation of joy seems to be lacking.

Following his experience with depression, Giles Andrea wrote: “And if depression has taught me one thing, it is this: what a rare and beautiful treasure is the simple human gift of joy. For me now, joy – our capacity to delight in one another and the world – is the reason why we are here. It is as simple as that. And I feel compelled to spread the word (2).”

Anhedonia may promote social withdrawal and negative feeling towards yourself and others. Emotional abilities may be reduced, and there may be a tendency to show fake emotions. We may struggle to adjust to social situations and our interest in intimacy may diminish.

Sometimes, anhedonia is divided into social anhedonia (a general disinterest in social contact), and physical anhedonia (an inability to feel pleasure from things likes eating, touching or sex)(11).

4. Fatigue or Loss of Energy

Contrary to many other medical symptoms, fatigue is an entirely normal phenomenon in particular situations. We all become tired, but it usually gets better by rest or sleep. However, chronic fatigue as a medical symptom is typically persistent and not relieved by rest (12).

Chronic fatigue is prevalent among patients with depression. It is often described as feeling tired all the time, exhausted or listless. Some people with depression experience total lack of energy sometimes called ‘anergia’.

Fatigue and depression seem to have a circular relationship. For some, fatigue will come first; for others, depression will come first, but for most, it will probably be unclear (13). The fatigue may lower self-esteem and make the depression worse, leading to more fatigue.

If the fatigue that comes with depression becomes overpowering, basic tasks such as getting out of bed and walking may be exhausting.

The symptoms of fatigue can affect physical, cognitive, and emotional function, impair school and work performance, disturb social and family relationships, and increase healthcare utilization (14).

5. Feelings of Worthlessness or Excessive Guilt

A study of patients with major depression published 2015 showed that self-blaming emotions occurred in more than 80% of patients with self-disgust/contempt being more frequent than guilt, followed by shame (15).

The majority (85% of patients) reported feelings of inadequacy and self-blaming emotions as the most bothering symptoms compared with 10% being more distressed by negative emotions towards others.

Patients with depression often tend to misinterpret events or minor setbacks as evidence of personal failings (16).

A patient with depression has described her feelings in the following manner (17):

“I should be a spy; I am so good at leading a double life. I can put on a smile, muster up a good conversation (after ignoring a few calls and messages), but the reality is, all those “normal,” happy interactions exhaust me, and for that, I feel guilty.

I feel guilty that I want to scream at my boyfriend who is just trying to be understanding. I feel guilty that I cause those closest to me to worry. My parents, my partner, my family, and friends, all of them try to support me, to ensure I don’t get too low. How do I tell them it isn’t them and no matter what they do often I just feel low? I feel guilty that their efforts to help sometimes just make it worse.

I feel guilty for canceling plans last-minute. I mean to go, I want to go, but often I just don’t have the strength. I am brilliant at making excuses, but the shame I feel for letting people down is ever-present.

I even feel guilty for feeling guilty. Maybe some other people understand this warped way of thinking. I would tell anyone else with depression to not be so hard on themselves, to acknowledge their efforts. But to me, I just feel guilty.”

6. Sleep Disturbance (Insomnia and Hypersomnia)

Several types of sleep disorders may occur in patients with depression. The term insomnia is used often used to describe the symptoms associated with these sleep disorders.

Insomnia may be a difficulty falling asleep, waking up frequently during the night with difficulty returning to sleep, waking up too early in the morning, or merely an unrefreshing sleep. It is not defined by the number of hours slept but reflects the satisfaction with sleep. Insomnia is often associated with tiredness, lack of energy, difficulty concentrating, and irritability.

Depression may be associated with difficulty getting to sleep (initial insomnia). Waking in the middle of the night (middle insomnia) or earlier than usual (terminal insomnia) with difficulty turning to sleep is common. Prolonged nighttime sleep or daytime sleeping (hypersomnia) may occur as well.

About three-quarters of depressed patients have insomnia symptoms, and hypersomnia is present in about 40% of depressed young adults and 10% of older patients, with a preponderance of females (18).

Disturbed sleep is a very distressing symptom which has a significant impact on quality of life in depressed patients (19).

Many patients with depression wake up prematurely in the early morning hours, unable to get back to sleep. This early-morning awakening is often associated with dysphoria and depressive thoughts, and sometimes there is an agitated, even a panicky feeling. This may often get better during the day and the evenings are often more comfortable.

7. Neurocognitive Dysfunction (Difficulty Concentrating, Remembering or Making Decisions)

Neurocognitive dysfunction is common in patients with depression (20).

Memory loss and an inability to focus or concentrate may be pronounced. Working memory, fluency, and planning and problem-solving abilities may be impaired.

People with depression often feel like they can’t focus. Comprehending what you are reading may become difficult and affect the ability to store information. This may negatively impact enjoyment when reading for pleasure.

The ability to receive information or directions may be impaired. We may appear easily distracted. This may affect performance at school and work. Sometimes these symptoms may be misinterpreted as lack of interest or consideration.

In most cases, neurocognitive dysfunction in depression is readily distinguished from that caused by dementia.

8. Change in Appetite and Body Weight

Reduced appetite and weight loss are common in patients with depression. However,  increased appetite and weight gain may also occur.

Changes in eating habits are often related to other symptoms of depression, such as lack of energy and interest or pleasure from activities.

While a loss of appetite is common in depression, the sadness or worthlessness experienced by many patients may be associated with overeating (emotional eating). Emotional eating is eating in response to emotional rather than physical hunger.

9. Psychomotor Disturbances (Restlessness, Irritability, Retardation)

Psychomotor disturbances that are common in depression include both agitation and retardation (16).

Psychomotor agitation is a series of unintentional, nonproductive or purposeless motions. In patients with depression, this may present as hand-wringing, pacing, and fidgeting.

Psychomotor retardation is a slowing down of thought and physical movements and may include slowing of body movements, thinking, and speech.

10.  Thoughts of Suicide or Death

Depressed patients often experience recurrent thoughts of death. Suicidal ideation often occurs and there is a risk of suicidal attempt in some patients with depression (21).

Sometimes, suicidal ideation is passive. Patients often consider life not worth living and that their closest family and friends would be better off if the patient were dead.

In contrast, active suicidal ideation is marked by thoughts of wanting to die or commit suicide (16). There may be suicide plans and preparatory acts (e.g., selecting time and location, choice of method, or writing a suicide note). Such behavior indicates the patient is severely ill.

Suicidal ideation is usually preceded by hopelessness and negative expectations for the future. The patient may regard suicide as the only option to escape a never-ending and intense emotional and often physical pain

Alarmingly, many patients with suicidal ideation have not been recognized as having depression. In a large Canadian study, 48% of patients who had suicidal ideation and 24% of those who had made a suicide attempt reported not receiving care or even perceiving the need for care (22). The investigators concluded that future research should be directed toward finding better ways to identify these individuals and address barriers to their care and other factors that may interfere with their receiving help.

The annual suicide rate in the United States is approximately 13 per 100,000 individuals. Suicide is the tenth leading of cause of death. In 2014, the total number of suicide deaths in the United States was 42,773 (23). This equals 117 suicide deaths every day.

It is recognized that certain occupations and professions may be more susceptible to depression and suicide. Occupations that require frequent or difficult interactions with the public or clients, and have high levels of stress and low levels of physical activity seem to be at highest risk (24).

The medical profession has the highest risk of death by suicide of any profession or occupation. Other high control and highly regulated professions such as law enforcement, military, and the legal profession may be more likely to experience depression and suicidal behavior, and less likely to seek intervention because of the associated stigma and possible licensure implications (25).

Recent research suggests that suicide is three times more likely in individuals who have experienced a concussion, so occupations that might result in head injuries may be predisposed to suicide, with or without concomitant depression (26, 27).

A few patients with depression have described their thoughts concerning suicide on the website The Mighty (27). Here are a few examples:

“It feels like you’re all alone and no matter what’s said to you, you feel like it’s not true or doesn’t matter. It feels like you just need to end it all because you’re so tired of fighting every single day.”

“I didn’t realize what I was feeling until I came out of it. It felt like I wasn’t breathing, I was drowning, and someone was holding my head under water. I was lost, alone and there was no other way out. No one understood me and no one ever would. When I finally broke free of the deep suicidal thoughts, I was able to see them for what they were, not before or during. I felt choked by the emotions and blinded by them.”

“A constant ache in my heart, my lungs, my wrists, my legs, my mind and the pit of my stomach. The ache that tells me nothing is sacred; everything is pointless. That nothing ever has or ever will matter. Why must I continue breathing? Why must I keep getting out of bed every day when I am so incredibly tired? Feeling utterly worthless, to the point that you wonder if your own children would be better off without you around.”

 “The thought of death formed as a monster in my head. It is after me; I cannot run away from it. I don’t want to die, but I don’t want to live, either. The pain is too much strong, so I desperately think I cannot take another day. But deep down inside of me, I always have a tough wish to see another day — as a human instinct, I guess. I grabbed this very little feeling to go on. I hope everyone else will [too].”

“And if depression has taught me one thing, it is this: what a rare and beautiful treasure is the simple human gift of joy. For me now, joy – our capacity to delight in one another and the world – is the reason why we are here. It is as simple as that. And I feel compelled to spread the word.” Giles Andrea

Diagnosing Depression

Symptoms of depression may include the following:

Persistently sad, anxious, or empty moods

Loss of pleasure in usual activities (anhedonia)

Feelings of helplessness, guilt, or worthlessness

Crying, hopelessness, or persistent pessimism

Fatigue or decreased energy

Loss of memory, concentration, or decision-making capability

Poor abstract reasoning

Restlessness, irritability

Sleep disturbances

Change in appetite or weight

Physical symptoms that defy diagnosis and do not respond to treatment – (very commonly pain and gastrointestinal complaints)

Thoughts of suicide, death, or suicide attempts

Poor self-image or self-esteem

To establish a diagnosis of major depression, a patient must express one of the first two items above and at least five of the other symptoms listed. Such disturbances must be present nearly daily for at least two weeks (25).

The Bottom-Line

Dear reader. If you have read this article, it may be for general information purposes or because you fear or believe that you may be suffering from symptoms associated with depression. If the latter is true, I want to remind you that depression is not a personal weakness but a serious medical disorder.

Because depression is a disease, it can not be “willed” or “wished away”. Unfortunately, that is a common misperception by the public and some medical professionals.

Patients with depression often feel terrible. The combination of physical and emotional symptoms may be overwhelming. The tiredness, darkness, and emptiness may seem unbearable. However, depression is a treatable disease. Almost all people who have suffered from depression will tell you that things will get better. And that is true.

And, remember; Never be ashamed of your depression. You wouldn’t be if you had a brain tumor, heart attack or leukemia.

Oh, and finally; Don’t try to deal with your depression by yourself. Seek professional help.

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