#pcp = primary care physician

[billa-billa007]

PTs in the primary care space with Dr. Katie O'Bright

Physical Therapists (PTs) are healthcare professionals who specialize in treating individuals with physical limitations and impairments. They play a critical role in helping patients improve their mobility, function, and overall quality of life.

[drmarshallbahr]

Dr. Marshall Bahr Linkedin

https://www.linkedin.com/in/dr-marshall-bahr

My linked in profile, click here

[mostlysignssomeportents]

How to have cancer

THIS WEEKEND (November 8-10), I'll be in TUCSON, AZ: I'm the GUEST OF HONOR at the TUSCON SCIENCE FICTION CONVENTION.

I've got cancer but it's probably (almost certainly, really) okay. Within a very short period I will no longer have cancer (at least for now). This is the best kind of cancer to have – the kind that is caught early and treated easily – but I've learned a few things on the way that I want to share with you.

Last spring, my wife put her arm around my waist and said, "Hey, what's this on your rib?" She's a lot more observant than I am, and honestly, when was the last time you palpated your back over your left floating rib? Sure enough, there was a lump there, a kind of squishy, fatty raised thing, half a centimeter wide and about four centimeters long.

I'm a 53 year old man with a family history of cancer. My father was diagnosed with lymphatic cancer at 55. So I called my doctor and asked for an appointment to have the lump checked over.

I'm signed up with Southern California Kaiser Permanente, which is as close as you come to the Canadian medicare system I grew up under and the NHS system I lived under for more than a decade. Broadly speaking, I really like KP. Its app – while terrible – isn't as terrible as the other apps, and they've taken very good care of me for both routine things like vaccinations and checkups, and serious stuff, like a double hip replacement.

Around the time of The Lump, I'd been assigned a new primary care physician – my old one retired – and so this was my first appointment with her. I used the KP app to book it, and I was offered appointments six weeks in the future. My new doc was busy! I booked the first slot.

This was my first mistake. I didn't need to wait to see my PCP to get my lump checked over. There was really only two things that my doc was gonna do, either prod it and say, "This is an extremely common whatchamacallit and you don't need to worry" or "You should go get this scanned by a radiologist." I didn't need a specific doctor to do this. I could have ridden my bike down to the KP-affiliated Urgent Care at our local Target store and gotten an immediate referral to radiology.

Six weeks go by, and my doc kind of rolls the weird lump between her fingers and says, "You'd better go see a radiologist." I called the Kaiser appointment line and booked it that day, and a couple weeks later I had a scan.

The next day, the app notified me that radiology report was available in my electronic heath record. It's mostly technical jargon ("Echogenic areas within mass suggest fatty component but atypical for a lipoma") but certain phrases leapt out at me: "malignant masses cannot be excluded. Follow up advised."

That I understood. I immediately left my doctor a note saying that I needed a biopsy referral and set back to wait. Two days went by. I left her a voice message. Another two days went by. I sent another email. Nothing, then a weekend, then more nothing.

I called Kaiser and asked to be switched to another Primary Care Physician. It was a totally painless and quick procedure and within an hour my new doc's intake staff had reviewed my chart, called me up, and referred me for a biopsy.

This was my second mistake. When my doctor didn't get back to me within a day, I should have called up KP and raised hell, demanding an immediate surgical referral.

What I did do was call Kaiser Member Services and file a grievance. I made it very clear that when I visited my doctor, I had been very happy with the care I received, but that she and her staff were clearly totally overloaded and needed some kind of administrative intervention so that their patients didn't end up in limbo.

This is a privilege. I'm a native English speaker, and although I was worried about a serious illness, I didn't have any serious symptoms. I had the ability and the stamina to force action in the system, and my doing so meant that other patients, not so well situated as I was, would not be stuck where I had been, with fewer resources to get un-stuck.

The surgeon who did the biopsy was great. He removed my mass. It was a gross lump of yellowy-red gunk in formaldehyde. He even let me photograph it before it went to pathology (warning, gross):

https://www.flickr.com/photos/doctorow/54038418981/

They told me that the pathology would take 2-5 days. I reloaded the "test results" tab in the KP website religiously after 48 hours. Nothing was updated. After five days, I called the surgical department (I had been given a direct number to reach them in case of postsurgical infections, and made a careful note of it).

It turned out that the pathology report had been in hand for three days at that point, but it was "preliminary" pending some DNA testing. Still, it was enough that the surgeon referred me to an oncologist.

This was my third mistake: I should have called after 48 hours and asked whether the pathology report was in hand, and if not, whether they could check with pathology. However, I did something very right this time: I got a phone number to reach the specialist directly, rather than going through the Kaiser main number.

My oncologist appointment was very reassuring. The oncologist explained the kind of cancer I had ("follicular lymphoma"), the initial prognosis (very positive, though it was weird that it manifested on my rib, so far from a lymph node) and what needed to happen next (a CT/PET scan). He also walked me through the best, worst and medium-cases for treatment, based on different scan outcomes. This was really good, as it helped me think through how I would manage upcoming events – book tours, a book deadline, work travel, our family Christmas vacation plans – based on these possibilities.

The oncologist gave me a number for Kaiser Nuclear Medicine. I called them from the parking lot before leaving the Kaiser hospital and left a message for the scheduler to call me back. Then I drove home.

This was my fourth mistake. The Kaiser hospital in LA is the main hub for Kaiser Southern California, and the Nuclear Medicine department was right there. I could have walked over and made an appointment in person.

Instead, I left messages daily for the next five days, waited a weekend, then called up my oncologist's staff and asked them to intervene. I also called Kaiser Member Services and filed an "urgent grievance" (just what it sounds like) and followed up by filing a complaint with the California Patient Advocate:

https://www.dmhc.ca.gov/

In both the complaint and the grievance, I made sure to note that the outgoing message at Nuclear Medicine scheduling was giving out false information (it said, "Sorry, all lines are busy," even at 2am!). Again, I was really careful to say that the action I was hoping for was both a prompt appointment for me (my oncologist had been very insistent upon this) but also that this was a very broken system that would be letting down every patient, not me, and it should be fixed.

Within a couple hours, I had a call back from KP grievances department, and an hour after that, I had an appointment for my scan. Unfortunately, that was three weeks away (so much for my oncologist's "immediate" order).

I had the scan last week, on Hallowe'en. It was really cool. The gadget was awesome, and the rad-techs were really experienced and glad to geek out with me about the way the scanner and the radioactive glucose they infused in me interacted. They even let me take pictures of the scan visualizations:

https://www.flickr.com/photos/doctorow/54108481109/

The radiology report was incredibly efficient. Within a matter of hours, I was poring over it. I had an appointment to see the doc on November 5, but I had been reading up on the scans and I was pretty sure the news was good ("No enlarged or FDG avid lymph nodes are noted within the neck, chest, abdomen, or pelvis. No findings of FDG avid splenic or bone marrow involvement").

There was just one area of concern: "Moderate FDG uptake associated with a round 1.3 cm left inguinal lymph node." The radiologist advised the oncologist to "consider correlation with tissue sampling."

Today was my oncology appointment. For entirely separate reasons, I was unable to travel to the hospital today: I wrenched my back over the weekend and yesterday morning, it was so bad that I couldn't even scratch my nose without triggering unbearable spams. After spending all day yesterday in the ER (after being lifted out of my house on a stretcher), getting MRIs and pain meds, I'm much better off, though still unable to get out of bed for more than a few minutes at a time.

So this morning at 8:30 sharp, I started calling the oncology department and appointment services to get that appointment changed over to a virtual visit. While I spent an hour trying various non-working phone numbers and unsuccessfully trying to get Kaiser appointment services to reach my oncologist, I tried to message him through the KP app. It turns out that because he is a visiting fellow and not staff, this wasn't possible.

I eventually got through to the oncology department and had the appointment switched over. The oncology nurse told me that they've been trying for months to get KP to fix the bug where fellows can't be messaged by patients. So as soon as I got off the phone with her, I called member services and filed another grievance. Why bother, if I'd gotten what I needed? Same logic as before: if you have the stamina and skills to demand a fix to a broken system, you have a duty to use them.

I got off the phone with my oncologist about an hour ago. It went fine. I'm going to get a needle biopsy on that one suss node. If it comes back positive, I'll get a few very local, very low-powered radiation therapy interventions, whose worst side effect will be "a mild sunburn over a very small area." If it's negative, we're done, but I'll get quarterly CT/PET scans to be on the safe side.

Before I got off the phone, I made sure to get the name of the department where the needle biopsy would be performed and a phone number. The order for the biopsy just posted to my health record, and now I'm redialing the department to book in that appointment (I'm not waiting around for them to call me).

While I redial, a few more lessons from my experience. First, who do you tell? I told my wife and my parents, because I didn't want to go through a multi-week period of serious anxiety all on my own. Here, too, I made a mistake: I neglected to ask them not to tell anyone else. The word spread a little before I put a lid on things. I wanted to keep the circle of people who knew this was going on small, until I knew what was what. There's no point in worrying other people, of course, and my own worry wasn't going to be helped by having to repeat, "Well, it looks pretty good, but we won't know until I've had a scan/my appointment/etc."

Next, how to manage the process: this is a complex, multi-stage process. It began with a physician appointment, then a radiologist, then a pathology report, then surgery, then another pathology report, then an oncologist, then a scan, then another radiologist, and finally, the oncologist again.

That's a lot of path-dependent, interdepartmental stuff, with a lot of ways that things can fall off the rails (when my dad had cancer at my age, there was a big gap in care when one hospital lost a fax from another hospital department and my folks assumed that if they hadn't heard back, everything was fine).

So I have been making extensive use of a suspense file, where I record what I'm waiting for, who is supposed to provide it, and when it is due. Though I had several places where my care continuity crumbled some, there would have been far more if I hadn't done this:

https://pluralistic.net/2024/10/26/one-weird-trick/#todo

The title of this piece is "how to have cancer," but what it really boils down to is, "things I learned from my own cancer." As I've noted, I'm playing this one on the easiest setting: I have no symptoms, I speak and write English fluently, I am computer literate and reasonably capable of parsing medical/technical jargon. I have excellent insurance.

If any of these advantages hadn't been there, things would have been a lot harder. I'd have needed these lessons even more.

To recap them:

See a frontline care worker as soon as possible: don't wait for an appointment with a specific MD. Practically any health worker can prod a lump and refer you for further testing;

Get a direct phone number for every specialist you are referred to (add this to your phone book); call them immediately after the referral to get scheduled (better yet, walk over to their offices and schedule the appointment in person);

Get a timeframe as to when your results are due and when you can expect to get a follow-up; call the direct number as soon as the due-date comes (use calendar reminders for this);

If you can't get a call back, an appointment, or a test result in a reasonable amount of time (use a suspense file to track this), lodge a formal complaint with your insurer/facility, and consider filing with the state regulator;

Think hard about who you're going to tell, and when, and talk over your own wishes about who they can tell, and when.

As you might imagine, I've spent some time talking to my parents today as these welcome results have come in. My mother is (mostly) retired now, and she's doing a lot of volunteer work on end-of-life care. She recommends a book called Hope for the Best, Plan for the Rest: 7 Keys for Navigating a Life-Changing Diagnosis:

https://pagetwo.com/book/hope-for-the-best-plan-for-the-rest/

I haven't read it, but it looks like it's got excellent advice, especially for people who lack the self-advocacy capabilities and circumstances I'm privileged with. According to my mom, who uses it in workshops, there's a lot of emphasis on the role that families and friends can play in helping someone whose physical, mental and/or emotional health are compromised.

So, that's it. I've got cancer. No cancer is good. This cancer is better than most. I am almost certainly fine. Every medical professional I've dealt with, and all the administrative support staff at Kaiser, have been excellent. Even the doc who dropped the ball on my biopsy was really good to deal with – she was just clearly drowning in work. The problems I had are with the system, not the people. I'm profoundly grateful to all of them for the help they gave me, the interest and compassion they showed, and the clarity and respect they demonstrated in my dealings with them.

I'm also very grateful to my wife, my parents, and my boss at EFF, all of whom got the news early and demonstrated patience, love, and support that helped in my own dark hours over the past couple of months.

I hope you're well. But you know, everyone gets something, eventually. When you find yourself mired in a broken system full of good people, work the system – for yourself and for the people who come behind you. Take records. Make calls.

Look after yourself.

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

https://pluralistic.net/2024/11/05/carcinoma-angels/#squeaky-nail

[bitchesgetriches]

and bitches how do I get sterilized (afab) i thought i might want kids in my 30s but i cant really risk it can i i just dont know what to do

Hi sweetness. I suspect a lot of people are in your boat right now. Personally, I got my first IUD implanted in January of 2017. NOTE THE TIMING. I also had a friend get her tubes tied around that time.

The most important thing to remember is that getting sterilized as an AFAB person is over 99% effective and pretty damn permanent. So if you think you just can't risk getting pregnant SOON, but you might want to SOME DAY... then don't get sterilized. Explore another option. Again, I have an IUD and thoroughly recommend it.

It's a fairly simple out-patient procedure, but as with any surgery, it comes with health risks. Sterilization for AMAB people is slightly less risky. Make sure to take all that into account.

So if you truly want to get sterilized, here's what I (a non-doctor) recommend:

The very first step is to make sure you have a primary care physician and health insurance. Your PCP is the one who will refer you for the surgery. Make an appointment and tell them this:

"I would like to be sterilized via a tubal ligation. I've carefully considered this for a long time, and after doing significant research and discussing it with my loved ones, I've determined it's the best decision for my future."

A lot of people get pushback from their doctors when they request sterilization. That's why you want to make it abundantly clear that this is not a sudden whim, but something you've put serious thought into. And married folks will sometimes be asked to clear it with their spouse first (that happened when my husband requested a vasectomy).

They might try to talk you out of it. They may flat out refuse to refer you. If this happens, just calmly say: "Thank you for your time. Since you won't help me with my healthcare needs, I will be seeking a new primary care physician at this time." Then get yourself a new doctor.

Under the ACA (the Affordable Care Act, aka Obamacare) the procedure will be completely free with your insurance. That's why it's important to make sure you have health insurance before you request the procedure. The Trump administration is sure to try repealing the ACA again (in his first term, John McCain was literally the deciding vote on overturning the ACA, and he's fucking dead now and congress is full of MAGA sycophants). So you need to work quickly in case your sterilization will no longer be covered.

I strongly recommend you seek more advice from healthcare professionals. @plannedparenthood is also a great resource for everything to do with reproductive healthcare. But this should help you get the ball rolling.

Good luck, my dear. Here's more of our advice:

How to Prepare for a Post-Roe World (Bonus Episode) 

How To Get an Abortion 

How (and Why) to Take Back Reproductive Rights: On Pulling Weeds and Fighting Back 

Did we just help you out? Say thanks with a Patreon donation!

[the-bad-batch-baroness]

Health Update

First, I want to say thank you to everyone who reached out or commented on the latest installment of Where's Mommy? to wish me good health. I am so grateful for all of you 💚

However, the health issue I'm currently dealing with isn't due to a virus or bacteria, and there's a possibility it won't get better.

A little history.

Back in 2022, there was a two week period where I felt like my blood sugar was dropping, and I was very symptomatic. There was a moment where I slumped down a wall at work because of it, and they had to dump sugar packets from the break room into my mouth to rouse me. It was a very scary time.

After those two weeks, I went to my Primary Care Physician who ordered blood tests and had me purchase a glucometer to test my blood sugar several times a day. However, during the two weeks she had me do this, I never got a reading below 70, and the same symptoms did not develop as they did prior. My blood work came back clean, and without a reading lower than 70, my PCP dismissed it and told me I was having anxiety attacks, lol. She told me to come back if the symptoms came back, and they never did.

Backing up a couple more years.

Without revealing too much of my medical history, I have a chronic illness called POTS (postural orthostatic tachycardia syndrome). It's a dysautonomia or a dysfunction of the autonomic nervous system, the system that controls all of the automatic functions of the body. It was caused by my battle with Lyme Disease in 2010 and is currently incurable. I was diagnosed with POTS in 2018, after being told for 6 years that I had anxiety, lol.

POTS is not a very well-known illness, but it's getting more attention these days. It garners a host of different symptoms, including tachycardia, chronic fatigue, brain fog, orthostatic intolerance, migraines, gut issues, syncope, dehydration, blood pooling, etc. Everyone's POTS presents differently, and most people with a POTS diagnosis live on disability. I made the choice not to.

Fast forward to 2024.

Fast forward again to this past Wednesday.

Well, I finally was able to get a POTS specialist in my state this year. A huge win! When I had my initial consultation, I had mentioned the low blood sugar episodes in 2022 and asked if it could be related to POTS. The doctor told me that they don't see POTS patients having low blood sugar issues, but we're concerned enough to refer me to an endocrinologist. Another big win!

I had my consultation with the endocrinologist, and he ordered more blood tests, some of the same tests as before, and some different (y'all, they took like 20 vials from me). He also gave me a CGM (continuous glucose monitor) to wear for 14 days so they can track my highs and lows to see if they can catch anything.

Well, the next night, my blood sugar dropped below 70, 20 times, and 55, 9 times. Which means I was woken up 9 times throughout the night. I got only about 2 hours of sleep, and still had to go to work the next morning. But, once again, it went back up by itself without any intervention from me.

Y'all, it caught A LOT in just the first day, actually night. My blood sugar dropped below 70, 11 times, and below 55, 4 times while I was sleeping. Now, because anything below 55 is considered critical and could be fatal, there is an alarm that cannot be overridden and will sound. It sounds like a smoke alarm. So, I was awoken 4 times.

The odd thing is that my blood sugar dropped, then went back up on its own. I didn't eat or drink anything. Blood sugar doesn't really do that, so I thought it was odd. This also begs the question: If I'm asymptomatic at 53, then what level was I at in 2022 when I had symptoms? Honestly, I don't want to know.

Here is a nifty graph!

All of the red is considered low blood sugar, below 70, and anything close to that 50 line is considered critical low blood sugar. And again, I did not eat anything during the night.

There are four major anomalies with my low blood sugar occurences:

Most cases of hypoglycemia are seen in diabetics, I am not diabetic

Most cases of hypoglycemia seen in non-diabetics are sporadic, mine are consistent

Hypoglycemia is normally corrected by consuming sugar, mine auto-corrects

When blood sugar drops, it creates symptoms, I do not get symptoms

There are only a handful of things that can cause hypoglycemia in a non-diabetic and even less consistently at night time. The doctor has already ruled out insulinoma (insulin producing tumors in the pancreas), so that leaves even less, and also the good old "we don't know what's wrong with you".

I'm not going to lie. This whole thing terrifies me. There's no telling how long my blood sugar has been doing this, and it only takes one dip below 50 for me to slip into a coma and die in my sleep. Luckily, my blood sugar does this crazy autocorrect thing, and I haven't died yet! Humor makes this easier.

Right now, I'm emotionally, mentally, and physically exhausted. Adding this on top of my already difficult life with POTS has been hard to cope with, and I'm crying a lot.

Hopefully, I'll get results soon, and my endocrinologist can figure out why this is happening and how to manage/fix it if it can be managed/fixed. Maybe I've got a completely new illness, and you'll find me in a medical journal! Wouldn't that be something.

Anyway, thanks for the continued support. I have a lot of IRL support from friends and family, but while I go through this process, I may seem distant, my posting might be sporadic, I may not keep my fic posting schedule, etc. And when I have an update, I promise to let y'all know!

Much love 💚💚💚

Steph

[skynapple]

No no no but I just thought of the FUNNIEST saddest thing. If you choose any of the other LI's over Zayne,, him as your primary care physician (PCP) and having to ask him to prescribe birth control....

[morlock-holmes]

More true stories of American health care:

Insurance: "Here's the primary care physician we've assigned to you, Dr. X"

Calls Dr. X's office

Receptionist: "Let me see if the scheduling department is taking phone calls right now"

The scheduling department is not taking phone calls, but they do have a voice message saying that there are no openings and no wait list.

Me: calls a bunch of other numbers

Me: gets an appointment to see a PCP on Christmas Eve morning, the earliest they have.

Me: Realizes that I don't have enough medicine refills to last until then, so I call insurance.

Me: "Hey, the PCP I am supposed to see doesn't have any openings to see me until six months from now, how do I get refills until then?

Insurance Company: "Oh, don't worry, if your PCP can't see you we can give you a telehealth appointment with a registered nurse, we have a program specifically designed to do that."

Me: "Great"

At which point I am billed $700 for that telehealth appointment, with a note saying that the claim was rejected, because I am supposed to go to my PCP for prescription services.

The PCP I have never met. The one I can't get an appointment with.

The one I specifically told them I couldn't get an appointment with, leading them to explain to me that this is what Bridges is for.

As usual, once I find the right person to talk to (Not in the billing department) they basically act like this is my fault.

"Well, when you called our number and told the customer service rep that you weren't able to see your PCP, you informed the wrong part of the company about it. It's your responsibility to make sure that the right part of the company knows about this, you obviously can't just call customer service, duh."

[bomberqueen17]

adderall day 1

I'm not going to have any particular deep thoughts about this, but I feel like I should write stuff down. Several people have advised that.

I still don't know how much this is going to cost me, as my insurance couldn't be verified and I'm going to have to do messy things probably to find out. But I've got the pills in my hot little hand, 16 of them, and a follow-up appointment, and perhaps by then I'll know what this is actually costing.

It seems that it varies wildly how people manage to get ADHD dx's. Many many PCPs will not diagnose it or prescribe for it. It seems extremely gatekeepy to me, and not in a helpful way. my own PCP, as I describe more and more of my struggles to get healthcare in general, is being revealed to me to be less and less of any kind of a good fit-- she just seems baffled by everything I say. She asked if I have heartburn, for example, and I said, truthfully, oh yes, if I don't eat regularly, one of the ways I realize I've gone too long is that I start to have heartburn. So I've learned to be conscientious about my eating schedule, and eat small meals and snacks at regular intervals throughout the day, and that has cleared up the problem. And this actively baffled her, she was like "i've never heard of anything like this", and I can't imagine what she thought I was saying. Does no one else in the human race ever get queasy/stomach-acidy from going too long without food? Especially eating heavily and then not eating for a long time afterward? That's the worst for me, so I avoid that. I highly doubt I am the only person ever to experience this. But she seemed convinced that I must not know what heartburn is.

That's just one example. So. If I can get my head on straight at all, I am going to start looking for a new primary care physician. I'm sure this doctor is fine, just not for me.

(She is obsessed that my fasting blood glucose levels are too high. I read an article about it, in the 2010s sometime the CDC decided that 5.7 was a new worrying number (I don't know what the units are, but 7 is what people with well-managed diabetes shoot for), and now they were going to declare this new number "pre-diabetes" and start medicating it. The WHO has refused the concept of "pre-diabetes", pointing out that about 2% of people with this number wind up developing full-blown diabetes whether medicated or not, and that's about the same number of people who develop diabetes without having had this diagnosis, so it is in fact not any kind of reliable indicator of looming diabetes, so it should be referred to as "elevated fasting blood glucose levels" and not the new fictional "pre-diabetes". But there's money in selling that medicine, so American doctors are encouraged to make this diagnosis. And my doctor has put it into my chart that she plans to start me on Metformin if this number does not go down.

I'm refusing that. Medicate me for diabetes if I develop diabetes. I can be annually screened for it just like anyone. Sure, keep an eye on it! I take this seriously. But i am not getting medicated for a condition the WHO thinks is fictional. Thanks.)

Anyway that was a digression.

I'm hoping to at least make a start on dialing in my meds with this online guy, so that when I switch PCPs I can show up with the ADHD treatment as a fait accomplit and not have the new PCP throw a fit. I might try it with the current one too-- "Idk you told me it was incredibly complicated and insurance doesn't cover it so I went to my insurance company and they sent me to this guy and it wasn't complicated at all and I'm responding super well to the treatment so I guess this is what I do now?" but I am just anticipating her throwing a fit of some kind, since she is absolutely convinced I have major depressive disorder and has been trying to get me to go back on Celexa, which did me so much no good that I cold-turkeyed off it and gave myself horrible brain zaps. Don't fucking do that guys.

(It was with this same practice! It's on there, I no-showed to an appointment because I had so little executive function I wasn't even able to keep track of it! And she's still like yah medicating u for depression is super what's going to work. ma'am i have never been suicidal but I remember being on Celexa and most of it was my shitty life situation at the time but mostly it is a gray expanse of despair and ineffectualness, and getting inexorably fatter whilst starting to develop an eating disorder about it, and getting benched by my roller derby coach despite exercising myself to constant exhaustion and performing better than I ever had on the track because she saw my spreading waistline and assumed I was slacking off, and anyway. Yeah no.)

So anyway. I'm letting myself be stream of consciousnessy because it seems right. I had a reasonable breakfast, a lot of water, some coffee, a multivitamin, and my first pill about an hour ago, and am now ensconced in the recliner with the cat because the cat insists. I have started to feel.... kind of... like my throat feels kind of dry so I'm drinking more water, and I just got a little bit not quite dizzy and am acutely aware of all my eye movements, so I guess that's notable.

OK the plan. I would like to someday be able to make to-do lists, that's a medium-term goal. Meanwhile I'm still doing narratives of how i'd like a day to go. I have fallen off that a bit; I've been trying to do not a bullet journal but a just regular day planner in this new year (i got something on clearance off amazon lol) and mostly what I've used it for is as a diary post-hoc, writing down what i got done, and making little notes of what I want to get done, because otherwise my memory wipes itself and I don't know what I did all last week either. I fell off it this week because Dude was out of town and I was off kilter. But I'm going to fill back in what I can remember-- I'm keeping track of what meals I cook, what exercise I do, things like that-- and hope to keep it up going forward.

Routine, I hope, is what will help me.

Today. It is rainy today. I didn't get some of my stuff done while Dude was gone because of course the list I made would have taken six weeks of work, that's how my lists go. But I did get a lot done, so I'm going to write all that down. And today it is rainy, so I can spend time in the basement. What I want to do is empty out all my nice baskets I use to tote craft things around, and re-fill them with more curated selections. I think one basket for like, all the sewing tools, just all of them, in one place, and then another basket that is like, all of the embroidery supplies, and then a container that is An Adequate Selection Of Thread and also machine-sewing supplies? maybe? and then Active Projects can go into a third container that may or may not travel with me. Anyway, thinking about that is a work in progress.

I need to pack for my first trip of the season to the farm. I need to put away all the supplies from painting the kitchen, because I am finally officially totally completely done with that. I need to then tidy the kitchen counter and there's a little wooden cart that used to have our coffee stuff on it and I've been using it to dump all the shit and assorted project detritus from the ongoing painting on, and I need to then move that cart somewhere once I've put away all the things on it.

That seems like a reasonable amount of things to expect to complete today. OK I need to get out from under this cat because I have to pee now. All right. She'll be fine she just wants the chair really.

Yah ok i really gotta pee and dude is in the shower so i'm going to go get dressed and dance around a little lolsob. wish me luck.

[huntersmoon1]

Can a heart surgeon also be a regular doctor?

Cuz as far as I know a PCP (Primary care physician) is a regular doctor people see for yearly check ups,med refills, and stuff like the Pap test women get every 5 years.

Something I recently had done for the first time and I hated every minute of it.

Wait does that mean Zayne’s had to give Mc a Pap test at least once depending on her age?! 😳

[divineslcyer]

Art & Commission Signal Boost

So this passing week, we discovered an infection in my mom's foot after her appointment with her PT (Physical therapist). We went straight to her PCP (Primary care physician) upon noticing her foot looked darker in shade, like it was properly bruised. Now for the past two months, my mother's ankle hasn't shown much progress in healing but from what I understand with diabetics, it takes longer than average to heal. At her PCP, we learned her foot likely has an infection, and had to go to Mercy ER for because of the pain in her foot and infection, it was raising her blood sugar levels to higher than normal rates (i mean 300+ high) which is VERY unusual as my mom's been keeping to her meds and learning to stabilize her sugar levels.

Due to the urgency of the situation, travels, buying food outside since we hadn't had the means to go to the store yet, and my being busy tending and monitoring her, I've had to use up the funds for some of my other bills instead. So I'll be linking here my art commissions and graphic commissions for those who can help or are interested in buying work. I accept payment from Cashapp, paypal, and Zelle.

Here's some examples of my newer graphics, mainly character style psd's and dash icons;

and for those who want simple character/dnd busts, I do have a special for $50 that are like so;

Otherwise other commissions are available, slots are open so feel free to dm me here or on my other socials, even discord if interested. Please boost and reblog, as I am actively looking for work to help, takes a moment but means a lot! Thank you!

[whereismyfoot]

so now that we're both out of that bathroom... are you gonna be my new PCP?

- @adamant-stanheight

... Your primary care physician?

[compassionatereminders]

to 🪦 anon:

hey, i'm also living in the US! i'm not diagnosed with schizophrenia specifically but i have/do experience hallucinations and delusions as a part of my bipolar disorder and am prescribed antipsychotics to treat that.

luckily in my experience psychiatrists aren't super stingy with antipsychotics because they aren't a controlled substance and you can't really abuse them, like i've also been prescribed ritalin (stimulant) before to treat adhd and navigating that prescription and trying to get refills etc for that way was more difficult.

but yeah that's familiar, that w some medications insurance won't let a PCP prescribe, so you HAVE to see a psychiatrist. like 7 years ago when i was only diagnosed with depression, it was totally fine for my primary care physician to write me a script for an antidepressant, but it gets weird with medications and diagnoses that aren't as widely used. which really sucks when you literally already know exactly what kind of treatment would help, it's just an annoying hoop for you to jump through and i'm sorry you have to do it.

if it's any consolation, psychiatrists tend to have a wider knowledge base on psychiatric medication, and so it may be useful in the future to have a psychiatrist for the purpose of navigating side effects etc. like in my experience if you're like oh hey this med makes me feel like shit, psychiatrists will have more suggestions for similar types of medication and also experience with treating other people with the same/similar diagnosis and treatment plan.

best of luck to you out there, i hope the psych appointment in december is no biggie and you're easily able to get the meds you need. i wish you the best with navigating driving as well, i can't rlly speak to that bc i have some intense car crash ptsd but it's agonizing to have ur freedom and autonomy taken from u. much love to you and to Kat!

Thanks for sharing your experience!

[castielspahdehrah]

Post-Therapy Vent

Keep reading or don't. Either is fine, but just know that my therapist gives y'all her seal of approval.

So, I told her about my experience w/coming back to Tumblr and how empty and meaningless it seemed.

First, she was proud of me for being vulnerable enough to take that step of even logging back in. She knows how isolated I've purposely kept myself for a long time now, so the fact I'm even back here and talking to people is a giant leap in the right direction.

Second, I told her what I write and why. Believe it or not, it's not just for the smut lol. The angst stuff I've written was me workin' through things, maybe not specific to my life, but workin' through general pain nonetheless. She said it beats her advising me to start a journal because she can see the value in writing fanfic and bringing about catharsis via fictional characters which is a safer, baby step towards IRL catharsis.

Like you guys have all said, she also hopes I keep my foot in the door, at the very least, because shutting this door and locking it back up now would only unravel the progress I'm making on my own, even without her help. She's told me before it's not so much that I need therapy, per se. I know very well where I stand and I know what's wrong and why it needs fixed. I just need a support system to keep going forward and she'll gladly be that for me.

Now, for the heavy.

When I first started seeing her, I told her I wanted to start fresh. I didn't want to tell her about my past history with therapy; the good, bad, or ugly, and I wanted her to give me her 2 cents after getting to know me. Now, without me ever saying a word, she knew I've already been or damn well should've been diagnosed w/C-PTSD.

She was absolutely correct on that one and I told her that I am ready and willing to do what's necessary to start working through it. She was surprised and impressed that I'm open to EMDR (Eye Movement Desensitization and Reprocessing) and/or DBT (Dialectal Behavioral Therapy). I do draw the line with Cognitive Behavioral Therapy and Group Therapy though. Even without giving my reasoning, she's not a fan of them either, but at this point I'm open to almost anything that will allow me to feel again, instead of shutting down like a damn robot. I don't even care that I could potentially feel 12-24 years of trauma all at once...at least I won't be both numb AND heavy at the same time.

Today, I felt comfortable enough to give her another breadcrumb...a diagnosis I was given at 16 yrs old and believed wholeheartedly that I had up until about 10 yrs ago. Like she said, it's like my symptoms had upended themselves and did a complete 180. Well, not only is that diagnosis "fluid" or "transitional" or can go into "remission" in a sense, it can also exist alongside a diagnosis that my surrogate sister thought I had. This is all to say that she agrees with me that a "re-diagnosis" is in order especially considering it's been 30 fuckin' years since the last one.

So, here's where we stand...

I'm gonna get referred to a psychologist for the "re-diagnosis" testing. In that same building, there should be a psychiatrist who can not only handle the C-PTSD therapy, but take over for my Primary Care Physician and put me on some meds that might actually help me.

Don't get me wrong, my PCP gets major points because he thought ahead enough to do a GeneSight test to see what medications I can metabolize and what ones I can't which is a damn sight better than anyone else has cared to do...however, he still didn't quite pick the right ones, as far as she's concerned.

In the meantime, she wants me to channel my inner nerd and really research my previous diagnoses compared to how I feel now. She's adamant (and correct) that nobody knows my body as well as I do and if I have a general direction to go in, the psychologist that "re-diagnoses" me won't waste anyone's time by looking in the wrong places first.

This is my healing era and it's been a VERY long time coming...but I had to be ready and willing to face it in order for it to do any good. The fact that I recognize this speaks volumes on how much I've already healed and just didn't realize it.

I'm no longer upset with myself for waiting this long to get back into therapy. I'm proud of myself for recognizing that it was finally time.

[actuallyvady]

I've been on medicaid for several years, but never bothered to find a primary care physician-- i've been generally healthy and while i know i should have gone for checkups and whatnot, nothing has made it necessary to figure this shit out.

I realized the other day that what I really wanted for my 40th birthday (four months from now) was top surgery, something I hadn't really even thought much about but has been in the back of my mind, apparently.

I won't get it in four months-- everything is a process and has a wait list. But medicaid in my state covers it, and I found a place that takes it for top surgery, and I submitted an inquiry. They emailed back with some things I would need to have in order to be put on the wait list for a consultation. So it seems I finally need to find a PCP-- i need letters saying this is medically necessary and other such things.

So I go to the medicaid website and start trying to figure things out and...

... the health center I was looking at for surgery is the health center where I, a person on medicaid in the county where I live, am supposed to be receiving care anyway. Well, that's convenient.

It might be faster to do it another way, but I went through their LGBT center to find a PCP-- they have an online form for it, so why not? If I can get that squared away, that makes a lot of the rest of the process so much easier.

[thejoysofdessert]

Boy do I sure dislike the physician covering my PCP sending in a script for 1/4 my normal count of pills that make life worth living. Luckily, my primary care doc will likely be back in January. I have 32 pills to ration through January.

[roguemonsterfucker]

What is PCP? I only know of the drug that everything was blamed on in Buddy when the cops and media needed a cover story

Primary care physician