#pittsburgh therapy

[iero]

Speaking of tattoos, I'm TRYING to talk myself out of getting a new tattoo when I go back to Pittsburgh in a month... On one hand, it's like therapy to me. On the other hand, I'm trying to save money...

[najeeharris]

Chat is this real…

[pittsburghbeautiful]

UPMC in Pittsburgh

UPMC – The University of Pittsburgh Medical Center The University of Pittsburgh Medical Center ( UPMC ) is a nonprofit health enterprise that operates on a global scale. It has a workforce of 92,000 employees, 40 hospitals with over 8,000 licensed beds, and 800 clinical locations, including outpatient sites and doctors’ offices. Additionally, it has a health insurance division with 3.8 million…

[florida3exclamationpoints]

.

[mariacallous]

On a recent Thursday afternoon, researchers Lanuza Faccioli and Zhiping Hu wheeled an inconspicuous black and white plastic cooler from an operating room at a hospital in downtown Pittsburgh. Inside was a badly scarred liver, just removed from a 47-year-old man undergoing a transplant to receive a new one from a donor.

But what if patients could avoid that fate? Faccioli and Hu are part of a University of Pittsburgh team led by Alejandro Soto-Gutiérrez attempting to revive badly damaged livers like these—as well as kidneys, hearts, and lungs. Using messenger RNA, the same technology used in some of the Covid-19 vaccines, they’re aiming to reprogram terminally ill organs to be fit and functioning again. With donor livers in short supply, they think mRNA could one day provide an alternative to transplants. The team plans to begin a clinical trial next year to test the idea in people with end-stage liver disease.

Alcohol use, hepatitis infection, and a buildup of fat in the liver can cause scarring over time. When there’s too much damage, the liver starts to fail. “Right now, if you get end-stage liver disease, it’s irreversible,” Soto-Gutiérrez says. “Well, we found that is not true. It is reversible.”

Soto-Gutiérrez and his team have been experimenting on rats and organs taken from people undergoing transplants at the University of Pittsburgh Medical Center, one of the busiest transplant centers in the US. To help design the mRNA and figure out how to deliver it to the human liver, they’ve partnered with Drew Weissman, a physician and immunologist at the University of Pennsylvania who won the 2023 Nobel Prize in Physiology or Medicine for his pioneering work on mRNA. Together, Soto-Gutiérrez and Weissman lead the Center for Transcriptional Medicine, launched in April with the goal of bringing these medicines to patients.

On the day I visited, I followed Faccioli and Hu through a maze of hallways until they deposited the freshly explanted liver at a pathology lab, where a team of scientists was anticipating the special delivery. After infusing the liver with an experimental mRNA therapy, they placed the organ in an oxygenated bath meant to maintain its function for several days.

A healthy liver is spongy and reddish-brown in color with a smooth appearance. But when the surgeons took this one out of the cooler, it was hard, marbled, and covered in bumps—evidence of cirrhosis, a type of end-stage liver disease. Over time, the man’s healthy liver cells had been replaced by scar tissue, and eventually, his liver stopped working. His only option was to get a new one.

Livers are the second most in-demand organ. In 2023, a record 10,660 liver transplants were performed in the US, driven in part by a steadily growing number of living donors. In a living liver transplant, a piece is taken from a healthy person’s liver and transplanted into a recipient. But even with this uptick in transplants, not everyone who needs a new liver receives one. Patients may have other health problems that disqualify them from a transplant, and others may die while waiting for one. In 2022, the latest year for which data is available, the Centers for Disease Control and Prevention recorded nearly 55,000 deaths due to chronic liver disease.

Living donor transplants are possible because of the liver’s unique capacity to regenerate itself—more so than any other organ in the body. In a healthy person, the liver can regrow to its normal size even after up to 90 percent of it has been removed. But disease and lifestyle factors can cause permanent damage, rendering the liver unable to repair itself.

When Soto-Gutiérrez was studying medicine at the University of Guadalajara in Mexico, his uncle died of liver disease. From then on, he became dedicated to finding a treatment for patients like his uncle. In the early years of his medical career, he noticed that some patients with scarred livers were bound to a hospital bed waiting for a transplant, while other people with cirrhosis were walking around, seemingly living normal lives. He figured there must be cellular differences in these livers.

He teamed up with UPMC transplant surgeon Ira Fox to look for transcription factors—master regulators that can dial up or down the expression of groups of genes—that can potentially reprogram injured organs. Genes rely on transcription factors to perform many essential functions in organs. Together, Soto-Gutiérrez and Fox have analyzed more than 400 failing livers donated by transplant patients. When they compared them with dozens of normal donated livers that acted as controls, they identified eight transcription factors essential for organ development and function.

They zeroed in on one in particular, HNF4 alpha, that seems to act like a main control panel, regulating much of the gene expression in liver cells. In healthy liver cells, levels of HNF4 alpha were turned up, and so were other proteins it controls. But in the cirrhotic livers they examined, HNF4 alpha was almost nonexistent.

The team needed a way to get the transcription factor into liver cells, so they turned to mRNA technology. Used in some of the Covid-19 vaccines, mRNA is a molecule that carries instructions for making proteins, including transcription factors. In the Covid vaccines, the mRNA codes for a part of the virus known as the spike protein. When injected into a person’s arm, the mRNA enters cells and kicks off the protein-making process. The body recognizes these spike proteins as foreign and generates antibodies and other defenders against it.

The Pitt team is using mRNA instead to essentially turn back time in injured organs. “What we’re proposing to do with mRNA is use it to deliver proteins that have the capacity to repair those damaged liver cells,” Weissman says. “Our hope is that we can treat end-stage liver disease and turn the livers around, maybe forever, or at least until patients can get a transplanted organ liver.” Instead of delivering instructions for a foreign protein to generate an immune response, they’re delivering the genetic code for producing a transcription factor—HNF4 alpha.

In a paper published in 2021, the approach revived human liver cells in lab dishes. The researchers have since tested the mRNA therapy in rats with cirrhosis and liver failure. They treated a group of rats every three days for three weeks while a second group served as a control. The animals that were receiving the injection of HNF4 alpha started being more active. The untreated rats continued to decline and eventually died, the expected result at their stage of disease. Some of the treated rats were still living six weeks after receiving the mRNA medicine. Those results have not yet been published in a peer reviewed journal.

The team is also testing the mRNA infusions in human livers removed from patients undergoing transplants—the process I got to observe. Unlike live rats, explanted human livers can’t be observed for weeks on end. Livers have to be retrieved quickly and infused with the mRNA treatment soon after they’re removed from the body. They stay fresh for just four days or so in a preservation fluid. Six hours after the mRNA infusion, levels of HNF4 alpha start going up and last for two to three days. When HNF4 alpha peaks, other essential liver proteins, such as albumin, start to increase as well. That’s important, Soto-Gutiérrez says, because maintaining those protein levels could mean the difference between a patient needing a transplant or not.

Ideally, Soto-Gutiérrez says the mRNA therapy would be something patients could get once a week or every other week in an outpatient facility and go back home. But initially, they’ll need to test the experimental treatment in very sick patients, likely ones that are hospitalized, to make sure it’s safe. The team is gathering data from the rat and human liver experiments to submit a clinical trial application to the Food and Drug Administration in the coming months.

While livers are the first target, Fox thinks other injured organs may be amenable to this approach. “We’ve been wondering whether the same process might be taking place in other organs,” he says. Currently, the team is searching for similar transcription factors in lungs with chronic obstructive pulmonary disease and kidneys with chronic kidney disease.

Josh Levitsky, a liver transplant specialist at Northwestern University who isn’t involved in the work, says new treatments for chronic liver disease are sorely needed. Current therapies can help slow down scar tissue buildup and ease symptoms but don’t address the underlying disease. “The concept of reprogramming and being able to reverse liver failure could be really game changing if it were to pan out in clinical studies,” he says.

But lots of questions remain. How much damage could be reversed? Would patients need to be on the therapy indefinitely? Or would their livers rebound enough to go off it? Could a liver ever be restored back to normal?

“It certainly has a lot of promise,” Levitsky says, “but the clinical development is going to take a long time.”

[whatareyoureallyafraidof]

Just a Thought...

Here's a little lesson I taught at physical therapy yesterday. A few therapists and patients were discussing the woeful performance of the Pittsburgh Pirates. They lamented that the team never really gets better. Now, it's well known that the team owner doesn't spend a lot (in relative terms) of money on the team. So, I explained that if they really wanted the team to get better, they should stop watching them; stop buying their merchandise, and stop going to their games. The owner has shown that he will give you what you accept. If you accept a team that struggles -- year after year -- to remain in the middle of the standings, that's what the owner will give -- while still making money for himself. I told them this also translates to shopping. Does it annoy you when you go to Walmart, and they only have one cashier on duty -- while having 10-20 "self-checkout" lanes open? You're in a hurry, so you ring up your items (sans any kind of employee discount for doing their job). All while being watched by one employee and multiple cameras to ensure you're not cheating them by not ringing up every item. Well, it's the same principle. If you show Walmart that you'll do their job for them, they'll give you what you'll accept. Why put more cashiers on duty if the people will do it themselves? But, if -- and I know this would be an inconvenience for a day, or two -- if 27 shoppers lined up at the one manned cash register, and refused to use the self-checkout lane, it would force Walmart to open another lane. And, if it happened again the next day, Walmart might get the message. It's just a thought.

[allsadnshit]

Those 35mm photos are beautiful! If you don’t mind, and sorry if you’ve answered this before, but would you mind sharing how you and your husband met? You two have a beautiful relationship

oh jeez everyone knows this is my favorite question lol

my husband and I met through being tumblr mutuals when we were probably around 17! we lived in the same state but still 6 hours apart so we never thought of each other as a tangible person to know and meet, it was truly just a silly little internet friendship liking each other's posts and occasionally messaging about little things like books we were reading or music we listened to but never anything lengthy or personal.

that went on for like 7-8 years, sometimes not talking for a long period of time because we really were just internet friends! then when I was 24, before my endometriosis diagnostic surgery, I was at my absolute sickest I'd ever been. pretty much totally house-ridden and also in a really transitional moment because I had just finally had a long term very not fulfilling relationship end + was processing a lot alone quarantined in my house because covid lockdowns just started. I had a conversation with a really close friend where I said I felt like I had always just been dating passively in relation to who was close by and never really on "dream person" levels and she asked who I'd hit up if I could date anyone and Myles was who came to mind to me! So the next time he dm'd me on ig about something silly like complimenting my new shoes I posted I flirted for the first time and he responded enthusiastically and we realized we had always quietly had little crushes on each other!

we talked every day for like a month while I moved to a new short term lease and went through lots of urgent care visits figuring out my next moves medically, and he decided we couldn't wait any longer to meet so he bought a car and drove 5 hours to pittsburgh in the night after work one weekend and we met outside my new apartment that had no furniture yet at 1 am and spent the whole night talking. we knew we were very very in love right away, and even though that first weekend ended with him having to take me to the ER from extreme pain that turned out to be from constipation because of how truly nervous I was LOL he came back a week or two later and stayed full week! at the end of that week we decided he'd move in with me for the rest of my 6 month lease while I got surgery then moved to philly to finish his lease together.

myles and I both hadn't ever really been in a relationship so serious or passionate so it was really really scary at times when we fought or felt like we would mess things up with each other but we both dug really deep to learn how to talk to each other in a way we had never communicated with anyone else and touched some really important parts of ourselves to really get to know one another's fears and desires and eloped a little over a year after meeting!

he's totally changed my understanding how much you can trust, depend on, or love someone. it's opened me up to healing in every other part of my life (going to therapy, having big talks my family, starting new careers, etc) <3

[swaglet]

i know u need to exercise as part of maintaining a healthy lifestyle while having a heart condition but considering that my heart condition is a result of covid and i still have to go to my pcp and my cardiologist to have it investigated, and if i exert myself too much or get too warm it makes my heart rate spike to 180+ and makes me black out, how am i supposed to continue exercising in low impact ways that are friendly to my heart? i'm starting to go crazy not being able to do my workout routine because it was part of what kept me stable and gave me inertia to get thru the day like it was part of my solid routine and i relied on it, now i'm not rly sure what to do. plus i'm worried now that i'm sitting on my butt resting in a bed, if i keep doing that the entire time i recover and/or go through cardiac therapy/strengthing, it will let my heart muscles weaken even more. idk. idek when they're going to take me off of iv fluids and electrolyte supplements so i figure i should just leave it alone for now. my hospital physician told me that even though i'm 22 i'm probably better off seeking out treatment from the pittsburgh children's hospital because they're pretty much the only place within multiple states that might have any clue how to help. i don't know man i'm so pissed off right now

[joe9cool]

Collide-Justin Herbert-40 The End

A/N: This is fanfiction, I do not know or own the Chargers. Also you do not have my permission to post my stories. 

June 29th, 2023

Sara woke up to a cold, empty bed. Well, not really empty. Eugene was right above her head, while Nova liked to be at her feet. She looked over at the time 7:30am. She just had just got in a a couple nights ago from filming in North Carolina, as much as she loved the show and her castmates, it was exhausting filming overnights and taking three hours for one scene, only for the writers to tweak something.

She had a few days off, then another week of filming, and then two weeks for pre press for the film. Her phone was already loaded with social media shoutouts and texts, all wishing her a happy 27th Birthday. She smiled as she looked at all of the funny birthday tributes that her friends from Pittsburgh and LA posted. Sara's heart melted as she got a long written message from Holly saying how glad she was to have her in Justin's life.

Speaking of him, he was probably at the training center getting his therapy in. He told her he wanted to take her to dinner but she kept refusing, as she got older she didn't care about the fancy parties or the lavish gifts, she just wanted a cozy night in with the man she loved.

Sara laid there for a few more minutes before her mini tigers let out their cries for food. Her stomach was sending out the signal as well, so she got up and padded to the kitchen. When she walked into the open room she didn't expect to see a bunch of roses and balloons, with big silver balloons in the number 27. She looked around in shock. On the counter, there were three wrapped boxes, with a plate of chocolate chip pancakes. Approaching the counter, she saw the note

Happy Birthday my love! I'll see you in a few hours!

-Justin.

She smiled, before smelling the pink roses. Looking at the cats she smiled. "Your father is the sweetest." They mowed as to say 'yeah but our breakfast'

She scratched their heads. "Okay I'll feed you guys first then I'll open the gifts." She got out all of their raw ingredients that she picked up from Erewhon. (she spent a fortune and Justin made fun of her) While they were chowing down their bowls of food she opened the gifts. The first was an all inclusive spa package, the next was a Burberry purse that she had bookmarked on her laptop. She laughed, she knew he was snooping. Then there was the brand new espresso machine that was set up. Sara squealed, Justin wasn't much of a coffee drinker, but hopefully she could make some drinks he would like.

The next was one of sentimental value, it was a book that contained all of their photos together. They were some goofy ones, ones that Holly took of them in the hottub from their quick trip to Eugene last month. There were two of them caught by photographers. One of them leaving the sushi restaurant and another one of them walking the cats around her place. Sara laughed at that one. Then there were the photos of them at Bella's birthday party at Jerry's. She made a note to go back there again.

The last pages had her tearing up. It was a professional photos of them at Joe's wedding. One of them was a group shot of them standing with others. Next one was a candid of them talking at the bar, she didn't even know there were photos of that.

There was a note written in Justin’s neat handwriting that she envied.

July 16th 2022

I laid eyes on you for the first time

I'll never forget that night.

The very last page

27 things I love about you.

Your love for animals (particularly our cats)

Your passion for what's right.

How you know what and when to say the right things

The love you have for your friends and family

You never give up

Your emotional strength

It kept going, some were sweet, some were funny, and some were dirty and referred to her skills in the bedroom. Overall it was the sweetest gift any partner had given her and topped all of the other gifts.

She was finishing her breakfast and rereading Justin's letter. She asked Heidi to take care of social media on her bday. This way it was stress free for her.

AnnSophie and Samira walked in, leaving Sara confused. "Not that I'm not glad to see you guys. But how did you get in?"

"Well first of all, happy birthday, second Justin said we could kidnap you for the full spa day thing." AnnSophie spoke as she pet Nova. "I'm not going to say no to a spa."

Samira laughed. "Also we got to get you ready for tonight's-" Annie cut in. "For dinner, Justin wanted to take you somewhere nice."

Sara shrugged, "I mean I'd be happy ordering Indian and having a movie night with the cats but." She put the dishes in the sink. "Where's Lexi?"

"Joseph is watching her." Both her and Samira looked at AnnSophie. "What?"

"Wasn't aware you trusted Joey Like that." Sara shook her head. "He's great with her for your information. It's nice to have a friend. Now excuse me, I have to go to the bathroom." AnnSophie walked, more like limping to the bathroom, and the other girls looked at each other. Once they heard the door closed they began giggling.

"Yeah he's a friend alright."

"Looking a little too relaxed"

—------------------------------------------------------------

"That is the sweetest thing!" The girls cooed over Sara's telling of the birthday photo album Justin gave her. She had messaged him saying thank you. He hadn't responded, but she didn't expect him to.

They were having lunch at her favorite spot in the center of Calabasas after the spa. A few paps spotted them and began taking pictures, wishing her a happy birthday, and asking about her plans later.

While she was getting her pedicure she made a call to the poverty stricken areas of Pittsburgh and Los Angeles. Each grocery store she donated $27,000 to cover low income shoppers groceries. She didn't want any fuss or announcement, but of course the company put out a massive thank you that got to the public. Sara didn't want to make a massive deal out of it.

She had responded to friends and family and thought it was weird that her sisters hadn't called her. It was a usual tradition that she had gotten calls from everyone. Including Aunt Willa, well that wouldn't happen since the order of protection was put in place.

As they enjoyed their lunch, Sara got another call from Bella who she put on speaker. "Hey babes."

"Happy Birthday baby!" Her friend sang and Sara laughed. "What are you doing on this fine day?"

"I'm having lunch with Annie and Samira right now?"

"At the hotspot?" Sara was confused. "Am I that predictable?" She felt a presence behind her and assumed it was a waiter. "I'm right behind you." She whipped her head around to see Bella on her phone.

"Bitch! Everyone squealed. Causing the other people to look. She wrapped the supermodel in a tight hug. "What are you doing here?"

"I've missed the last one, I'm not missing this one." Bella exchanged hugs with the other girls and sat down.

This was already shaping up to be the best birthday

—------------------------------------------------------------

"Sara.. god. . Please." Justin whimpered as she kept her pace on top of him.

He was not even home for ten minutes before his girlfriend was on him practically jumping him. "Thank you so much!" She spoke between kisses. "I am missing one thing."

He furrowed his eyebrows "what?"

"Birthday sex, birthday sex." She sang as her hands went to his shorts. He laughed. "Babe, I got to shower, I came straight from practice."

"Well we will just shower together then." Immediately stepping out of her summer dress and sandals. "We sat outside and it's hot." That was one of the downsides of her birthday being June. It was always going to be a scorcher no matter where she was. Maybe they should go to Iceland next year.

Once their clothes were off, Justin carried her into the bathroom. The water was cooler than what she was used to, but she knew her and Justin were going to be busy.

"You know it's your birthday right?" He breathed as she kissed down his stomach and got to her knees. She gripped his erection and began placing kisses on it to which Justin had an immediate reaction. "It's my birthday, and I want to suck your dick. I want your cum on my face. Will you give me that for my birthday?"

Justin moaned as she took him back into her mouth. "I can't say no to the birthday girl can I?" He fell back against the shower wall as Sara worked her magic with her mouth. He put his hands on the sides of her face and guided her, gagging when he reached the back of her throat. "Sara." He moaned as he reached go grab and handful of her breast. "I'm gonna cum." Quickly, she pulled off and pumped him until he finished all over her face.

Once they finished their shower Justin thought that would be the end of it until after his final surprise. However he didn't get a chance to dry off before she was on him riding him.

"Oh Justin!" She squealed as he began thrusting upwards. As much as he was enjoying the amazing view they had to get ready for their dinner plans. Finally she reached her climax and dragged him along. Sara collapsed on top of him and they had a few minutes to catch their breath before he made them get up and get ready. "It's my birthday and I want to stay in." She pouted. Justin laughed. "I promise I'll make it worth it."  She put her mascara tube on the counter and walked up to him hugging him. "You have already done enough today." He bent down and kissed her, getting the sticky lip gloss on his lips. "You deserve it."

They managed to make it to their reservation on time. Learning from the last time they went to dinner, Justin reserved a private room. Justin made Sara enter the room first.

"SURPRISE!!" She was Startled when she turned the lights on and saw the faces of friends and family. There were her parents, her sisters, nieces and nephew's, including her brand new niece Ameilia.  Mark and Holly were there as well as their kids and family. Plus she saw her hometown friends. She turned around and lightly smacked Justin. "You planned this?" She said in disbelief. He nodded. She turned around and was met with the arms of all fifty guests. Even some of the Chargers were there. Joey was holding Lexi, looking like a natural family man next to AnnSophie. Sara's eyebrows raised at that.

As she mingled, Justin was never too far away from her. If she moved too far away he would find her. When he was next to her he had to touch her. Whether it was his arm around her or holding her hand as she led him to the food table.

He got a little uncomfortable as people congratulated him on his new contract. It guaranteed him and Sara to be in Los Angeles for at least five years. It was one of the things they discussed as a couple.

—-----------------------------------------------------------------

"Justin, this is your contract. Not mine." She laid in her trailer. It was late, but Justin had called her, updating her on the offer the Chargers gave him and his agent. It was five years and it would put him at one of the highest paid quarterbacks. Hell, he'd be making more money than her.

"And I've told you, this contract affects the both of us." He didn't want to say it over the phone, but his future plans involved her. Heck, when he and his agent sat down at the table with Tom and Dean he called Sara his future wife, raising eyebrows.

"Justin, it's sorta a no Brainer. Our careers are here, you love it here, your family is close."

"What about you? Wouldn't you like to be closer to your family? I could take a short deal-"

"Justin Patrick. Stop it. I love it here, and you do what's best for you."

---------------------------------------------------------------------------------------

"Happy Birthday to you! Happy Birthday to you! Happy Birthday Dear Sara! Happy Birthday to you!" The crowd sang and Sara blew out the 2 and 7 candle on the green cake Justin was holding. Once she blew it out, she pulled Justin down for a quick kiss. Friends who videoed it posted it on social media, which circled all around social media.

Once the cake was cut  and served, desserts were eaten, photos were posted and an impromptu dance party went down, the party dwindled down to just Justin and Sara and  their immediate family. They watched as the parents were talking. "I was nervous they weren't going to get along." Justin admitted as they gathered all of the leftover food and gifts. (Justin told them to donate to charity in lieu of a gift.)

Sara laughed. "I bet my dad's setting a time for golf tomorrow." He laughed and truth be told she did worry about that a bit. She was glad when the Herbert brothers were joking and laughing with her sisters. She felt herself get misty eyed as she thought of Justin putting this together. "Baby what's wrong?" Justin looked at her with concern. She shook her head. "Nothings wrong. Everything is perfect."

And for the first time, it truly was. The whole night she was back and forth wrestling with her mind. It was something she should have done earlier. Justin was right, and with this party, all that he's done for her. This move seemed right, and natural.

"Justin?" He looked up from his task. "Yes?"

"Let's move in together."

She had never seen him smile so big.

—-------------------------------------------------------------

"Didn't expect to see you here." Joe laughed as he greeted Justin. He had just gotten out of video and workout, and he decided to bring Sara food while she was on set filming.

He always wondered what a professional set would be like. Granted, he filmed commercials, but this was an actual Hollywood set.

He hugged Joe. "Hey man, I thought I would surprise Sara. Sorry you got to spend your first anniversary on set."

Joe shrugged. "It's okay. Alicia is in Montana filming, so we will just celebrate next week. Come on, Sara is just finishing up a scene." He led Justin past the trailers and behind the director, where everyone else was watching. The scene took Justin by surprise.

Sara was laying in a puddle of red, which was definitely fake blood. She had a fake gunshot in her side, and she was gasping for breath. Then she coughed, and phony blood came spilling out of her mouth.

It looked so real, and if Justin didn't know any better it would have freaked him out. In the distance, someone he didn't recognize came running up to Sara's character. "I got you, I'm gonna call 911."

"CUT!" the director yelled, and Sara was helped up by the extra. They spoke for a few minutes, then walked over to the director. She smiled as she spotted Justin. Once everyone was done and they called break she went over to him. "Hi baby, I'd hug you but."

He laughed. "It's okay I get it." She nodded. "Come on, I got an hour before I got to be in hair and makeup for the next scene. He followed her to her trailer and went inside. It was a decent size, it had Sara's decorating all over it. It made him wonder how she would decorate his… well their house. "The movers came today, got most of the stuff." The main things, like her piano were coming, plus her music collection and the painting that Ben made for her were there. Most of her clothes were in his closet.

They had had a little argument about space, and Justin brought up maybe buying a house together. "I think we should look at some houses." He told her as he got out their lunch he picked up. Sara sighed. "I know, I love your house though."

"So I do, but we have to think long term." Sara raised her eyebrow and Justin laughed. "Come on, don't act like you haven't thought of the future." She got up from her vanity and straddled him on his chair. "I have, but I'm curious. What does the future look like for you Mr. Herbert?"

He smiled. "Well it would involve a bigger house, with some kids, and a dog."

"How many kids?" He shrugged. "I would like three. But it's up to you."

With a serious face she spoke. "I want as many kids as God blesses me with." His eyes widened. "Uh.."  She burst out laughing. "Jeez Justin, do you not hear my commentary watching those old Duggar shows?"

"I mean yeah, but still." She giggled. "I always said three or four like my own family. But who knows? I think three is a good number."

He smiled. "Three sounds good."

She got off his lap to eat as the time was going by fast. "I can call my realtor and we can start looking. Personally I'd like to stay in Irvine." She nodded. "I like it there too. I think I'll sell my house."

Justin's eyes widened in surprise. That was her first home she purchased. It was important to her. "Are you sure?"

She nodded. "Yes, I mean it does hold sentimental value. But it is small, and I'm ready to move on."

"Maybe I should keep my house?" Justin wondered out loud. She laughed. "I mean we don't have to decide anything yet. Looking for a house takes time."

They were interrupted by a knock at the trailer, and the door opened to see Sara's costar Jesse Lee Soffer come in police gear. "They are getting ready for the next scene." He looked at Justin and stuck his hand. "Hello, I'm Jesse." As she shook the older man's hand. Sara cut in. "He is the new guy on set. He actually is my love interest."

"Oh really?" Sara nodded, not paying attention to Justin's body demeanor. "Yeah he plays the detective on my case."

"So what exactly happened in that scene with you on the ground?" She laughed. "Oh so in that scene, I get robbed and when I try to chase the guy down, I get shot."

Jesse cut in. "I'm in the next scene with her and the main cast members. Speaking of, they want you to change into the next outfit." She nodded. "I have the hospital gown."

He nodded and left the trailer. Justin turned towards Sara. "Is this the guy you have sex scenes with?" She nodded."Just a few. Nothing too serious. We have an intimacy coordinator for that." He nodded and she laughed. "Are you jealous?"

"I mean a little." He admitted. "I know it's silly."

"Your feelings are validated. I promise, I've never caught feelings for any of my co stars. Sex scenes are uncomfortable to  know? Forty people are watching you and the director is all in your face saying you moved your head the wrong way." He laughed. "That is awkward."

She smiled. "Don't worry, I only want your dick." He laughed, then leaned closer to her. "Want to get some tonight?"

"I won't be home til the next day." He groaned and she laughed. "Sorry, we got one more late night scene and we are good for the week." She kissed him. "But I still have time, and we have this bed behind you." He turned around, not realizing there was in fact a bed in her trailer. He raised his eyebrow. "Oh?"

Once again, she straddled him. "I mean…. I've been really stressed." She began kissing his neck.

"Babe, as much as I am always down to have sex with you. I don't want prop blood on me." She looked down and huffed. "Right." They both began laughing as she got up.

"I have to go. I got therapy." He got up and gave Sara one last kiss. "I'll see you tomorrow night. I'll make sure the movers have the rest of the things."

She nodded. "Don't  forget to drop off the boxes in the corner. Those are all that I'm donating." He nodded. It was decided that Sara would donate all the stuff that Justin already had like utensils, plates, appliances. Things like that. She decided to donate it to the local shelters.

"Oh I can't wait to sleep in our bed." She moaned. Justin smiled, he loved the way it sounded. —-------------------------------------------------------------------

"This one has been on the market for about sixty days. It has six bedrooms and five and a half baths." Justin’s realtor, Seth looked down at his clipboard as Justin and Sara walked around what was supposed to be the living room. The house was gorgeous, but the downside was that there was no swimming pool.

As of right now, they were only looking. Justin was due to start training camp in a few weeks and Sara was wrapping up filming after zipping around the world promoting Oppenheimer and would be doing it again in a few months for Dune 2. It was probably the worst time to buy a house. But Justin and Sara's relationship was anything but typical.

The news broke that they were living together as soon as Sara listed her home for sale. In a surprising turn of events, AnnSophie decided to purchase it and turn it into a summer vacation home for her and Lexi when she was in Los Angeles filming. While it was emotional for Sara's, at least she could still come and see it whenever she liked, and she trusted the new owner to take care of her first big girl purchase.

The next step was to take Justin's house off of most public records. Her team took care of that, and for the most part there was no bothersome from neighbors or the community. Justin and Sara did have to deal with the occasional cameras when they were out and about together, but it didn't happen as often as Justin thought it would.

The start of living together was a little rocky at first. Sara was aware that Justin was neat and organized, but it was a different scenario living with him. He side eyed her for the littlest things. "Why don't you organize your products by your routine?" "Don't put food just anywhere, there is a system."

It was an adjustment, but it worked for them. Sara had him on a skincare routine. (Yes, that included sunscreen) and Justin had her eating healthy. He indulged in wine and some sweets. They both loved ice cream and made milkshakes. Sara worked out with Justin in his basement gym.

The results showed too, and people brought up her being on Ozempic to which Sara shut down when she had her interview with 'Elle' magazine.

"My boyfriend is an athlete, so I've joined him in the gym and changed my diet and I'm more consistent and it obviously shows. I always try to be open and honest with my fans, I promise I'm not taking anything for weight loss"

Any talk of the meds went out the window when the article hit stands. People were surprised that she brought up Justin, even though she didn't bring him up by name it was common knowledge who she was referring to.

The real test was them making an appearance together at Taylor Swift's closing show her Eras tour, there was also Justin's invitational. They discussed going together and being seen out in public and while they would never walk a red carpet together, they could be spotted out and about at high profile events

—----------------------------------------------------------------

Sara was talking with Holly, Carly, and Ashley as they waited for Justin to make his thank you speech. As he and his college buddies were golfing with teammates and pros she was helping out Holly making sure everything went off without a hitch.

It was important to her that she stayed out of the shine. It was about charity, and the kids that were in attendance.

Some people did speak with her, and their teens were big fans. She got to meet Justin's cousins, and they were so nice. One just had a baby, who had no issues passing him for her to hold and snuggle while the guys were talking

She noticed Justin staring at her.

Little did she know he was going crazy.

"Don't you get any ideas, Mitch told him as she caught his younger brother looking at his girlfriend kissing the baby. "Isabelle is already losing her mind. Had to remind her we needed to complete residency first."

Justin laughed. "No, I'm not thinking anything right now." That was a lie.

Mitch knew better. "But you know she's the one?"

Justin's smile said it all. —------------------------------------------------------------ "Oh darling, this dress would look gorgeous on you! And it's your color!" Pierpaolo Piccioli, the creative director of Valentino, was over their house with his team and racks of dresses and clothes. Sara had just signed on to be the face of the high end luxury brand, and in no time, Piccioli's team was over with Law with ready to wear pieces and drawings of custom designed handbags, couture items for Sara.

Justin was at meetings all afternoon, so he had no idea of the takeover when he walked into their house.There were clothes, shoes, makeup and handbags everywhere. It was his worst nightmare as a neat freak. A man he knew as Sara's stylist Law came up to him. "So sorry about this, but Pierpaolo insisted last minute his team come right now"

Justin must have looked confused, because Law laughed. "Men, he's the creative director of Valentino."

"Oh." All he knew was that it was expensive. Law grabbed his hand and Justin dropped his Nike bag. "Come, Sara will model the clothes for you and you can give your opinion." He allowed himself to be dragged into the open space where Sara was standing on a riser in front of large fold out mirrors, no doubt the Valentino team brought them. She turned towards him and smiled. "Hi baby! I'm sorry, we are almost done. How do I look?"

Justin smiled. She did look stunning, she was in a red ball gown. He walked over to her and kissed her. The writer smiled, talking notes for their design story. "You look beautiful." He admitted.

"Okay Sara! Me and Law have agreed on the last accessories for your shows! And -oh hello." A short slender man came into the room and stopped when he saw Justin. "And you must be Justin." He walked up to him and kissed both of his cheeks. "Ciao, Pierpaolo." Justin smiled nervously, he felt underdressed in his own house. "I'm Justin Herbert. Nice to meet you."

"I promise we are done, however." The man took a step back and walked around, studying Justin's height. "How tall are you?"

"6'6" He felt like he was being poked and prodded like it was the combine. "Do you know your measurements?"

"My what?" Sara giggled. "Paolo, he only wears Nike athletic clothes, owns two suits which he bought for college graduation"

The man tskked. "Simona. Get his measurements. Here- have Bendetta help Sara out of the dress and Justin you step on the platform."

Sara had to stifle a laugh as she stepped off.  Justin looked like a deer in headlights. "Uh I don't think that's necessary."

Paolo wasn't taking no for an answer. "I insist. You have the perfect body for fashion and you waste it." Hesitantly Justin stepped up, and Sara walked up to him. Despite high heels she looked like a child walking up to a monster. "Justin, you don't have to do this." She spoke softly. "Say the word, and I'll tell him to leave you alone."

He shrugged. "I mean, I don't want to insult him. Plus if I just do this. I'll get free clothes." Sara laughed. "Look at you thinking like a celebrity." She let herself be led away to change, while a woman began to measure his length and width on his body. "This isn't going to work, you need to be in your underwear." The woman spoke in a thick Italian accent.

"I beg your pardon?" She shook her head. "Do not worry, I've run plenty of men's fashion shows. I've seen more than surgeons." He laughed, and began taking off his clothes to only be in his boxers.

Paolo was taking down the measurements as Simona was rattling them off. He was asking Justin questions about his overall style which he was no help. He liked plain clothes. "Oh so we have a quiet luxury aesthetic. I love it. Oh I wish I had brought some men's pieces. Next time, but for now I'll send some ready to wear over."

"You don't have to, but I appreciate it." Sara came out of the room in her usual attire of sweats. "Can you get some custom tailored suits? Nothing fancy, just some casual and special occasion ones. "

"I'm on it." The gang packed up fast, and before Justin knew it, the team was out the door with one last kiss to Sara. He looked at her. "Wow." He admitted.

"It's something isn't it?" He nodded. "Sure you don't want to back out?" He laughed and kissed her.

"I'm not making that mistake again."

—---------------------------------------------------------------

"No nothing good starts in a getaway car."

Sara and Kristen screamed as they grasped onto each other as the intro for Getaway car played before Taylor began singing. They both couldn't believe it as she saved the best for last.

Behind them in the VIP booth Justin and David both looked at each other. Their girlfriends met last week, but they were already fast friends. Sara got last minute tickets to Taylor's Eras tour for them to join them.

Justin was a little uneasy, as he met the flashes of phone videos and cameras. They were watching every move that the couple made. Everyone commenting on the video of Sara going crazy to Cruel Summer and Style. There was a moment where Justin had Sara in his arms as she was singing 'Lover'

Ladies and Gentlemen will you please stand. With every guitar string star on my hand. I take this magnetic force of a man to be my lover.

As they jumped around and screamed the lyrics to getaway car Justin spoke with David as best as he could.

The song was over, and Justin handed Sara a bottle of water as she was sweating in the Los Angeles heat. "Thank you baby" she smiled.

Taylor spoke. "This song is for someone here tonight, who spoke into existence that one day she would experience this moment in this song. Well I hope this is it."

The song began playing, and Sara gasped.

I'm perfectly fine, I live on my own, I've made up my mind, I'm better off being alone.

Sara began singing the words she knew so well. She felt Justin come up behind her and wrap his arms around her. The bridge came on, which was her favorite, and then she turned around and looked into Justin's eyes

And all at once you are the one I have been waiting for King of my Heart Body and Soul

Justin smiled down at Sara and tucked a piece of her hair behind her ear. She smiled and turned back around to face the stage.

In a surprise, Justin spun her around, in a sea of 70,000 people he kissed her. He didn't care about the photos or the videos, the commentators or any of the articles that were going to come out that same night.

It was just them two.

------------------------------------------------------------------

The next morning Justin woke up to get ready for his day. He was excited about the season, camp, and just everything to come. He looked over at Sara sleeping peacefully with the cats and he smiled. He did his usual routine, making sure to have her coffee set up so all she had to do was press the start button.

He pulled out of the garage and began to play songs connected to his bluetooth to his car 

a song came on, it was his favorite and it put him back to July 16th 2022

The dawn is breaking The light is shining through You're barely waken And I'm tangled up in you.

A/N: Guys, I am emotional writing this. I cannot thank you enough for all of the support messages and likes. I started this story with no direction and not even sure I was going to finish this yet here I am. Just because this story is over, doesnt mean you cannot ask me questions about their canon, other things. Also give me a little time to crank out the epilogues. I love you all and thank you!

[metalheadsforblacklivesmatter]

Does it make sense to push children to have hormone therapy/puberty blockers?

I'm answering this question in good faith because the person that asked has been following this blog for a while.

First off. Hormone therapy and puberty blockers are very different from bottom surgery in that they can be easily reversed and do not involve surgery.

Second off hormone therapy and puberty blockers are two very different things.

Puberty blockers are easily reversible. You can stop taking them at any time, and you'll go through your normal puberty.

Children that aren't trans are have been prescribed puberty blockers if they are going through puberty too early for decades, as was their initial purpose. (As early puberty can cause health issues)

And if a trans child changes they're mind and decides they aren't trans? They can simply go off puberty blockers and go through puberty. That simple.

Furthermore. GHT (which is often called "hormone replacement therapy" in the trans community) is often prescribed to non-trans children who aren't developing properly due to hormone deficiency.

It's been widely reveered as safe in non-trans children.

And the use of both in trans patients is fairly simple. Puberty blockers is exactly as described. They block puberty. If there's a trans-boy that knows he's a boy. Not forcing him to develop breasts would generally be a good idea for his mental health and reduce the need for top surgery later. And if he later decides he was wrong? He can simply go off puberty blockers and go through female puberty and be a woman. Not that difficult. (I'm using consistent he/him pronouns in this example to not confuse the person that asked in case there's a potential language barrier.)

Hormone replacement therapy in children just doesn't make sense for prepubescent children. Why? Because they haven't hit puberty yet.

HRT is the treatment to let trans people undergo the puberty of their gender identity, and it just wouldn't make sense to prescribe this to children that aren't of puberty age.

And standford has done a study on hormone replacement therapy in teens (the age in which its normal to undergo puberty) and found that trans teens that undergo the puberty of their gender identity tend to have better mental health than those who start HRT later in life.

And also no one is forcing kids to go on puberty blockers or HRT. That's just... made up. In fact parents usually force their trans teens to NOT transition to their gender identity.

-fae

[kfedup]

Fun/joy

i procured tickets to go see Peter Gabriel (nosebleed stadium seats) in July and lawn seats at Blossom to see Duran Duran. 

That’s a good start to letting myself have fun and feel joy, yeah? 

Yeah. 

I’ve never seen either of these acts, and Peter Gabriel has been such an important soundtrack to my life for so long. I return to Us and So and The Last Temptation of Christ and Growing Up Live during growth phases. He’s truly a tour guide of the deep. I listened to US the other day for the first time since I moved out - holy fuck it’s 9 years in December. That album hits very different this side of two divorces, let me tell you. 

I’m also toying with driving the two hours to Pittsburgh by myself to see Beyoncé’s Renaissance tour. A $250 nosebleed ticket might be crazy, but this album has been my anchor for the last year. Now that I think about it, it’s been my entry point to joy and fun inside my body and I don’t know why I didn’t think of that during therapy. I’mma listen to it again on the dog walk this morning. This album is pure club. I am transported to The Filmore East gay parties in the early 90s where I danced for two days and nights without ceasing in an ocean of beautiful men who were the very definition of joy expressed with abandon and trust in the middle of a raging war in NYC. 

Maybe this is how I protest the grind that is life on Earth in America. Even if it is furthering capitalism. At least it’s for the sake of art and joy. 

Oh, shit... and two days before Peter Gabriel, I could see Nick Cave at Playhouse Square. And Loreena Mckennitt at the Goodyear in Akron in October. And Atmosphere in Pittsburgh. 

Fuck it, I’m not replacing the sewer line to my house until next year - or maybe I’m selling before I even need to do it. 

This bitch is getting her joy. 

[sc0tters]

https://www.tumblr.com/sc0tters/755988907998527488/tiktok-make-your-day

FERAL AHSHSKAKWOKXJDIQ

no bc i know you mentioned sidney and celine finally getting together in time for them to win the 2017 cup as a family but what if sidney actually broke up with kathy a lil before the 2015-2016 season and celine’s back in pittsburgh with a coparenting w/benefits situation with sid?!

I feel like it was around Christmas time when Sidney came swearing that she couldn’t go on that new years trip with her boyfriend (2015) of course she never listened but when she was indeed shown a ring she knew she couldn’t marry him.

So she goes home and breaks down telling Sid everything as she knew he was right (that was more than likely night #1 of either hooking up or she kissed him but he rejected her because of her mind potentially not being in the right place.)

In May (2016) she gets a job in Pittsburgh and with her growing closer to Sidney and seeing the strained relationship that Nate has with him she took their lives and moved back closer to Sid.

By August/September they start hooking up after Celine called him in a whimpering mess as Nathan was at a friends place for the night and she was needing some help between her legs.

Christmas time then is when they start actually working together as a family and Celine would have definitely put Sidney and Nathan into therapy when she realised that their relationship was still incredibly strained (imagine Nathan doesn’t want to play hockey anymore because he’s left his whole team but because he’s made friends on the baseball team Sidney takes it the wrong way)

In May when things are looking so much better for the family they decided to have a barbecue at his where everyone finally got to meet Celine and Nathan.

[mybeingthere]

The Strange, Sad, and True Story of Andy Kehoe

"Andy Kehoe was the son of a sea merchant that was killed by pirates when he was just eight years old. His father barely had time to throw his son overboard before the cargo ship --that usually carried pickles and kittens to Spain-- now carried the burning corpses of his father and all his closest friends to the bottom of the ocean.

Young Andy endured three days in the ocean before washing ashore on the Galapagos Islands. There he was raised by iguanas and learned much about the world. Like how to lie in the sun to raise his body temperature and how to swim underwater for 15 minutes to get to the yummy green algae on the bottom of the sea bed. Andy even swam like an iguana… head forward, arms at the side, and legs hanging still. How he did this without a tail is still a mystery.One day, Andy found a gloriously warm spot and lay out comfortably on his belly to soak up the sun. To Andy’s surprise, this spot ending up being on a cruise ship and his naked, sleeping body on the main deck caused an almost violent stir of shrieking women, crying children, and the anger of men not so secure with their own sexuality. 

Cruise security quickly came to carry the upsetting, naked boy below to the ship’s holding cell. Andy knew he had been swimming in the cold ocean all day and his body temperature was not quite high enough to fight back… so he allowed himself to be quietly carried away without the usual frenzied struggle.

Here, he was stuck in a cell with a shirtless, red-faced man that got drunk and slapped a woman in the pool. As a strong male iguana would, Andy battled this man for alpha male status and dominance of his territory by hissing, flashing his green-stained teeth, and slapping the man wildly with his arms and legs. 

Andy was soon shackled and hidden away from other people. Slowly, he began to learn some English. The first words he learned were, “Shut the fuck up you fucking freak!” and “You better back the fuck up!” That meant he should stop his high-pitched shrieking and stop running madly at the door when people showed up at it. The crew soon tired of Andy and secretly dumped his body overboard in the night off the coast of California.

Over the years, Andy experienced a lot in America and endured many, many beatings. 

Eventually, Andy Kehoe somehow found himself in Pittsburgh, Pennsylvania making art for a living and the days of lying in the sun amongst his iguana friends are a faint and fading memory thanks to many years of forced therapy and brain trauma."

Lots more stories here https://andykehoe.art/abouthttps-//andykehoeart.com

[deldeldel90]

The “It’s Pittsburgh” road trip fanfiction you wrote is so funny to me because the background of: 

Frederick: eighteen, getting proper help, moved in with Gwen and striving to get a biology major,going to therapy, beginning to learn how to play the violin. 

And then . . . There's these two idiots (my favorite idiots, by the way), Blaine and Lance. 

Blaine: twenty-six, absolutely no emotional awareness, cannot express his Feelings in the slightest, cannot talk about his problems at all, is anti-therapy, rich bitch as always, pretentious as hell, overprotective but has trouble saying “I love you” 

Lance: twenty-one, goofy as hell, also cannot express his traumas (offered a therapy card, used it as a bookmark instead), aspiring film director, goes on a random ass road trip to a place he's never even researched (would've been homeless if it weren't for the Above Idiot), and probably living with five roommates + the rats and the roaches 

These Two. 

I love these two. And thank you for writing the fic (⁠≧⁠▽⁠≦⁠) I may not have an AO3 account to properly comment, but just know that I extremely liked it! 

(NOTE: the “Lance’s Guide” series you write is also very good! I love fanfiction with Prince Lance getting spoiled, as he's a very good boy who deserves so much love! 💞💞) 

HI ANON!!!!!!

aksgajsnsjsnsb oh my gosh 😭😭 FIRST: thank you so much!!!! You're so nice wtf???? Akahskaja!! And just!!! I'm so happy to read this?? You are so kind???

your description of Blaine and Lance in that fic is accurate ngl LMAOOO

And yeah 💀💀 Frederick's the only one who has his shit together in that fic (even though he doesn't appear aksjahsja)- Blaine may be a CEO and super wealthy, but my guy is NOT doing well. and yeah, Lance and Blaine r holding on by a thread, each doing it differently. Lance is probably hanging on better than Blaine, though,, since this red-plaid boy is not addressing shit. Like, at all.

Lance's Guide hhhhhhhh it makes me happy. and I agree w you!! Lance deserves nice things, y'know :D

And thank you for sending me this lovely ask!!! It made my night :)

[americangenderdolls]

Happy Black History Month! Introducing,

Tamany Greene

Tamany (she/they) is a 10 year old nonbinary girl living in Pittsburgh in 1989, with her parents and older sister. Tamany is Autistic and otherwise physically disabled due to being born prematurely with heart defects, and uses a walker.

Tamany is an imaginative girl who loves fantasy movies, her favorites being The Neverending Story, Labyrinth, and The Dark Crystal. Fantasy gives her a place to escape from the ableism she faces, and the general medicalization of her life- in fantasy worlds anything can happen, and she can do anything. She isn't stared at and whispered about by strangers in the street, isn't constantly being poked at in doctor's offices and physical therapies, she can be whoever she wants and be loved, be a hero.

[image description: Tamany is outside in front of snow and cedar trees. Tamany is a Black doll with brown eyes and long dark textured hair, with rose gold glasses. She is wearing a navy blue hat with a pink flower, and a yellow, purple, pink and turquoise fleece jacket over a red American Girl shirt, and black pants. ]