#propranolol is used for anxiety

[salt-baby]

#please tell me anything you may know about propranalol bc i've been on it for a year for tachycardia #that they can't find the reason for - and recently it's either getting worse or the dosage isn't strong enough anymore #they want to put me on metoprolol but the side effects listed are ... not appealing #and the fact you can't just stop taking it scares me but also i'd like to lay down to sleep #and not feel like my heart is gonna vibrate out of my chest #it's even more disconcernting when i check my bpm and it's in 70s but i still feel like i just got off a rollercoaster inside #they checked my heart and it looks and is functioning fine and don't seem to know what else to do # my bp is very slightly high so they latched onto that and like ok but they haven't even looked at #like adrenal gland issues even though my thyroid is also acting up #it's currently fine while i'm walking and moving around but trying to lay down i 'feel' my blood pounding in my ears #it's terrible trying to concentrate but i also can't sleep i am so tired also my legs keep cramping #idt it's pots though bc up til now the increased heartrate was if i was standing up and moving #thenit was under control for months #then suddenly the thyroid stuff kicked up and the tachycardia too just in the last month or so #they keep saying the propranolol was also 'off-label' for anxiety which they seem to be trying to say i have #but like yeah having a heartrate that untreated shoots up to over a hundred when sitting down doing nothing #does cause some level of anxiety you know?

I’m glad you asked! your tags prompted a bunch of research (which i had an absolute blast doing)

I feel very strongly about the usage of propranolol in pots because I think its extremely frequent prescription is reflective of a misunderstanding of how POTS works. to walk you through this:

I recently attended a talk given by a neurologist on forms of dysautonomia in children - POTS was a central focus. The presenter showed head-up table tilt data like this (which is from Cheshire et al.):

[image ID: a line graph from a scientific paper. the graph is of head up tilt testing data, specifically SBP, DBP, and HR. the graph is labeled “Postural Tachycardia Syndrome”, and the axis of the graph each have a short line labelled “50 mm Hg or beats/min) for the vertical axis, and “1 min” for the horizontal axis, to indicate scale. Below the lines of the line graph, testing periods are labelled “Supine”, “Head-up tilt to 70 degrees” and “Supine”, from left to right. All lines are variable, fluctuating up and down a few mmHg or BPM. the SBP line remains mostly level, the DBP line increases around 10 mmHg during the “Head-up tilt to 70 degrees” portion of the graph, and the HR line increases over 50 BPM during the “Head-up tilt to 70 degrees” portion of the graph. DBP quickly returns to normal in the second “Supine” section of the graph, with HR slowly returning to normal over the course of around 2 minutes. End ID ./. ]

The presenter went on to say that this proved that people with POTS don’t have any drop in blood pressure when they stand up, just a sudden increase in heart rate. which, isn’t how pots is understood to work.

in general, when you stand up, gravity is suddenly acting on your body (and the blood inside it) in a different way - suddenly, its a lot harder to get your blood up to your head (and to your arm or fingers, where blood pressure is measured). in healthy people, the blood vessels in the lower half of your body constrict automatically, and push blood back up to the heart. In people with pots, this is impaired, and blood starts to pool in the legs. 

As a result, sensors near the heart called baroreceptors (among others) realize that the blood pressure coming from the heart is low, and speed up the heart rate to compensate. This compensation happens almost instantaneously, hence why there’s no sign of it on the tilt table data, but regardless the blood pressure did still drop out. All the tilt table data tells us is that the rest of the body, those baroreceptors and other blood pressure mechanisms, that’s all working fine. In some people with POTS, there’s even a little dip in blood pressure before the HR shoots up. 

Eventually, though, if the drop in blood pressure is severe enough, the heart just can’t keep up, and the lack of blood to the brain makes you faint (syncope). People with POTS don’t have symptoms of just high heart rate, they have symptoms of low blood pressure as well. But some doctors think that because they can’t measure the drop in blood pressure, it doesn’t exist, and heart rate shoots up for no clear reason.

propranolol is a type of medication called a beta-blocker, which means it acts on certain kinds of receptors called beta receptors (and on certain types of those receptors, but I’m not getting into that here). in effect, it lowers heart rate, and can lower blood pressure as a result. It’s a very familiar medication to any cardiologist, and generally regarded as safe and mild.

But in people with POTS, that heart rate rise didn’t pop up out of nowhere - it’s really important to keeping you conscious! so decreasing the heart rate without thinking about the blood pressure isn’t really a great idea.

That said, there’s evidence its effective in people with POTS, from a variety of different studies, and its one of the first meds usually prescribed for POTS. However, in recent years, I’ve started to see some others arguing against it as well. 

for more on your specific symptoms:

What you described rang a bit of a bell for me. supine (laying down) and resting tachycardia aren’t really associated with the kind of POTS I know, although not completely unheard of. that said, you said you weren’t sure if your heart rate really was increased while lying down, but you were pretty sure you felt it (and I trust you - something is going on, even if you can’t catch it with a sensor). and you described yourself as slightly hypertensive - if its under 130/90 ish at most of your appointments, I wouldn’t worry. nurses don’t always have the best technique in taking blood pressure, and can often measure falsely high readings. over 140/100, and they’re probably on to something with the hypertension thing.

Anyway, those symptoms (hypertension and supine tachycardia) remind me of a subtype of POTS (a less common one) called hyperadrenergic pots. It’s proven pretty difficult to find stuff on this subtype, but I was able to find a couple papers. From Conner et al.:

“This form is characterized by a gradual onset with slowly progressive symptoms. Patients report experiencing tremor, anxiety, and cold clammy extremities with upright posture. Many patients note increased urine output when upright. True migraine headaches may be seen in over half of patients. Gastrointestinal symptoms in the form of recurrent diarrhea were seen in 30% of the patients.”

One paper mentioned those with a hyperadrenergic form of POTS had supine tachycardia that gets worse when upright (Ross et al., second paragraph of the introduction).

You’re on the right track with the adrenal gland stuff - to confirm this, there should be about a 10 mmHg increase in systolic blood pressure upon standing, and there should be elevated catecholamine levels (which has to do with adrenal hormones). Your doctors will have to rule out something called a pheochromocytoma, which is a benign (NOT CANCER) tumor on the kidney that can cause similar symptoms. (and if it is a pheochromocytoma, which they’d figure out using a scan like an MRI or CT, then they’d want to remove it surgically).

Your doctors likely didn’t test your catecholamine levels because its a pretty finicky test, and can be time intensive for both patient and administer. additionally, as a wild guess, this doesn’t seem like the kind of test insurance likes to cover.

So lets suppose you do have the hyperadrenergic form of POTS - what medication options are available to you? According to Conner et al., a couple! They list bupropion (wellbutrin), escitalopram (lexapro), clonidine, and labetalol (a different kind of beta blocker). Clonidine was recommended by other papers as well. Worth mentioning is that I did come across a study that suggested midodrine WON’T work for the hyperadrenergic subtype (Ross et al.), which Conner et al. agrees with.

And if you have the more common form of POTS (neuropathic), then it may be helpful to try fludrocortisone (or florinef). Some studies also suggest increasing blood volume (ie, drinking a lot of water and eating a lot of salt), which is what florinef does, can be helpful in the hyperadrenergic form, so florinef might be worth trying either way.

anyway, i hope all of this was helpful. you’re welcome to reply back with questions or comments, or send them to my ask box. i’m glad you liked my post, and hopefully my response wasn’t too overwhelming! I wish you the best of luck with your symptoms.

POTS Medication Vocabulary

after about the third time a doctor prescribed a medication that made my POTS drastically worse, and about three doctors visits past giving up on being an easy patient, i started asking my doctors the following questions whenever they prescribed a new long term medication:

is this medication a hypotensive? (will this medication lower my blood pressure?)

does this medication have a risk of tachycardia? (can this medication raise my heart rate?)

is this medication a diuretic? (will this medication dehydrate me?)

can this medication cause hyponatremia? (will this medication cause my body to lose salt?)

your doctor likely doesn’t know all of this off the top of their head for every medication, but they should know the most common adverse reactions. some may simply tell you they have no clue. i still think it’s worth asking to force them to consider these mechanisms.

for additional consideration:

Keep reading

[garaktime]

On the upside new med (propranolol) is apparently used off label as an anti anxiety medication. With that, plus my regular anxiety meds and duloxetine, I'm pretty sure I'm about to become the chillest dude on the planet

[sporesgalaxy]

hiiii SO ! I'm thinking of trying to get meds for anxiety, but I'm not sure exactly what they do. does it just make there be.. less anxiety? Or does it muffle it?

Different medications have different effects! I'd say it's probably a good idea to ask what your doctor recommends based on your symptoms, and then read about the side effects yourself and see how you feel about them in relation to your symptoms (of anxiety AND anything else!), and let your doctor know if any of the side effects worry you and why.

To use myself as an example: it's currently my second try taking meds for anxiety. I don't remember what the name of the first anxiety medicine I tried was, but when I decided to try meds a second time, I told my new doctor that the last time I tried, my meds had made me feel depressed and emotionally numb, which made me struggle a lot more overall.

She used that info to recommend me Fluoxetine, which is perscribed as both an anti-anxiety (and anti-OCD, which this doctor knows I have) med AND an anti-depressant, so depression is not a common side effect.

The results have been really great! I have an easier time getting out of bed in the morning, and...I mean, Im still CAPABLE of getting scared of stuff, but it's within a reasonable threshhold now. I still feel a sense of urgency and worry if I might be late to something, but it doesn't have me uncontrollably gripping my steering wheel so hard that my fingers hurt, with my heart pounding the whole way there. Worry is no longer a primarily physical sensation for me, which it used to be a MAJORITY of the time. It's just a normal thought-feeling....in my brain. Who knew it could do that!!!!!! not me for most of my life!!!!

I also take propranolol, which is sometimes perscribed for anxiety and sometimes perscribed for high blood pressure or other heart problems. My blood pressure is fine, but my anxiety causes my heartrate to jump VERY OFTEN (which I used to not notice, but today being without my meds for the first time in a while, I felt how often it was and yeah, it was BAD. Like 10 different heartrate spike events in maybe 2 hours). Propranolol keeps my heartrate lower which prevents the adrenaline spike that can send me into a panic spiral about panicking lol.

[dantesunbreaker]

Why Do You Lie? Ch. 3/3

Daryl Dixon x Transmasculine Reader

I have this posted on Ao3, but I like having my work cross posted. This has some pretty heavy themes so be warned. I kind of hate this chapter. It was rushed and I wasn't motivated. Some traumatic stuff happened during the writing of it so I went a month without working on it. So apologizes if it doesn't live up to the rest of the story.

Trigger Warnings: Attempted Suicide, Mention of Transphobia, Mentions of Drug Overdose, Self Harm, Mental Illness

Stunned sums up about all that Daryl can feel in the moment as he staggers backwards when you barrel past him into the cell block. Shit. Of all the things, making you cry was the last thing that Daryl wants to be responsible for. Just.. he always struggled with this kind of thing. Relationships. Emotions. Anything of the like was almost like a foreign concept to him, something that would just make his head spin when he tried to wrap his mind around it. Not that he didn’t want those things. He really did. Especially with you. But it is far easier to fall back on old ways than to adapt to change. Kind of like the saying you can’t teach an old dog new tricks. Daryl sometimes sure felt like an old dog.

With a heavy sigh, the archer crouches down to examine the bottles spilling out from your discarded messenger bag. Taking the time to actually read the label, Daryl finds himself still at a loss for what it could possibly be. It’s baffling. Merle was notorious for his experimenting with drug use. If you could get high from it, you can bet your ass that Merle had tried it at least once. So why didn’t Daryl recognize this one?

Lifting your bag, Daryl stuffs all the bottles back into your bag and sets his way towards the one person he trusted to know the answers to what it was and why you were after it. Hershel. Probably the only other person at the prison you readily would confide in. With such a calm, gentle soul, the old man could put anyone at ease. Daryl finds him in the infirmary, book in hand as he peacefully reads to pass the time.

“Hey,” Daryl breaks the silence as he steps into the room, setting your bag down on the table but choosing to remain standing opposite Hershel. “Can I ask ya somethin’?”

Giving a content hum, Hershel snaps the book shut and sets it down on the table as he turns to give the archer his undivided attention.

“Certainly. How can I be of service today?”

In one swift motion a single bottle is pulled from your bag and placed onto the table directly in front of Hershel with the label facing him. A word hasn’t even left Daryl’s lips before the older man is plucking the bottle off the table and turning it over in his hands.

“Hopin’ ya might be able to tell me whatever this is used for,” Daryl explains as he shifts anxiously from one foot to the other, a small pit of dread forming in his gut.

“Propranolol. It’s a beta blocker, which means it blocks the effects of epinephrine. Adrenaline. Commonly you will see it used to treat heart conditions or high blood pressure, but in some cases it may also be used in treating the physical effects of anxiety,” the bottle is once more set on the table between them. “Not something on our usual lists of medicines. Who did we pick this up for?”

That small feeling of dread forming in Daryl’s gut is suddenly a dense heavy weight that makes him feel he might drop to the floor. Of course. With all the time spent watching over you or spent with you, he knew you to be a highly anxious individual. The hunter in him often thought of you as a skittish buck, always moments from freezing in the metaphorical headlights or bolting for the trees. Things as simple as a wrong word said in conversation could stall you up, with only Daryl’s hand resting on your shoulder seeming to pull you back to reality. But somehow Daryl never put much thought to your behavior. With the way Daryl felt towards you, it was hard not to think everything about you was normal and perfect.

“Y/N,” Daryl finally manages to get his dry tongue into motion. “Had his whole bag stuffed with ‘em. Froze up and nearly got himself bit doin’ so. I uh... sorta got into it with him about. Twice. ”

“I suppose that’s why the boy seemed so distressed when I saw him run past?” The archer gives a short nod. “Well, you best go find him and not waste anymore time. Y/N is a very troubled young man. I fear that he may do something rash to himself if he hasn't already.”

Fear spikes at Daryl’s heart as he realizes the gravity of the situation. Heart thudding against the cage of his ribs, Daryl bolts towards the only way you could have gone. How could he have been so stupid? Hershel watches as the archer races away before he slowly stands to begin gathering supplies to prep the infirmary. If you were still alive, your best chance for survival was to be able to get the necessary medical help as soon as possible.

Reaching the cell block he had helped clean not too long ago, Daryl throws open the door and takes a cautious step through. Part of him expects, hopes, that you would pop your head out of one of the cells to greet him. But of course that isn’t the case. However, about halfway down the block the archer thinks he can see something scattered across the floor. Impending dread seeps further into his senses as he takes silent steps closer. Tiny blue pills pepper the ground in a sporadic pattern.

No! Rounding the corner into the cell, Daryl feels as if his heart stops dead in his chest at the sight of your crumpled form pressed back against the wall. Crimson pools on the ground just below you while a slow dribble continues from your left wrist. Dropping to his knees without grace, Daryl rips the bandana from his pocket. In most circumstances he would care more about the cleanliness of the scrap of fabric, but in his urgency he doesn’t bother checking. All that matters at the moment is getting something around your wrist to staunch the flow of blood. Tightly, perhaps too tight for your comfort, Daryl binds your injured wrist with his own trembling hands.

“Come on, Y/N,” Daryl’s words come out as a pained growl, fingers traveling up your neck in search of your pulse. A short lived wave of relief crashes over him when he feels the still steady beating of your heart. Having a pulse was good, but it didn’t guarantee that you were out of the woods.

Rough, calloused fingers brushing against your cheeks slowly coaxes you back to the realm of consciousness. Worried crystal blue eyes peer back into your eyes the moment you convince your eyelids to flutter open. Perhaps there is life after death. Why else would the man you’ve been secretly pining over for so long be kneeling in front of you? But then the pain returns and hits you like a sack of bricks. Of course, it would be far too good to be true to think you had made it to heaven. A swift and peaceful death would be too much to ask for.

“Daryl?” Your voice is thick as if from sleep, a dull ache beating at your throat.

“I’m here,” the archer shuffles closer, open palms moving to cup your cheeks as his thumbs stretch to the corners of your eyes as if it somehow would help keep them from closing again. “Stay with me, sunshine.”

There is a soft fluttering in your heart at the gentle tenderness the normally gruff archer seems to display in this moment of darkness. So unlike your previous interactions of the day. A sad smile paints your lips as you feel the need to rest once again pulling at your senses.

“You have such beautiful eyes,” you can’t keep back a half giggle half content sigh. “For what it’s worth... I love you. I care for you... Always have.”

With a trembling hand, you reach up with your blood stained appendage to stroke the archer’s cheek, leaving a trail of scarlet in its wake. For a moment you swear you can see unshed tears welling up behind those crystal blue orbs.

“I. Love. You,” you hope to drive the message home. If anything, Daryl needs to know that he is capable of being loved, that he is worth something.

When your eyes snap closed, the archer lets out an undisguisable sound of protest as he attempts to keep you from slipping away from him. Pulling you to him, Daryl presses you tight into his chest and holds you there for a tense moment. Then you are lifted up and cradled against his chest and supported by his arms. Carrying you back to the infirmary seems to take an eternity, though only because Daryl knows that your life's on the line. Sweat clings to the archer’s skin as he is finally easing your limp frame onto the bed Hershel already has prepared for you. Stricken with shock, the archer can do little more than stand beside the bed with a feeling of numbness as he finally pulls away from you. Only the nudge at his shoulder from Hershel breaks him from his stupor.

“Daryl. Daryl, I need you here with me son,” there is a sense of urgency in the older man’s voice, yet he manages to stay calm and collected. “Tell me how you found him.”

Spying the blood soaked bandana around your wrist, Hershel presses two fingers to your neck in search of your pulse. It is still there beating slow but steady. Now it is the matter of doing what he can to keep it that way.

“In one of the empty cell blocks,” Daryl is quick to answer, watching Hershel’s every move intently. “Bleedin’ from the wrist there,” he points to the fabric Hershel is slowly unwrapping. “Had little blue pills all over the floor around him. Managed to keep him awake for about a minute or two before he was like this.”

A sigh leaves Hershel. “Do you know how many he took?” Daryl responds with a shake of his head. “Let’s hope not enough. We don’t have anything on hand to treat a beta blocker overdose.”

Tense silence washes over the room as the archer begins to anxiously pace back and forth across the concrete floor. He hates this feeling. Like he is powerless, useless to do anything to help you. But he doesn’t know enough about medical shit to be of any help. He would just be in the way. So he just has to place all his trust in that Hershel will do his best for you.

“Y/N is a lucky young man,” Hershel hums as your wound is exposed to the world and wiped clean with a damp towel. “He hit a vein instead of an artery. Bleeds slower.” In fact, part of the wound is already beginning to clot and slow the flow of blood leaking out of you. “Appears he also managed to go without causing any severe nerve or tendon damage. Indeed a lucky man.”

Glancing over Hershel’s shoulder, the archer considers the wound, stunned to only see a wound no longer than an inch and a quarter. How could something so small have the potential to cause such damage? The time it took between Hershel tying off the few stitches and securing a fresh clean bandage around your wrist was miniscule.

“I’ve done what I can,” Hershel begins to clear away the supplies, cleaning up the impromptu workstation. “Physically, he will be alright,” the older man turns to fixate Daryl with a particular look. “Psychologically, he may still need some help. Y/N is going to need you, Daryl.”

Sucking in a much needed breath he wasn’t aware he had been holding, Daryl gives a wordless yes as he fights the feeling of tears wanting to tickle at his eyes. As Hershel leaves the room Daryl continues to pace the floor for a few tense moments before he drops into a chair he pulls up alongside the bed.

It seems like hours that Daryl sits beside your bed, eventually reaching to pull your hand to rest in his lap. Eventually you begin to stir in the bed, making soft groaning noises as your face scrunches up in discomfort. Hopeful, the archer squeezes your hand ever so slightly in hopes to coax you further back to him. Blinking a few times you manage to return to the land of the living. Even the dull lighting of the prison hurts your eyes, but you focus on pushing past it.

“Hey,” is all you hear from your side as you finally take note of a firm hold on your hand.

Forcing your head to turn, you feel a pause in the beating of your heart as you see none other than Daryl gazing back at you with a look of pained fondness. Why was he here? Why was he looking at you that way? What happened? And then it all comes rushing back to you. The pills, the arguments, the blood...and Daryl finding you with tears hiding behind his eyes.

Before you can say anything, Daryl breaks the silence. “I’m sorry,” there is regret dripping from his voice as he stares back at you. “Hershel told me...about what the pills are for. I’m real sorry, I shouldn’t have been so hard on ya without knowin’... And I don’t expect ya to just forgive me. But I didn’t ever want to hurt you like this.”

“I forgive you,” you blurt out without a thought. It was never in question that you would forgive him, people make mistakes all the time without thinking about it. And, you knew that Daryl would truly want to cause anyone pain or distress on purpose. “Just...don’t do it again please?”

He nods simply. For a while, you think that is the end of the conversation. You glance down at the bandages wrapped tight around your wrist and can only assume Hershel took care of you. Despite the circumstances, you are grateful. Some things just happen for a reason. The world must still have some purpose for you.

“Look,” Daryl lets out a sigh after a long moment and turns his gaze to your hand still in his lap. “Ya know I’m not real good with this shit, but I’m tryin’. But...I like bein’ with you, caring for you. I’m a fool for not sayin’ nothin’ sooner.” There is a long pause of silence, you ever so patiently waiting for his next words with bated breath. “But, if you’ll have me...I’d like to be your fool.”

A new pain blooms in your heart, but not in an unwelcome way. Rather, you feel your very being ache in that moment for Daryl. But also for yourself. It is hard to fight against what you know and is your comfort, no matter how much you want what’s waiting just on the other side.

Sensing the archer’s growing unease at your lack of answer you finally part your lips. “I’d love nothing more, Daryl. I’ve sorta been hoping for a long time that you might feel that way,” feeling shy, you try to push away the heat rising up your cheeks.

Silence that is not quite comfortable, but not quite awkward fills the room as both of you look at anything around the room besides each other. It will be a while before there is a sort of comfortable ease in this newly formed relationship. Neither of you really knows how to do this, but you know that it is worth it as you feel Daryl gently squeeze your hand that still rests within his. Pink dusts his cheeks as he continues to look at the wall beside you, but there is an innocent smile tugging at the corner of his lips.

[teslacarbombz]

god god god god god these medicines r gonna be my downfall. been on propranolol for "anxiety" (but its only lowering my blood pressure) and the other night i woke up and got up quick to use the bathroom and almost fucking ate shit on the floor cuz i got so dizzy. that never happens to me btw its only started happening since i got on these meds. i also feel dead btw

[metaltea]

tiny irl update, tw for weight stuff (but like positive)

Idk if I mentioned it but I started a diet two weeks ago and so far 2 pounds down! Got a long way to go (currently at 170, goal is 120 since that seems to be a good healthy mid weight for my height and age) but I'm really happy all my efforts to avoid all the junk food I usually eat is paying off.

Also haven't had to use my propranolol in a couple days (it's a beta blocker that lowers your heart rate and helps keep you from having panic attacks basically) which is insane cause I was taking 40mg twice daily for a longass time or my heart would go apeshit. So that must mean either my anxiety or blood pressure is down, maybe both, so that's a big positive.

Been intermittent fasting to help keep myself from snacking late at night like I always do, plus all the other alleged benefits. Doing 16:8. The first week was rough, tons of cravings at night, but I think my body's starting to get used to it. Now I don't have much of an appetite at night, only in the morning. Idk how much of it is me sleeping through most of the fast lol but yea. If it's contributing to the lowered blood pressure then I def wanna stick with it for now.

Kinda crazy how eating healthy and exercising effects you so much, like I had a slice of cake the other day and felt horrible, didn't realize how much excess sugar was effecting my depression/anxiety, but I think a lot of it was just caused by such a junk food rich diet. I've been cooking real foods, spacing a couple snacks throughout the day to keep my blood sugar stable, tracking my calories to make sure I'm not getting too many BUT not too little and surprisingly there were many days I would've gone below the safe amount due to anxiety so it feels better knowing I can tell when I'm having the right amount now. Like I have a little more domain over my body ya know?

But yea just a lil happy vent ig!!

[fairiepunk]

Can I just vent real quick? About yet another shitty experience I’ve had with mental healthcare in the U.S.?

Vent below the cut. Tw: medication, anxiety

So I started what is more or less my dream job a few weeks ago (yay!), but I’ve found over the past few weeks that this job is triggering as hell for me (fuck!).

My anxiety has been through the roof for these past few weeks, and over the past week, I’ve had severe panic attacks that are nearly impossible to get myself out of regardless of what coping skill I use.

Knowing it would take at least a week to see my regular psych med provider to see about making adjustments, I went into the local behavioral health urgent care (which I’m sure is SUCH a great resource for so many people! I don’t want to shit on it, because I’m sure others have had good experiences, I just did not.)

It is worth noting at this point that the urgent care is a part of the facility I go to for psychiatry regularly, and I was reassured multiple times that they had access to my chart which includes my med allergies.

On my med allergy list is buspar, which is noted as giving me psychotic symptoms. Also on my med allergy list is a note about seroquel potentially causing psychotic symptoms (I took it at the same time as another new med, so we weren’t sure which med caused the psychotic symptoms.)

So imagine my surprise when I was offered buspar. I responded with “I can’t take buspar, it causes me to hallucinate. That should be on my allergy list.” To which, the provider scoffed and said “Well, we don’t do benzos here.”

I have no desire to take benzodiazepines. I am terrified of taking them due to my parents being addicted to them at various points in their lives. This is not to med shame anyone who does take them. I know they can save people’s lives, but just know that I was not seeking them out by any means.

She suggested increasing my propranolol, and then decided against it since my blood pressure was “already on the low end” (she put the cuff on my fucking elbow).

At the end of the appointment, she decided to send over a script for seroquel, and they made me an appointment to meet with my regular psych med provider next week. While I’m reluctant to try this med again, I am willing to because this anxiety is *unbearable* and this is my only option for now.

So I get home, and call the pharmacy to see how much my med will cost. The med provider never sent over the script, and when I called the urgent care to say “hey, I think the system might have glitched. Could you send the script over again?” The receptionist said “Oh sometimes pharmacists just say that they didn’t receive the script. Just keep asking them about it. We’ll double check on our end though.”

The pharmacy did not receive the script before they closed today. I hope they get it early tomorrow. This sucks ass. I am suffering.

[brunchbitch]

Update of sorts

Just got through my first week of classes (second to last semester!) and I’m not crazy about 2 out of 3 professors, but oh well. All of them seem like hard asses and tough graders so that’ll be interesting. I’m jealous that so many of my classmates are graduating in May but the trade off was a much more manageable fall schedule. Idk.

I’ve been doing well-ish with cutting down on weed. A couple weeks ago right after the new year I tried to go back to my schedule of no weed during the week (well… really just Tuesday through Thursday lmao) but I had AWFUL trauma dreams and it really affected my mood. So last week I didn’t do as well, though definitely less smoking in the week. This week I took edibles Tuesday night bc I wanted to make sure I would sleep well before my internship, but I didn’t have anything Wednesday or Thursday night. I had some fucked up weird dreams for sure BUT they weren’t directly trauma related so definitely easier to handle. It’s definitely an ongoing challenge but I’m hoping I’ll get used to this schedule and it’ll just become second nature.

Therapy with B is good - we’re now switching to every other week! NEVER thought I wouldn’t be in weekly therapy!! I was worried my behaviors would escalate bc I’m scared of “getting better” and being seen as not sick, but so far so good and it’s helpful to be aware of it.

My parents are coming out next weekend and my mom and I are going wedding dress shopping!!!! Crazy!!!! But we still have 554 days until the wedding so I have plenty of time. This will be more to get a sense of what styles/silhouettes I like. It’s gonna be surreal to look in the mirror with a wedding dress on. Hoping my mom isn’t too opinionated if we disagree lol.

I can’t remember if I have said this on here yet but A and I have decided to move to Seattle in august! I’m soooo excited but also nervous to be close to my family again. A also feels conflicted about it but we’ll take it one day at a time and it doesn’t necessarily need to be permanent. It feels a little silly career wise to leave Boston which is a city with such amazing hospitals and go to Seattle which has one level one trauma center, but I might want to work in a specialized outpatient clinic anyway. I would NOT want to work in an ED so maybe it doesn’t really matter. I think it would be really cool to be a medical social worker in an outpatient cancer clinic working with young adults, though I know that’s very specific and I’m not sure exactly what’s available out there. I’ve started to look at jobs just to get a sense, but obviously I’ll have to study for and pass my licensing exam first. I would love to take more Spanish classes while I’m working on that. I miss it!

Overall things are really good. I keep waiting for shit to hit the fan but idk… weed plus A plus a meaningful internship (last year too) has led to such a long period of stability (well long for me lol). A and I were talking about how at the end of this decade he will be 43 (!!!) and I’ll be 39. I started thinking about my life seven years ago at 24 and it feels like I was a completely different person. I would’ve laughed in your face if you told me I would be where I am today. Idk. It’s weird. I worry that one day I’ll relapse with my depression bc I genuinely feel… happy? So it’s kind of easier to not use behaviors. But if I felt depressed and hopeless, things might be very different. I guess I have to remind myself to take it one day at a time.

Edit: I also started on propranolol a couple months ago and WOW has it made a difference in my anxiety especially at my internship. I feel like I’ve worked really hard to work on the mental distortions, but the physical aspect of the anxiety has just been so tricky. After taking neurobiology last summer, I really am recognizing that trauma can have such long term effects on your body.

[one-sided-bbl]

prescription medication ranking list

as a bipolar baddie, ive learned that the only thing that can save me is prescription medication.

Anti Psychotics/ Mood Stabilizer

aripiprazole (Abilify): made me feel nothing. took this for a month and genuinely cant tell u if it made a difference. 2/10

latuda: omg when i say this will put u to SLEEP. my psychiatrist gave this to me and said " u cant be manic if ur asleep" and he MEANT it. if you havent tried it I recommend it 10/10 only reason im normal

lamictal: i have been prescribed this for over a year and maybe have take it four times. its a good backup when im extra crazy but i still prefer latuda

Benzos/Anti anxiety

Propranolol: DO NOT TAKE THIS IF U HAVE SERIOUS ANXIETY. I was on the verge of s*icide and this didnt do SHIT 4/10 i would recommend this for somebody who has anxiety AND heart issues

Busbar: this shit makes u feel like ur drunk. dont take this and drive. but even tho it makes u feel weird i didnt notice much of a difference. 5/10 better for long term issues

klonopin: sister <3 i remember i had a deep panic attack going on for five days straight and my psychiatrist said... "girl try this" and it works omg. however, itll make you stupid for a full 24 hours like i dont remember whole conversations when i take this shit. 8/10

xanax: i prefer klonopin, xan is too short to help with my panic attacks. xanax i feel only makes sense when youre over the age of 29 like why tf r u abusing this 5/10

Anti depressants/ stimulants

Zoloft: i took this for like two weeks and it didnt do shit. i truly believe this is only helpful if youre not bipolar 1/10

Wellbutrin: ok DO NOT take this alone if youre bipolar. said panic attack that lasted four days was because i was on this without my latuda. however, at higher doses i really enjoyed this one as it helped with my adhd a lot. 6/10

Adderal: my sister i stopped taking wellbutrin because adderal helped a lot more. i use it as an antidepressant. stop putting shortages on my elixir of life!!! 8/10 the crashes suck

Vvyvanse: if only my insurance would cover it... everything said about adderal excluding bad come downs. 9/10

[sleepingpills-uk]

Modvigil-200 (Modafinil) 200mg tablets

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Modvigil-200 (Modafinil) is a tablet form of Modafinil containing 200mg per tablet. Modafinil is prescribed to people with sleeping disorders such as narcolepsy. It can help increase wakefulness in patients with excessive sleepiness by acting on neurotransmitters in the brain. There are also off-label uses for Modafinil. It improves cognition, memory and alertness and is often used by students before and during exams and by workers with heavy demands of deadlines.

What is Modvigil-200 tablets contain 200mg?

Modvigil-200 tablets contain 200mg of Modafinil as the active ingredient. Doctors primarily prescribe Modafinil to treat excessive daytime sleepiness linked to conditions such as narcolepsy, obstructive sleep apnea, and shift work sleep disorder. Modafinil promotes wakefulness and enhances cognitive function without inducing typical stimulant effects like jitteriness or agitation. It’s essential to use Modafinil as directed by a healthcare professional since it can have side effects and may interact with other medications. Buy Modvigil-200 (Modafinil) online from our online store. We sale the best sleeping pills online in UK through our online pharmacy.

Uses of Modvigil-200 tablets

Modvigil-200 (Modafinil) tablets of Modafinil per tablet. Doctors prescribe Modafinil to individuals with sleeping disorders like narcolepsy. It enhances wakefulness in patients experiencing excessive sleepiness by affecting neurotransmitters in the brain. Additionally, Modafinil is used off-label for its cognitive enhancement properties. It boosts cognition, memory, and alertness, commonly taken by students before and during exams, as well as by workers facing demanding deadlines. Buy Modvigil-200 (Modafinil) 200mg tablets online from our online store. We sale the best sleeping pills online in UK through our online pharmacy.

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Swallow Modvigil-200 (Modafinil) tablets whole with a glass of water. You can take them with or without food. If you’re using them for narcolepsy, take them in the morning. For cognitive enhancement, take them about an hour before starting your work.

Your doctor will advise you on the dosage based on your condition. Typically, the recommended dosage is 200mg once daily in the morning for narcolepsy and 200mg before starting work for shift work sleep disorder or as a study aid.

Side effects Modvigil-200 tablets

The most common side effects associated with Modvigil-200 (Modafinil) are:

• headaches

• nausea

• anxiety or nervousness

Less common side effects you may experience include:

• back pain

• muscle stiffness

• swelling

• belching

• vomiting

• diarrhoea

• constipation

• heartburn or indigestion

• decrease in appetite

• dryness of the mouth or skin

Precautions Before Using Modvigil-200 tablets

Modvigil-200 (Modafinil) should not be used by patients with heart or heart valve issues.

Before taking Modvigil-200 (Modafinil), you should advise your doctor if you:

• are pregnant, or trying to become pregnant

• are breastfeeding

• are taking any other prescription or over-the-counter medicine

• have any allergies

• have or have had in the past any problems with your kidney, liver or heart

• have any history of mental disorder

• are taking any MAOIs (monoamine oxidase inhibitors)

Modafinil may cause dizziness. Do not drive or operate machinery until you realize how you react to Modafinil. Do not take alcohol with Modafinil.

Drug Interactions with Modafinil:

• Erythromycin or ketoconazole may increase the risk of Modafinil’s side effects.

• Carbamazepine, phenobarbital or rifampin may decrease the effectiveness of Modafinil.

• The side effects of clomipramine, desipramine, diazepam, hydantoins, omeprazole, propranolol and warfarin may be increased by taking Modafinil.

• The effectiveness of cyclosporine, hormonal products (birth control pills, hormone replacement therapies etc), midazolam, quetiapine, or triazolam may be decreased by using Modafinil.

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[uksleepingpills-blog]

Modvigil-200 (Modafinil) 200mg tablets

From: £37.50

Modvigil-200 (Modafinil) is a tablet form of Modafinil containing 200mg per tablet. Modafinil is prescribed to people with sleeping disorders such as narcolepsy. It can help increase wakefulness in patients with excessive sleepiness by acting on neurotransmitters in the brain. There are also off-label uses for Modafinil. It improves cognition, memory and alertness and is often used by students before and during exams and by workers with heavy demands of deadlines.

What is Modvigil-200 tablets contain 200mg?

Modvigil-200 tablets contain 200mg of Modafinil as the active ingredient. Doctors primarily prescribe Modafinil to treat excessive daytime sleepiness linked to conditions such as narcolepsy, obstructive sleep apnea, and shift work sleep disorder. Modafinil promotes wakefulness and enhances cognitive function without inducing typical stimulant effects like jitteriness or agitation. It’s essential to use Modafinil as directed by a healthcare professional since it can have side effects and may interact with other medications. Buy Modvigil-200 (Modafinil) online from our online store. We sale the best sleeping pills online in UK through our online pharmacy.

Uses of Modvigil-200 tablets

Modvigil-200 (Modafinil) tablets of Modafinil per tablet. Doctors prescribe Modafinil to individuals with sleeping disorders like narcolepsy. It enhances wakefulness in patients experiencing excessive sleepiness by affecting neurotransmitters in the brain. Additionally, Modafinil is used off-label for its cognitive enhancement properties. It boosts cognition, memory, and alertness, commonly taken by students before and during exams, as well as by workers facing demanding deadlines. Buy Modvigil-200 (Modafinil) 200mg tablets online from our online store. We sale the best sleeping pills online in UK through our online pharmacy.

Dosage and Administration of Modvigil-200 tablets

Swallow Modvigil-200 (Modafinil) tablets whole with a glass of water. You can take them with or without food. If you’re using them for narcolepsy, take them in the morning. For cognitive enhancement, take them about an hour before starting your work.

Your doctor will advise you on the dosage based on your condition. Typically, the recommended dosage is 200mg once daily in the morning for narcolepsy and 200mg before starting work for shift work sleep disorder or as a study aid.

Side effects Modvigil-200 tablets

The most common side effects associated with Modvigil-200 (Modafinil) are:

• headaches

• nausea

• anxiety or nervousness

Less common side effects you may experience include:

• back pain

• muscle stiffness

• swelling

• belching

• vomiting

• diarrhoea

• constipation

• heartburn or indigestion

• decrease in appetite

• dryness of the mouth or skin

Precautions Before Using Modvigil-200 tablets

Modvigil-200 (Modafinil) should not be used by patients with heart or heart valve issues.

Before taking Modvigil-200 (Modafinil), you should advise your doctor if you:

• are pregnant, or trying to become pregnant

• are breastfeeding

• are taking any other prescription or over-the-counter medicine

• have any allergies

• have or have had in the past any problems with your kidney, liver or heart

• have any history of mental disorder

• are taking any MAOIs (monoamine oxidase inhibitors)

Modafinil may cause dizziness. Do not drive or operate machinery until you realize how you react to Modafinil. Do not take alcohol with Modafinil.

Drug Interactions with Modafinil:

• Erythromycin or ketoconazole may increase the risk of Modafinil’s side effects.

• Carbamazepine, phenobarbital or rifampin may decrease the effectiveness of Modafinil.

• The side effects of clomipramine, desipramine, diazepam, hydantoins, omeprazole, propranolol and warfarin may be increased by taking Modafinil.

• The effectiveness of cyclosporine, hormonal products (birth control pills, hormone replacement therapies etc), midazolam, quetiapine, or triazolam may be decreased by using Modafinil.

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[beeearhive]

When you work with amazing people, you're definitely blessed! . They're not easy to find. But I found them.

And we're the few. Imagine a simple stretch on our facial muscle to avoid wrinkles can relieve someone's anxiety better than propranolol

One of our patient who left a feedback for me said " I was really scared when I came here, but whenever you greet us with smile,it lessen our anxiety"

There's this line I never forget from the series the residents.

"We dont have to like all our patients,but we have to take care of them, because whoever they are, they're sick and in pain. But we have to deal with them, yes its hard. But.. not many people can get a chance to make a difference. "

And we're the few. Imagine a simple stretch on our facial muscle to avoid wrinkles can relieve someone's anxiety better than propranolol

But whats the use of just smile If I've got no team to support me?

Thank you to our patients who appreciates our care. This award maybe named Bernadette, but I read it as Team effort!

Without my team, my day will always be frowning. When we're losing the energy, feeling exhausted, overwhelmed, our team are amazing keeping you up,laugh about it, turns out we're all counselors (nursing is not just patients advocate, also colleagues advocate) Management (right there) who supports us when we suggest adjustments needed to help the system easier for patients and the team. You make our work easier.

Without our nurses,Manager ,pathways,doctors, consultant, Receptionist, pre assessment team,pharmacist,porter, housekeeping, volunteers..Everyone at wms who are one call away when we need them. I dont think I'll be able to do the best. Might be good. But not best.

Thank you everyone!

All of you are the Best part of the hospital. For me and for our patient.

At our hospital we believe that "most of the annoyed/impatient or demanding patient, had probably had bad experience for them to act like that. Lets change their mind and show them the best care possible they deserve"

This Tulip award is for all of us!

Proud to say at this work place?

We have Safety, Kindness, Teamwork and Improving.

One last quote for those not very nice to us.

"My excellence is the best revenge"-aj austin the residents.

[myrawjcsmicasereports]

Airway Management In A Difficult Intubation Due To The Presence Of A Goiter by Jevaughn Davis in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Large goiters have been known to cause tracheal deviation or compression, presenting the potential for a difficult airway. If time allows, preoperative workup including multispecialty evaluation and advanced imaging can mitigate the potential for airway complications. Awake fiberoptic intubation is often the method of choice for the anticipated difficult airway but may not always be tolerable for patients. We herein describe a patient with a 10–15-year history of a large multinodular goiter causing tracheal deviation without overt symptoms of airway compression. Planned awake fiberoptic intubation was not tolerated by the patient due to opposition from the tongue and failure of scope advancement beyond the base of the tongue. The patient was later successfully intubated with video laryngoscopy after mask induction.

Keywords: Airway Management, Goiter, Difficult Intubations, Awake Fiberoptic Intubations, Video Laryngoscopy.

Introduction

A goiter describes an enlarged thyroid gland which can cause tracheal deviation or stenosis when sufficiently large [1], presenting significant difficulty in airway management. Careful consideration and planning must be given to the patient with a large goiter and should include thorough history and physical exam [2], multidisciplinary preoperative evaluation, and imaging, if time allows. Awake fiberoptic intubation (AFOI) is considered the gold standard for the anticipated difficult airway, though video laryngoscopy, amongst other techniques, can be used in combination with or instead of AFOI, with similar success rates [3-5]. Studies have shown that success of AFOI is largely dependent on the anesthesiologist’s familiarity with these techniques [3].

Aside from operator comfort with the chosen intubation method, appropriate sedation and analgesia are paramount to a successful AFOI [4, 6]. Sedation should be light enough to allow for spontaneous ventilation, as heavy sedation can lead to respiratory distress, apnea, or hemodynamic instability [7] while anxiolysis by medication or cognitive reassurance is integral. Analgesia can be delivered via topical anesthesia to the upper airway or by regional techniques to subdue cough and gag reflexes for decreased overall patient discomfort [4]. Unbalanced or incomplete sedation or analgesia can lead to treatment failure and contingency plans should be in place if AFOI is not successful.

We present the case of a patient with a large goiter presenting without respiratory distress or upper airway complaints, who underwent rigorous preoperative imaging and multispecialty evaluation. AFOI was planned and attempted but was unsuccessful due to patient intolerance. The patient was successfully intubated with video laryngoscopy after mask induction with sevoflurane.

Case Presentation

An 82-year-old (53kg) woman with a 10–15-year history of goiter presented for one day duration of right leg pain after a mechanical fall 3 months prior.   She was initially mobile without issues until her pain acutely increased the prior day.  Her emergency room work up was notable for an acute femur fracture. Labs were notable for elevated white blood cell count of 15.83, and findings consistent with subclinical hyperthyroidism, which included elevated thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine. She reported having an intermittently rapid and irregular heartbeat, increased anxiety and nervousness and dysphagia to solids initially. She adapted for her dysphagia by eating slower, taking smaller bites, and chewing her food well. Otherwise, she denied issues with respiration and had noticed no changes in her respiratory patterns in the last 5 years.  Vitals were notable for a respiratory rate of 34 and a heart rate of 110 for which her primary team started her on propranolol.  Physical exam was notable for a visible, and mobile goiter (Figure 1).  She had no known allergies and was not taking any medications.  Family history was noncontributory.  There was no familial or personal history of complications with anesthesia, and no prior intubations.  Surgical history was pertinent for a prior cesarean section.  American Society of Anesthesiologists (ASA) physical exam score was IV.Admission two view chest x-ray was notable for tracheal deviation and subglottic narrowing (Figure 2A/B). The anesthesia team peri-operatively evaluated her, wherein she was a mallampati class II and she denied respiratory symptoms or trouble with lying flat.  Beside ultrasound revealed a vascular mass with a patent trachea while upright and moderate compression when the head of the bed was less than 30 degrees. Trauma surgery was consulted for a surgical airway should intubation attempts prove unsuccessful.  Trauma surgery determined the borders of the mass were unclear and expressed concerns that if intubation failed and urgent surgical exploration needed, a surgical airway would be challenging and potentially unsuccessful given the unknown anatomy.  They determined the mass to be hypervascular, and a surgical airway could lead to massive hemorrhage.  The case was moved to another day for a more robust evaluation of the neck mass.

Ultrasound revealed a markedly enlarged thyroid gland compatible with a goiter containing multiple enlarged nodules with two right nodules measuring 5.2 x 4 x 5 cm and 5.2 x 4 x 4.2 cm in addition to a left nodule measuring 5.6 x 4.6 x 5.2 cm. The thyroid was enlarged and heterogeneous with multiple coarse calcifications with the left lobe measuring 11.4 x 6.3 x 7.9 cm and right lobe measuring 8.6 x 5.2 x 4.7 cm.  All nodules were heterogeneous with solid, mixed solid, cystic, and calcified parts.  A computerized tomography (CT) neck and soft tissue scan was performed and demonstrated an enlarged heterogeneous thyroid gland with multiple coarse calcifications with the left lobe greater than right lobe (Figure 3).  The left lobe measures 11.4 x 6.3 x 7.9 cm and the right lobe measures 8.6 x 5.2 x 4.7 cm, with the largest nodule in the right gland measuring 6.0 x 4.0 x 4.7 cm the upper /mid pole (Figure 4A/B).

On CT neck and soft tissue, the airway proved to be largely patent with regions of luminal narrowing (Figure 5). Otorhinolaryngology performed a flexible fiberoptic laryngoscopy and discovered a widely patent airway without significant airway compression.  Both trauma surgery and otorhinolaryngology surgery opted to be available for intubation.

The decision was made to perform an awake fiberoptic intubation for patient safety in the setting of a possible difficult intubation.  Induction began with 0.4 mg IV glycopyrrolate and nebulized 5% lidocaine in the preoperative area for 30 minutes.  The patient was then taken to the operating room, where she was placed on standard monitors in addition to nasal cannula with capnography.  A remifentanil infusion was started at 0.07mcg/kg/min and topical 4% lidocaine gel was administered bilaterally to the tonsillar pillars.  After about seven minutes, the fiberoptic scope was introduced; however, despite the absence of a gag or cough reflex, the scope could not be advanced without the patient’s tongue actively fighting provider efforts.   A second attempt was made with jaw lift and tongue retraction, however the patient’s tongue continued to interfere with fiberoptic scope advancement.  The decision was made to abandon awake fiberoptic intubation since the patient was easily masked.   Anesthesia was induced with 8% sevoflurane in oxygen with the patient in a semi-recumbent position and anesthesia was maintained with 50% oxygen and sevoflurane for a minimum alveolar concentration of 1.2 after intubation.  A 7.0 reinforced endotracheal tube was inserted with the aid of a C-MAC video laryngoscope after obtaining a grade 2 Cormack and Lehane view.    After confirmation of placement with end-tidal carbon dioxide, paralytic was administered (30 mg IV Rocuronium) for the surgical procedure.  Additionally, the patient was given 10 mg IV Dexamethasone, 4 mg IV Ondansetron, 40 mg IV Ketamine, 2g IV Ancef, and 0.7 mg IV Hydromorphone during the case.   Neuromuscular train-of-four ratio was continuously monitored and at the end of the case, the patient was reversed with 200 mg IV Sugammadex and a train-of-four with height greater than 0.9 was obtained. After full inhalational agent washout, the patient met extubation criteria and was extubated to nasal cannula without issues.  In the post anesthesia care unit (PACU), she was maintained on nasal cannula with capnography in the event additional IV opioids were needed for operative pain.  A fascia iliaca nerve block was placed for further pain control to minimize opioid usage. PACU stay was uneventful, and she returned to her inpatient room.

Discussion

Goiters can often be accompanied by airway deformities leading to difficult or challenging mask ventilation and or laryngoscopy. Induction of anesthesia in these cases can lead to complete airway closure, making mask ventilation and tracheal intubation difficult, leading to unintended surgical airways or cardiopulmonary mortality and morbidity [8-9].  Cardiorespiratory complications occur approximately 14.3% [8] of the time in patients with anterior or middle mediastinal masses.  Cardiorespiratory signs and symptoms at the time of presentation usually confer the highest rates of perioperative complications [8-9].  Partial or complete airway closure is usually in part due to the pressure exerted on the trachea by surrounding soft tissue especially during periods of tissue relaxation such as during sleep, sedation and under general anesthesia. Induction of anesthesia can result in increased relaxation of soft tissues which causes the soft tissue to collapse onto the surrounding airway, increasing the pressure being exerted on the trachea.  This mass effect on the trachea can be alleviated or worsened in certain positions due to gravity.  It is often important to probe patient history about “how they sleep” or whether being supine causes any respiratory issues.  Ideally these patients should be preoxygenated and intubated in the position most comfortable to them.  This is the position least likely to cause respiratory symptoms, panic and is most likely to avoid tracheal compression.

Many techniques can be used to aid intubation in this population.  Ideally, spontaneous respiration should be maintained.  Spontaneous respirations preserve negative pleural pressure, which allows for patency of the airway.  Thus, sedation should be minimized, or providers should use sedative agents that minimally affect respiratory function and tone.  These agents include ketamine, dexmedetomidine and ultra-low doses of remifentanil.  When possible general anesthesia should be substituted for neuraxial or regional anesthetic techniques as these techniques offer lower potential for respiratory depression, apnea and or loss of airway.

Depending on anesthesiologist preference, techniques such as awake direct laryngoscopy, awake tracheostomy, awake fiberoptic intubation or awake rigid bronchoscopy may be utilized.   Awake fiberoptic intubation has won favor with many anesthesiologists given its versatility and its ability to allow continuous ventilation if placed through a laryngeal mask airway.  There is no significant difference in the first attempt success rates of fiberoptic intubation and video laryngoscopy [3].   Alhomary et al. found that intubation times were shorter for video laryngoscopy and there were no significant differences in failure rates [3].  There was no difference when comparing adverse events like postoperative hoarseness, sore throat, or low oxygen saturation [3]. In this case, awake fiberoptic intubation was unsuccessful while mask induction with sevoflurane and video laryngoscopy led to a successful outcome.  Based on the current literature, video laryngoscopy and awake fiberoptic are both effective and comparable techniques, thus depending on the clinical scenario, fiberoptic intubation should not be the automatic default technique and thought and consideration should be given to video laryngoscopy or awake laryngoscopy.  The competency, skill set, and experience needed by anesthesiologists for video laryngoscopy and fiberoptic are different.  It is estimated that an anesthesiology needs to perform 25 fiberoptic intubations to become competent when compared only 6 video laryngoscopes for competency [10].

Conclusion

Goiters when large enough present an increased risk of cardiopulmonary complications surrounding management.  For non-emergent surgeries, patients should be properly optimized.  Optimization involves up to date imaging and identification of the goiter and its effect on the patient’s underlying airway. Comprehensive planning involves a multidisciplinary medical team, proper preoperative assessment, and discussion to best provide a safe outcome for the patient.  Video laryngoscopy and awake fiberoptic are both effective and comparable techniques.  Both techniques should be considered depending on the clinical scenario.

[bigapollospectra]

Is There Any Cure For Hand Tremors - Brain Specialist in Patna

Hand tremors may be distressing, affecting daily activities like writing, consuming, or maybe holding items.

Why Do My Hands Shake When I Hold Something? While tremors are regularly associated with neurological issues, various kinds and causes exist, every with unique treatment strategies.

Big Apollo Spectra Best Neurology Hospital in Patna, gives professional session and remedy for coping with hand tremors, supplying desire for those handling this situation.

What Causes Hand Tremors?

Hand tremors are uncontrollable muscle movements that cause shaking in a rhythmic fashion.

These could stem from a range of factors, from lifestyle choices to neurological conditions. What Is The Most Common Cause Of Hand Tremors:

Essential Tremor: A neurological illness that essentially influences the palms, it's miles the maximum common cause of tremors in adults. Essential tremors typically worsen with motion and can have a genetic hyperlink.

Parkinson's Disease: Hand tremors may be one of the early symptoms of Parkinson’s, in which tremors are regularly greater stated at rest. This illness impacts motor manage and has diverse levels of development.

Multiple Sclerosis (MS): Tremors are one of the signs skilled via MS patients because of nerve damage affecting muscle manage.

Anxiety and Stress: Emotional triggers like pressure and tension can temporarily purpose hand tremors. While often quick-lived, continual strain may also additionally exacerbate this symptom.

Medications and Substance Use: What Drugs Cause Shaking Hands? Some medicinal capsules, particularly those affecting the fearful device, can cause tremors as a facet impact. Excessive alcohol intake or withdrawal also can activate tremors.

Hyperthyroidism: An overactive thyroid gland can cause brilliant tremors as one in every of its signs and symptoms due to stepped forward metabolic charge.

Is There a Cure for Hand Tremors?

The approach to treating hand tremors depends at the underlying purpose, and even as there isn’t a time-venerated several treatment options can control signs and symptoms effectively.

Patients at Big Apollo Spectra Hospital can gain from a neurology Specialist Near Me to their unique situation. Here’s a look at some of the How To Stop Hand Tremors Naturally:

1. Medications

Beta-blockers: Drugs like propranolol are generally used to address important tremors. They assist lessen the frequency and severity of tremors by way of the usage of blocking positive anxious device features.

Anti-seizure Medications: Drugs inclusive of primidone can help lessen crucial tremors in patients who do now not reply to beta-blockers.

Dopaminergic Medications: Medications that increase dopamine in the brain can improve motor control and decrease shaking for tremors caused by Parkinson's disease.

Benzodiazepines: Prescribed for tremors caused by anxiety, because of capability dependency, they're commonly used as a quick-time period answer.

2. Lifestyle Modifications

Making changes to at least one’s each day conduct can considerably assist in managing hand tremors:

Avoid Caffeine and Alcohol: Both materials can exacerbate tremors in susceptible people. Reducing or disposing of them from one’s eating regimen can also additionally offer comfort.

Stress Management: Practices like meditation, respiratory sports, and yoga help lessen pressure stages, which may additionally moreover, in turn, lessen tremors.

Physical Therapy: Exercises focused on strengthening hand muscles and enhancing coordination can assist individuals in better managing their symptoms.

3. Occupational Therapy

Occupational therapy is beneficial for those whose tremors intrude with each day sports.

Therapists paintings with patients to expand coping strategies, introduce assistive gadgets, and modify duties to cause them to much less hard.

4. Botox Injections

Botox injections can be used to in short paralyze the muscular tissues accountable for tremors, mainly in cases of immoderate critical tremors.

This remedy might also additionally provide consolation for up to 3 months, even though it may restriction certain motor features.

5. Surgical Options

What Is The Latest Treatment For Essential Tremor? Surgical options can be considered when medications and non-invasive treatments prove ineffective.

Deep Brain Stimulation (DBS): Involves implanting electrodes in specific regions of the brain during surgery.

These electrodes generate electrical impulses that modify ordinary mind interest, decreasing tremors. DBS has confirmed incredible fulfillment in treating essential tremor and Parkinson’s-associated tremors.

Thalamotomy: This technique involves destroying a small a part of the thalamus, a mind form involved in motor manage.

It is plenty less commonly accomplished than DBS but may be effective for sufferers with extreme tremors.

6. Non-Invasive Techniques

New non-invasive strategies, which includes targeted ultrasound, are gaining traction in tremor manage.

This method makes use of sound waves to goal and smash tissue inside the mind accountable for tremors, imparting alleviation without the need for incisions.

Why Choose Big Apollo Spectra Hospital for Neurological Care?

How To Stop Shaking Hands Immediately? Big Apollo Spectra Hospital in Patna is devoted to providing comprehensive take care of neurological issues, which consist of hand tremors.

The hospital is staffed via manner of Best Neurologists In Patna and equipped with superior diagnostic and treatment technologies, deliberating personalised and powerful treatment plans.

With a multidisciplinary technique, sufferers gain from coordinated care in the course of neurology, bodily remedy, and occupational remedy.

Living with Hand Tremors: Tips for Day-to-Day Management

How I Cured My Essential Tremor? While treatment can extensively reduce tremors, practical techniques can assist manage every day sports:

Use Weighted Utensils and Pens: Heavier gadgets can provide higher manipulate for people with hand tremors.

Stabilize Elbows: Resting elbows on a flat floor whilst operating with hands can reduce shaking.

Prioritize Assistive Technology: Devices designed for human beings with tremors, which includes anti-tremor spoons and modified equipment, ought to make everyday obligations less difficult.

Support groups and counseling may be useful for emotional properly-being and offer a revel in of network with others going through comparable challenges.

Why Are My Hands Shaking For No Reason?

While hand tremors might not usually be absolutely curable, there are many powerful treatments to lessen signs and enhance high-quality of life.

With professional steerage and entire treatment alternatives available at Big Apollo Spectra Hospital, sufferers in Patna can locate treatment from the distressing results of hand tremors.

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[ineedtobeheardnotseen]

Well the propranolol works like a charm

Even though my depression has reached abysmal depths, I have very little anxiety

Which is great, because the anxiety is the part that makes me want to kill myself

The depression just makes me want to make decisions that will bomb my life

Like quitting my easy, steady job

It's hard not to view my job as the enemy even though I work for a government service that helps kids and families

After all, they still force us to work a full 40 hours per week on a regular 8-5 schedule, which scientists have repeatedly established is basically torture

I think I need to stop watching or reading the news for the sake of my own health because it doesn't help

My depression really just makes me tired and clouds my thoughts, it's all the awful news that makes me feel hopeless on top of it all

I read something about the fact that earth's water cycle is being disrupted, and the article was framed in such a way that it only really talked about the financial repercussions of such a thing, such as the impact on various countries' GDP and the agricultural industry

It said virtually nothing about how rising prices of both food and water due to this scarcity will impact communities and add to our suffering

Because the people who could fix this problem don't care about that

But honestly, presenting it the way the writers did just makes the situation look ideal to people who have stock and interest in water and agriculture because they will be able to raise prices and quote this article as an excuse

It's not going to drive them to make any sweeping and emergency policy changes

Rich people are playing a game of elimination, the point is to destroy as many of their peers as possible and steal their resources until there's only one man left holding all of the cards

The increasing disasters of earth only speed the game closer to its eventual conclusion

Those of us that aren't viewed as competitors in the game are instead viewed as managed resources, expended or conserved by our owners only as necessary to defeat other players in this game

They aren't kidding when they call capitalism a death cult

And we're powerless to stop them without risking both our lives and the lives of our loved ones

All we can do is live our day-to-day and hope for small joys to outweigh our suffering

You can imagine how thinking about all of that might impact my depression

It's Sunday

I have tomorrow morning off, and I'm supposed to go back into work for the afternoon

I hate going into work depressed, but I need to get used to it

My job is easy, my coworkers are kind, and I have plenty of opportunities to rest

I just have to do what I need to in order to get through each day

A friend is coming from out of state to visit me at the end of the month

A family member from out of the country is coming to see me at the beginning of next month

I have enough to look forward to, just gotta manage my mood in the meantime

[psychedelicmadness666]

The amount of other "mental disorders" I have.

I was diagnosed with Schizoaffective disorder Bipolar type and Chronic-PTSD as it said on my discharge papers when I got released from the psych ward.

The amount of disorders I was diagnosed with

Schizophrenia

Bipolar Disorder w psychotic features

PTSD

OCD

Borderline Personality Disorder

Depression

Generalized Anxiety Disorder

I had a lot of different diagnosis until I landed with schizoaffective disorder and PTSD. The meds I am on is Seroquel 300 mg, Haldol 5 mg twice daily, Duloxetine 30 mg, Depakote 500 mg,prazosin, propranolol.

My life has been nothing but tragic but not always. I would hear my name multiple times, I would see shadow figures, I would see things, my body feels strange, especially my neck I feel like there is something in my neck. I talk to myself a lot.

I believe that if I kill myself, I would be a famous celebrity. My art would be collected and that art historian will sort all of my 1,000 paintings. So far, I have 167 paintings done with 4 or more paintings are gone. Maybe, if I kill myself when I finish the 1000 painting or more. I will succeed being a famous artist. I have over 4 paintings shared. One painting is hung up at a clinic, the other is lost in an art studio, the other one is with a friend, and one of the other one is with a cousin of mine.

Sometimes, I feel like that things happen. I think and it happens. It's not out of coincidence. It happens. Something in my mind pops up and it's crazy. I think of a person and the person pops up. I think about a bird coming through and the bird will appear. The radio would be talking about something, I just thought of!

things are different.

I can't socialize as I used to with my family.