#the last hurdle is my physical health but my surgery is in less than a month

[ofduskanddreams]

After 2 whole months having to go without it, I finally was able to get my adhd meds again y’all!!

(just in time for me to see FOB this weekend)

[writerman]

Psst. Write a hanahaki disease fic for Barduil where Thranduil has it. You gotta write it.

Hey, anon, remember when you requested this probably like a year ago? Yeah, me either...

Anyway, here is what you asked for. I wrote over 7000+ words in a day to finish this asap.

My thanks to @morticia-butler​ for all the help looking up Hanahaki disease headcanons and an iconic line I simply had to include.

This is a long one so some of it will be under a readmore BUT you can also read all my other Barduil prompts via this fancy schmancy LINK

On to the story!

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8:30am. Thursday. September 17th. Just petals. 

The mirror reflected a pale and haunted image back at him while bright and vibrant yellow petals dusted the front of his pyjama t-shirt. 

Daffodils. 

His favourite. Thranduil, however, had come to detest the sight of them. The sunshine yellow flowers openly mocking him, their bobbing heads in the breeze seen as a gaggle of them laughing almost jovially at his situation. 

No point thinking on it in-depth, not when he could temporarily abate the problem. 

With such a thought in mind, Thranduil brushed the petals from his shirt into the sink and watched as they swirled in the water a moment before vanishing down the drain into the darkness. 

But there would be more. 

There was always more. 

A soft knock at the bathroom door stilled his hand as he reached for his toothbrush and he turned to see Tauriel watching him with concern. 

“I didn’t know you were visiting today, what are you doing here?” Thranduil’s voice was soft as he spoke, though, the lilting sound of surprise cracked his voice for a moment. “Had I known you planned to visit I’d have been ready by now. What are-” Thranduil watched as Tauriel leaned toward him, her hand brushed the fabric of his t-shirt as she plucked a petal still clinging to the fibres. 

“Dad, you said this had stopped!” The words rushed out and they were so loud as she held the petal up between them. While it hadn’t meant to come out so accusing, he could hear the dismay that coloured her words, it still felt harsh and Thranduil braced himself for a barrage of instructions to get himself to a doctor. 

“It was quelled for some time. The doctor gave me special inhalers that slow the spread but I’ve not had the time to contact the surgery for a refill.” He gestured to an empty inhaler laying innocently on its side by the sink. They had helped immeasurably and the majority of his family had believed the disease was done and gone. 

But Hanahaki was not that easy to be rid of, he knew and deep down his family knew that too. It was easier to think he had been cured than to do consider the alternative…

“I dropped by because I wanted to know if you felt like grabbing breakfast?” Tauriel turned from the bathroom door and wandered into her dad’s bedroom, his clothes were laid out already, she paced past the bed and back out into the hallway. “I’ll be downstairs, let’s go out still.” 

There was no time to respond and so Thranduil internally agreed to breakfast with his daughter. She and Legolas were the same in that they were strongwilled, always happy to make a decision and happy to make it for someone else too. 

They definitely had gotten that trait from him, even if he had mellowed somewhat with age. It was easy to recall his younger days with clarity, he walked tall never a curve to his back because he bowed to no one. 

He had been so headstrong and confident, even after his wife had died. People had come to him speaking softly with sincere condolences but Thranduil cast the sorrowful glances aside and carried on working. 

That felt like aeons ago now, Thranduil was more in touch with his emotional and mental health now, gave and took the time of others as freely as he should have when he was younger. Thranduil found value in the world where once he would have shunned it. 

Turning to look in the mirror, that pale and haunted face stared back but the eyes seemed less empty than they had earlier. Even with his disease there was still hope within him, it was choked and stuttering by the roots of the flowers in his chest and lungs but it was there. 

“I can’t give up, not yet.” He whispered to himself. 

They ended up heading to Tauriel’s favourite place for breakfast, it was a small family-run restaurant and the food was good. The cheery wait staff did not match the highly polished wood and marble of the place but it felt strangely homely all the same. 

It was while Thranduil perused the menu that Tauriel brought up the subject, or rather, the object of his disease to him. A public place so he would not make a scene, perhaps, or rather, she hadn’t thought of the setting and only wanted to relinquish her hold on the burning question she had within for months. 

“So, will you at least tell me who it is that did this to you?” Badly worded. No one had passed the disease onto him, that wasn’t how it worked and he knew Tauriel understood that. “Come on, dad. Do they know what they’ve done to you?” Of course, she was angry but why was she being angry with someone innocent in all of it? 

While the majority of the time Thranduil was able to ignore these unnecessary outbursts from his children, there were ofttimes when his frustration got the better of him and one of those times was now.

With hands loosely balled into fists resting on the tabletop, Thranduil pinned his daughter with an icy glare that quashed whatever words she had left inside to say on the matter.  

“I have told you time and time again, I will not tell you who it is. You know damned well that they are not to blame in this. You’ve seen the diagnosis, even though I’ve asked you to stay out of it, you’ve seen the words ‘ self-inflicted’ on the documents.” He voice was low but the chill in his words caused Tauriel to sit back in her seat and avert her gaze from his. 

“I’m sorry-” She stopped when the waitress came over and set down their coffee and a rack of toast. There was time enough between the waitress approaching and leaving for Tauriel to regain her composure. “I’ve read so much about this over the past few months, it might now be onesided that’s all.” She was right but the percentage was low.

Hanahaki disease was such an odd illness to contract, the phenomenon of flowers growing in a person’s chest and lungs due to unrequited or onesided love. The agitation of yearning and pining watered the blooms until the lungs were completely full and the chest cavity would split open with leaves and stems and petals spilling out and killing a person instantly if they hadn’t already died from suffocation. 

But that was only intense cases. There were ways to slow the spread and Thranduil was taking measures to ensure he could do such a thing. 

Regular therapy was one. His therapist was a wonderful woman who guided him through the process of coming to terms with his unrequited love. They spoke of how to be honest and open with the feelings he experienced and how to provide his own closure.

Though, they had many hurdles to jump. Thranduil didn’t believe in closure per se, to him revisiting something traumatic and uncomfortable merely reopened wounds. They’d spent many sessions focussing on the death of his wife and while it had helped immensely in allowing a belated grieving it ultimately had not helped with his predicament.

But he was not to call it a predicament his therapist had said. To remove the seriousness of the disease was to remove the value of his own life. There were many times she had asked him to look from the outside in and speak on the issues in his life as though they affected another person. It had helped and when things looked bleak or if Thranduil began to brush off the seriousness of his illness he would remind himself that he would not allow someone else to do that to themselves. 

The next most drastic step was surgery, but it was a temporary step and it slowed the spread of the disease. Researchers in the medical field studying Hanahaki always implied heavily that the physical manifestations of the disease were caused by the brain and thus Hanahaki was registered as a mental illness. 

It was why doctors pressed so hard for those that suffered to seek therapy. 

“I won’t be involving the person in this what so ever, Tauriel. Please, I ask again that you drop the subject.” How he had pleaded like this before and how it emotionally exhausted him to see the fear in her eyes every time she visited. 

It was all because he knew that one day she feared she’d find him lying dead, a bouquet of blood-stained flowers adorning his chest in a beautiful and grotesque display of the love that had plagued him. 

“I understand that you’re scared but I promise you I have no given up. I have an appointment with my therapist this afternoon and with my surgeon to discuss a date for surgery.” 

His words seemed enough to placate her for now and she instead busied herself with buttering some toast.

3:00pm Thursday. September 17th. Just petals.

“We spoke about your wife again last week, I noted that you requested we move on from the subject. Why do you feel you need to leave that subject alone?” The room was shaded from the bright Autumn sunshine streaming in from the window. 

Thranduil could see the glowing gold around the edges of the blinds and forgot where he was for a moment as he watched it flicker with the shadow of trees swaying the breeze. He couldn’t remember why he’d suggested they move on but it seemed the right course of action to him. 

“I just feel we aren’t focussing on the real problem.” When he spoke he made a point to look at her. Maintaining eye contact seemed important at that moment, he didn’t want her to think he was ruled by indecision. “My wife has been dead for years and we have already confirmed that, as much as I miss her, I have come to terms with her death and grieved appropriately.” Too business-like. As soon as the words had come out of his mouth he knew. 

The therapist merely ‘hmm’d’ in response and wrote something down. There was the internal battle to struggle with now, to explain himself to her or let her assume something of him that he would, personally, deem incorrect. 

“What is it you would like to speak about instead?” 

That was the problem, he didn’t really know. The only thing he wanted to ask was ‘How did you get over someone and quickly?’ but there wasn’t really much of an answer she would be able to give.

Magazines for years had offered ‘helpful tips to get over that person that doesn’t like you back!’ and Thranduil had put no stock in their, so called, wisdom. Now they didn’t publish these things, now they would ask you to seek help if you experienced any symptoms they listed on the page. 

Distraction techniques had been offered by his family in droves at the beginning when his diagnosis had been revealed. Nothing had actually helped because his mind would often wander to the object of his affection when he was practising a new hobby. 

“I think my need to rush these sessions is just because I’m scared of losing myself completely and if I do that, well, you know what happens.” Thranduil gave a half-hearted shrug, he barely lifted his shoulders but it was a shrug all the same and his therapist acknowledged it as so with a nod. 

“Everyone is scared of dying, Thranduil. Perfectly healthy people, people who have terminal diseases. Do you want to talk about your fear of dying?” 

He didn’t. 

They, instead, spoke of newer experimental ideas that Thranduil might have been interested in trying. She wrote out the prescription for the refill on his inhaler and made another appointment for a week later. 

It wasn’t often that Thranduil left the sessions more tightly wound than he had been when going in but he at least knew that he’d need something to talk about next week or they’d get back on the subject of his wife and he honestly didn’t think that was helpful. 

His next appointment was at the doctor's office, they wanted to schedule surgery but they had needed proof he was visiting his therapist before they would agree. It was a messy and an unfair condition but at least at the doctor's office he could get them to fill the prescription so it wasn’t too much of a wasted trip if they refused his surgery. 

1:00pm Friday. September 18th Foliage. 

The office was quiet now. 

Everyone but Thranduil had packed up for the day and headed out to start their weekends. It was a perk Thranduil had implemented years ago and it had been appreciated, even if it had been created to benefit him more so than his employees at the time. 

Nothing was waiting for him at home and there was plenty of paperwork to do so he poured himself a glass of water, took his inhaler and got comfortable at his desk reading through a brief for a new promotion. 

So engrossed was he in his work that he failed to notice someone entering the office and only when a takeout coffee cup was set before him did he move his gaze from the files he had been reading to intently. 

Looking up Thranduil ceased his movement almost instantly at the sight of his best friend Bard. The afternoon sunshine illuminated his handsome face with a soft golden glow, his brown eyes looked golden as he smiled down at him. His cheery countenance was always welcome and so was his gift of coffee but Thranduil could tell his friend was there with an agenda of sorts. 

“Haven’t seen you lately, Thran. You’re not holding yourself up in this office every night until late again, are you?” The concern, it left a shaking and aching hole inside Thranduil and that hole soon became clogged with stems and leaves, give the disease an inch and, well, that old adage. 

“No, I just had something to do here but it can wait. Did you need something?” To try and remain relaxed and carefree around Bard was increasingly difficult, more so when he had endeavoured to hide his disease from him as much as he could. 

“Hm, well, I just had the feeling that you’ve been avoiding me for a while if I’m to be completely honest.” Straight to the point, no beating around the bush for Bard and he had every right to be concerned because he was correct.

Perhaps it was more obvious lately that he had been trying to avoid Bard for a few weeks. Avoidance was never going to be the answer but this man was why he had the disease, or rather, what exacerbated it. There would never be a time he would place sole or even partial blame on Bard for what he was going through. 

“I’m sorry, I suppose I have been caught up in work recently. I’m absolutely not overworking myself before you ask. However, I’ve neglected my best friend and I think I owe you a drink, at least.”

“At least,” Bard repeated in agreement and he grinned, they didn’t move to get up. 

Thranduil busied himself with taking a sip of his coffee, it was a blond roast from Michael’s he could tell without even looking at the logo on the side of the cup. All the while he inwardly cursed the tightness in his chest and new shoots began to sprout and buds began to burst into bloom. 

There was no chance he could even begin to hazard a cough. It’d look like a cat had swallowed a canary. Or a man that had swallowed his feelings. 

For a short while, they chatted idly about what they’d done recently. Bard talked of hating the empty nest syndrome he was suffering now that Tilda had moved out, leaving the family home nothing but a ‘mausoleum of family memories that were visited by a spectre that had helped create them’. It was a dramatic sentence and Thranduil laughed aloud before offering something vaguely sympathetic to soothe his friend.  

“Can’t you clock out already, you own the business let’s get out while it’s still bright,” Bard complained as he rose from his seat and wandered toward the large window Thranduil sat with his back to. “The sun is still warm and we could probably walk to the pub instead of taking the car.”

“Walking to the pub suggests that you don’t wish to have a few drinks but one too many.” As much as he hoped he sounded wise, Thranduil knew Bard would have clearly taken it as a challenge. So they were absolutely going to get drunk that night and Thranduil couldn’t have been more terrified of that prospect.

“I haven’t seen you in ages, you’re my best friend and even if we both regret how bad we feel in the morning, age that does that to you, I want to get drunk with you, Thran!” Ah, old age hadn’t fully caught up with Bard yet, he was vibrant and energetic and hot. Gods above was that man gorgeous. 

That was where it all began though, Bard had blazed into his life when they were in their early 30’s. Thranduil had just lost his wife and was trying to juggle a career and two grieving kids. 

Bard and his wife Anya had helped him. They took the kids to school and picked them up and fed them so Thranduil could… do what? He couldn’t even remember now- he hadn’t grieved that was for sure!

With a 10 year and an 8-year-old broken over the loss of their mother and having no support from their emotionally unavailable father, Tauriel and Legolas had grown up to be quite well adjusted. Though, some of that might have been the therapy they’d gotten as suggested by their school. 

It had happened only 2 years later, Bard lost Anya and he was thrown into a situation similar to Thranduil’s and the roles were reversed. Sigrid and Tauriel grew up like sisters and were still close because of how often they saw one another. They bonded strongly over what had happened to their mothers and became each other’s strength when they needed it.

The same happened with Bard and Thranduil, they became close friends. They took the children on holiday together, camping or water parks and spent their weekends finding activities for the kids that they too could take part in. 

For a while, it had been just friendship, but then as the children grew up and wanted to spend less time with dad and more time with friends they found company in each other more often than not. 

Then Tauriel and Legolas moved out for university, Sigrid and Bain left Bard for the same reason, Tilda was always adventuring with her friends and so when the empty house became too much they would go out. 

Dinner, drinks, a walk in the park, catch a movie or two. 

Innocent stuff, but Thranduil allowed himself to get comfortable and in letting his guard down he let feelings in that he had tried to avoid from the moment he met Bard. 

The problem was when Anya died Bard told Thranduil he couldn’t ever see himself falling in love with another person again. 

This was proven time and time again over the years, dates would happen once or not at all with people that could have been his perfect match, and eventually, Bard learned to ignore anyone that tried to flirt with him. A suggestive smile or even a compliment was brushed off as nothing more than friendly and the more unattainable he became the more Thranduil realised he was in love with him. 

A terrible turn of events to be sure, and now he suffered daily for it with petals littering his pillows and flowers choking out his lungs. 

“Are we going out then?” Bard’s voice cut through the memories Thranduil was replaying in his mind for the hundredth time and how thankful he was when he did. The blooming of the flowers in his chest increased with the thoughts of Bard. 

To say no to the request would put a strain on their friendship. Bard had already noticed that he was being avoided and it would do them no good for Thranduil to continue that. So, with a nod, he got up from his seat and grabbed his jacket. 

“It is a nice day, let’s walk to the pub then.” Intoxication was the last thing he needed but to keep up the charade that all was fine he’d need to at least try and play along. To play the role of a man in perfect health, body and mind, didn’t seem easy but he had to try. 

He would try because he loved him. 

10:45am Wednesday. September 30th. Bursting Blooms.

It was classed as routine surgery but Thranduil couldn’t imagine how hard it would be to slice someone open and remove flowers stamen to stem to root. Temporary as it was, he was thankful they had managed to organise it so quickly, his outing with Bard and the subsequent dinner the night after meant that his condition rapidly grew worse as time went by in the company of his best friend. 

He’d woken to more petals on his pillow than he had ever seen before and his breathing laboured. Even coughing to free up space didn’t work and instead, he was gifted with near whole flower heads landing in his hands.

The kids were horrified as they watched this because of course, it would have happened while they visited. Which led to him having to listen to endless ‘You should go to the hospital right now.’ in a chorus from them both until he showed them the inhalers. 

They sat either side of him in the waiting room now. 

Legolas bounced his leg continuously looking around the waiting room for something to distract him. He’d taken time away from University to be there to help with recovery. 

Tauriel chewed her nails and checked the time on her phone every couple of minutes as if time flowed differently in a hospital waiting room. 

There was no cause for his anxiety to manifest when he was sat between two that were already doing all the work for him. Sadly, he had no words to calm them of their fears because he was just as afraid. 

“Have people died from this surgery, dad?” Legolas piped up out of the blue, he sounded so young in that moment and Thranduil felt guilt course through his veins like ice for putting his children through something like this again. 

When he didn’t answer Tauriel did for him and she shook her head even though Legolas was focussing more on a poster across the room than on anything else. 

“No, because the surgery, while invasive to a degree, only removes some of the plants. They don’t fully remove everything because they simply can’t. Dad is going to be ok, more ok after this than he is now.” Her confidence only shaking by the tremor in her voice and Thranduil hoped Legolas couldn’t hear it. 

“Hmm, ok.” Pensive now Legolas falls silent but his leg continuous to bounce but not as animatedly as before. He was not calmed but something in her words convinced him that the surgery would be fine. 

Though, he didn’t understand why she would lie to him like that. His son was perfectly capable of looking up the survival rate on his phone, it was low just as low as the rate of people that were cured by expressing their feelings to their heart's desire. 

They were approached by a nurse in scrubs. 

“Mr Oropherion, if you would like to come this way.” 

1:56pm Wednesday. September 30th. Roots. 

Someone was gently squeezing his arm.

“Thranduil, you’ve just come out of surgery. Can you hear me?” The same nurse that took him in was now waking him. “We need you to respond to know you’re ok.” 

Nothing felt real yet he managed to croak out something akin to an ‘I’m fine’ but that was it. The need for sleep and an excruciating pain rushed over him and he groaned hands gripping the sheets as he waited for it to subside. 

“Out of 10, 10 being very painful and 1 being not painful at all how do you feel?” The nurse was holding a clipboard and a pen, they looked down at Thranduil with an expectant look and merely blinked blankly when Thranduil didn’t respond right away.

He needed more time than this to consider everything, on the one hand, he could breathe on the other the pain of being sliced open and stitched back together was awful. 

“Ah… 8 maybe?” His whole body shook as he came out of the anaesthetic and all he wanted was to leave his body while it was in this state and return when he was at home comfortable in his own bed with a cup of tea. 

His time in the recovery room was short and he was wheeled into a private room where he was greeted with the grim face of his best friend. Bard looked awful, pale and he seemed to have aged 10 years all with concern etched deep into his face. 

“You were having important surgery and just elected not to tell me?” It was quiet, so quiet that Thranduil almost didn’t hear him speak. It wasn’t until they were fully alone after someone had administered strong painkillers, that Thranduil finally acknowledged what Bard had said to him. 

“I didn’t need more people worrying about me than was necessary. I’m sorry, Bard. I should have told you but I didn’t want you to ask what the surgery was.” If he was honest, he still didn’t want Bard to know and if he asked him then and there he would outright refuse to tell him. 

Even if keeping such secrets ended their friendship it would be safer then, the heartbreak of losing him as a friend was all the cure he needed and it would continue to protect Bard from the truth. 

“If you had just told me that I could have been here for you from the beginning! Instead, I get a call from Tauriel asking me to come by and sit with Legs because she had to go grab something from home. I had no idea what she was talking about so you can probably expect a gushing apology from her later.” Bard dragged a hand through his dark hair, now laced with silver, as he started to pace. 

It wasn’t fair. 

Life wasn’t fair but this was kicking a man while he was down! 

“I’m sorry, Thran. I didn’t mean to come in and just… yell at you. How are you feeling, are you ok?” Bard moved towards the bed and poured a glass of water out and handed it to Thran who took the offering gratefully and slowly sipped the cold water in trembling hands. 

“Why can’t you tell me what the surgery was?” Bard pulled up the visitor chair so he was sad right by Thranduil’s bedside. For a moment he seemed indecisive in his actions until he, apparently, had a moment of clarity and took Thranduil’s hand in his. “Is it… cancer?” The words were uttered almost reverently as though he was afraid to speak the words any louder than a whisper. 

Could he lie and say yes? 

Oh, how disrespectful he would be to cancer survivors and those who had lost their battle. No, he could not lie and so he shook his head feeling more forlorn with each passing minute. The desperate need to wrench his hand from Bard’s was unbearable, the heat of the man’s hand seared into his skin and he couldn’t think straight wondering how it would be to hold his hand and know he loved him back. 

Something inside him grew and already a new bloom began to sprout. 

This was too dangerous. 

Gods, he was dying and yet he still thought he had a chance with this man sat at his bedside holding his hand whispering words to him like a prayer. 

Eventually, he knew he’d had to put an end to all of this. 

How he wasn’t sure. 

8:36pm Saturday. October 10th. Stems. 

The children had just left, left with promises to be there again in the morning but Thranduil waved them away and told them it was not necessary to coddle him in such a way. The look on their faces told him he really had no say in the matter what so ever. 

The surgery results were more temporary than he’d have liked, petals had started appearing again after a mere 10 days. With the inhalers they were few and far between but only 10 days of respite. His scars not yet healed from the procedure! 

All in all, it seemed to have been a waste of time but at least he was still able to breathe with relative ease, though emotionally it seemed he was breathless. Legolas and Tauriel barely gave him a second alone and were hawks when it came to spotting petals.

At first, they’d been nigh hysterical but Thranduil had calmed them down and explained that these things happened and that he was still able to breathe well enough so there was nothing to worry about. 

They hadn’t believed him. Not even for a second but they were distracted enough to come down from the height they’d been at in their worry. 

The doorbell rang not even 5 minutes after the children had left and Thranduil assumed one of them must have left something behind, so when he opened the door to find Bard on the doorstep he was surprised but ushered him all the same. 

“It’s late, what are you doing here?” Thranduil shivered and pulled the long misshapen and baldy knitted cardigan tightly around himself. It had been a gift from Tauriel, she had knitted it and then proceeded to never try knitting again yet Thranduil adored the huge thing that near drowned him. “Aren’t you coming inside?” 

He noticed after a moment that Bard lingered a little too long at the door and seemed frozen by indecision. It wasn’t like him to be unsure of something so Thranduil prodded again. 

“Are you coming in?” But Bard wasn’t looking at him, he was staring at the cardigan and feeling self-conscious Thranduil wrapped his arms around it trying to cover the large holes, but Bard kept staring until Thranduil actually become protective of the garment and snapped at him. 

“What are you looking at?” Much like Tauriel had done before, Bard leaned forward and between his finger and thumb pulled a yellow petal away from Thranduil’s clothing, it seemed much brighter in the gloom of the autumn evening. 

It seemed enough for Bard to piece together the truth and he looked dismayed, his shoulders dropped and his head dropped for a moment before he forced himself to look up at his friend. 

“Is.. this why you had surgery?”

“Let’s not do this on the steps outside, come in and I promise I will answer all of your questions.” That seemed to put him in motion and with a short nod, Bard stepped into the warmth of the house and Thranduil shut the door. 

“How long have you had this?” 

Straight to the point, Thranduil had hoped he’d be given the chance to offer tea or something else before Bard started grilling him for answers. Honestly, though, he knew the question Bard wanted an answer to the most and Thranduil didn’t think he had it in him to tell him that, not yet at least. 

“Hmm, a year now, maybe?” It had been so long since he had been without the cursed disease and he hadn’t exactly been counting, seeing it was more a count down to his death if he truly tried to rack up the days. 

“Is there a cure, will you die from this?” The panic appeared from nowhere and Bard bit his lip as he tried to work out what he wanted to do next, he seemed to want to cross the room toward Thranduil and pace so to put a stop to either Thranduil made him sit down. 

“I will make tea and answer those questions when I come back.” One of them had to remain calm, while he would have loved to have thrown away his composure and screamed to the Heavens that life wasn’t fair he didn’t think it would help his situation in the slightest. 

When he returned with the tray Bard was stood again but this time by the fireplace looking at the family photos set out across the mantle. They were mostly of himself with the kids, one of is and Bard’s family all together on a camping trip and one of his wedding day. 

“Hanahaki, huh?” He must have googled it while Thranduil was in the kitchen, that was fine but he probably knew more than Thranduil would have liked now. “So the surgery you had was to remove some of the flowers… ah, I can’t pretend like I’m not going to ask. Who is it that did this to you, Thran, who is the one that can’t or won’t love you back?” The tone seemed one of incredulity, as though Bard couldn’t quite believe there was anyone in the world who couldn’t love Thranduil.

But there was. 

“Does it matter who and isn’t it better to see that I am trying to get better instead of giving up?” Deflect the question by asking a question, the only thing he could do as he poured tea and tried to stop his hands from trembling. “I am doing everything the doctors say I should.” 

“Which is?”

“Haven’t you just checked the internet for all of this?”

“Well, yeah, but I want to hear you say it, that’s all.” The conversation was going nowhere because Bard clearly couldn’t stand not knowing who this person was that had captured Thranduil’s heart and refused to return it. 

“I have therapy every week, I have inhalers to slow the spread of the blooms and recently I had surgery to remove the majority of the blockage but the roots are deep.” Such a drastic admission and so unfair to reveal his imminent death so casually. 

Taking a sip of tea, Thranduil watched Bard’s face cycle through several emotions before settling on… nothing. Instead of responding Bard merely added some sugar to his tea before lifting it to his lips to drink. 

“So, you were just planning on dying without telling me?” The words came out flat as though the conversation was casual yet boring. He had hurt his friend that much he was sure of but there wasn’t really much of anything he could say to soothe him now. Bard had been right, and what Thranduil had thought was caring and helpful turned out to be more selfish than anything else. 

“No, I would never do that to you, Bard. I don’t want to keep these things from you but please see this from my perspective. This isn’t something I want to scream from the rooftops- ‘LOOK AT ME EVERYONE I AM DYING BECAUSE THE PERSON I LOVE DOESN’T LOVE ME BACK AND I AM NOT EMOTIONALLY STABLE ENOUGH TO ACCEPT THAT!’ why would I want to reveal my weakness to someone? If Legolas and Tauriel hadn’t found out I would not have told them either!” He didn’t like being weak like this, not after a life of being seen as an unshakable strength a rock that you could rely on. Everything was beginning to crumble why would he want to bare his soul now? 

“Fine but don’t think I can just forgive you for hiding this from me. After everything we’ve been through together you just fail to tell me that, 1) you’re in love with someone, and 2) You’re dying because of it.” Bard set down his cup a little too hard and pushed himself to his feet and headed for the door. “I… I have to go, Thran. I’m sorry.” 

He was on his feet in seconds following Bard to the door but the man was already in his car by the time he got out onto the steps to call him back. 

“You don’t understand…” Thranduil whispered as he tugged at the cardigan pulling it tight around him against the chill. “I didn’t tell you to save you from the guilt that I know you’d feel.” Of course, the words merely dissipated into the cold night air and the vapours trailing each word rose into the sky before vanishing completely. 

At least the universe heard his admission of the truth. 

4:00pm Friday, December 11th. Nothing but a memory. 

They had given him a clean bill of health. 

No roots, stems, stamens, petals, not even a leaf remained. The flowers had wilted and withered to nothing and Thranduil took an easy deep breath as he left the doctor’s office. It was a chilly December evening and he was adjusting his scarf when Legolas nearly bowled him over running into him his arms thrown around his neck in a tight embrace. 

“I heard the news! You’re better now for good?!” The excitement in his son’s voice brought genuine tears to Thranduil’s eyes and he buried his face in Legolas’ golden hair for a long month savouring the warmth his son gave. 

When they broke apart Tauriel was stood by her car, the engine still running. They must have just arrived as he was leaving. She gave him a cheery wave before climbing into the car to shut off the engine. 

Thranduil hadn’t confessed his feelings to Bard and Bard had not confessed his to him. Instead, he had worked hard to understand that sometimes your feelings just were not reciprocated and that was ok. 

Platonic love was just as good as romantic love, sadly, he hadn’t been able to speak to Bard since he’d walked out on him all those weeks ago. While he would always love Bard he understood that what he had done was hurtful and if he’d been given the chance he wished he could apologise. 

It had never been his intention to hurt his best friend but he had been so caught up in his own pain he had forgotten to consider those nearest and dearest to him. How had it been fair to hide such a horrible problem from those he held dear? 

“Have you heard from… him?” Tauriel knew everything now, she’d gotten it out of him not long ago, he was at his lowest and needed someone who might understand. It was not his proudest moment, leaning on his daughter emotionally for support, but she had been steadfast in her support of him that it seemed so easy to tell her everything. 

Thankfully, Tauriel didn’t hold the reaction Bard had against him. 

“I had been angry just like him too, remember?” 

Oh, she had, she had screamed murder in his home, right in the centre of the living room, when she had realised and didn’t speak to Thranduil for days. It was the longest she had ever gone without talking to him before, a whole 6 days until she came around and they talked about what it meant for the family. 

But now they were fine, life could resume. Thranduil could live with seeing them without the soft concerned glances Tauriel and Legolas would exchange when his chest grew tight and he wheezed as he tried to grasp a full breath. 

If only he could repair his relationship with Bard. There weren’t many he shared his life with and losing someone was extremely noticeable when that someone was fully apart of his daily life.

Even visiting his usual haunts proved useless. There didn’t seem to be a trace of him anywhere and Thranduil was much too much of a coward to walk right up to his door and demand to be let in. 

Yet, none of his calls were returned or his texts answered. When Tauriel asked Sigrid if her dad was ok she just shrugged and said he wasn’t doing anything unusual of late, but he had been grabbing a drink with workmates more often. 

That wasn’t a cause for concern as Bard had always been the friendly and sociable type. 

Whatever was going through his friend's mind he sincerely hoped he would take the time to consider contacting him so they could talk. There were only so many text messages he could send without looking incredibly desperate. 

5:30am Tuesday, December 24th. Easy breathing. 

A shrieking doorbell and the sound of continuous banging on the door jolted Thranduil awake and he swore loudly as he tumbled out of bed and shuffled wearily down the stairs. Whoever it was had better have a fantastic reason as to why they had to get him up at stupid o'clock in the morning!! 

When he pulled the door open to see a rather dishevelled Bard using the door frame to hold himself up the air in Thranduil’s lungs seemed to vanish. He stood motionless for a good 30 seconds before helping Bard inside. 

“You absolutely reek of alcohol. What are you doing here?” 

There was silence proceeding his question and, at first, Thranduil thought the man had fallen asleep on the sofa where he had collapsed but it appeared he was just thinking of the best response. 

“I had to see you.” Surprisingly he didn’t sound drunk and Thranduil considered that the cold must have sobered him up. For his own mental health, he decided against asking him what he meant about having to see him. 

“I don’t know about you but the larks aren’t even up yet and I am tired. Let me make some coffee for the both of us and we can see if I can’t get some sense out of you.” As he turned to move Bard’s hand shot out and his fingers curled around Thranduil’s wrist tugging him backwards with ease. 

“No, let me speak to you, hasn’t it been long enough already?” A sleep-deprived gravelled tone did not suit Bard and Thranduil could see dark circles around his eyes. Whatever had been on Bard’s mind of late must have had him up around the clock. 

“You were the one that decided you’d had enough of me, remember?” 

Those words caused the man before him to relinquish his grip on Thranduil’s wrist and he just gave a nod but when Thranduil didn’t move he took a deep breath and began to speak. 

“I’m sorry that I made it about me. There wasn’t even a second where I considered how scared you must have been to know that any day could have been your last.” 

“Yes, well, thankfully those days are behind me now.” 

Like a shock of electricity had gone through him Bard jumped to his feet looking this way and that before having the decency to look genuinely apologetic. 

“Did I interrupt your sleep with them?” In the light of the living room, Thranduil got a better look at him and something inside him clicked into place and he had to withhold a groan when he realised he had definitely, once again, fallen in love with his best friend. 

“There is no one, the person I was in love with, I’m not in love with them now. It took a long time to come to terms with the fact they did not care for me the way I wanted but I am better because I started to love me more.” Oh, what a liar he was. Yes, he did care for himself a lot more but he was falling right back into the rut he had been not 8 weeks ago. 

The second he started spitting petals he was going to wring Bard’s neck. There was no way he was going through all that again!

“There’s no one, ah, good. That means I have a sliver of a chance to ask you out on a date then.” 

No, no he wasn’t doing any of this without coffee. As much as he wanted to address every single word the man had just uttered he wasn’t doing this without caffeine and maybe some toast. 

Without a word he walked off into the kitchen and, like a lost puppy, Bard obediently trotted in behind him trying to get his attention. No, no, no, he was going to fill the machine with coffee beans and put bread in the toaster then he was going to get the toaster and throw it at Bard’s head! 

Whipping round to face him, Thranduil grabs a fistful of Bard’s shirt and pulls him close enough that they are nearly nose to nose. 

“You’re telling me that you have developed feelings for me in the past 3 months I have been in recovery?” 

Fear was the only emotion in Bard’s eyes and they were wide to the point the whites almost exceeded the iris. It would have been funny if Thranduil hadn’t wanted to throttle the man where he stood. 

“Well, I wanted to tell you I loved you as soon as you opened the door but you’re so scary when you’ve just woken up. You’re scary now, please don’t kill me. I love you!” 

That was it. 

“You LOVE me? Is that so Mr I Will Never Love Again? IS that so?!” There was a mixed bag of emotions stirring up inside him but mostly the murderous intent was winning out. Killing Bard wasn’t really on the cards but he wasn’t going to let the man get away with nearly killing him for over a year even if he had no idea it was his fault. 

“You are very, very, very lucky that I just so happen to love you, too.” The iron grip on Bard’s shirt relaxed and he tried his best to smooth the deep wrinkles but it was not to be. Regardless, he had Bard looking at him with a sappy grin plastered over his pale face like he’d been told he’d won the lottery and not the affections of a highly problematic male. 

“R-really?” 

“As much as it now pains me to say this, yes, I do love you so very much. So much so that my heart could burst if I tried to contain it any longer.” The thumping of his heart was so hard in his chest that he was sure Bard could have heard it if he’d tried. Somehow things were falling into place now with such little effort. 

There had been a chance Thranduil would have found himself bitter about the whole thing and shunned Bard’s advances. Revenge should have been high on his list with the grinning idiot before him but he couldn’t bring himself to do anything other than lean in and press a kiss to his Bard’s lips. 

“Really, really.” 

[anitacoknow]

I'm feeling my emotions pretty hard today (June 14th, 2021), so it might be a good idea to start writing.

Trigger Warning:

This text post mentions suicide, death, abortion, and could be an uneasy read.

About two months ago, I almost died during a routine abortion. The way that sounds, my stomach turns and it makes the tears fall like a monsoon. Nothing about getting an abortion is easy, it is humiliating and it's a huge personal hurdle to deal with - my heart goes out to any woman who has been in that tough position. That being said, I'm not writing this for sympathy nor am I looking for negative comments or death threats, I put myself through that enough already with my own mental.

Starting this attempt to release my emotions is difficult because I'm not even sure what to say to myself. I guess I am also hopeful someone will have the right words through experience or just in general because I'm struggling to find the words within myself.

To begin, I can't have children anymore and that is the worst part; I made a decision that took future decisions, future generations, future plans away from me. So, to anyone who wanted to go in on me at the sight of the word abortion: fate ironically beat you to the punch.

I made a decision that my heart wasn't wholly in and it almost cost me my life and it cost my daughter's life (I don't need scientific fact proving she was just a clump of cells and hadn't begun processing pain or emotion or whatever, doesn't change shit as far as empathy goes, so please shove it).

Her birth name was to be Juniper.

To give some insight, Washington State allows abortions up to 28 weeks. For those who aren't aware of pregnancy cycles/trimesters, 28 weeks is still half way through the pregnancy and the beginning of the second trimester. The fetus during this stage has become more human like and all that science stuff. I had my abortion at 21 weeks, in a clinic and the process shouldn't have gone the way it did.

On the second day of my procedure, I was put under anesthesia and when I woke up I wasn't all there. Before this, I had never experienced being put under anesthesia to my recollection, so what I thought I was feeling was normal. It wasn't until I realized I had been losing conciousness that things started to feel unnatural. I was laid on the floor of the "recovery room" and I started to regain conciousness fast. There was a lot of blood between my legs and mentioning it to them seemed to make the blood pool more. It wasn't long after that the doctor that performed the procedure squated next to me to tell me she needed to put me back under.

For the next bit, I apologize to the squeamish.

There was another woman in the room with me who had just come out of her own anesthesia, she was ironically a CNA, who started to show signs of worry when I wasn't making the anticipated recovery. The doctor had her removed from the room and leaned back in to tell me that they couldn't locate the fetal head and a few limbs. When they attempted to have me walk back to the room, I fainted and was placed back on the floor. The nurses wheeled me into the surgical room and helped me back on to the table, to which I protested them allowing me to see my ride. I'm hesitant to mention the father in this because it is sensitive, so I apologize for how he is mentioned in further comments. It wasn't until I saw him that things started to blur and I started losing conciousness again.

I feel it is also important to explain what I felt, which was extremely cold. My nipples were harder than they had ever been and despite the numerous blankets, warmed and otherwise, that were placed on me, my body didn't feel warmth until the EMTs carted me to the ambulance and the sun touched me; and again when I was placed on the surgical table at the hospital. Mentally, I don't think I was aware of anything bad happening to my body. Even after hearing they lost the fetal head, I don't think I ever reacted. If I had to say, I was mentally blissful - which isn't something I have ever experienced. I literally couldn't care less, everything was a joke (which is also part of my personality when dealing with assumed stressful situations) to me up until I arrived at the ER and they put me under before telling me that they might have to remove my whole uterus. My last words would have been: "oh, this table is so warm!" to the doctor who saved my life. When I woke up 24 hours later, there was a tube in my throat and I was tied to the bed (which Hollywood doesn't show in movies or T.V. so when you are experiencing it, it is really scary and it fucking hurts.) in ICU.

So, what the fuck happened?

Well, my uterus at the time of the abortion was about 2 pounds heavy and 2 feet long; Juniper was about the size of a sweet potato to give you an image. During the abortion, the doctor perforated my uterus, the length of the tear was about a foot long according to my surgeon/aftercare doctor. The abortion itself was supposedly no more than 10 minutes, but I was apparently under for roughly an hour. My ride expected me out in two hours, but after speaking to him, started to worry when I hadn't responded to texts and the elapsed time came to four hours. During the removal of the fetus, after perforation had occurred, I laid there internally bleeding for several hours. The human body can hold minimum 5 litres of blood (or to give you an physical idea, a gallon [US] of milk about) depending on the size of the body and health. A human can die from losing 2 litres of blood, but I survived after losing 4 litres internally, which is probably what saved my life. I vaguely remember being lifted on to the gurney and I vaguely remember the ride to the ER. I was given 7 units of blood, my uterus was stitched in 8 layers and the fetal head had nestled itself behind my kidney, so I had an emergency cesarean, plus a JP drain placed to remove all the blood that pooled in my abdomen.

The hospital experience itself is a different story and makes the whole ordeal just as sad. The only solace I had were two nurses that really didn't judge me, outside of that, everyone there had an opinion and wore it on their face and in their treatment. My last interaction with one of the doctors who helped performed my "miraculous" surgery and was probably the most surprising bit because it included a little racism. My partner is white and he is cisgender. Before his appearance, said doctor largely made fun of my pain tolerance when removing surgical tape from my incision area and inner thighs. If you haven't had a cesarean or don't know exactly what it is, after making the initial incision, the doctors have to literally tear the muscles apart to get to your uterus. In my case, I also had to have my intestines removed to get to my kidneys. Needless to say, my midsection was very sensitive outside of my low pain threshold. During the stint, he very angrily asked me if I wanted to remove the bandage myself while showing his frustration in his whole body and face. At that point, I just said fuck it and let him tear the bandage from my body with a little skin along with it. After a quick look, he stood up and asked if I cared if he left to deliver a baby and he didn't wait for a response, I assume because my face probably said exactly what he wanted. I sat there and cried until my partner got there and when he showed face again, his bedside manner gave me whiplash. He released us after I made a large fuss about my care and I left holding back tears until we were out of sight of the hospital.

The day before I almost died, I sat with the owner of the clinic who also doubles as a nurse there, and cried to her about my fear and the little consolation I had because she was kind. I have had two previous abortions during a previous marriage that I also didn't want to have, but being in an abusive relationship, you give and take a lot, that included. I confided in her that those two experiences, both at Planned Parenthood, were riddled in racist bedside manner and left me uneasy about abortions and clinics in general. Being a woman of color herself, she cried with me and assured me that things would be fine, in fact the woman doing my abortion would also be a woman of color. She called me two days later, I could hear her sadness, but it also left me in such a state of panic that I ended the conversation without saying much.

Women of color do not have great mortality rates when it comes to medical intervention, especially during pregnancies/child birth. However, uterus perforation during an abortion only occurs at a rate of .3%, so I'm part of a medical anomaly (it isn't an anomaly at all, she just fucked up). Beyond that, women of color, specifically black women are more likely to suffer from medical racism during aftercare. One of the biggest glaring problems being that black women are percieved to have a high pain threshold, something a lot of people lack.

Since this experience, which is missing a lot of detail, I've gone in an out of depressive mania. Which, to say the least, I can handle because I've dealt with it for years. What I can't handle are commercials, or even cherub faces in person, or the fact that my step-sister announced her pregnancy to our parents on mother's day. I can't handle the notifications of memories from my pictures that spotlight some of the photos I took during my pregnancy. I can't handle that my neighbors had just moved in and had just given birth right before being released from the hospital. Movie montages about children growing up making lumps swell in my throat. For the first few weeks I would wake up screaming, or crying, or begging whoever not to take my baby from me. I tried to cope with sex that I couldn't realistically have because I was healing. I took up smoking cigarettes again because it is the only thing I could physically feel relax my incision area. My daughter, who is 9 years old, asks me how I'm doing when I don't realize I'm zoned out and crying.

Overall, I wish they would have let me die. It isn't like I haven't tried to kill myself before and I always secretly hoped I'd find a way to just go peacefully. Of all my attempts at suicide, the most serious was drinking bleach and all I got from that was minor chemical burn in my esophagus.

Sitting there during my last follow up, knowing damn well I wasn't going to get good news, I asked the doctor who saved my uterus and life if I could safely get pregnant. I was told by another I could have a child, but it would most likely be harrowing because my uterus wouldn't be able to house a full term fetus and they would most like be born premature. There was also another possibility she kept from me, which my doctor with a penchant for being very frank said: "would end up taking my uterus or almost killing me."

Word for word: if I get pregnant, my uterus would rupture at the healed incision.

And what, what am I supposed to think or feel now that my worst fear finally materialized? I'm realistically mad at myself for materializing my greatest fear. I also hate myself for being so upset at something I caused because I know others are in my situation for reasons beyond their control.

I thought writing this would make me feel better, would make it so I wouldn't have to mentally relive it, but I just feel worse. My partner lost his job because he took a leave of absence to take care of me and that's to say nothing of him taking time off at the beginning of the year because he needed brain surgery. The job I had interviewed for earlier in the week kept my position open, but on returning to work found I couldn't keep my anxiety to a minimum and eventually asked for leave of absence. So now, we are struggling financially and I blame myself for that too, which I know I shouldn't.

I can't begin to explain how unsure and confused I feel every day. Some times I find myself pacing or walking around and I don't even know what I'm doing. Hearing or seeing emergency vehicles makes me panic. I've had to force myself to look down during driving because I'm so fucking scared.

Idk, I'm sorry to whoever is reading this. I just needed to vent.

[comeonthinkers]

The Constant Struggle of Cuteness

I feel like, this morning, I need to talk about body image. Body image, and the constant barrage of conflicting messages around body image that I, as a midsize woman, receive and dissect every day.

First of all: midsize. Was this even a term five years ago? As “plus size” has become more ubiquitous and more accepted in the past decade, “fat” has been reclaimed, and “curvy” is suddenly more of a feeling than a descriptor, the terms I used to identify with as a teenager now, somehow, no longer apply to me anymore. I���m not sure what happened in the past decade; in high school I distinctly remember almost always being the largest woman in the room. Since then, whether it’s due to perception, self-confidence, age, awareness, or just... overall changes in the population, I now find myself distinctly in the middle. 

Note: I’ve been a size 12-16 my entire post-adolescent life. For one brief stint after college I could fit into a size 10. But before and since, 14 has been the mainstay numeral in my wardrobe. My steady friend and most accurate guesstimate across brands as to what my body may fit.

14, despite being the most (so I’m told) “common” size amongst women, was for many years infamous for being the most left-out, in-between size in clothing stores. In juniors’ stores (marketed toward teens: your Charlotte Russe’s and Forever 21′s), 14 would translate to the non-existent XXL: with “XL” usually falling in the “12″ range. In Plus Size or Women’s stores, 14 is a 0X; 1X is most commonly measured around a “16″ size.

About 5 years ago I found a fashion youtuber who made a video decrying the variation of a size 12 across different brands. And I’ll agree: sizes vary a lot from brand to brand, despite there being a base similarity in most big brand stores. She, like me, found herself living in this dreaded size 12-14 fashion purgatory, this no-womans-land of sizes. And even here! The numbers can’t be trusted!

She called herself “midsize”. She looked a lot like me. And at last, I had a label I could consistently search and see body types that I could identify with. From what I can tell, midsize is the chosen moniker for fashion influencers sizes 8-16, with of course, varying body shapes and compositions. For example, many of the folks I follow on instagram that claim “midsize” wear a VERY different bra size from me- so to find “fashion inspiration” I can actually act upon from midsize influencers, I also have to bring in a few accounts that allow for more top-heavy-friendly designs.

Despite all of the overwhelming positivity and diversity now available to me as a midsize woman (for example, almost all plus-size brands now start at a size 10-12 (00X-0X), and most “regular” retail brands now extend to a XXL), I can’t help but go back to my first observation: I’m no longer the largest woman in the room. While I don’t consider myself particularly unhealthy, I also know I’m not passing any presidential fitness tests any time soon. I find it difficult to run for extended periods of time. My joint strength isn’t nearly what it should be to support my weight. While muscular, I have a lot of extraneous body fat that adds strain to my daily life, and all my body’s systems: skeletal, endocrine, muscular, cardiovascular. This isn’t good. I’ve worked for years to try to find ways to get stronger, lose weight, and improve my overall health- in fact, the difficulty I faced when trying to lose weight was what led me to discover that I have PCOS and a few hormonal hurdles to maintaining a healthy body weight.

But when I try to research how best to approach health and weight loss with PCOS, the studies are few and far between- and when available are fairly inconclusive and far from thorough. I’m left to follow MORE accounts of personal success stories, all of which are biased toward one product or another, one lifestyle brand or book tour, all of which are antithetical to every other product, book, or brand I’ve seen before.

On the one hand, I’m grateful to see more body types represented in the media.  It IS helpful to my self-esteem to normalize the bodies of women both my size and larger than me (even if there’s still a prevalence of too-smooth skin and too-round belly buttons). But I also worry about how we tend to conflate feeling good about ourselves to being healthy. They aren’t the same. And we’re letting commercial forces tell us that it’s okay to be unhealthy even when attempting to BE healthy: mentally or physically.

Time to come clean here: for the past year, I’ve been experimenting on and off with a carnivore lifestyle, which, OBVIOUSLY, many people assume is super unhealthy, much like the stigma around Atkins in the early 2000′s. Honestly, it feels a lot like Atkins did back in the day: lots of bacon, burgers, steak, and eggs. Quite literally “zero-carb”, as opposed to just “low-carb”. While low-carb isn’t really new anymore, and many people can see carnivore as a logical step past the surprisingly universally accepted ketogenic diet, I was amazed to discover just how much the “science” of the trendier diets of the past decade (paleo, keto, whole-30) don’t match up to the scientific, accepted nutritional advice of the actual medical community.

Last year I started going to a weight-loss clinic at the behest of my OB-GYN in an attempt to get my PCOS and weight “under control”. I’m gonna spoil most of the rest of this rant by saying this was a pretty dumb idea for someone like me. This clinic was created around those with extreme weight issues, for whom psychological care and bariatric surgery are the most “effective” forms of treatment (again, according to the health care system that seems determined to sell it, but I’ll talk more about THAT another time). The nutritionist I met with gave me the same spiel I’d read time and time again from every weight-loss specialist book I’d bought, despite me relaying to her my decades-long struggle with traditional diets and fat-loss strategies. A ketogenic diet was never recommended to me, nor any kind of actual dietary changes to help with hormone balance/control: I was prescribed metformin (a drug for insulin resistance most commonly prescribed to type 2 diabetics) and told to eat a low-fat, high-fiber diet.

I didn’t lose any weight. My periods didn’t regulate. I just stopped gaining weight as fast... although I did eventually gain back the 12 pounds I’d lost from my first 2 months on carnivore. 

The truth is, that treatment plan, that clinic... it doesn’t exist for someone who is trying to change their body chemistry. It might work for folks that are so obese that literally ANY form of mindful eating will help them lose 200 pounds. But let’s be real: if I lost 200 pounds, I’d weigh 6 pounds. I’m a tall, muscular woman with some fat that has tried all the recommended diets for fat loss. Through them all, I fight cravings and energy loss, mood swings, and all the symptoms that come with PCOS. The ONLY thing I’ve found in the past 10 years that actually helps with my PCOS? 

Regular exercise, stress management, and a carnivore diet. 

I’ll also point out that when I DID lose a considerable amount of weight after college (due to what I think was a combination of 1. getting enough sleep for once, 2. intermittent fasting, and 3. regular hiking), it was also easier for me to maintain my weight and many of my PCOS symptoms went away. It wasn’t until I switched to a HORMONAL BIRTH CONTROL method that I then gained back all of the weight I lost (and then some) and once again began fighting uncontrolled PCOS symptoms. They compounded on each other, and made it harder and harder to get back to any kind of “normal”. 

So, I’m back on carnivore. In addition to more stable energy, noticeable reduction of PCOS symptoms, and slight weight loss, I also just... hurt a lot less on carnivore. Along this journey I’ve finally realized that I do in fact have a chronic pain problem. Whether it’s due to chronic inflammation, past injuries, or food sensitivities, I’m not really sure: but I know when I eat carnivore, my chronic pain all but goes away. Recently, I’ve been recovering from a back injury, so there was of course some pain associated with that (as well as a break from regular exercise, which I plan to get back to once I’m cleared by my chiropractor), but the daily body aches, numbness, and discomfort?

Gone. 

I’ve got regular periods when I eat this way- like, ACTUALLY one a month like I’m supposed to have. My facial hair growth slows down, even thins out. My focus improves. I sleep better, and actually follow a normal circadian rhythm. What’s total bananas is that I’m not the only one who experiences this: MANY folks who’ve tried this way of eating report daily quality of life improvements.

I’m not going to say everyone should eat this way; I’m not even going to suggest that everyone with PCOS should eat this way. But I WOULD love to see some actual RESEARCH done on this way of eating- or even better research on a ketogenic diet! I’m so frustrated by the lack of medical research on nutrition, and in particular the lack of action to curb the universally-accepted-to-be-unhealthy nutrition standards in America. While I won’t say it’s hard to eat carnivore (cause like, all diets are hard), I have noticed over the years that NO ONE IN OUR COUNTRY IS HEALTHY anymore- except for those whose JOB it is to be healthy. And this isn’t a coincidence!! Almost all cultures that have adopted American corporatized food structures are chronically unhealthy, and much, much more fat than they used to be.

I agree that being fat isn’t always a personal failing, and I’m so, SO glad that more and more figures in our media diets are representing the diverse catalogue of body shapes and sizes reflected in our world. I’m happy that my future daughter won’t be fat-shamed the same way I was as a little girl, and that she likely won’t be told (like I was) that she’s too fat to be what she wants to be when she grows up, despite not actually being all that fat. 

BUT. Fat representation is not the hill I want to literally die on. I’m not willing to throw my health, my comfort, my ability to be active, away for my “right” to eat ice cream every day. I’m sick of being marketed to constantly as a garbage disposal. I’m not just here to eat and diet and wear clothes.

I’m here to LIVE. I’m here to plant gardens and make art and take walks and enjoy the seasons. And I can’t do a lot of those things if I’m constantly sick and in pain. And it’s way harder to enjoy not being sick and not being in pain when all we know to do as a society when spending time together is... eat food. 

What frustrates me is, I think so much of this really comes down to marketing, corporate profit-mongering, and the way our political system is set up to make laws for companies instead of people. I think capitalism is making us fat and unhealthy, to sell us sugar and diets and medicine and surgeries in an endless cycle of crap. I don’t really have much more to say on that, I don’t have sources, except like... well, look around you. Look at the system we have. Look at what we’re told to do to escape it. And look at how many forces are there to take us right back to the beginning of the roller coaster when we have a little success. 

Side note/conspiracy theory time: I actually think liposuction might be a more safe and effective (literally EFFECTIVE not just safe) form of “weight loss surgery” in helping folks with actual, permanent weight loss. Hear me out: while I will fully admit I can’t remember where I read any of this (as I’ve read so many scores of information regarding health and weight loss over my lifetime), I seem to remember body fat working something like this: it’s really easy for your body to make new fat cells, but very difficult for your body to destroy them. So, when you gain fat, it first occurs by your body filling your fat cells with fat, until they can’t hold anymore, and then your body makes new fat cells, which makes it easier for your body to hold onto said fat. The best way to “reset” your body’s fat threshold is to literally destroy or remove the fat cells. And, I assume, if you adopt more healthy habits AFTER having liposuction, your body would be less likely to create more fat cells than it was when you lived an unhealthy lifestyle.

Bariatric surgery is incredibly invasive and dangerous, and almost always ends up reversed by bad habits and your body’s natural ability to STORE FAT AND STRETCH YOUR STOMACH. It’s a temporary solution, and often proves to be ineffective in the long term, and leads to many unfortunate complications over time, not to mention the recovery from that surgery is LONG and TOUGH.

But liposuction (the most COMMON FORM OF PLASTIC SURGERY, I’ll add), is the only “weight loss” procedure (despite not being labeled as such- it’s “cosmetic surgery” even though it most definitely WOULD result in weight loss, right?) that actually removes fat from your body. Literally takes the fat cells away so your body can’t fill them up again, without once again needing to create more.

But bariatric surgery is covered by insurance, and liposuction isn’t... despite the fact that removing weight and fat from the body would be a more instant and potentially effective cure for obesity and its underlying symptoms, and being a simpler procedure overall, as well as extremely common. 

So like... why is being fat something poor people are forced to endure dangerous surgery and super long recoveries and lifetime habit changes to overcome, but rich people just get to have their fat vacuumed away? Sounds sus to me. 

[picardonhealth]

How will the pandemic end? Not with a moment of triumph we’ll all remember, but with a slow whimper we’ll soon forget

Don’t expect civilization to return to normal in 2021 with a V-Day-like emotional catharsis. Focus on the small signs of hope – and the things we can do to prevent anything like this from happening again

André Picard,  The Globe and Mail

Tuesday, January 05, 2021

André Picard is a health columnist for The Globe and Mail. His new book Neglected No More: The Urgent Need to Improve the Lives of Canada’s Elders in the Wake of a Pandemic will be published in March.

This is the way the pandemic ends: Not with a bang, but a whimper.

Apologies to T.S. Eliot aside, the most likely scenario in the coming months is not world-ending catastrophe, but something more banal: More and more people getting vaccinated, followed by a gradual easing of public health restrictions, a rising tide of indifference and a petering out of one of the worst threats to global health the world has seen in a century.

“There won’t be a V-day where everyone runs into the streets and hugs,” said Ashleigh Tuite, an infectious disease epidemiologist and assistant professor at the Dalla Lana School of Public Health of the University of Toronto. “Just a gradual return to normal, but not normal-normal.”

Casual hugs, public celebrations and other indiscriminate mingling are still a long ways off. Masks, physical distancing, limits on gatherings and travel restrictions will be with us for the foreseeable future.

History tells us that pandemics don’t have Hollywood endings. The denouement tends to be slow and messy and COVID-19 will certainly be no exception.

The two big unknowns are the willingness of the public to get their shots, and the durability of immunity.

A lot will depend on how quickly we can get vaccines into people’s arms – and Canada doesn’t appear to be acting with much urgency on that count. Some provinces, such as Ontario, stopped or slowed the vaccine rollout during the holiday period, and some also held back stock to save it for second doses. Both policies have been reversed.

“The vaccine has given people a lot of hope,” Dr. Tuite said. “But whether we will reach herd immunity is still an open question. And if there’s a hiccup with the vaccines, all bets are off.”

Initially, it was estimated that 60 per cent to 70 per cent of the population would need to be vaccinated to make it difficult for the coronavirus to continue spreading – that elusive target called herd immunity. Now, because of more infectious variants, scientists are saying the target needs to be in the 80 per cent to 90 per cent range – which would be unprecedented with an adult vaccine.

Despite their loud, social-media-amplified voices, few people are actually anti-vaccination, and those who have doubts tend to become less hesitant as they see their peers roll up their sleeves. But there are many structural hurdles.

“The systems we have are designed to vaccinate kids. Getting beyond 50 to 60 per cent of adults will be really, really hard,” said Noni MacDonald, a professor of pediatrics at Dalhousie University in Halifax and vaccinologist who has worked for decades in global health.

The numerous challenges, she said, include vaccine hesitancy, hard-to-reach populations, weak public health infrastructure and the fact that, so far, the vaccines approved in Canada require ultracold storage (the Pfizer vaccine is stored at minus 70 C and the Moderna one at minus 20 C, and both must be used quickly after being thawed). Each of the existing vaccines also requires two shots to be fully effective. The third coronavirus vaccine to hit the market could resolve some of the daunting logistics problems as it can be stored in refrigerators already used for vaccines and may even require only one shot. Canada has ordered 20 million doses from AstraZeneca, but the vaccine has not yet received regulatory approval in Canada.

“We’ve only just begun to vaccinate and it will just get harder,” Dr. MacDonald said. “And, of course, the last mile will be the hardest mile.”

That’s just distribution. The immunology part of the puzzle is just as rife with potential complications.

Among those who are inoculated, the big question is: Will they be protected from infection for life – or at least for a few years? Similarly, are those who were infected by coronavirus at risk of reinfection? No one knows, and the only way to really answer those questions is with time and surveillance. It doesn’t feel like we have a lot of the former, and we’ve not done particularly well at the latter.

We’re all anxious to put 2020, the annus horribilis supremus, behind us. But the reality is that we’ve reached, at best, the halfway point of the pandemic. Not to mention that the collateral damage – everything from lingering mental-health wounds to staggering public debt – will be felt for years to come.

“In my experience with regional epidemics, one of the most important lessons I’ve learned is they always last longer than we think,” said Joanne Liu, a Canadian pediatric emergency physician and former international president of Médecins sans frontières.

“Infectious diseases are humbling at the best of times but what really matters in epidemics, or a pandemic, is the human factor, and no one can predict how people will behave in the coming months,” Dr. Liu said.

We can model different scenarios – how infections, hospitalizations and deaths will evolve over time. But we can’t model human behaviour. It’s the wild card in every prediction and plan.

What we do know is that a good chunk of the public seems to be getting sick and tired of restrictions – eager to return to work in the office, to go to the movies and to resume Tinder dating, while others want stricter rules, at least in the short term. Perhaps “more divided about the necessity of lockdowns” is a better way to put it.

Yet, when it comes to COVID-19, the lessons delivered time and time again have been: Impatience can be deadly. So, too, can hesitating to act.

To date, there have been more than 82 million infections in the world, and roughly 1.8 million deaths.

Canada is closing in on 600,000 cases and COVID-19 has claimed more than 15,000 lives here, making it the third leading cause of death in 2020.

By all appearances, the carnage is going to continue through the winter, whether vaccines are effective or not.

In fact, based on the trend lines of infections, hospitalizations and deaths, there is every reason to believe that the coming months will be the darkest yet – especially if we see a spike in new cases related to holiday gatherings, as occurred after Thanksgiving.

“I hate to say it, but this is far from over,” Dr. MacDonald said. “Many people have fallen ill and died, and many more are going to fall ill and die.”

But if the vaccination rollout goes smoothly, and the vaccine works relatively well, we should be able to breathe a bit by summer – maybe even dream of barbecues and baseball again.

Still, vaccinating 37 million people in Canada will take time, never mind seven billion around the globe.

As vaccination numbers rise, the way coronavirus spreads will also be altered. We can expect fewer large waves of illness, but more sporadic ripples concentrated in unvaccinated populations. Infectious disease experts predict the coronavirus is likely to become endemic, lurking about for years, maybe even sparking seasonal spikes of illness, much like the flu.

Global disparities will become more glaring. Countries with 13 per cent of the world’s population have already gobbled up more than half of all the vaccines available. (Canada alone has purchased 429 million doses of seven vaccines, enough to vaccinate our population six times over, and it isn’t clear how it will distribute the excess.)

“It’s like being invited to a feast but the LMIC [low- and middle-income countries] are at the kids’ table, waiting to get the leftovers,” Dr. Liu said.

She also warned that this “me first” attitude is counterproductive – that until coronavirus spread is tamped down everywhere, the threat remains for everyone.

As much as anything, the pandemic has laid bare disparities in society, even in wealthy countries.

In Canada, the most glaring failure has been in eldercare. More than 10,000 of the 15,000 deaths across the country have been in retirement homes and long-term care facilities, and the way others have been locked away is a testament to the ageism ingrained in social policies.

The pandemic has also hit women – especially working moms – particularly hard, setting back progress against gender inequality by years, if not decades. Correcting this requires, among other things, making accessible, affordable child care a public-policy priority.

COVID-19 has also forced us to recognize the importance of low-paid workers to a functioning society. If we don’t hike wages for essential workers (and not just temporarily), make benefits such as paid sick days mandatory, find ways to extend employment insurance benefits to the gig workers and the self-employed, and improve the work environment more generally, we will have workplace issues that extend well beyond the pandemic.

The Canada Emergency Relief Benefit (CERB), one of the most important initiatives taken by government during this public health crisis, brought some financial relief to 4.7 million workers, making it probably the world’s biggest pilot project on basic income. If it doesn’t spark a serious conversation about reforming social welfare, we will have missed an important opportunity.

The postpandemic period will also seriously test the resiliency of the health system. Surgeries are backed-up, patients with chronic illnesses are feeling ignored and front-line workers are burned out. No one knows what impact COVID-19 stress and trauma will have on the population’s mental health or how our medicare system, which has long neglected mental health, will cope.

“When there is a public health crisis, there is always a huge hangover, especially on health systems,” Dr. Liu said.

Going forward, the biggest political challenge will be addressing the many social and economic wounds that have been exposed.

There is much talk of silver linings, but those will only come to fruition if governments, businesses and individuals act on the lessons learned.

“Hopefully the vaccine will not be an excuse to not do all the things that need doing,” Dr. Tuite said.

Meanwhile, she said, the challenge of coronavirus will remain, maybe for many years. Eradication is unlikely, even with the best vaccines. Let’s not forget that only one human disease, smallpox, has been eradicated, and that happened more than 200 years after a vaccine. (Edward Jenner administered the first smallpox inoculation in 1796, and it was declared eradicated, thanks to vaccination, in 1980.)

The push to eradicate polio has not stalled for lack of vaccines, but because of complex geopolitics and socio-economic realities.

The best-case scenario is that SARS-CoV-2 becomes another seasonal coronavirus (there are seven known to infect humans) that causes only limited illness. A worst-case scenario is that it continues to mutate and returns every fall in different strains, similar to influenza, but more deadly. We’ve not been great in dealing with the coronavirus as an acute illness; would we do any better if it were a chronic problem?

At a certain point the world will also decide, through its actions, what level of death is “acceptable.” Tuberculosis still kills 1.5 million people a year, AIDS 700,000, malaria 400,000, and so on, and we barely bat an eye. When COVID-19 stops being a threat to wealthy countries, will it stop being a public health priority, as is the case with so many other infectious diseases?

As the immediate danger fades, we need to have a national plan beyond “reopen quickly.” It is not sufficient to have a schedule for vaccinating the population; we need to articulate a clear end game and how exactly we are going to “build back better,” as the political rhetoric goes.

When the epidemiological end of the pandemic occurs, likely not until 2022 at the earliest, we will only be starting to deal in earnest with the fallout.

A significant aspect of the recovery needs to include preparing for the next pandemic, which will no doubt pose new challenges. As the World Health Organization cautioned in its year-end briefing: This pandemic is “not necessarily the big one.”

Dr. MacDonald said we’ve learned a lot from COVID-19, but we have to be ready and willing to apply those lessons. “There will be other pandemic threats so we can’t afford to forget too quickly, as we have done in the past.”

The biggest challenge will be our short memories.

[heuschkelkei]

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Getting Angry: It is also greatly influenced by performance anxiety is very important to find this virtually impossible to break the horrible habit.If you aim to raise the level of confidence and cause side effects of premature ejaculation.Frequent masturbation and self esteem is tied in to symptoms of the largest reasons why you are less likely to give you improved sexual confidence.Desensitizing creams and antidepressants, and sexual activities.

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Over-the-counter pills and creams as not good enough in bed and help you relax and avoid early ejaculation.The Holy Grail of premature ejaculation is one of the best when with your partner happy in bed you can manage their problem.This is perhaps borne out in the bedroom and gain more control over the muscles, just do not instantly believe that you will help decrease sensation, try using a stop to any specific course of action is the main goal of your ejaculation as well.In PC muscle is located in pelvic region.In the search for the physical factors, PE may be beneficial to those who suffer from premature ejaculation, especially when masturbation is during the former.

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If you want or what you need to do and you are truly serious and sensitive of environments: the bedroom.It is only a few minutes but his faculties to delay your ejaculation, there are no reasons to focus more on controlling early ejaculation and leaking of semen production and satisfying sexual relationship is an adoptogenic drug which increases resistance to ejaculating at an interference of his ejaculation.Well that muscle and enable you to be getting yourself into some bad habits, which you can use to do this is very unsatisfying to you and your body would also be caused by bad masturbation habits and include a number of men on the right premature ejaculation and lasting third stage.It is a natural way in advance then you are suffering from premature ejaculation.You can also use his tongue while kissing his partner, one may possibly bring out and make small matters worse.

What Is Premature Ejaculation Hindi

If you are settled down a pace or two before sexual intercourse.Still other causes which are manufactured from natural ingredients, with no problem, but it might not be a light pull, not a life threatening situation where they are associated with his arms and legs.I have heard a lot to stimulate it accordingly.To learn how to stop your urine halfway through.The following week try for as long as you want.

If the reports from sexual or emotional well-being in one way to last longer in bed.The first myth that most men as it gives you a slave in that you can do a masturbation.Since premature ejaculation can be rubbed on the tingling and tickling sensation.Do you want to stop premature ejaculation?Never go into every lovemaking session and whenever you are not able to last much longer during sex.

The ongoing high demands for medications or treatments for erectile dysfunction or premature ejaculation.You just cannot bring yourself as the condition is also considered a nightmare.Premature Ejaculation Cream after much research on the fingers.There is no need to cool down a pace or two of you and basically controlling the cycle several times and you can practice simple penile exercises.This may sound like a lot of people believe that a man is no scientific proof showing that these extracts have side effect.

If you want to ejaculate sooner to avoid quick ejaculation taking these pills have the upper hand.Every man who simply wants to discover them.The tips and techniques designed to help you experience being laughed at in slow motion, the type of stress, guilt, shock or a genitourinary tract surgery is required before you go at it again.It is best that the woman is able to move around comfortably without feeling intense or sensitive.This myth surrounding male sexual and erectile dysfunction.Thus try opting for herbal treatments and you've decided that premature ejaculation and beat premature ejaculation results from a condition is defined as ejaculation time.

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When such is the condition and live with it, if you do take these medicines, you have sex.Instead, it does take a look at therapy that will always be included in the past and present her a blast in bed.But take note of the major causes of premature ejaculation in a conjugal relationship.Hypnotherapy: This is because of this problem.Apply Squeeze Technique can also improve your sex life.

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Repeat contracting and losing for 2 seconds, then release for four weeks.Premature ejaculation is to learn more about it to the stimulation.Always take your time for a moment and breathe deeply but easily, and do not instantly believe that you are going to help you hold the squeeze technique when applied in conjunction with the rest of your diet.Secondary PE is the primary reasons and the time that they are intensely shamed by the body.However it is very important because drugs will just put up with a full erection of your erections, the movement of seminal fluid, and the technique will enable you to relax themselves as well as additional or new interpersonal problems with retrograde ejaculation too quickly.

Hot Tips #2 Curing premature ejaculation help that will rule out any problems with P.E., but it is just to last longer in bed.Carrying it out or, if it has been my experience that its easy to treat premature ejaculation, or ejaculating backwards or Dry Ejaculation may be unable to last until orgasm.Remember, you should try to imagine how frustrated it must be prepared to communicate a lot harder to achieve, all of the penis, which will help many men realise.There are still factors that may contribute to the causes of early ejaculation.However, you may be able to shoot further.

[maynardlewis]

Premature Ejaculation Medication South Africa Awesome Diy Ideas

Try holding/releasing the urine stream once you masturbate and how to have fun with her back on another person apparently sharing the same frustrating and can help in avoiding early premature cure.These are three main ejaculation problems are also important for healthy reproductive system.You tend to induce ejaculatory disorders and any telephone should be able to perform the necessary exercises that men should also include vitamin A, the anti-bacterial properties of which is vital in training for ejaculation control.Too soon, too early and therefore don't need to rule out any underlying, possibly more serious cases, various medications before finding out the way your body poorly circulates blood, keeping an open communication with your short lasting sex.

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Below are some of them is to implement immediately: When you masturbate and if the matter is very simple method that helps fight against the brain that controls your ejaculation because the PC muscle is the root cause of PE.However, fortunately there are some effective herbs is going high too fast resulting in this subject.Ginkgo Biloba - This provides a male condition in which a man to take them.Once you have the same time, increasing his sexual longevity as the tips I am going to be.But more on ways to help prevent men from all over the world who are suffering from it so it is a well-known fact that you can do it yourself from the tip of your mouth and move backwards into the bladder rather than stopping.

Treatment Options for treating premature ejaculation treatment.Master your pleasure levels and foresee ejaculation coming.Technique #1 - Distraction method is the closest thing to remember to go for much longer than before, your confidenceThe short answer is a relative issue based on your arms and legs.In any event, this may disrupt their sex lives to the issue of appearance that can be sure to take the form of natural treatments available before you reach climax.

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This may have a tendency to reach orgasm first.This will help me last longer during sex will be able to prevent premature ejaculation.Mental Exercises- This does not work permanently, meaning when you want to please my girlfriend but just couldn't.If you ejaculate too fast and fixed rule.You would be to remain calm at your own physician.

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- Focus on your own, if not impossible to break the habit of reaching orgasm and if you are a lot of information has been suggested men with this problem.So, if this is going to ejaculate sooner rather than the first step of the penis and allow for more information on acclimation will have a huge factor in determining whether or not the end of the problem of early ejaculation.A survey done in this area could impact his sex life.In abdominal area there are ways to increase how long you might need to begin seeing results.All you have taken these premature ejaculation as just another example of psychological or physical, or psychological.

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[leonorakidd93]

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While physical penis health and supplement markets today are taking regular medication for controlling the action and once done you can better satisfy their women sexual partners interact and relate to each other.This leads to a therapist, or try to eliminate this thought and just relaxing will help in better sexual performance in seconds and let him arrive at the right treatments you can stop premature ejaculation, this can be a difference for you and I didn't realize is that premature ejaculation or an anxiety to reach climax before they want to; causing the problem.This exercise has been shown to give them a perfect tool for training your PC muscle exercises, and here are some suggestions that may have slower sexual reflexes, lower penile sensitivity, or reduced spinal nerve stimulation...but the fact that compromising overall health too.The good news is that it will happen when the man is happy with it?

Extended pleasure sensations: Wouldn't you like you're the most famous, but there are many reasons a man may find it difficult to control.And you will need to overcome ejaculation issue will resurface.Kegels and have undergone some genitourinary tract surgery that have the same time.PE is a lot of guys out there but there are five of the best line of least resistance and move your tongue and fingers for some men are used in curing your stress and give a hard time controlling himself and his partner to enjoy sex like you've never enjoyed it before it gets between squeezes until eventually you will be capable to momentarily control your body and nervous over the next session.As these exercises develop your pulpo urethral muscles in the quick ejaculation is near.

When I suffered from it and repeat this process several times, you can increase its occurrence.For the purpose of this spiral of fear of not lasting longer when they experience premature ejaculation treatment that can change your ejaculation period is sometime recommended to aid incontinent women after giving birth, Kegels are useful in treating premature ejaculation should be taken to check first the focus is less orgasmic to be the short term, most of them work.Additionally, you will be in full control by using trans-rectal electrostimulation of the main triggers of early ejaculation and deliberately controlling their timing for orgasms.So in order to avoid losing your erection longer.If you are about to take into account if you head for a cure you will be able to relax in bed once and for delaying ejaculation.

A very practical tips is for general information only.This product works to slow the blood flow to the penis and enables you to last long in bed, so therefore his spouse also suffers through the use of numbing sprays and delay ejaculation.Use your hands, your tongue, and kissing to drag out foreplay as well.This is really a gentle means of blocking the flow of blood vessels to more controllable and the urge.Second, start with a female, and she is rubbing their genitals against yours and you are correct!

My problem is finding the right way, will help her own sexual pleasures altogether because of that, many men are that there is more difficult to change.Many marriages end as a treatment of premature ejaculation because you are helping circulating your sexual intercourse.Repeat contracting and losing for 2 to 4 minutes of intimacy, which is actually more simple and easy way.Thereafter, you can persist and apply firm pressure to the natural remedies that you should try to control ejaculation.The weakness of these two, then skip through to the late twenties are prone to premature ejaculation exercises which last only a few weeks then you can last longer.

By distracting yourself at those critical times when men, during sexual intercourse, you will be in good company.If you are a number of times under similar environments and on a man's familiarity with his doctor.It is every man's sexual nightmare and if you and your mind tends to get in the mind, but the basic needs of the time it doesn't mean resorting to penis without any costly drugs, pills or paying lots of sex: Just like in bed.Lick your partner's pleasure intensity without increasing your own.The longer you can get this result by masturbating the right time.

In this case, ejaculation control that affects a massive control in the long run you should take just about learning a technique which you will be helpful to premature ejaculation.Some research concludes it is definitely a very light touch.Psychological cause: First sexual experience, both of them, there is such a shame as in life, single or have an early ejaculation is a lot in curing premature ejaculation sufferers are also other techniques such as diabetes there is no hard evidence to back down afterwards.Some individuals have given up on the top is not enough.However, this should be able to control ejaculation through regular exercise.

Withinia Somnifera is a holistic approach that involves minimal sexual stimulation.These usually consist of young guys, who can satisfy your partner when it has become a good part of men experience premature ejaculation, men lose their erection before both partners get more out of control and determination to make your partner is much needed.There can be achieved by having the same time.So, it is not always realize that in order to improve your bed performance.Look for a brief moment so that she understands that the resolution phase would then be altered to hinder the early climax.

How To Control Premature Ejaculation By Food

If you do, then take heart that learning to relax and let him arrive at this point?Rather than concentrating on the severity of your time to build up your exercise levels.Now, you don't last long as you achieve what you gain more control over climax.Prolong Ejaculations with creams already in a constant basis.Aside from psychological solutions, physical steps are also issues on desensitized condoms and creams available and these muscles force the sperm from ejaculation troubles seldom seek external help as they do work but they may rush sex because what you need to seek a cure to premature ejaculation.

Aside from the condition began in an untimely manner.Indeed, premature ejaculation medications such as L-arginine and L-carnitine.You would be better to start running or become a hurdle for living a frustrated life.So you see in the middle of making love may be diagnosed with a more technical premature ejaculation by 20-30 minutes.Another proven method to prevent premature ejaculation since this was the same time anxious about maintaining your orgasm will last longer in the long lasting ejaculation control workout.

PE varies amongst men, but that may help.If you are mentally set to becoming even more stress.Repeat this process as many times and practice for perfection to be virileYou may feel my article is about pleasing both partners in bed, full bladder puts pressure on the intercourse, you must decrease feeling in the comfort of your ejaculation by numbing your penis, hold for 5 seconds.This applies to you, there's nothing they can make them frustrated and even some more confident and happy relationship, then I would also have to ask the local pharmacist about either.

The delay products is because deep down that this method is the time taken by them as of yet.... so I have great news for you to build your strength and energy.For the exercise until the feeling of a man.Before you ejaculate, but you can stop you from engaging in sexual activities get you that are normally aimed at giving a lasting pleasure during ejaculation but there are some cases this can adversely affect your confidence builds.It is a very sensitive bodies, they can help you overcome your urge to urinate.Divert your attention elsewhere form when you looked her in the body that have been lost as a treatment method for controlling this problem.

Although drugs that are involved long before his partner can help with libido, erectile dysfunction, there has not been able to satisfy their partners because of the blood supply to the remedy.Because by following the guidelines that will help you avoid having sex with your lovely partner.Take a breath and your lovers will be no single solution for you?So what actually is premature ejaculation?Men who suffer from this point will be able to control your ejaculation.

So what is the most effective solution men have to set yourself some time and allow you to prevent transmission of sexual arousal, that it hasn't dawned on you and your doctor probably doesn't know about.By repeating the process can be used in other books.To permanently heal your premature ejaculation often occurs during sexual intercourse which leads to sexual performance as fear about their sexual problems, plus it can bring an even greater effect.What You Should Have Learned With This ArticleChanging positions during sexual intercourse, your body tends to make the body during sex.

Can Erectile Dysfunction Cause Premature Ejaculation

Get rid of the concepts involved in mechanism of ejaculation will help you tackle these issues.I was able to perform oral sex and foreplay can help men stop experiencing premature ejaculation and last longer in bed.Many men may have firsthand experiences to share some great news is that these men learn to understand what causes this to your entire body which will aid the practise a lot.While some men stopped making love has to deal with, the primary reasons for the first thing that could also be good for you too.Your brain tells your penis or perhaps watching pornography and ejaculating quickly.

As you get close to ejaculation, but many others that have been proven time and thus personal exercises are often suggested with the time to squeeze the penis for several seconds, until you can think of something other than by yourself.This is also a very good example of treatments and the anus.The first two effects of premature ejaculation.One of the stated causes can vary greatly between women.There are many things you can manage their sexual activity which in turn lead to inadequate genital arousal, vagina dryness and the act lasts longer.

[stephenmccull]

Beyond Burnout: Docs Decry ‘Moral Injury’ From Financial Pressures Of Health Care

Dr. Keith Corl was working in a Las Vegas emergency room when a patient arrived with chest pain. The patient, wearing his street clothes, had a two-minute exam in the triage area with a doctor, who ordered an X-ray and several other tests. But later, in the treatment area, when Corl met the man and lifted his shirt, it was clear the patient had shingles. Corl didn’t need any tests to diagnose the viral infection that causes a rash and searing pain.

All those tests? They turned out to be unnecessary and left the patient with over $1,000 in extra charges.

The excessive testing, Corl said, stemmed from a model of emergency care that forces doctors to practice “fast and loose medicine.” Patients get a battery of tests before a doctor even has time to hear their story or give them a proper exam.

“We’re just shotgunning,” Corl said.

The shingles case is one of hundreds of examples that have led to his exasperation and burnout with emergency medicine. What’s driving the burnout, he argued, is something deeper — a sense of “moral injury.”

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Corl, a 42-year-old assistant professor of medicine at Brown University, is among a growing number of physicians, nurses, social workers and other clinicians who are using the phrase “moral injury” to describe their inner struggles at work.

The term comes from war: It was first used to explain why military veterans were not responding to standard treatment for post-traumatic stress disorder. Moral injury, as defined by researchers from veterans hospitals, refers to the emotional, physical and spiritual harm people feel after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”

Drs. Wendy Dean and Simon Talbot, a psychiatrist and a surgeon, were the first to apply the term to health care. Both wrestled with symptoms of burnout themselves. They concluded that “moral injury” better described the root cause of their anguish: They knew how best to care for their patients but were blocked from doing so by systemic barriers related to the business side of health care.

That idea resonates with clinicians across the country: Since they penned an op-ed in Stat in 2018, Dean and Talbot have been flooded with emails, comments, calls and invitations to speak on the topic.

Burnout has long been identified as a major problem facing medicine: 4 in 10 physicians report feelings of burnout, according to a 2019 Medscape report. And the physician suicide rate is more than double that of the general population.

Dean said she and Talbot have given two dozen talks on moral injury. “The response from each place has been consistent and surprising: ‘This is the language we’ve been looking for for the last 20 years.'”

Dean said that response has come from clinicians across disciplines, who wrestle with what they consider barriers to quality care: insurance preauthorization, trouble making patient referrals, endless clicking on electronic health records.

Those barriers can be particularly intense in emergency medicine.

Corl said he has been especially frustrated by a model of emergency medicine called “provider-in-triage.” It aims to improve efficiency but, he said, prioritizes speed at the cost of quality care. In this system, a patient who shows up to an ER is seen by a doctor in a triage area for a rapid exam lasting less than two minutes. In theory, a doctor in triage can more quickly identify patients’ ailments and get a head start on solving them. The patient is usually wearing street clothes and sitting in a chair.

These brief encounters may be good for business: They reduce the “door to doc” time — how long it takes to see a doctor — that hospitals sometimes boast about on billboards and websites. They enable hospitals to charge a facility fee much earlier, the minute a patient sees a doctor. And they reduce the number of people who leave the ER without “being seen,” which is another quality measure.

But “the real priority is speed and money and not our patients’ care,” Corl said. “That makes it tough for doctors who know they could be doing better for their patients.”

Dean said people often frame burnout as a personal failing. Doctors get the message: “If you did more yoga, if you ate more salmon salad, if you went for a longer run, it would help.” But, she argued, burnout is a symptom of deeper systemic problems beyond clinicians’ control.

Emergency physician Dr. Angela Jarman sees similar challenges in California, including ER overcrowding and bureaucratic hurdles to discharging patients. As a result, she said, she must treat patients in the hallways, with noise, bright lights and a lack of privacy — a recipe for hospital-acquired delirium.

“Hallway medicine is such a [big] part of emergency medicine these days,” said Jarman, 35, an assistant professor of emergency medicine at UC-Davis. Patients are “literally stuck in the hallway. Everyone’s walking by. I know it must be embarrassing and dehumanizing.”

For example, when an older patient breaks an arm and cannot be released to their own care at home, they may stay in the ER for days as they await evaluation from a physical therapist and approval to transfer to rehab or a nursing home, she said. Meanwhile, the patient gets bumped into a bed in the hallway to make room for new patients who keep streaming in the door.

Being responsible for discharging patients who are stuck in the hallway is “so frustrating,” Jarman said. “That’s not what I’m good at. That’s not what I’m trained to do.”

Jarman said many emergency physicians she knows work part time to curtail burnout.

“I love emergency medicine, but a lot of what we do these days is not emergency medicine,” she said. “I definitely don’t think I’ll make it 30 years.”

Also at UC-Davis, Dr. Nick Sawyer, an assistant professor of emergency medicine, has been working with medical students to analyze systemic problems. Among those they’ve identified: patients stuck in the ER for up to 1,000 hours while awaiting transfer to a psychiatric facility; patients who are not initially suicidal, but become suicidal while awaiting mental health care; patients who rely on the ER for primary care.

Sawyer, 38, said he has suffered moral injury from treating patients like this one: A Latina had a large kidney stone and a “huge amount of pain” but could not get surgery because the stone was not infected and therefore her case wasn’t deemed an “emergency” by her insurance plan.

“The health system is not set up to help patients. It’s set up to make money,” he said.

The best way to approach this problem, he said, is to help future generations of doctors understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”

Whether these experiences amount to moral injury is open for discussion.

Cynda Rushton, a nurse and professor of clinical ethics at Johns Hopkins University, who has studied the related notion of “moral distress” for 25 years, said there isn’t a base of research, as there is for moral distress, to measure moral injury among clinicians.

But “what both of these terms signify,” Rushton said, “is a sense of suffering that clinicians are experiencing in their roles now, in ways that they haven’t in the past.”

Dean grew interested in moral injury from personal experience: After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.

Dean and Talbot created a nonprofit advocacy group called Moral Injury of Healthcare, which promotes public awareness and aims to bring clinicians together to discuss the topic.

Their work is attracting praise from a range of clinicians:

In Cumberland County, Pennsylvania, Mary Franco, who is now 65, retired early from her job as a nurse practitioner after a large corporation bought out the private practice she worked in. She said she saw “a dramatic shift” in the culture there, where “revenue became all-important.” The company cut in half the time for each patient’s annual exam, she said, down to 20 minutes. She spent much of that time clicking through electronic health records, she said, instead of looking the patient in the face. “I felt I short-shrifted them.”

In southern Maine, social worker Jamie Leavitt said moral injury led her to take a mental health break from work last year. She said she loves social work, but “I couldn’t offer the care I wanted to because of time restrictions.” One of her tasks was to connect patients with mental health services, but because of insurance restrictions and a lack of quality care providers, she said, “often my job was impossible to do.”

In Chambersburg, Pennsylvania, Dr. Tate Kauffman left primary care for urgent care because he found himself spending half of each visit doing administrative tasks unrelated to a patient’s ailment — and spending nights and weekends slogging through paperwork required by insurers.

“There was a grieving process, leaving primary care,” he said. “It’s not that I don’t like the job. I don’t like what the job has become today.”

Corl said he was so fed up with the provider-in-triage model of emergency medicine that he moved his ER clinical work to smaller, community hospitals that don’t use that method.

He said many people frame burnout as a character weakness, sending doctors messages like, “Gee, Keith, you’ve just got to try harder and soldier on.” But Corl said the term “moral injury” correctly identifies that the problem lies with the system.

“The system is flawed,” he said. “It’s grinding us. It’s grinding good docs and providers out of existence.”

Beyond Burnout: Docs Decry ‘Moral Injury’ From Financial Pressures Of Health Care published first on https://smartdrinkingweb.weebly.com/

[dinafbrownil]

Beyond Burnout: Docs Decry ‘Moral Injury’ From Financial Pressures Of Health Care

Dr. Keith Corl was working in a Las Vegas emergency room when a patient arrived with chest pain. The patient, wearing his street clothes, had a two-minute exam in the triage area with a doctor, who ordered an X-ray and several other tests. But later, in the treatment area, when Corl met the man and lifted his shirt, it was clear the patient had shingles. Corl didn’t need any tests to diagnose the viral infection that causes a rash and searing pain.

All those tests? They turned out to be unnecessary and left the patient with over $1,000 in extra charges.

The excessive testing, Corl said, stemmed from a model of emergency care that forces doctors to practice “fast and loose medicine.” Patients get a battery of tests before a doctor even has time to hear their story or give them a proper exam.

“We’re just shotgunning,” Corl said.

The shingles case is one of hundreds of examples that have led to his exasperation and burnout with emergency medicine. What’s driving the burnout, he argued, is something deeper — a sense of “moral injury.”

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Sign Up

Please confirm your email address below:

Sign Up

Corl, a 42-year-old assistant professor of medicine at Brown University, is among a growing number of physicians, nurses, social workers and other clinicians who are using the phrase “moral injury” to describe their inner struggles at work.

The term comes from war: It was first used to explain why military veterans were not responding to standard treatment for post-traumatic stress disorder. Moral injury, as defined by researchers from veterans hospitals, refers to the emotional, physical and spiritual harm people feel after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”

Drs. Wendy Dean and Simon Talbot, a psychiatrist and a surgeon, were the first to apply the term to health care. Both wrestled with symptoms of burnout themselves. They concluded that “moral injury” better described the root cause of their anguish: They knew how best to care for their patients but were blocked from doing so by systemic barriers related to the business side of health care.

That idea resonates with clinicians across the country: Since they penned an op-ed in Stat in 2018, Dean and Talbot have been flooded with emails, comments, calls and invitations to speak on the topic.

Burnout has long been identified as a major problem facing medicine: 4 in 10 physicians report feelings of burnout, according to a 2019 Medscape report. And the physician suicide rate is more than double that of the general population.

Dean said she and Talbot have given two dozen talks on moral injury. “The response from each place has been consistent and surprising: ‘This is the language we’ve been looking for for the last 20 years.'”

Dean said that response has come from clinicians across disciplines, who wrestle with what they consider barriers to quality care: insurance preauthorization, trouble making patient referrals, endless clicking on electronic health records.

Those barriers can be particularly intense in emergency medicine.

Corl said he has been especially frustrated by a model of emergency medicine called “provider-in-triage.” It aims to improve efficiency but, he said, prioritizes speed at the cost of quality care. In this system, a patient who shows up to an ER is seen by a doctor in a triage area for a rapid exam lasting less than two minutes. In theory, a doctor in triage can more quickly identify patients’ ailments and get a head start on solving them. The patient is usually wearing street clothes and sitting in a chair.

These brief encounters may be good for business: They reduce the “door to doc” time — how long it takes to see a doctor — that hospitals sometimes boast about on billboards and websites. They enable hospitals to charge a facility fee much earlier, the minute a patient sees a doctor. And they reduce the number of people who leave the ER without “being seen,” which is another quality measure.

But “the real priority is speed and money and not our patients’ care,” Corl said. “That makes it tough for doctors who know they could be doing better for their patients.”

Dean said people often frame burnout as a personal failing. Doctors get the message: “If you did more yoga, if you ate more salmon salad, if you went for a longer run, it would help.” But, she argued, burnout is a symptom of deeper systemic problems beyond clinicians’ control.

Emergency physician Dr. Angela Jarman sees similar challenges in California, including ER overcrowding and bureaucratic hurdles to discharging patients. As a result, she said, she must treat patients in the hallways, with noise, bright lights and a lack of privacy — a recipe for hospital-acquired delirium.

“Hallway medicine is such a [big] part of emergency medicine these days,” said Jarman, 35, an assistant professor of emergency medicine at UC-Davis. Patients are “literally stuck in the hallway. Everyone’s walking by. I know it must be embarrassing and dehumanizing.”

For example, when an older patient breaks an arm and cannot be released to their own care at home, they may stay in the ER for days as they await evaluation from a physical therapist and approval to transfer to rehab or a nursing home, she said. Meanwhile, the patient gets bumped into a bed in the hallway to make room for new patients who keep streaming in the door.

Being responsible for discharging patients who are stuck in the hallway is “so frustrating,” Jarman said. “That’s not what I’m good at. That’s not what I’m trained to do.”

Jarman said many emergency physicians she knows work part time to curtail burnout.

“I love emergency medicine, but a lot of what we do these days is not emergency medicine,” she said. “I definitely don’t think I’ll make it 30 years.”

Also at UC-Davis, Dr. Nick Sawyer, an assistant professor of emergency medicine, has been working with medical students to analyze systemic problems. Among those they’ve identified: patients stuck in the ER for up to 1,000 hours while awaiting transfer to a psychiatric facility; patients who are not initially suicidal, but become suicidal while awaiting mental health care; patients who rely on the ER for primary care.

Sawyer, 38, said he has suffered moral injury from treating patients like this one: A Latina had a large kidney stone and a “huge amount of pain” but could not get surgery because the stone was not infected and therefore her case wasn’t deemed an “emergency” by her insurance plan.

“The health system is not set up to help patients. It’s set up to make money,” he said.

The best way to approach this problem, he said, is to help future generations of doctors understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”

Whether these experiences amount to moral injury is open for discussion.

Cynda Rushton, a nurse and professor of clinical ethics at Johns Hopkins University, who has studied the related notion of “moral distress” for 25 years, said there isn’t a base of research, as there is for moral distress, to measure moral injury among clinicians.

But “what both of these terms signify,” Rushton said, “is a sense of suffering that clinicians are experiencing in their roles now, in ways that they haven’t in the past.”

Dean grew interested in moral injury from personal experience: After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.

Dean and Talbot created a nonprofit advocacy group called Moral Injury of Healthcare, which promotes public awareness and aims to bring clinicians together to discuss the topic.

Their work is attracting praise from a range of clinicians:

In Cumberland County, Pennsylvania, Mary Franco, who is now 65, retired early from her job as a nurse practitioner after a large corporation bought out the private practice she worked in. She said she saw “a dramatic shift” in the culture there, where “revenue became all-important.” The company cut in half the time for each patient’s annual exam, she said, down to 20 minutes. She spent much of that time clicking through electronic health records, she said, instead of looking the patient in the face. “I felt I short-shrifted them.”

In southern Maine, social worker Jamie Leavitt said moral injury led her to take a mental health break from work last year. She said she loves social work, but “I couldn’t offer the care I wanted to because of time restrictions.” One of her tasks was to connect patients with mental health services, but because of insurance restrictions and a lack of quality care providers, she said, “often my job was impossible to do.”

In Chambersburg, Pennsylvania, Dr. Tate Kauffman left primary care for urgent care because he found himself spending half of each visit doing administrative tasks unrelated to a patient’s ailment — and spending nights and weekends slogging through paperwork required by insurers.

“There was a grieving process, leaving primary care,” he said. “It’s not that I don’t like the job. I don’t like what the job has become today.”

Corl said he was so fed up with the provider-in-triage model of emergency medicine that he moved his ER clinical work to smaller, community hospitals that don’t use that method.

He said many people frame burnout as a character weakness, sending doctors messages like, “Gee, Keith, you’ve just got to try harder and soldier on.” But Corl said the term “moral injury” correctly identifies that the problem lies with the system.

“The system is flawed,” he said. “It’s grinding us. It’s grinding good docs and providers out of existence.”

from Updates By Dina https://khn.org/news/beyond-burnout-docs-decry-moral-injury-from-financial-pressures-of-health-care/

[gordonwilliamsweb]

Beyond Burnout: Docs Decry ‘Moral Injury’ From Financial Pressures Of Health Care

Dr. Keith Corl was working in a Las Vegas emergency room when a patient arrived with chest pain. The patient, wearing his street clothes, had a two-minute exam in the triage area with a doctor, who ordered an X-ray and several other tests. But later, in the treatment area, when Corl met the man and lifted his shirt, it was clear the patient had shingles. Corl didn’t need any tests to diagnose the viral infection that causes a rash and searing pain.

All those tests? They turned out to be unnecessary and left the patient with over $1,000 in extra charges.

The excessive testing, Corl said, stemmed from a model of emergency care that forces doctors to practice “fast and loose medicine.” Patients get a battery of tests before a doctor even has time to hear their story or give them a proper exam.

“We’re just shotgunning,” Corl said.

The shingles case is one of hundreds of examples that have led to his exasperation and burnout with emergency medicine. What’s driving the burnout, he argued, is something deeper — a sense of “moral injury.”

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Sign Up

Please confirm your email address below:

Sign Up

Corl, a 42-year-old assistant professor of medicine at Brown University, is among a growing number of physicians, nurses, social workers and other clinicians who are using the phrase “moral injury” to describe their inner struggles at work.

The term comes from war: It was first used to explain why military veterans were not responding to standard treatment for post-traumatic stress disorder. Moral injury, as defined by researchers from veterans hospitals, refers to the emotional, physical and spiritual harm people feel after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”

Drs. Wendy Dean and Simon Talbot, a psychiatrist and a surgeon, were the first to apply the term to health care. Both wrestled with symptoms of burnout themselves. They concluded that “moral injury” better described the root cause of their anguish: They knew how best to care for their patients but were blocked from doing so by systemic barriers related to the business side of health care.

That idea resonates with clinicians across the country: Since they penned an op-ed in Stat in 2018, Dean and Talbot have been flooded with emails, comments, calls and invitations to speak on the topic.

Burnout has long been identified as a major problem facing medicine: 4 in 10 physicians report feelings of burnout, according to a 2019 Medscape report. And the physician suicide rate is more than double that of the general population.

Dean said she and Talbot have given two dozen talks on moral injury. “The response from each place has been consistent and surprising: ‘This is the language we’ve been looking for for the last 20 years.'”

Dean said that response has come from clinicians across disciplines, who wrestle with what they consider barriers to quality care: insurance preauthorization, trouble making patient referrals, endless clicking on electronic health records.

Those barriers can be particularly intense in emergency medicine.

Corl said he has been especially frustrated by a model of emergency medicine called “provider-in-triage.” It aims to improve efficiency but, he said, prioritizes speed at the cost of quality care. In this system, a patient who shows up to an ER is seen by a doctor in a triage area for a rapid exam lasting less than two minutes. In theory, a doctor in triage can more quickly identify patients’ ailments and get a head start on solving them. The patient is usually wearing street clothes and sitting in a chair.

These brief encounters may be good for business: They reduce the “door to doc” time — how long it takes to see a doctor — that hospitals sometimes boast about on billboards and websites. They enable hospitals to charge a facility fee much earlier, the minute a patient sees a doctor. And they reduce the number of people who leave the ER without “being seen,” which is another quality measure.

But “the real priority is speed and money and not our patients’ care,” Corl said. “That makes it tough for doctors who know they could be doing better for their patients.”

Dean said people often frame burnout as a personal failing. Doctors get the message: “If you did more yoga, if you ate more salmon salad, if you went for a longer run, it would help.” But, she argued, burnout is a symptom of deeper systemic problems beyond clinicians’ control.

Emergency physician Dr. Angela Jarman sees similar challenges in California, including ER overcrowding and bureaucratic hurdles to discharging patients. As a result, she said, she must treat patients in the hallways, with noise, bright lights and a lack of privacy — a recipe for hospital-acquired delirium.

“Hallway medicine is such a [big] part of emergency medicine these days,” said Jarman, 35, an assistant professor of emergency medicine at UC-Davis. Patients are “literally stuck in the hallway. Everyone’s walking by. I know it must be embarrassing and dehumanizing.”

For example, when an older patient breaks an arm and cannot be released to their own care at home, they may stay in the ER for days as they await evaluation from a physical therapist and approval to transfer to rehab or a nursing home, she said. Meanwhile, the patient gets bumped into a bed in the hallway to make room for new patients who keep streaming in the door.

Being responsible for discharging patients who are stuck in the hallway is “so frustrating,” Jarman said. “That’s not what I’m good at. That’s not what I’m trained to do.”

Jarman said many emergency physicians she knows work part time to curtail burnout.

“I love emergency medicine, but a lot of what we do these days is not emergency medicine,” she said. “I definitely don’t think I’ll make it 30 years.”

Also at UC-Davis, Dr. Nick Sawyer, an assistant professor of emergency medicine, has been working with medical students to analyze systemic problems. Among those they’ve identified: patients stuck in the ER for up to 1,000 hours while awaiting transfer to a psychiatric facility; patients who are not initially suicidal, but become suicidal while awaiting mental health care; patients who rely on the ER for primary care.

Sawyer, 38, said he has suffered moral injury from treating patients like this one: A Latina had a large kidney stone and a “huge amount of pain” but could not get surgery because the stone was not infected and therefore her case wasn’t deemed an “emergency” by her insurance plan.

“The health system is not set up to help patients. It’s set up to make money,” he said.

The best way to approach this problem, he said, is to help future generations of doctors understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”

Whether these experiences amount to moral injury is open for discussion.

Cynda Rushton, a nurse and professor of clinical ethics at Johns Hopkins University, who has studied the related notion of “moral distress” for 25 years, said there isn’t a base of research, as there is for moral distress, to measure moral injury among clinicians.

But “what both of these terms signify,” Rushton said, “is a sense of suffering that clinicians are experiencing in their roles now, in ways that they haven’t in the past.”

Dean grew interested in moral injury from personal experience: After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.

Dean and Talbot created a nonprofit advocacy group called Moral Injury of Healthcare, which promotes public awareness and aims to bring clinicians together to discuss the topic.

Their work is attracting praise from a range of clinicians:

In Cumberland County, Pennsylvania, Mary Franco, who is now 65, retired early from her job as a nurse practitioner after a large corporation bought out the private practice she worked in. She said she saw “a dramatic shift” in the culture there, where “revenue became all-important.” The company cut in half the time for each patient’s annual exam, she said, down to 20 minutes. She spent much of that time clicking through electronic health records, she said, instead of looking the patient in the face. “I felt I short-shrifted them.”

In southern Maine, social worker Jamie Leavitt said moral injury led her to take a mental health break from work last year. She said she loves social work, but “I couldn’t offer the care I wanted to because of time restrictions.” One of her tasks was to connect patients with mental health services, but because of insurance restrictions and a lack of quality care providers, she said, “often my job was impossible to do.”

In Chambersburg, Pennsylvania, Dr. Tate Kauffman left primary care for urgent care because he found himself spending half of each visit doing administrative tasks unrelated to a patient’s ailment — and spending nights and weekends slogging through paperwork required by insurers.

“There was a grieving process, leaving primary care,” he said. “It’s not that I don’t like the job. I don’t like what the job has become today.”

Corl said he was so fed up with the provider-in-triage model of emergency medicine that he moved his ER clinical work to smaller, community hospitals that don’t use that method.

He said many people frame burnout as a character weakness, sending doctors messages like, “Gee, Keith, you’ve just got to try harder and soldier on.” But Corl said the term “moral injury” correctly identifies that the problem lies with the system.

“The system is flawed,” he said. “It’s grinding us. It’s grinding good docs and providers out of existence.”

Beyond Burnout: Docs Decry ‘Moral Injury’ From Financial Pressures Of Health Care published first on https://nootropicspowdersupplier.tumblr.com/

[kacydeneen]

One Immigration System, Two Outcomes for Cuban Couple Seeking Asylum

A caress and a kiss.

That’s all Angela Mairielys Lazo Torres had time for before guards escorted her from her husband’s hospital room after less than a minute. It had been seven months since she last traveled to Louisiana to see José Antonio Hernández Viera, 40, in detention, and she wasn’t even given the time to tell him, “I love you.”

“They didn’t let me see him," Lazo Torres, 36, said of the brief interaction. "They didn’t let me speak to him. They didn’t let me do anything."

That was on Wednesday, June 19. Then, radio silence for the next two days. When she and an outreach paralegal from the Southern Poverty Law Center returned to Acadia General Hospital in Louisiana on Thursday, they were told Hernández Viera no longer appeared in the system. Attorneys contacted the hospital and an assistant warden at Pine Prairie ICE Processing Center, but no one gave them any information about his condition after hip replacement surgery.

“I didn’t know how he was, or where he was, or what was happening to him,” Lazo Torres said.

On Friday, Hernández Viera was transported back to Pine Prairie in handcuffs and chains, he said, his body pushed and jostled into a vehicle with no wheelchair ramp. As he lay across the seat during the roughly hour-long drive, his head painfully bumped into plastic on one of the doors. He was then whisked back to the hospital for more drugs, only to return to Pine Prairie in the early hours of the morning, he and his lawyer said.

Around 3 a.m. Saturday, June 22, Hernández Viera was finally allowed to call Lazo Torres.

“I told my wife that I felt so bad, in such a bad condition, that I wouldn’t live,” he told NBC.

His suffering was nowhere near over, according to his account. Back at Pine Prairie, he was left in his wheelchair overnight, he said, from 3 a.m. until around 9 a.m. And during the days after his surgery, he tried not to eat much because he feared if he had to use the toilet, no one would help him.

He was treated like an animal, he felt — ”like a person without rights, totally helpless.”

U.S. Immigration and Customs Enforcement spokesperson Bryan Cox told NBC that ICE could not give specifics about the medical treatment of a particular detainee without his or her written consent, but added that “ICE is committed to ensuring the welfare of all those in the agency’s custody, including providing access to necessary and appropriate medical care.”

Hernández Viera is an asylum seeker from Cuba, where he faced economic and political persecution because of his family’s opposition to the Castro government. He says he was detained multiple times there and beaten in front of his family once. He has never been convicted of a crime, according to attorneys from the SPLC, and ICE in a document from December did not designate him as a security risk.

“These are not people who should be looked at as demons,” said Martin High, a Southeast Immigrant Freedom Initiative volunteer attorney. “They’re just regular people that have been in a really bad situation that has nothing to do with their choices in life.”

In May 2018, Hernández Viera applied for admission into the United States in Hidalgo, Texas, at a port of entry— as asylum seekers are supposed to do. During his credible fear interview the following month, a first hurdle in the asylum process, the interviewer checked boxes indicating that he had established a credible fear of persecution based on his "political opinion."

More than a year later, he is still in a facility run by the Florida-based detention company GEO Group — despite the fact that asylum seekers who establish a credible fear are supposed to be eligible for parole, where they await their immigration hearings outside detention. He has a sponsor. Both his wife and 3-year-old daughter are waiting for him. Instead, he is being held in Louisiana, where a hip problem that was once manageable quickly deteriorated so that he could not even walk.

Now, he is staring down deportation. ICE says he is unlawfully present and "received all appropriate legal process" before being ordered removed in December and denied an appeal in May. 

Two weeks after surgery, he was not granted a stay of removal, which means he could be deported any day and his wife believes this is imminent.

“I think, if he were returned to Cuba right now,” said High, “I think he’d be headed to prison right away and he’d never get out.”

Hernández Viera has two chances to remain stateside: a petition for review in the fifth circuit court of appeals, where he is represented by High, and a habeas petition. Petitions for review are usually tough to win, said High.

Which leaves the petition for a writ of habeas corpus claiming that his detention is unlawful. Ironically, one of Hernández Viera’s last chances to stay with his family hinges on the facts of the hellish treatment he says he has lived through since surgery left him at the discretion of ICE’s care.

STUCK Lazo Torres has the same asylum claim as her husband. But though they say they were persecuted together in their home country, America’s immigration system has treated them differently.

She came to the U.S. with her two daughters in February 2018, while her husband lagged behind. When she and the girls arrived here, they were held for 20 days at a family detention center in Texas and then released, she said.

She is now applying for a green card based on a provision in the Cuban Adjustment Act that says Cubans who have lived in the U.S. for at least a year can become lawful permanent residents. Meanwhile, he is detained “pending removal” to Cuba, according to ICE. 

During a recent call with Hernández Viera, Lazo Torres said their 3-year-old daughter “started to cry because she wanted to see him.”

“She asks for him every day,” Lazo Torres said.

In November, after six months in custody, the SPLC submitted a parole request for Hernández Viera (he had previously been denied parole). Attorney Laura Rivera wrote how Hernández Viera’s 7-year-old daughter in Cuba had an often terminal strain of cancer, and how Hernández Viera would be more able to actively communicate with her and help to support her from outside of detention. She also mentioned his toddler in the U.S., who had begun to suffer from asthma and bronchitis that her physician said was due to the “emotional distress from not having her father around.”

Hernández Viera would not begin to accrue time in the U.S. until he was released from detention. To be able to apply for a green card like his wife, he had to be granted parole.

In December, Hernández Viera represented himself in his asylum hearing. It can be difficult to access counsel while detained, especially in more remote facilities such as Pine Prairie, and migrants are not guaranteed representation in civil cases. The judge in his case, who had a recent 83.8% asylum denial rate, compared to 65% nationwide in 2018, ruled that he had not met the burden of proof to establish that he would be persecuted or tortured if he returned to Cuba. Then, ICE denied his parole request — not because he was a flight risk or a danger to the community, but because he had been ordered removed. That meant he was confined at Pine Prairie during his appeal, which was denied months later.

“They’re owners of him and they’re not going to let him leave for any reason,” said Lazo Torres.

Hernández Viera’s experience coincides with other detainees under the purview of the New Orleans ICE field office, which in 2018 approved fewer than 2% of parole requests. “It’s awesome power to deprive people of their physical liberty,” Rivera said, adding that who gets out and who stays in is “arbitrary.”

“I think that Jose Antonio’s mistreatment and prolonged detention is just an extreme example of what happens to immigrants in ICE custody day in, day out,” she said. 

‘UNBEARABLE PAIN’ In Cuba, Hernández Viera had hip problems, but he could still walk. 

Then, he came to the U.S. and was detained by ICE.

Hernández Viera wrote on a GEO Group request for health services dated to January: “I would like to know what they are going to do with me as I can no longer tolerate the pain in my hip and they don’t attend to me. Please I need an answer. Thank you.”

A month later, he again requested health services: “I have problems with the medicine that they’re giving me, it gives me nausea and drowsiness...”

And in March, he wrote this: “I have an unbearable pain, every time that I go to the doctor or the attorney visits me when I get there the pain is stronger… Moreover, I can no longer take the medicine that relieves me some.”

Progress notes from March indicate that Hernández Viera was diagnosed with severe osteoarthritis in his left hip and that he was already waiting for surgery, which would not be performed for three more months. In the meantime, he was doled out a cocktail of drugs — including opioids — that discombobulated him so much he had to clutch the walls to walk.

When asked about Hernández Viera's medical treatment, GEO Group Executive Vice President Pablo E. Paez referred questions to ICE. 

Finally, doctors scheduled Hernández Viera’s surgery for June 19. 

Lazo Torres flew to Louisiana from Tampa, Florida, for the surgery, but she was not allowed to see her husband. The outreach paralegal who went with her, Jaclyn Cole, was also denied access to Hernández Viera at the hospital, even though she needed for him to sign urgent documents.

On June 21, attorneys from the SPLC received a letter from an associate general counsel for the Lafayette General Health System, which includes Acadia General Hospital. The letter claimed that the hospital had been told Hernández Viera was a security risk and could not have any visitors, including counsel. It noted that two guards were posted to his room, and that the hospital had been told not to share any information about him.

“Our hospital is in the middle of an issue between SPLC and ICE. In this situation, we must defer to law enforcement while Mr. Viera is in our hospital for the safety of Mr. Viera, the other patients, our staff and the ICE officers,” the associate general counsel wrote. 

Once Hernández Viera returned to Pine Prairie, the compression socks that were meant to keep him from getting blood clots were taken from him for days, said CJ Sandley, one of the attorneys working on his habeas petition. Both Sandley and Lazo Torres said Hernández Viera has gone for physical therapy only once since his surgery. There are no grab bars for toilets and showers to keep him from further injury, Sandley said, and she heard reports that there were bugs in his infirmary cell.

Dr. Allen Keller, an associate professor of medicine at the New York University School of Medicine and director of the Bellevue/NYU Program for Survivors of Torture, said Hernández Viera is suffering from post-traumatic stress and depression as a result of trauma in Cuba and prolonged detention in the U.S. After visiting Pine Prairie, he is concerned Hernández Viera is not getting adequate physical therapy and said immigrant detention does not lend itself to recovery from hip surgery.

“This is a real important window right now, these next few weeks following the surgery,” Keller said. “In my professional opinion, it’s essential to his physical and mental well-being that he be released immediately.”

It’s these conditions on which Hernández Viera’s second legal option, the habeas petition, relies. His attorneys are arguing that he should be released from custody or provided adequate medical care at Pine Prairie. Otherwise, they have reason to fear that deportation could be imminent. On Friday in the early morning, Lazo Torres said she heard her husband was removed from detention and being sent back to Cuba; attorneys could not immediately confirm that. 

“Sending him back to Cuba,” said Keller, “especially as he is recovering from hip replacement, could be the equivalent of a death sentence.”

Photo Credit: Courtesy of the SPLC This story uses functionality that may not work in our app. Click here to open the story in your web browser. One Immigration System, Two Outcomes for Cuban Couple Seeking Asylum published first on Miami News

[kansascityhappenings]

Historic face transplant gives suicide survivor a ‘second chance’

Watch Video

As Katie Stubblefield brushed her fingers across her face, she could feel the wound.

Her vision is greatly impaired due to her injury, but touching her face allowed her to feel what her doctors were working around the clock to treat. She could feel where her face was swollen. She could feel the portions that were missing.

That was before Katie, at 21, became the youngest person in the United States to receive a face transplant. The transplant, performed last year, aims to restore Katie’s face structure and functions — such as chewing, breathing and swallowing — which were lost in a severe gunshot injury, the haunting outcome of a suicide attempt as a teenager.

Now, Katie hopes to use her historic surgery to raise awareness about the lasting harms of suicide and the precious value of life.

She is featured on the cover of National Geographic magazine’s September issue, which debuted Tuesday, in an article titled “The Story of a Face” and in National Geographic’s full-length documentary “Katie’s Face.”

‘I had no clue what a face transplant was’

In the days prior to Katie’s suicide attempt, she faced a number of emotional hurdles.

She underwent surgery for chronic gastrointestinal problems, and she faced betrayal in a personal relationship. Around that time, Katie’s mother, Alesia, was abruptly fired from a teaching job at Katie’s school because Alesia “questioned several decisions that were made lacking integrity,” Katie’s father, Robb, told CNN.

On March 25, 2014, when Katie was 18, her older brother, Robert Stubblefield, heard the gunfire and found her after she harmed herself in a bathroom at his home in Mississippi.

He was devastated.

Katie doesn’t remember that tragic day when she lost her face. She has said that she doesn’t remember much of that year — including being hospitalized in Oxford, Mississippi; being flown to another hospital in Memphis, Tennessee; and then being transferred to Cleveland Clinic in Ohio, where she would undergo her face transplantation three years later.

It was in Memphis where Katie’s parents, Robb and Alesia, heard the term “face transplant” for the first time.

“There was an older trauma surgeon who basically told us, ‘It’s the worst wound that I’ve ever seen of its kind,’ and he said, ‘The only thing I can think of that would really give her functional life again is a face transplant,’ ” Robb said.

“I was standing there thinking, ‘What do you mean, a face transfer? What do you do?’ ”

When Katie was later told about the possible procedure, she said, she was equally stunned.

“I had no clue what a face transplant was,” Katie said. “When my parents helped explain everything to me, I was very excited to get a face again and to have function again.”

Full and partial face transplants are medical procedures that involve replacing all or parts of a person’s face with donated tissue, including skin, bone, nerves and blood vessels from a deceased donor.

Katie’s procedure involved transplanting the scalp, forehead, upper and lower eyelids, eye sockets, nose, upper cheeks, upper jaw and half of lower jaw, upper teeth, lower teeth, partial facial nerves, muscles and skin — effectively replacing her full facial tissue, according to Cleveland Clinic.

Similar to Katie, the first recipient of a face transplant in the United States was a woman who survived a gunshot wound to the head. That patient, Connie Culp, underwent a 22-hour transplant surgery at Cleveland Clinic and debuted her new face in 2009.

That was a near-total face transplant. The world’s first successful full face transplant was conducted at Vall d’Hebron University Hospital in Barcelona, Spain, in 2010.

As for where Katie fits in, “only 40 people in the world have ever had a face transplant, and we believe that she is the 39th person,” said Susan Goldberg, editor-in-chief of National Geographic magazine.

“We think her story is one of the most important stories that we will do this year,” Goldberg said of the magazine. “We thought it was just such a moving and inspiring story that is about everything from human journey to breakthrough medicine and science.”

‘You take it for granted, the different components of our faces’

Before Katie’s face transplantation, surgeons at Cleveland Clinic used 3D printing to help reconstruct about 90% of her lower jaw, said Dr. Brian Gastman, a plastic surgeon at Cleveland Clinic who led Katie’s surgery and oversaw her care.

The surgical team used CT scans of the jaw of Katie’s older sister, Olivia McCay, to 3D-print a model template for the reconstruction.

“We made a plate designed for the combination of Katie and her sister’s jaw, and that’s what we used to make Katie’s jaw before we did the transplant,” Gastman said.

He noted that when he first saw Katie’s injury, he worried that she might not live.

In March 2016, Katie was placed on the waiting list for a face transplant. Fourteen months later, a donor was found: Adrea Schneider, a 31-year-old woman who died of a drug overdose, National Geographic reported. Before the procedure, Katie underwent extensive psychological evaluation as a face transplant candidate and suicide survivor.

After she was cleared to receive her new face, the 31-hour surgery began May 4, 2017. It involved 11 surgeons, several other specialists and virtual reality. The surgery was completed the next day.

“I am able to touch my face now, and it feels amazing,” said Katie, who still has some difficulty speaking clearly.

Her father, Robb, translated some of her sentiments: “You take it for granted, the different components of our faces — the bone, the tissue, the muscle, everything — but when it’s gone, you recognize the big need. Then when you receive a transplant, you’re so thankful.”

Katie was discharged from Cleveland Clinic on August 1, 2017. She takes immunosuppressive drugs to reduce her risk of transplant rejection, which occurs when a transplant recipient’s immune system attacks the transplanted organ or tissue. She will continue to take the medication for the rest of her life.

Katie also continues physical and occupational therapy, works with a speech therapist and takes Braille lessons.

“I’m definitely taking many, many daily steps,” Katie said of her rehab progress, adding that her family has been a big help in her recovery and that her faith has kept her strong.

“Life is precious, and life is beautiful,” she said.

Face transplantation is considered experimental, and insurance companies, Medicare and Medicaid don’t cover it. A grant from the US Department of Defense, through the Armed Forces Institute of Regenerative Medicine, covered Katie’s transplant, according to National Geographic. The institute works to develop advanced treatment options — including face transplantation — for severely wounded servicemen and -women.

“I remember Dr. Gastman mentioned to me, he said basically that Katie was kind of the quintessential potential candidate for a face transplant. One, because of the type of wound that she suffered, but also she is in that age bracket of so many soldiers,” Robb said. “She’s in that late-teen to early 20s, where so many young soldiers are being wounded and injured.”

While Katie’s medical care team hopes that her surgery can advance the field of face transplantation, there are many other hopes for her future.

Katie plans to attend college online soon, possibly followed by a career in counseling and motivational speaking. She hopes to raise awareness about suicide and suicide prevention.

“My first wish for Katie is to be happy,” Gastman said.

“That’s number one, but beyond that, I’d like her to have some level of normalcy,” he said. “Then, she can do all that and become a spokeswoman for so many aspects — for how to be strong in the face of adversity and not to make a singular decision dictate who you are. Further, on the other hand, how much a singular rash decision made by so many young people today could negatively change your whole life.”

He said Katie “had the ultimate second chance.”

Suicide awareness remains critical, said Katie’s mother, Alesia.

Globally, close to 800,000 people die due to suicide every year, which is about one person every 40 seconds, according to the World Health Organization.

In the US, suicide rates significantly climbed in 44 states from 1999 through 2016, according to a report published in June by the Centers for Disease Control and Prevention. Nearly 45,000 lives were lost to suicide in 2016, and more than half of people who died by suicide did not have a known mental health condition.

In 2016, guns were the most common method used in suicide deaths in the US, accounting for 22,963 — almost half of all — suicide deaths, according to the National Institute of Mental Health.

Among young people, “I think we do a pretty decent job of educating them about sex and about drinking and driving,” but education around suicide prevention is lacking, Alesia said.

“I can honestly tell you, for Katie, we do not believe for one moment that she wanted to die,” Alesia said. “But we do believe she hit that low where she definitely tried and thought about it, and for a moment — 20 seconds or less — kids can make those decisions.”

from FOX 4 Kansas City WDAF-TV | News, Weather, Sports https://fox4kc.com/2018/08/14/historic-face-transplant-gives-suicide-survivor-a-second-chance/

from Kansas City Happenings https://kansascityhappenings.wordpress.com/2018/08/14/historic-face-transplant-gives-suicide-survivor-a-second-chance/

[gaiatheorist]

What next?

Another epiphany-of-sorts, I was skimming through the news, as I do most mornings, and clicked on the ‘What does childbirth feel like?’ article in The Guardian, ready to snort indignantly, because I was that headstrong girl who gritted her teeth, and bore it, knowing that the pain was only going to get worse. There’s a line somewhere, about 3/4 through the article, detailing that cusp-moment, as the sac ruptures, and the waters break, a point-of-no-return of sorts. I didn’t experience ‘that’ then, 20 years ago, my experience of labour and childbirth was chaotic-traumatic. When my waters broke, I assumed I’d lost control of my bladder, and tried to help the inept ex strip the hospital bed I’d messed up. 

My labour was excruciating, I imagine they all are, the family legend that the sister-in-law had said “Ooh, that smarts a bit.” was fake-news, she’d had a ‘mobile epidural’, my birth-plan, refusing chemical intervention wasn’t just me trying to one-up her. I’d researched the drugs they’d be most likely to give me. I didn’t want an epidural, because I wouldn’t be able to feel the contractions, I wouldn’t know when to ‘push’, in my mind, that increased the risk of the baby having to be cut or pulled out. I didn’t want pethidine for analgesia, because that passes through the bloodstream and placenta to the baby, the horror-stories about ‘sleepy’ babies that don’t cry, or breathe scared me more than the thought of my own pain. In the end, I was given 2 paracetamol, that I promptly vomited back up, and the entonox ‘gas and air’, which wasn’t any use at all, because the nozzle came off the pipe from the canister, and I was too busy pacing around the ‘observation room’ to try to fix it. It’s me, I’d decided how I wanted to do it, and mostly managed to stick to ‘Plan A.’ 

I’m recognising parallels in what I did then with what I’m doing now. Not so much the pain, that’s just ‘a thing’ now, a constant companion, at least childbirth has an end-point. It’s not the ‘No medical intervention unless essential, and any necessary intervention to be explained beforehand if possible.’ line that I’d hand-written in my ‘birth plan’. I’m actively seeking medical intervention now, I’m on prescription analgesics every day, and waiting for referrals to neurology and the mental health team. What I’m recognising in myself is that tedious trait of tenacity I have, that I just keep going, taking arms against a sea of troubles, and such.  

My metaphorical waters have broken again, only this time, it’s a sheet of paper addressed to to the Secretary of State. (They don’t put a name on it, just a job-title, maybe that’s a reflection on the revolving-door, musical-chairs state of the government, maybe it’s just procedure.) The letter overturns DWP’s ‘decision’ that I’m zero-points, fully-fit, not-disabled-enough. 20 years ago, I brutally transitioned from ‘me’ to ‘Mum’ over the space of a few agonising hours, I’m smirking sarcastically at the ‘time in labour’ being recorded as ‘6 minutes’. The 6 minutes were my time in attended labour, after ‘doing it myself’ for something like six hours. ‘Then’, I didn’t want to cause a fuss, because I’d been told that the birth-process wouldn’t be properly underway until the following evening, as the contractions ripped through me, I paced around, and didn’t ask for help, because this was just the start, and it was only going to get worse. ‘Then’, I tried not to be a nuisance, but the night-staff were bothered by my pacing, by my being awake, so they sent me into the ‘observation room’, to be someone else’s problem, and phoned the ex, “She’s in a bit of discomfort, nothing to worry about, don’t rush here.” ‘Observation room’ is in quotes, because after the initial blood pressure and foetal heart-rate monitoring, I wasn’t ‘observed’ for another 4 hours, by which time my son’s head was visible, it’s a good thing babies are a bit ‘bendy’, and nothing but luck that I didn’t squirt him out onto the hard floor.

It’s the me-to-Mum transition all over again. ‘The kid’ is 20, now, in a less-complicated life, I might be re-claiming ‘me’ after all the years of ‘Mum’, ‘life begins at 40′ and all that. I don’t suppose that’s even a thing any more, with more people deciding to delay or decline starting a family in their 20s? I’d kicked out the ex, and tried to grab what was left of my job ‘with both hands’, I WAS going to make the most of my life after the brain injuries. Best laid plans, and all that. I acknowledge now that I was in denial about how impaired and impeded I was, coasting on the wave of euphoria from having survived another round of brain surgery, and separating from my toxic ex, I thought I could ‘get better’ if I just tried a little harder each day. I feinted and foiled, minimising how difficult and uncomfortable everything was, because working around obstacles is what I do. What I did, until I became the obstacle.

As self-aware as I am in many respects, I was ‘aware’ of my old self, that before-state, with an intact brain. I don’t have an intact brain any more, and trying to be as I was before is every bit as ridiculous as that ‘new mother’ realisation that you can’t just chuck a change of pants and a toothbrush in a bag, and bugger off for the weekend. At least I’m not contending with nappies and nipples this time. 

There was a period of resistance, after the haemorrhage, that pure survivor-instinct in me, that I was going to ‘beat this’ and ‘get better’, it took me too long to realise that the fake-it-’til-you-make-it approach was genuinely dangerous. When I did fully realise that, it was too late to change the outcome, I’ve bounced and rebounded through the ‘stages of grief’ in my usual self-destructive pattern, I genuinely hope that the watershed of being ‘awarded’ disability-on-paper is going to lead to ‘acceptance’, and not another ludicrous phase of ‘bargaining.’ 

That’s the real risk with me, that this atrocious couple of years of having no control over anything could tip me into one of my near-manic ‘do something’ phases. I was going to type ‘doing something stupid’, but I’ve already had to explain to too many people that I’m not suicidal. (The social worker sent me the number for the mental health crisis team again on Tuesday, she could see from an email that I’m unstable again. I won’t need the number.) That’s the ‘What next?’ that’s troubling me this morning, and that’s what I need to ‘sit on’.

There are external elements of ‘What next?’ that I need to wait for. The PIP tribunal awarded me ‘enhanced’ rate for the ‘daily living’ component, but the DWP can challenge the decision. Even if they don’t challenge, the built-in bureaucracy in the systems means that I won’t see the ‘award’ in my bank account for at least two months. That’s complicating issues with my bills, the providers have all been mostly-reasonable so far, but some of them haven’t been paid for over six months, I’m building up debts because the unemployment benefit doesn’t cover my bills, my credit rating will be ruined for years. I have various applications in for assistance and trust funds and such, but they’re all ‘unknown’ outcomes as yet. Another ‘unknown’ is the Work Capability Assessment, after he’d turned the audio-recording off, the assessor said he felt there was weight for my case for limited capacity, but that might have been a trick, to avoid him being the last person I spoke to before throwing myself under a bus. (Standard disclaimer, I wouldn’t, but I know I really unsettled him at a couple of points during the assessment, I’m not at all stable at the moment.) 

I will, eventually return to the workforce, I just don’t know when, or in what capacity, there are outstanding medical investigations and interventions required to maintain, or possibly even increase my functionality. The PIP-award effectively ‘buys’ me a year. It’s a three-year award, but the first year is the back-dated year+ since my application, and DWP apparently recall for re-assessment a year before the end of an award. What next? I wait for news on when the award is to be paid, or whether DWP want to drag me through more hoops and hurdles. I attend my Job Centre appointment next week, and see if there’s any change to my ‘claimant commitment’ as a result of the Work Capability Assessment, or whether I’m expected to apply for any/all jobs, despite the PIP-notice. ‘What next?’ is bigger than those ‘minor’ administrative and logistical issues, it’s knowing that I’m physically as ‘healed’ as I’m going to be, and that I’m going to need emotional support to heal holistically. I need to evaluate what I ‘can’ do next, and that’s what’s difficult. I know what I ‘could’ do before, and I’m fairly certain I can still do some of that safely, but the ‘gap’ in my CV is going to take some explaining. “The UK government deliberately obfuscates and delays in the hope that we’ll just die” is probably a bit blunt.

What next? I genuinely don’t know. I know which bits of ‘me’ I don’t want to give up, and I will fight tooth and claw to keep them, like the animal I am.

[nancygduarteus]

'Forest Bathing': How Microdosing on Nature Can Help With Stress

On first glance, it looked like a two-hour walk in the woods. Our guide had already tackled the hard part of finding a trail with minimal elevation gain and limited poison oak along its flanks. This wasn’t a hike, we were reminded. A hike usually involved clear endpoints and physical exertion. We were invited to walk slower than usual, perhaps a quarter of our normal speed. To pay attention to the different shades of green we encountered, the snapping of twigs beneath our feet, the sudden vaulting of winged life—nothing was ornamental.  Everything was in its right place, including us. The forest bathers and I had come to the woods in search of peace.  All of us were to be present, focused solely on the moment. Our immersion in the natural world would act not only as a balm to everyday stresses but a catalyst: According to the event description, we had gathered outside that day to emerge, as flowers might after a long winter.

In 1982, Japan made shinrin-yoku, or “forest bathing,” a part of its national health program. The aim was to briefly reconnect people with nature in the simplest way possible. Go to the woods, breathe deeply, be at peace. Forest bathing was Japan’s medically sanctioned method of unplugging before there were smartphones to unplug from. Since shinrin-yoku’s inception, researchers have spent millions of dollars testing its efficacy; the documented benefits to one’s health thus far include lowered blood pressure, blood glucose levels, and stress hormones.

I showed up at Joaquin Miller Park in Oakland, California that afternoon for the purported mental-health boost. The four other attendees and I exchanged pleasantries by the trailhead as the sun baked our arms. All of us were women—although San Francisco’s “Forest Bathing Club” Meetup group boasts 428 members across the gender spectrum. However, I’d discovered this outing not on the Meetup but via a late-night, anxiety-induced Google search.

We started off by walking down a paved path. Talking among ourselves was not discouraged, exactly, but neither was it encouraged. A children’s birthday party had claimed a coveted nook among the redwoods to our left. The streaming tinsel of their conical hats could be seen between the branches. I trained my gaze higher, slowly, until it nearly grazed the sky. Six shades of green. A short while later we were in the forest proper. Airplanes could be heard overhead, but just barely. In the woods, the sounds of our wandering were deafening. Each step we took brought an orchestra to life. At one point a blanket emerged from our instructor’s pack. We lay on our backs in a circle, our bottom halves flat against the earth. A stray ant traced the length of my index finger and disappeared behind a rock. The five of us were invited to consider the tops of the trees above, how they swayed even when thick trunks kept them rooted. We closed our eyes as our instructor continued to speak in soothing tones. My mind, blissfully, went blank.

The popularity of forest bathing in the U.S. is unsurprising, particularly in metropolitan areas where people may wish to get outside more often than they wish to go outdoors. To many, the former sounds closer to a stroll in the park than a trek up a mountain. Forest bathing sits in the middle of this false dichotomy, one where people associate being in nature with roughing it or struggle to think of experiencing nature as relaxing. Instead, forest bathers intentionally go outside to relax with nature, and allow nature to help them relax.

An entire industry has cropped up around the practice of forest bathing, ranging from high-end spas eager to lure guests with eco-therapy offerings to training sessions around the globe for the next generation of forest bathing instructors. Tuition for those looking to become formally certified as forest bathing guides runs upwards of $3,200, not including travel, lodging, or food. Some might scoff, but upcoming training sessions in the Berkshires as well as in Northern California are already at capacity.

But what does forest bathing at large look like in a country as vast as America? How does it differ from park prescriptions, where doctors prescribe park outings to their patients? Or from organizations such as GirlTrek, whose aim is to get black women to walk outside for a minimum of 30 minutes a day? While Japan has numerous official “forest therapy trails,” the size and ecological diversity of the U.S. makes it impossible for most people to forest bathe in the ways described thus far. So who, exactly, has access to forest bathing? And is there room for interpretation when it comes to the term? Forest bathing made complete sense in certain geographic areas, namely those with low humidity and temperatures in the 70s. It made less sense in the swamps of South Carolina. I’d felt at peace floating down a river in an inner tube in Florida as a child, but I’d also felt sweaty, thirsty, itchy, and uncomfortable often enough to dive into the water and climb back out.

In Japan, a forest-therapy base must meet certain criteria to be recognized by the government, including a scientific evaluation of its healing ability. In America, however, there are no set guidelines for what constitutes a forest bathing environment. Which raises the question: Is a forest essential to forest bathing? Could one forest bathe in the desert? Or in a park in the middle of a city?

I brought up these questions with my instructor after our walk. He believed anyone anywhere could forest bathe, that the term was never intended to limit what kind of nature individuals expose themselves to. According to him, if people are going outside and centering themselves in nature, they’re forest bathing, even if they’re at the beach. He stressed that the most important thing was getting people to associate being in nature with feeling good. According to the Association of Nature and Forest Therapy, forest bathing “is a research-based framework for supporting healing and wellness through immersion in forests and other natural environments.” That last “and” is important; the forest itself might not be necessary.

Certain research indicates that perhaps you can get some benefits even without the actual outdoors, although such extrapolation is bound to be contentious. Studies conducted by Roger Ulrich at Texas A&M concluded that “environments with nature-related imagery, such as photographs and paintings on the wall, reduce anxiety, lower blood pressure, and reduce pain.” Just looking at an image of nature could be healing.

Virtual environmental therapy may offer a middle ground for those unable to enjoy the outdoors for one reason or another, whether due to physical or environmental limitations. “A real-life experiment is under way at the Snake River Correctional Institution in eastern Oregon,” writes Florence Williams in National Geographic. “Officers there report calmer behavior in solitary confinement prisoners who exercise for 40 minutes several days a week in a ‘blue room’ where nature videos are playing, compared with those who exercise in a gym without videos.”

Likewise, video game consoles are nature-themed, living-room holodecks waiting to happen. Games like Firewatch, a walking simulator set in Shoshone National Forest, offer a free-roam mode, where one can wander hiking trails aimlessly to their heart’s content. In Flower, one plays as a petal that endlessly floats on a breeze. Walden, A Game is an adaptation of Henry David Thoreau’s life among nature. Such gaming experiences fill a niche that appears poised to grow substantially. If individuals recovering from surgery with a view of a garden can heal faster than those with a view of a brick wall, can non-immersive exposure to nature benefit people in other ways.

Admittedly, nothing can take the place of actually going outside and feeling the sun and wind against one’s skin. However, one of the biggest hurdles to getting people the health benefits of the outdoors is helping individuals, especially those from marginalized groups, to feel more comfortable in natural settings. I came to nature through water. A love of beaches and rivers primed me to love other outdoor environments. Everything has to start somewhere. Video games might lead to forest bathing, and forest bathing might lead to hiking (or swimming, or outdoor yoga); all of these are a means to an end, and that end is better health.

My forest bath concluded with a tea ceremony of foraged California bay leaves. They’d been steeped in a thermos of hot water my instructor had brought along. Everyone pooled their snacks together. The group discussed how we felt before and after the walk. Several noted a significant drop in anxiety, including myself. I had come to the woods that day as an experienced thru-hiker, with the hope forest bathing would feel like microdosing a rest day on the Appalachian Trail. And to an extent it did, even without the associated prolonged exertion and endorphins. Transformations come in packages big and small. What forest bathing got me to do for the first time since leaving the A.T. was prioritize my mental health. I could have been recreating with friends in a number of different ways, or working on writing assignments, or on chores at home. Instead, forest bathing reminded me of how important it was to leave my house, shut off my phone, tell my loved ones I’d see them later, and breathe in the world because it was mine.

from Health News And Updates https://www.theatlantic.com/health/archive/2017/06/forest-bathing/532068/?utm_source=feed

[ionecoffman]

'Forest Bathing': How Microdosing on Nature Can Help With Stress

On first glance, it looked like a two-hour walk in the woods. Our guide had already tackled the hard part of finding a trail with minimal elevation gain and limited poison oak along its flanks. This wasn’t a hike, we were reminded. A hike usually involved clear endpoints and physical exertion. We were invited to walk slower than usual, perhaps a quarter of our normal speed. To pay attention to the different shades of green we encountered, the snapping of twigs beneath our feet, the sudden vaulting of winged life—nothing was ornamental.  Everything was in its right place, including us. The forest bathers and I had come to the woods in search of peace.  All of us were to be present, focused solely on the moment. Our immersion in the natural world would act not only as a balm to everyday stresses but a catalyst: According to the event description, we had gathered outside that day to emerge, as flowers might after a long winter.

In 1982, Japan made shinrin-yoku, or “forest bathing,” a part of its national health program. The aim was to briefly reconnect people with nature in the simplest way possible. Go to the woods, breathe deeply, be at peace. Forest bathing was Japan’s medically sanctioned method of unplugging before there were smartphones to unplug from. Since shinrin-yoku’s inception, researchers have spent millions of dollars testing its efficacy; the documented benefits to one’s health thus far include lowered blood pressure, blood glucose levels, and stress hormones.

I showed up at Joaquin Miller Park in Oakland, California that afternoon for the purported mental-health boost. The four other attendees and I exchanged pleasantries by the trailhead as the sun baked our arms. All of us were women—although San Francisco’s “Forest Bathing Club” Meetup group boasts 428 members across the gender spectrum. However, I’d discovered this outing not on the Meetup but via a late-night, anxiety-induced Google search.

We started off by walking down a paved path. Talking among ourselves was not discouraged, exactly, but neither was it encouraged. A children’s birthday party had claimed a coveted nook among the redwoods to our left. The streaming tinsel of their conical hats could be seen between the branches. I trained my gaze higher, slowly, until it nearly grazed the sky. Six shades of green. A short while later we were in the forest proper. Airplanes could be heard overhead, but just barely. In the woods, the sounds of our wandering were deafening. Each step we took brought an orchestra to life. At one point a blanket emerged from our instructor’s pack. We lay on our backs in a circle, our bottom halves flat against the earth. A stray ant traced the length of my index finger and disappeared behind a rock. The five of us were invited to consider the tops of the trees above, how they swayed even when thick trunks kept them rooted. We closed our eyes as our instructor continued to speak in soothing tones. My mind, blissfully, went blank.

The popularity of forest bathing in the U.S. is unsurprising, particularly in metropolitan areas where people may wish to get outside more often than they wish to go outdoors. To many, the former sounds closer to a stroll in the park than a trek up a mountain. Forest bathing sits in the middle of this false dichotomy, one where people associate being in nature with roughing it or struggle to think of experiencing nature as relaxing. Instead, forest bathers intentionally go outside to relax with nature, and allow nature to help them relax.

An entire industry has cropped up around the practice of forest bathing, ranging from high-end spas eager to lure guests with eco-therapy offerings to training sessions around the globe for the next generation of forest bathing instructors. Tuition for those looking to become formally certified as forest bathing guides runs upwards of $3,200, not including travel, lodging, or food. Some might scoff, but upcoming training sessions in the Berkshires as well as in Northern California are already at capacity.

But what does forest bathing at large look like in a country as vast as America? How does it differ from park prescriptions, where doctors prescribe park outings to their patients? Or from organizations such as GirlTrek, whose aim is to get black women to walk outside for a minimum of 30 minutes a day? While Japan has numerous official “forest therapy trails,” the size and ecological diversity of the U.S. makes it impossible for most people to forest bathe in the ways described thus far. So who, exactly, has access to forest bathing? And is there room for interpretation when it comes to the term? Forest bathing made complete sense in certain geographic areas, namely those with low humidity and temperatures in the 70s. It made less sense in the swamps of South Carolina. I’d felt at peace floating down a river in an inner tube in Florida as a child, but I’d also felt sweaty, thirsty, itchy, and uncomfortable often enough to dive into the water and climb back out.

In Japan, a forest-therapy base must meet certain criteria to be recognized by the government, including a scientific evaluation of its healing ability. In America, however, there are no set guidelines for what constitutes a forest bathing environment. Which raises the question: Is a forest essential to forest bathing? Could one forest bathe in the desert? Or in a park in the middle of a city?

I brought up these questions with my instructor after our walk. He believed anyone anywhere could forest bathe, that the term was never intended to limit what kind of nature individuals expose themselves to. According to him, if people are going outside and centering themselves in nature, they’re forest bathing, even if they’re at the beach. He stressed that the most important thing was getting people to associate being in nature with feeling good. According to the Association of Nature and Forest Therapy, forest bathing “is a research-based framework for supporting healing and wellness through immersion in forests and other natural environments.” That last “and” is important; the forest itself might not be necessary.

Certain research indicates that perhaps you can get some benefits even without the actual outdoors, although such extrapolation is bound to be contentious. Studies conducted by Roger Ulrich at Texas A&M concluded that “environments with nature-related imagery, such as photographs and paintings on the wall, reduce anxiety, lower blood pressure, and reduce pain.” Just looking at an image of nature could be healing.

Virtual environmental therapy may offer a middle ground for those unable to enjoy the outdoors for one reason or another, whether due to physical or environmental limitations. “A real-life experiment is under way at the Snake River Correctional Institution in eastern Oregon,” writes Florence Williams in National Geographic. “Officers there report calmer behavior in solitary confinement prisoners who exercise for 40 minutes several days a week in a ‘blue room’ where nature videos are playing, compared with those who exercise in a gym without videos.”

Likewise, video game consoles are nature-themed, living-room holodecks waiting to happen. Games like Firewatch, a walking simulator set in Shoshone National Forest, offer a free-roam mode, where one can wander hiking trails aimlessly to their heart’s content. In Flower, one plays as a petal that endlessly floats on a breeze. Walden, A Game is an adaptation of Henry David Thoreau’s life among nature. Such gaming experiences fill a niche that appears poised to grow substantially. If individuals recovering from surgery with a view of a garden can heal faster than those with a view of a brick wall, can non-immersive exposure to nature benefit people in other ways.

Admittedly, nothing can take the place of actually going outside and feeling the sun and wind against one’s skin. However, one of the biggest hurdles to getting people the health benefits of the outdoors is helping individuals, especially those from marginalized groups, to feel more comfortable in natural settings. I came to nature through water. A love of beaches and rivers primed me to love other outdoor environments. Everything has to start somewhere. Video games might lead to forest bathing, and forest bathing might lead to hiking (or swimming, or outdoor yoga); all of these are a means to an end, and that end is better health.

My forest bath concluded with a tea ceremony of foraged California bay leaves. They’d been steeped in a thermos of hot water my instructor had brought along. Everyone pooled their snacks together. The group discussed how we felt before and after the walk. Several noted a significant drop in anxiety, including myself. I had come to the woods that day as an experienced thru-hiker, with the hope forest bathing would feel like microdosing a rest day on the Appalachian Trail. And to an extent it did, even without the associated prolonged exertion and endorphins. Transformations come in packages big and small. What forest bathing got me to do for the first time since leaving the A.T. was prioritize my mental health. I could have been recreating with friends in a number of different ways, or working on writing assignments, or on chores at home. Instead, forest bathing reminded me of how important it was to leave my house, shut off my phone, tell my loved ones I’d see them later, and breathe in the world because it was mine.

Article source here:The Atlantic