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You can follow the acting recommendations or give the script your own taste. Have fun!
[Noises] (Acting recommendations or pov’s so you know where in the story you’re at) {how to pronounce}
Everytime you see a space
is a new paragraph.
Remember to give time between paragraphs for the listener to respond.😊
POV of VA: it's a normal consultation day, when a pretty patient arrives for a checkup... she's healthy...or is she?
Characters personality: you're a good and kind doctor, a bit funny sometimes and with a light-hearted personality.
Begins script:
FEEL FREE TO ADD AS MANY FX AS YOU'D LIKE
(You're ending a consultation) Ok, so just take the pills, and stay off those flowers ok?
(Funny) I know, you wanted to surprise your wife, but next time.....maybe a box of chocolates? (Giggle)
Alright... Take care.
[Door closes]
[Keyboard]
(Thinking out loud) Alright.... This goes here and ...perfect, that note is done.
(Asking your assitant) Anna?................ Send in my next patient please. Thank you.
Umm..how many more do I have for today?
(Rethoric) 2 more including this one?
(Tired) Great, I'm so tired.
Thanks Anna.
[Door closes]
(Ugh mocking) (Sigh) Today's been such a slow day...I mean, who on earth buys a huge bouquet of roses when they have such a strong pollen allergy... seriously (giggle)
[Door knock]
Come in....
(Soon as your new patient arrives you're blown away by her beauty)
(Professionally nice but blown away) Hello, I'm Dr (insert asmrtist name) and you are...?
(Reverb thoughts) Wow she's so beautiful...
(Reverb pep talk) Can it (insert asmrtist name) she's a patient you can't afford to think like that. Be professional!
(End of reverb)
(Coming back to reality) Oh umm...pleased to meet you.
Take a seat please.
[For the whole interview question part you can add a soothing keyboard sound on the back if you'd like, like you're taking notes]
(Professionally nice) So...tell me, What brings you here today?
(Rethoric) Oh, so you got a new health insurance and they gave you a free checkup at this hospital?
(Nice) Ok. yeah, it's always good to get a checkup every once in a while.
Which health insurance company did you hire?
Yeah, their health plan is very complete.
Do you have any current symptoms of any kind?
(Rethoric) Small seasonal allergy?
(Giggling) Yeah, that's very common this days, tell me about it (giggle)
Any medication you're taking for it?
(Sounds logical) Oh, that's the standard.
Any other medications?
(Rethoric) Occasional aspirin for a headache?
Ok.. that's fine.
Any relevant medical history?
(Rethoric) You got your appendix out when you were 12? Ok...
And..no chronic diseases?
Glad to hear.
Diseases in the family? Cancer, diabetes, hypertension, high cholesterol, anything relevant?
(Rethoric) Oh, your grandpa died from colon cancer 2 years ago?
(Sorry) Oh, sorry to hear.
And...how old are you?
(Giggle) I know, as a man it's never easy to ask that question, but as doctor I have to.
When was the last time you went to the doctor?
(Shocked) 2 years ago?!?!
Remember it's always good to see the doctor once a year. So I'm glad you're here now. (Seeth smile)
(Starting the physical examination) (End keyboard sounds)
(Always be calm, you want to inspire confidence to the listenepatient that there's nothing to worry about)
(Professionally nice) Alright. So I would like to start by assessing your vitals. I'm gonna check your pulse and then take your blood pressure...is that ok?
Alright... Just gonna get a feel here in your wrist...
(Wait a sec)
80... You're pulse is fine
If you would lend me your arm please, just gonna wrap the pressure cuff around.....
Alright...just relax.....you may feel some pressure while I take the measurement.
[Pressure cuff sound inflate and deflate]
75/110...
(Rethoric) Low?....
(Confident) Not really... it's said 80/120 is the standard, but it really depends on the patient, medical history, the height, the weight....so for you 75/110 is fine.
I'm gonna take a listen to your heart now. Ok?
Gonna warm up the stethoscope with my hands before I start ..
(Funny nice) You know, there's nothing meaner than a cold stethoscope (giggle). So I try to avoid that with my patients.
Alright, Just breath normally..
(Listening attentively) mmm....ok....
Could you squeeze both your hands really tight for me?, I'm gonna take another listen.
(You keep listening) mmm
Ok, relax...
Everything sounds normal.
Now I'm gonna listen to your lungs ok?
(Do not breath along you're listening) Take a deep breath for me...in ..........and out.......
Once more please...in......and out ....
Again.....in.......and out....
Last one.....in.....aaand out ....
Alright...it all sounds fine there.
Now, I'd like you lay down in the examination table so I can assess your abdomen ok?..
Alright.
There we go.
Now, I'm gonna lift up your shirt slightly, is that ok?
Ok ..
You said you haven't had any recent abdominal symptoms right?
Ok.
I'm gonna take a listen to your abdomen then..
Now, it may take some time for vowel sounds to appear, but that's normal, so you have nothing to worry about.
(Wait a few sec)
Ok, everything sounds fine.
Now I'm gonna do some percussion, this mainly requires me tapping around your abdomen to asses dullness ok?
Alright.
[You may include the abdominal percussion sounds if you'd like]
(Thinking aloud) (Something sounds a bit off but you don't wanna raise any alarms) Hmm...
Ok..
Now I'd like to palpate around your abdomen to check everything is fine...is that ok?
Ok..... Gonna start pressing here on the top center, any pain there?...people with reflux or heart burn tend to have pain around that area...
Nothing? Good.
Now pressing here on the right side...no pain?
Good.
Any pain or tenderness here on the lower area?....no?..good
Now pressing here on the left side.
(You feel a small-medium mass like 2 in big on that area and get concerned)
(Concerned) Hmmmmm.....hmmmm....
(Concerned) Any pain when I press here?
(Rethoric concerned) No?
Hmmm..
I'm gonna press a little deeper...
(Concerned) No pain when I press deeper?
Hmmmm
(Rethoric) What's wrong?
(Talking while feeling around) I'm feeling something here....
Feels like a small mass, a bit hard....
(Thinking out loud) It feels a bit irregular..hmmm
If you have any discomfort I need you to tell me please..
(She starts to stress and hyperventilate)
(Comforting) Hey hey hey, easy ok?
We don't know yet what it is... It may aswell be something simple.
Easy, I need you to calm down...
You're breathing to fast and that's gonna make you dizzy....
Deep breaths.....breath with me...in.....and out......in.....and out .....
That's it.....
(Professional) I'm gonna palpate one more time, I need you to stay calm please.
(Thinking out loud) Hmmmmm...ok.
Let's get back to the desk so we can discuss the next step.
(Wait a sec)
(Back at the desk)
(Calming her) Now I'd like to get you an ultrasound...
(She panics) Don't panic .. it's a painless procedure... And from there we'll know what's next ok?
(Rethoric) What could it be?
I don't want to jump into conclusions yet.
(Nice comforting worried) Just try to stay calm please.
Let me write you a prescription...
(Reverb thoughts concerned) I'm really worried about her...I do not like at all how that mass feels.
(Reverb feeling sorry for her) She looks so worried and no wonder....
(Reverb) Maybe I could get her that ultrasound after my last patient... I'm so tired though....I was supposed to go home and relax a bit. But poor lady..
(Rethoric) (Seeth) Curse your oversized heart (insert asmrtist name), ugh! Alright....
(End of Reverb)
(Thinking) Ummmm....
(Being nice) Look, I have only one more patient after you... If you'd like to wait... I could take you to the ultrasound room after and get the procedure done...
(Rethoric) Is it late for me?
(Lying to be nice) Nah, I was gonna do some paperwork after, but I can always do it tomorrow, so don't worry.
(Comforting) Hey, look at me....worrying is not gonna help... It could still be something benign..... so try to stay calm please?
Thanks.
(Calling your assistant) Anna?!
She's gonna wait in the waiting room until after the next patient.....
Could you please give her a tea with some honey?
Thanks.
Oh and, send in the last patient please.
(Talking to the patient again) Drink it please...the honey will prevent your pressure from falling after all that stress.
Alright.
(Voice fades away) Come in please....Hi, I'm doctor (insert asmrtist name).....

Hello! I’ve been researching tirelessly to try a new diet and I’ve decided to do animal based. I was going to try carnivore, but I have noticed that my body (and especially digestion) feel great when I’m eating carbs and fruit daily. Plus, I have hypothyroidism, and I know a high-protein diet would be amazing for me.
I am specifically asking about these supplements, as I do not live anywhere where I can easily access raw organs and wanted to try Heart and Soil as an alternative. I am also willing to try other supplements as well.
I see that there are a few supplements for organs. Any suggestions? Beef organs? Any recommendations for other supplements (I suffer from weight gain, asthma and allergies, dry skin, brain fog, hypothyroidism, fatigue)? Can you tell me about your good experiences with it, or even bad?
Thank you for all of your help. Super excited.

Wixela contains lactose Lactose is commonly used as a carrier in dry powder inhalers (DPIs) for asthma. However, not all asthma inhalers contain lactose. Here’s what you should know:

• Lactose in DPIs: Lactose is found only in DPIs, which are one type of inhaler used to deliver medication to the lungs¹. It’s used as a carrier to help transport the active drug into the respiratory system.
• Milk Allergy Concerns: For individuals with a milk allergy, there is a concern about potential contamination with milk protein when using DPIs that contain lactose¹. This is because lactose is derived from milk and may contain trace amounts of milk protein.
• Metered-Dose Inhalers: If you have a severe allergy to milk, you might want to consider using metered-dose inhalers (MDIs), which do not contain lactose¹. MDIs are an alternative to DPIs and deliver medication through a pressurized canister.
• Consult Your Doctor: It’s important to consult with your doctor if you have concerns about lactose in your asthma inhaler, especially if you have a milk allergy. Your doctor can advise whether switching to a different type of inhaler is possible and safe for your specific condition¹.

Remember, managing asthma effectively involves using the right medication and inhaler type that suits your health needs and considering any allergies or sensitivities you may have. Always discuss with your healthcare provider before making any changes to your asthma treatment plan.

Please note: I've mentioned some products and brands here just because I use them regularly in my work. Nothing has been received for their references in this article.

This is a simplified step-by-step guide to help dog owners understand the steps towards allergy diagnosis and management. Unless the logic behind the steps are communicated properly by the vet, I understand that the process may appear slow, frustrating and not always clear. It is important to keep a good dialogue with the vet throughout the process and not to expect a quick-fix after the first consultation.
Also note that each case is handled differently based on many factors such as the owner's financial limitations, country-specific norms and the veterinarians habits and experiences. Please note that this is just an example on how I myself approach allergic dogs. Other veterinarians may have completely different routines that works for them.
Common presentation:
Allergies typically begin to develop in dogs between the ages of 1 and 3 years old and usually present with one or more of the following symptoms:

• Itching and/or skin redness.
• Licking of legs and paws.
• Recurrent ear issues.
• Anal gland issues/butt scooping.
• Gastrointestinal symptoms such as diarrhea and gas.

There are plenty of differential diagnoses for each of these symptoms. For the sake of simplicity we must assume other conditions have already been ruled out, otherwise I would probably have to write a small book.
1: Anti-Parasitic treatment
Even if I strongly suspect allergies, I usually always start out an allergy consultations by ruling out parasitic infestations. A skin scraping can be performed and investigated under the microscope, but a negative skin scrape does not rule out parasites; it only rules out parasites at that small patch of skin where the sample was taken. It's a simple and cheap treatment, so if the issue happens to be parasitic it will save the owner a lot of time and money. If the symptoms are severe, I provide anti-itching drugs for a few days while the trial anti-parasitic treatment has time to work.
(Hypothyroidism can also cause allergy-like symptoms and should be ruled out (blood test) before initiating a full allergy investigation.)
2: Hypoallergenic diet trial:
If the symptoms are still present after anti-parasitic treatment course, I start the dog on a prescription Allergy diet for 8 weeks. We use Royal Canin Anallergenic since it's the most extensively hydrolyzed diet available. Hydrolyzed diets contain proteins that have been chemically 'chopped' into tiny subunits, so small that the pet's immune system cannot recognize them as allergens. Since they are not recognized by the immune system they will elicit no allergic reactions. During the food trial it is important that the dog ONLY eats the prescribed diet and avoids everything else, including treats and human foods. If the dog is severely affected I will provide anti-itching medicines for a few weeks at the start of the food trial, but it is important that the medicines do not mask the effect of the food change for us to know what actually worked.
If the symptoms disappear after the 8 week allergy trial diet, then great, we may conclude that food is the cause of the pet's allergies. I will then usually do elimination diets to figure out what types of food the dog actually tolerates. Some dogs may have to remain on prescription allergy diets for the rest of their lives. Some vets perform a food challenge test (Back to the diet they reacted on previously) after symptoms have cleared to check for recurrence as a way to confirm their diagnosis.
FOOD ALLERGY BLOOD TEST: These tests are somewhat controversial as they are NOT tools for diagnosis or identifying specific food allergens. However, they can be useful during a food trial in determining what protein sources the dog is less likely to have an allergic reaction to.
3. Environmental allergy screening + trial treatment.
If the allergy symptoms are still present after 8 weeks of prescription allergy diet, the cause of the allergy is more likely to be environmental (or both). At this point I usually recommend doing a blood test screening or panel against specific environmental allergens, such as pollen or mites. I always offer to do the blood test during step 2, but many clients prefer to go stepwise.
While waiting for the blood results I usually initiate treatment with Cytopoint injections. Depending on the severity I might add Apoquel short term for relief as it is very quick-acting and effective drug. For very severe cases corticosteroids might be required. I prefer Cytopoint for long term use over Apoquel and (especially) glucocorticoids due to having a more specific mechanism of action, while the alternatives are more broad-acting immuno-suppressive drugs. However, each patient responds differently - Finding the ideal treatment is usually a case of trial and error and there is no one-size-fits-all solution. Sometimes a combination is required.
NOTE: Neither Cytopoint or Apoquel cure allergies. They provide relief to the pet by blocking some of the symptom's pathways. However they are still very important medicines for improving the quality of lives for thousands of pets with allergies.
\ Cytopoint: Injections lasting 4-8 weeks.*
\ Apoquel: Daily tablet or chewable.*
4. Immunotherapy:
Immunotherapy is the closest we currently get to 'curing' environmental allergies. Please note that immunotherapy has nothing to do with food allergies which can only be managed nutrionally.
The results from the blood panel previously mentioned can be used to create a custom solution containing the most important allergens specific to the dog. The solution is injected or given orally in gradually increasing concentrations. This procedure desensitizes the immune system to said allergens, alleviating the symptoms over time.
It is worth noting that approximately 50% of patients will respond excellent to immunotherapy treatment, 25% will have good response, and 25% will not respond at all. Immunotherapy is no immediate relief and it may take months before any effect is observed. Concurrent treatment is usually necessary for symptom relief. Glucocorticoids should not be administered during immunotherapy as it will considerably decrease the success rate.
Additional (environmental) allergy management tips:

• Regular baths: For pets with environmental allergies, regular washing will remove allergens from the fur and may alleviate symptoms. Bedding, blankets etc in daily use should also be cleaned regularly.
• Allergen-neutralizing spray (such as Allergone): These products bind to proteins inactivating their effectiveness as allergens, preventing them from becoming airborne indoors and making them easier to clean. Allergone can be sprayed anywhere (beds, couches, blankets, carpets etc.) and is long lasting.
• Symptom Tracking: For seasonal allergies, symptom tracking can be very valuable. If you learn what months of the year the allergy starts, treatment can be initiated beforehand as a preventive measure. Preventing seasonal flair-ups will potentially save you veterinary expenses and your pet a lot of suffering.

I have posted previously about my history. The short story is: 4 pregnancies, 1 live birth, no living children (that is really depressing math!). RPL panel normal, I have endometriosis (diagnosed via Receptiva), doing IVF. Like many here, I get pregnant really easily but cannot seem to get out of the first trimester.
After each of my losses, my RE has done chronic endometritis (CD-138) testing. Every single time we have tested for CD-138, it has come back positive, even when testing post abx course. I have also had a hysteroscopy wherein we removed some "polyp-like" benign structures. The polyps came back positive for CE. I have done the EMMA/ALICE four times: 1 time my biome was perfect, 2 times it showed an overgrowth of a reproductive tract pathogen (they are commonly present but I had a disbyosis), and 1 time it showed absolutely nothing. I have taken Azythromycin x2, Amoxicillin, Clindamycin, and Doxycycline in the last 18 months.
My transfer protocol for my last pregnancy included prednisone, loratadine, aspirin, and famotidine (in addition to PIO and estrogen). It went great, until we miscarried and had a massive SCH at 9-10 weeks, right around the time that I started to taper the prednisone.
I am so fucking tired and really at a loss for what to do next. Has anyone here done any alternative treatments for recurrent CE? Like an endometrial infusion? Or a triple antibiotic regimen? I am not convinced this is even an "infection" but really just an inflammatory issue.
I do NAC cycling to reduce inflammation, eat well (high fiber, tons of veggies), limit caffeine and alcohol, take probiotics (oral and vaginal), meditate, exercise, go to therapy. I cannot make too many "lifestyle" changes without damaging my mental health, which is unfortunately at an all time low, coming up on two years of trying since the death of my son.

I have posted previously about my history. The short story is: 4 pregnancies, 1 live birth, no living children (that is really depressing math!). RPL panel normal, I have endometriosis (diagnosed via Receptiva), doing IVF. Like many here, I get pregnant really easily but cannot seem to get out of the first trimester.
After each of my losses, my RE has done chronic endometritis (CD-138) testing. Every single time we have tested for CD-138, it has come back positive, even when testing post abx course. I have also had a hysteroscopy wherein we removed some "polyp-like" benign structures. The polyps came back positive for CE. I have done the EMMA/ALICE four times: 1 time my biome was perfect, 2 times it showed an overgrowth of a reproductive tract pathogen (they are commonly present but I had a disbyosis), and 1 time it showed absolutely nothing. I have taken Azythromycin x2, Amoxicillin, Clindamycin, and Doxycycline in the last 18 months.
My transfer protocol for my last pregnancy included prednisone, loratadine, aspirin, and famotidine (in addition to PIO and estrogen). It went great, until we miscarried and had a massive SCH at 9-10 weeks, right around the time that I started to taper the prednisone.
I am so fucking tired and really at a loss for what to do next. Has anyone here done any alternative treatments for recurrent CE? Like an endometrial infusion? Or a triple antibiotic regimen? I am not convinced this is even an "infection" but really just an inflammatory issue.
I do NAC cycling to reduce inflammation, eat well (high fiber, tons of veggies), limit caffeine and alcohol, take probiotics (oral and vaginal), meditate, exercise, go to therapy. I cannot make too many "lifestyle" changes without damaging my mental health, which is unfortunately at an all time low, coming up on two years of trying since the death of my son.

I have mild allergies to pollen, hazelnuts, most pets, and dust. In my day-to-day, this was never a bother until adulthood.
Pears and unripe bananas make my gums hurt, my tongue itch, etc but I thought that was normal, until I looked it up and found out it wasn't. Turns out I have oral allergy syndrome. Like a lot of people with OAS, I'm also sensitive to certain other foods due cross-contamination. I don't have a soy allergy so tofu doesn't bother me but soy milk does. Oat and rice milk are the best milk alternatives for me, but they're also the most expensive.
I recently switched from vegetarian to vegan. Now if only my body would agree with my choice.
I'm worried I may be developing an allergy to nuts now. Eating roasted peanuts makes my gums ache. Just what I need-- a vegan who can't eat raw fruits or nuts.
I recently made an appointment with my allergist to figure out what my allergies currently are and how to deal with them.

Hey all!
Can’t remember who, but to the person that called out my previous post, thank you! Forgot to use my alternate account for this lol.
Anyways, I have a single guest, 0 reviews requesting to book my Airbnb, an ADU on the property, for 2 weeks. The only thing is they mentioned they have severe cat allergies and long haired dog allergies. Although my place has a no pet policy and I’d like to say we do a thorough cleaning after each booking, I can’t help but worry for the following reasons:
1) We have stray cats that hangout around the property occasionally, specifically in our backyards. Can’t guarantee that’s their hairs have someone slipped into the ADU or are scattered around the backyard of the ADU.
2) We bought a couch that was previously owned on fb marketplace, and the previous owners had a dog. We did a deep cleaning of the couch but still occasionally find a dog hair or two whenever we clean the couch after each booking.
3) Who knows if our previous guests have interacted with pets right before staying at our airbnb, and maybe tracked some pet hairs into the home.
I figure if I caution the guest about what I mentioned above, maybe it should cover me legally if he accepts the booking.
Would just letting him know via app messenger be enough and are there other ways to cover myself, or should I just not risk it?
TLDR: I have a single guest with severe cat/dog allergies requesting to stay at my no pet policy Airbnb. I’m afraid that no matter how much I clean there is always a chance some cat or dog hairs can wander into the home. If I caution them with this does it cover me, or should I just not risk it?

Hello, I'm travelling to Toronto for a wedding in June and am hoping they have an alternative to Alpro Growing Up toddler Oat milk. Does anybody know?? He has a milk allergy and can't drink soya either annoyingly so am trying to prepare in advance travelling with my 2yr old...

Introduction:

In the realm of alternative medicine, homeopathy stands as a unique and often misunderstood practice. Originating in the late 18th century, homeopathy has garnered both skepticism and praise for its principles and purported effectiveness in treating various ailments, including allergies. In this article, we delve into the fundamentals of homeopathy and explore its mechanisms in addressing allergies.

What is Homeopathy?

Homeopathy is a holistic system of medicine founded by Samuel Hahnemann in the late 1700s. At its core lies the principle of "like cures like," meaning that a substance that causes symptoms in a healthy person can be used in diluted form to treat similar symptoms in a sick person. This principle is akin to the concept of immunization, where a small dose of a disease triggers the body's natural healing response.

How Does Homeopathy Work for Allergies?

Allergies occur when the immune system overreacts to harmless substances, such as pollen, dust, or certain foods, leading to symptoms like sneezing, itching, or congestion. Homeopathy approaches allergies by stimulating the body's self-healing mechanisms rather than merely suppressing symptoms.
1. Individualized Treatment:
One hallmark of homeopathy is its personalized approach to treatment. Homeopaths conduct thorough consultations to understand the unique symptoms and constitution of each patient. By considering the individual's physical, emotional, and mental state, homeopathic remedies are tailored to address the underlying causes of allergies, not just the symptoms.
2. Dilution and Succussion:
Homeopathic remedies are prepared through a process of dilution and succussion (vigorous shaking). While the dilution renders the original substance virtually undetectable, proponents of homeopathy believe that the essence or energy of the substance is retained. This process is thought to enhance the remedy's therapeutic properties while minimizing any potential side effects.
3. Strengthening the Vital Force:
In homeopathic philosophy, illnesses, including allergies, are believed to stem from an imbalance in the body's vital force or life energy. Homeopathic remedies aim to stimulate and strengthen this vital force, enabling the body to overcome allergic reactions naturally. By addressing the root cause of allergies, rather than just suppressing symptoms, homeopathy seeks to promote long-term healing and resilience.
4. Minimal Side Effects:
One of the perceived benefits of homeopathy is its gentle nature and minimal side effects. Since homeopathic remedies are highly diluted, they are considered safe for use in people of all ages, including infants and pregnant women. This makes homeopathy an attractive option for individuals seeking natural alternatives to conventional allergy treatments, which may carry risks of adverse reactions or dependency.

Conclusion:

While homeopathy remains a subject of debate within the medical community, many people continue to turn to this alternative approach for managing allergies and other health conditions. Whether viewed as a placebo effect or a legitimate therapeutic modality, homeopathy offers a unique perspective on healing that emphasizes individualized care, holistic principles, and the body's innate ability to heal itself. As with any medical treatment, it's essential to consult with qualified practitioners and approach homeopathy with an open mind and critical awareness.

During a consultation with a laparoscopic surgeon, you can expect the following:

1. Medical History Review: The surgeon will review your medical history, including any previous surgeries, medical conditions, medications you are taking, and any allergies you may have. This information helps the surgeon understand your overall health and assess your suitability for laparoscopic surgery.
2. Physical Examination: The surgeon will conduct a physical examination to evaluate your current health status, focusing on the area of concern related to the surgery. This examination helps the surgeon assess the specifics of your condition and may include checking vital signs, palpating the abdomen, or performing other relevant tests.
3. Discussion of Symptoms: You will have the opportunity to discuss your symptoms or the reason for seeking surgical treatment. This discussion allows the surgeon to understand your concerns, clarify any uncertainties, and determine the most appropriate course of action.
4. Explanation of Procedure: The surgeon will explain the laparoscopic procedure in detail, including how it is performed, the expected outcomes, potential risks and complications, and any alternative treatment options available. This information helps you make an informed decision about whether to proceed with the surgery.
5. Questions and Answers: You are encouraged to ask any questions you may have about the procedure, recovery process, potential risks, or any other concerns you may have. The surgeon will provide clear and comprehensive answers to ensure you fully understand what to expect.
6. Preoperative Instructions: If you decide to proceed with laparoscopic surgery, the surgeon will provide you with preoperative instructions to follow before the surgery. This may include dietary restrictions, medication adjustments, and other preparations to ensure a smooth surgical experience.
7. Follow-up Plan: After the consultation, the surgeon may schedule additional appointments for further evaluation, preoperative testing, or surgical planning. They will also discuss the postoperative care plan and schedule follow-up appointments to monitor your progress after surgery.

Overall, a consultation with a laparoscopic surgeon is an opportunity for you to learn about your condition, explore treatment options, and establish a plan of care tailored to your individual needs and preferences. It's essential to communicate openly with your surgeon and ask any questions you may have to feel confident and informed about your decision regarding surgery.

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Understanding the Essence of Herbal Medicine
Herbal medicine, an ancient practice dating back centuries, revolves around the use of plant extracts to promote health and well-being. Unlike conventional pharmaceuticals, which often come with a barrage of side effects, herbal remedies offer a gentler, more holistic approach to healing. Pharma Botanica understands the intrinsic connection between nature and wellness, crafting products that harness the synergistic benefits of botanical ingredients.
Balancing Hormones Naturally
Hormonal imbalance can wreak havoc on both physical and emotional well-being, disrupting everything from mood to metabolism. Fortunately, nature provides a bounty of herbs renowned for their hormone-balancing properties. Pharma Botanica's herbal formulations are meticulously crafted to support hormonal harmony, helping individuals find equilibrium in their bodies. From chasteberry to black cohosh, these natural remedies offer a gentle yet effective approach to hormonal health.
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Allergies can cast a shadow over daily life, turning simple pleasures into sources of discomfort. Pharma Botanica recognizes the need for natural solutions to combat allergic reactions. Through the power of herbs like stinging nettle and butterbur, their allergy-focused formulations provide much-needed relief from sneezing, itching, and congestion. By addressing the root cause of allergic responses, these herbal remedies offer a holistic approach to managing allergies without the drowsiness and other side effects associated with conventional antihistamines.
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In conclusion, Pharma Botanica's commitment to herbal medicine, coupled with their focus on addressing hormonal imbalances, allergies, and heart health, positions them as a beacon of holistic wellness in Australia. With their natural remedies and botanical expertise, individuals can reclaim control over their health and embrace a more vibrant, balanced way of living. Experience the difference with Pharma Botanica and embark on a journey to wellness rooted in the healing power of nature.
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Chapter 1: the event
It was the fall of my intern year as I bean my off service trauma rotation. This month was ubiquitously notorious for being the most labor intrusive and least productive rotaion of our emergency medicine program. Knowing this I entered with the intention of simply surviving the month.
Another intern and I let’s call them A for sake of ambiguity, we’re the first emergency medicine residents to roste on the trauma services that year. A shaky start would be an understatement. In the words of chance the raper “like my grama with the Parkinson’s playing operation.” Would better describe it. Medically we did well. We were very competent and completed our work daily, but communication and coordination was non existent. Our Cheifs had informed us that Tuesday was our day of and the Trauma cheif residents had minimum communication with us, or our Cheifs as it seams when A and I did not report on Tuesday they sternly made their dissatisfaction known.
I have struggled with insomnia sense the age of 10. Had 2 sleep studies by this point in my life and been prescribed nearly every sleeping aid on the market. The 80-94 hr work weeks of our trauma rotaion only worsened my insomnia. My lack of sleep likely contributed to a less than prime adaptive immune system and 2 days out of my trauma rotaion I contracted strep like symptoms with associated nausea, requiring me to call for a sick day the next day. No the first day that I felt too ill to work. I was not fully aware of the reporting process. I reported to my Chiefs, but I did not believe I could come to work tomorrow with amble time and notice, however I was somewhat delayed in letting their Cheifs know, because the surgical chiefs rotated every few days and I did not know who my was going to be the next day. The second day which I had to call out sick I was able to locate the cheif for the next day and reprot according to our university’s protocol, which requires that if a resident feels they are not fit for work they must not come in and the university must have staff coverage without any fear or implementation of punitive actions.
I had finally survived to the last week of my trauma rotaion and I could see the light at the end of the tunnel. What I could not see was the pile of stress, shitty diet, lack of mental well ness and sleep deprivation which I was pushing down to reach the light. By this time I had seen a psychiatrist regularly for sleep medication. I had mentioned to him that I had been experiencing more stressed lately and feel that I might be depressed. he reassured me that it was likely only due to my circumstances, given the difficulty of the trauma rotation and wish to reassess once the rotation was over. Looking back I had to fill the habit of drinking more than I usually do. My only on nights before I have days off became 1-2 beers every other night. All of this repressed unhealthy shit finally pushed bad on September 23rd. That night I was at work even later than usual, I stayed up later than usual and couldn’t seem to fall asleep. With the stress of only having minimal sleep and knowing I only had 2 more days of trauma left, I took an extra dose of my sleeping medication.
I opened my eyes to the fighting sight of sun beaming in my window and I instantly knew I was late. (Sense I hadn’t seen the sun in a month) . Due to my need for scrupulous sleep hygiene I have been sleeping with my phone of and away for me. I rushed to grab it and watched as the little Apple logo seamed to glow on the screen for an eternity. Then in conjunction with its fading I saw 3 missed calls from my director, a text from college A and 2 missed calls from the surgical director. Still, I was able to calm myself, knowing that resident A had been late to this rotation by a few hours 2 other days and nothing came of it. I called my director back and he asked me to report to his office where I was greeted by my director, my coordinator and another emergency medicine facility.
With the only explanation of: “we just want you to get better”, I was handed a letter, to my relief it did not entail my termination, but a declaration of administrative leave and a requirement to undergo an evaluation at a well known university in Florida.
Lake any other savvy millennial, I did my research. By research I mean numerous google searches and screeches thru the depts of redit. To my dismay I discovered that in order for a residency program to fire you, they must first initiate an administrative suspension. I would soon find out however, being terminated would have been a delightful outcome compared to what ensued.
I spend the next few weeks in the wallos of regret and depression. I indulged in higher qualities of alchohol then I ever have before. I all but ceased communing with peers, and abruptly stoped any physical activity I had once enjoyed. Frightened as I was I was ensured, it will be ok “we just want you to get better”
Chapter 2 The evaluation : guilty until proven innocent I did exactly as instructed and scheduled an evaluation, I supposed that this was either a mental evaluation to assess if I’m fit for work with plans of termination or it actually was an evaluation to better treat my insomnia. To this day I regret my ignorance, and wish I had researched the process more. The Hindi / sand-skrt idea of Hamsa 🪬 is that in order to do any good you must have full knowledge or else good intentions can result in harm. I truely believe my director had good intentions, however but him and I did not have full knowledge of the nature of this evaluation.
Looking back see how easily I could have avoided my troubles by asserting legal aid at this point or even by researching this evaluation process more in depth. If one searches impaired practitioner program which I now know this evaluator works for, the search entire will populate 5 or 6 layferms along side their home website and there is a valid reason for this.
If one every finds themself in this process I employ you to bring a DSM to your evaluation or at least be familiar with the most common use disorders in the DSM-5, because your evaluation will turn into a dance of questions where the evaluator attempts to trap you in a round about way to stating something that may qualify for one of the diagnosis. I have provided an image from the DSM-5 below outlining AUD, which the evaluator concluded that I had the most severe from:
Image
Example***** Here are 10 examples of how he fraudulently assessed me taken directly from his assessment note.

1. Evaluator: Have you ever stoped drinking in the last year.

Me: yes I stoped every week day, I was only drinking on the weekends, until two weeks ago.
-Evaluator uses stoping and starting every week to qualify for 2 or more unsuccessful attempts to stop in the last year “There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.”

1. Evaluator Have you ever had withdrawal symptoms

Me no
Evaluator Well Have you ever had a hangover? You know that’s a from of acute withdrawal
Me: yes in college, I had a few but that was years ago and I’m pretty sure the pathophysiology is different.
Evaluator uses this to count for withdrawal symptoms even tho is was more than a year ago

1. Evaluator: Have you even taken your sleeping medication on a day or night which you drank? Me: Yes, I took my prescriptions are prescribed but I never drank close to bed

Evaluator: qualified this as dangerous behavior with alcohol (where the DSM gives examples such as unprotected sex and drunk driving). The sleeping medication I was on is not a benzodiazepine therefore it is not deadly with alcohol. I personally have seen many patients in the ED who have taken their entire bottle of the medication and drank copious amounts, we just monitor them over night and rehydrate them

1. Evaluator Has anyone told you you drink to much or been worried about you Me: No I drink much less than my friends

Evaluator what about your girlfriend? Me: well she actually doesn’t drink at all she doesn’t like it. She often buys me beer for The Weeknd’s tho. One time we went to a movie and she got a little irritated because I waited for beer then complained about them not having any craft beer. So she said, “you couldn’t have just said no” and drank something else. However, she apologized after and said it’s worth waiting if it’s my only day off.
Evaluator said this qualifies for continued drinking despite causing significant relation consequences, ie divorce.

1. Evaluator : you have sleep issues I hear, and your chart says you’ve had depression in the past, don’t you know that alcohol can effect your sleep and mood Me: yes that’s why I never drink within 3 hours of sleep.

Evaluator but you knew this and still drank
Evaluator: qualifies for drinking despite unwanted physical or psychological effects (this should be recurring to effects the alcohol is causing, I have had insomnia sense the age of 10 long before I took my first sip)
7 evaluator you were late for work and told my you had a drink the day before
Me: Yes but I was late because I didn’t sleep and took double my sleeping meds, I will never do that again
Qualifies for 2 significant work or school issues in the past year ( a therapist and other psychologist ensured me that being late on or a few days doesn’t count they typically are getting fired or failing) ( moreover, this would assume I was late do to drinking it’s self and also assume if happened more than once)

1. • Alcohol is often taken in larger amounts or over a longer period than was intended

He never once asked anything related to this question yet said I qualified in his final report 9. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. The evaluators logic here was sense I was late for work and I had 2 beers the day before I must be taking long to recover from it (this is assuming I missed due to alcohol)

1. Tolerance drinking more to require the same effect: this he checked as true in his final note however it was never even discussed in our evaluation. I did mention to him that I’ve been drinking more than I had earlier in the year frequency wise, but they said nothing to do with quantity or needing more.
   
2. Wanting to drink so bad you can not think of anything else: this is the only qualification of SAUD my evaluator said I did not have.
   

Moreover, without legal help I was not aware that I could obtain a second evaluation or even oppose going to get evaluated at all, but that wouldn’t have mattered seeing I still thought this was for my health and wellbeing as seen when I was asked why do you think you are here to today, to which I replayed “so that I can be evaluated to see what is needed to get back to work”.
To maks the ordeal more infuriating the evaluator continues to ingratiate himself and lie through the process telling you, “it will be fine as long as you are 100% honest”, “anything you say in here is between you and me” or “you slipped up once with your meds, I know your residnecy program they will probably just want a few more out patient tests”
Two weeks later I received a phone call right before I left for an out of state vacation to visit my nice for her birthday. During the call I was informed that I would be required to complete a partial hospitalization program (PHP) lasting “6-10 weeks” which would coast from 15-50 grand not including doctor visits or housing which is billed separately. I suppressed this inconvenience, enjoyed my vocation and reported when I returned, knowing that I must complete this soon so I may return to work with due to the fact that my payed time off would soon be diminished. At this time I had not yet heard of the organization PRN.
Chapter 3 Guilty till proven innocent: The diagnosis
Shell shocked I arrived to a in patient psychiatric unit and was rapidly cleared to progress to treatment without detoxification. During my 90 day of forced rehabilitation I met a few other individuals who were unjustly and fraudulently forced into treatment. I began to look up to one of these such members of the men’s community, who I will refer to as patient X for ambiguity sake.
Unlike me patient X did have alcohol use disorder. He spent many clinic days drinking to avoid alcoholic withdraws. The curious component of his story is that he admitted his depravity, saught help and through his own journey became sober. The bodies at be, namely his local physician, Health monitoring program, rejected his personal path to sobriety and forced him to undergo 90 days of in patient treatment before he could practice medicine again. When he checked in to rehab he had been sober for over a year.
Ask for Stories of people from online
As for me I spend many sleepless nights pondering how consuming a legal substance in a moderate amount could throw me into significant legal financial issues. My labs my toxicology, my story and my collateral from colleagues from colleagues all indicated light to moderate alcohol use but my evaluators word stood as the word of God.
More frightening was the director of this rehabs acknowledgment of this. The director who happens to also coincidentally be the evaluator, stated to me as well as to staff on multiple occasions: “ I suggest inpatient treatment for everyone who is reported”. “This is safer for me not to miss anyone who could harm patients, and I figure there must be a reason someone reported them.”
I am still elucidating the reason why I was determined guilty and proven innocent, however I can say from my 90 day stent that the majority of the patients at this rehab needed to be there. This program is saving lives of both providers and patients, however it is destroying the lives of those wrongfully accused.
Chapter 4 your lisense rehab or jail : Upon arivil I was sent to a detox hospital underwent a medical examination and was “one of the lucky ones” who required no detoxification and could report directly to PHP. Like everyone else, I spent 90 days in a PHP, being as 6-10 weeks is simply a lie they tell patients to decrease the change of resisting the treatment. When discussing the topic one therapist sated “if we told patients 90 days they would never come.” She then attempted to justify the treatment by outlining the story of a patient she had called who “didn’t make it to treatment” and killed themselves”. It is my belief that it is not the lack of PHP which impelled such professionals to take their life, but them realizing that they now will be obliged to undergo 90 days of PHP, 5 years of PRN monitoring with a loss of autonomy and hundreds of thousands of dollars taken from them that induced their hopelessness. For even if these professionals were truly mentally unstable in their addictions, in every case it was only following a phone call where they were informed they must undergo treatment that they took their life’s. By this time I still haven’t the slightest clue what PRN was.
Despite the security these programs provide for many my 6 main issues with them can be summarized in : 1. Kick backs: evaluators are directors of treatment clinics 2. The reported are guilty till proven innocent 3. The price, the overflow of money these places drag in from both patients and state universities is appalling, they charge separately for every visit and test 4. Although they make the claim that they are individualized, they are anything but. Every patient gets the same stay and treatment from the doctor drunk on the job and the one who was late to a shift 5. They force voluntary treatment. remember that friendly evaluator who promised he had your best interest at heart, so you opened up and told him everything about your substance use/ developmental / family history, well if you don’t stay for 90 days he will be “normally obliged” to tip the board of medical off to you.

1. The programs have overstepped their intended jurisdiction. -these programs work well if they function how they were intended at their inception. Cite original purpose. Originally these programs were designed to protect physicians and civilians from impaired practitioners; being healthcare workers who were impaired at work. Over the years, these organizations have extended their authority to encompass individuals with substance use disorders When not at work and also those who are in training to become healthcare professionals. Take for example myself compared to a physician who is impaired at work. A doctor who arrived for duty under the influence would surely benifit from the extensive testing, therapy and accountability enforced via these programs. In accordance the 20,000$ per year cost is appropriate when only making up roughly 7% of their yearly salary vs nearly half of a residents. In my case with my loss of income from employment, coast of treatment and monitoring, this year I will be required to pay 20,000$ to work. Yes, I will be losing money to work. Even if did indeed have a substance use disorder this level of monitoring wouldn’t not be considered appropriate.

Dispite all of the miscomings of this System My time spend in PHP was indeed helpful, as I believe it would be for anyone. Time for exercise, a reprieve from work and weekly counseling. A sample structure of my day to day schedule is provided below for insight:
Structure The general structure of these rehabitation centers is as follows: 1. One week of orientation phase, where you are not allowed in electronics or contact with the outside world world. Therefore, if you’re going, bring some things you would like to read or study. 2. In phase 2, you can use your phone however you cannot leave campus. You must stay in the dorm on campus. These shitty 1 room run down apartments with two other roommates will cost you about $1000 a week, they are required for at least four weeks and they are billed separately, no insurance will help you out here. 3. In phase 3 you can commute to campus if you beg your therapist and live very close. Whether you’re on campus or living off-campus, you are allowed to leave up to four hours per day. If you commute, you’ll be required to take a sober link decide you must Breath, alcohol test into every 6 hours. Like everything else in this program you must pay for this separately, a few hundred dollars a week. You advanced to other phases by completing assignments, however, assignments are limited by required built-in time, intrusive, scheduling, and reviewing. Therefore, if you do everything as rapidly as possible phase 1 will take one week phase 2 will take three weeks.
Every day schedule:
7:30: wake up, report to the front desk to inform them that you haven’t ran away yet and take and prescribed medications. They keep all your medications and require that you report to take them; for me this was antidepressants in an attempt to dispel the depression I contracted from being forced into treatment and whatever off label medication they were attempting to treat my ADHD with, since control medications were forbidden.
8 am: community group assessments This consisted of other patients presenting their assignments amongst the large group, on the weekends this was often an hour later and 12 study regularly took the place of assignment presentation.
10 am: process group. This was a two hour group therapy session with 6 to 12 other professionals in a therapist and training or occasionally a licensed mental health therapist.
1 pm: recreation This was generally about an hour of some sober themed craft or activity. Once a week this time slot was used for yoga.
2 pm: this was another time slot used for patients to present assignments as well as for individual therapy sessions. Each patient had one individual therapy session lasting 30 minutes per week.
3pm: This was time allotted to work on assignments or go to the gym on your sex specific scheduled gym day.
5pm: this time was used for guest speakers or another 12 step study group.
6 pm : this was generally an off-campus 12 step group
10 pm: report to the front desk and let them know you still haven’t ran away and take and Medication which are prescribed to take at night, then return to your cot bed in your room with 1-2 other roommates.
I found the community to be one of the most beneficial aspects of the PHP program. I was in a cohort of chill ass professionals of the same occupation who were always there to help each other.
Assignments The curriculum of the PHP consisted of assignment based on every step of the 12th step program. Generally, a patient would be required to complete an assignment on their own, review it with other patients, then faculty and finally present the assignment in front of the whole treatment group. You’re only given one assignment at a time and there are multiple steps to each which all requires scheduling this ensures that no matter how determined a patient is a full 90 days of treatment is required to complete all the assignments.
AA structure -the obsolete nature of AA has been verified in numbers studies, but I will refrain from divulging here and lend that endeavor to Dr. Lance Dodes very thorough discussion on the subject,in “the sober truth “
In all sincerity, if I truely did have a severe use disorder this experience could have been life saving. I only wish I could have used my 50 grand for someone who has spent their life time In addictive without reprieve. My first conversation when I was given my phone back was how I wish my father could be able to attend this PHP.
Chapter 5 reporting and PRN Self reporting What they ask you What you should tell them
There’s a third-party agency called professional resource network. Every state has their own. This agency works as a liaison between you and whatever credentialing service your occupation requires. Essentially they ensure your monitoring after treatment. Stake governments and licensing boards trust them, mainly because they monitor with the highest level of intrusiveness. This alleviates much work for state governments and licensing boards because once an individual is being monitored by a professional resource network, then they are deemed appropriate for duty and no further investigation/litigation needs to occur, as long as the monitored individual completely complies.
Because I was never impaired at work I was never reported to this agency. The general workflow of things someone would report you to professional resource network, then the resource network would contact you, and then you would be required to report for an evaluation at a treatment center, which would inevitably result in a suggestion I’ve treatment at that given treatment center. In my case I was sent to the treatment center without PRN being involved. Thus, two weeks into treatment. I was notified by my therapist that I needed to call PRN and self report. I attempted to resistance given that I did not have a problem and was not individually seeking help. I asked what happened if I didn’t self report. I was told that in order to stay in the treatment program I had to report to PRN. This meant either I report to PRN or I get kicked out of the treatment program and lose my job.
When you report to PRN they will ask you why you are in treatment. They will then list off every substance imaginable, asking you if you have ever tried the substance and when your last use was. Ultimately, they will obtain your discharge information from your treatment center, so it is in your best interest to report only what was found in your biochemical testing. If it wasn’t in your hair, I would argue that you don’t have a use disorder regarding that substance and it’s not relevant. I don’t believe it’s important for them to know that you smoked weed when you were 12.
Chapter 6 The contract:
Before being discharged from a treatment facility, a professional resource network will have you sign a contract. A little known fact which I was oblivious to is that contracts can be negotiated. Though this isn’t it possible, it is highly improbable that you can negotiate your contract since PRN has a power to delay your clearance to return to work.
Contractor almost never personalized, and I have not heard of a contract which is not a five-year agreement. You will sign releases of information so that PRN has access to all of your information which was gathered at the treatment facility. You must have a therapist, psychiatrist, primary care, doctor, and a addiction, medicine psychiatrist. You assign releases of information for all of them. You will be required To commit to: 1. three mutual aid meetings a week which you must log. I log smart recovery meetings. 2. Weekly therapy sessions with an approved mental health therapist from their list 3. Monthly doctors appointments with an addiction medicine psychiatrist 4. Yearly appointments with a primary care physician 5. Monthly appointments with a psychiatrist 6. Daily check-ins on a random drug testing app ( you will agree to weekly urine tests, a peth test 4 times a year, a hair test twice a year and a little caveat that says anything else they deem, clinically reasonable) 7. Quarterly update reports which you are required to obtain from a workplace monitor, therapist, addiction, medicine, psychiatrist, primary care physician and any other doctor you are seeing. 8. You must upload all of your prescriptions into a mobile application every single time you get them refilled and are not allowed to take them until they are approved. 9. Attendance of a PRN group via zoom. This is a local group you are assigned along with other monitored practitioners. There is a fee of roughly 130$ a month to attend this required group. For me all of these requirements coast around 20,000 a year. If you ever have a positive test even if it is the result of contamination from rubbing alcohol or unintentional ingestion of alcohol/ allergy medication your contract will rest to 5 years from the time of positive test. Once your five year contract is completed, you must ask to be released from monitoring. At that point they will search for any reason to keep you under monitoring. This could be dilute urines, daily check ins or a week where you did not attend mutual aid meetings. Every certification and license which you apply for will likely ask you if you were under a monitoring program/ have been treated for substance use. You must give an explanation and check yes. As far as licensing programs are concerned, if you were under the monitoring of PRN, you are safe, however they group practitioners who have had behavioral issues with practitioners who were diverting drugs from work. Therefore, keep in mind that you will be labeled as a sever addict.
7 Back to work and only work. During treatment your only goal is to return to work, however when you return your experience will be drastically distinct from what you remember. For me, I was now working in isolation. Missing six months of my training meant that no other Resident was on the same rotation as me. My coworkers at all formed friend groups. When I returned I was greeted with much concern for my well being. No one would speak to be about my absence, however everyone knew there is only one reason a resident would leave for 6 months then return. My Accdeemic meetings were consisting of attending telling me “I have a target on my back now” and “ I have to preform even better than others” in the light of my time missed. If this wasn’t alienating enough, the majority of Resident events, sponsored by recruiters and my university revolved around alcohol to which I had to give some excuse to why I can not partake with others. I’m fortunate that I do not have an addiction, because these stressful conditions along with the daunting amount of dead and requirements imposed by PRN are enough to make any addict relapse. While I was at treatment, I was in the dative with Samyr stories a physicians whose addictions got the best of them. Physicians who did not make it to treatment, often taking their own life. These stories were presented as a warning. Your addictions will kill you without our treatment was the message. When, in reality I did not hear one story in which the addiction killed physician. Every physician who didn’t make it to treatment took their life after being told they must report to a treatment facility. Perhaps they knew what this entailed and it was not their addiction or getting caught which caused them to end their lives, but the unmanageable and often unreasonable burden that treatment would put on their lives.
9 How to escape So your fucked your in PRN and should be or you should and now your recovered and want to terminated your contract.

1. You ask to be released early done at 1/2 time ( good luck)
2. You have “good reason” (no one has ever been let out of contract because of this reason, the verbiage is far too vague)
3. You serve all your time and they let you out(maybe, as discussed earlier, they would do everything they can to keep you in your contract as long as your practicing)
4. You can’t practice medicine anymore

10 Layer up butter cup : I cannot emphasize the extent to which legal help is required in this process. You much seek it and seek it early. Lawyers can provide many avenues to you early in the process. Once you have committed to treatment, gone for evaluation or are in a PRN contract , this is very little that you or legal help can do. Spend a few thousand dollars when you are accused and save the 20-30,000 later.
After you have been evaluated if you disagree as I did, then this is the process you must undergo. 1. Hire a occupation, defense, lawyer 2. Prove you don’t have an addiction, this is done by having an alternative evaluator with similar credentials state that either you don’t have an addiction or that PRN’s level of monitoring is not medically appropriate ( this will need to be a multi day neuropsychological evaluation, which will cost about $5000). 3. Your lawyer must draft in writing that the medical level of monitoring is not required such as another medical professional and send this to PRN 4. PRN will tattle on you to the board of medicine. 5. The board of medicine will conduct an investigation. 6. At the end or when they believe they have enough reasonable evidence to the board of medicine will suspend your license or claim, you must comply with the PRN contract to practice. 7. At this time your lawyer will defend you in the state court against the board. This is costly but much less than the coast of a 5 year PRN contract 8. If you win you will likely suggest an alternative level of care such as gonna get therapy every week. If you lose, than you wasted a fuck ton of money and are still bound by your PRN contract.
Overall this entire process has coast me Over all coast:
My finances for this year only including PRN and rent are as follows:
120-200$ every week for testing 480-800/ month
65 every week for therapy 195/month
125 every month for PRN group
About 50-69 every month for 2 doctor apts
So at least 745$/month at the lowest
Treatment at the recovery center coast 20,000 for me out of pocket and
I wasn’t payed for 6 months with no FMLA because I am a first year. At the 1 year mark I will have made 26,000 this year after taxes And payed About 29,000 on PRN alone
Rent is 1,000 so that’s 12,000 a year
Just in rent and PRN alone I will be at 26,000- 41,600 -15,600.
I will be in debt by at least 18,000 at the 1 year mark
Coast of treatment center 20,000 (with insurance) For each year of PRN roughly 20,000 Add that to 6 months of attending salary which was delayed due to my treatment time: at least 150,000 Layer coasts along with other evaluations 25,000 Missing 6 months of residency pay 30,000 Coast of 1 year in monitoring: 245,000 Coast of 5 years 325,000
If my case progress to a trail I will require an extra 20,000 in court coasts
Chapter 11 My secondary eval: Dr sushi After I arrived at my treatment center I challenge my evaluation multiple times. Each and every time I was discharged and often accused of alternate mental health/ substance abuse issues to discourage my advances. I was never given the opportunity to undergo alternative assessment, however PRN guidelines state that you can obtain a second option within 7 days of your first. This is a mute point, however, because you will not receive the results of your evaluation until over a week after it is conducted and the second evaluation must be conducted by another PRN hired evaluator of their choosing. During my stay in rehab I contacted PRN multiple times to attempt another evaluation/ legal help. They warned against both stating they were a “waste of money” and “pointless”.
After completing my treatment with the guidance of many addiction, experienced physicians, mental health counselors and psychiatrists recommendations I sought in a secondary evaluation. I chose a highly qualified professional with over 30 years of experience to conduct an extensive neuo psycho social evaluation of me. One that I was sure would be more extensive than the evaluation I received at treatment and more importantly an unbiased evaluation.
The results from my evaluation not only showed that I did not have a substance abuse problem warranting PRN level monitoring, but also that PRN was falling to allow adequate treatment of other conditions such as my ADHD. My evaluation showed my ADHD was not only untreated by PRNs attempt at using non controlled medication, but also in the top 3% most severe presentations of ADHD. My evaluator went on to explain my results by questioning why my treatment center even mandated I undergo neuro cognitive evaluation. The only neurodiverse findings were my IQ, my dyslexia and my ADHD. However, a neuo cognitive examination can be billed separately by treatment centers, therefore they always recommend one.
Chapter 12 Amongst its greed, intrusive nature and faulty accusations, professional recourse network function highly proficiently at the task they were designed to; protective physicians and patients from physicians who are impaired at work. In this domain they save lives, offer second changes and protect the public. When they act beyond their intended jurisdiction by imposing unnecessary monetary demands on practitionersin training, accuse practitioners without proof or act on behavior exemplified outside of a work setting they unjustly and inappropriately attack the week and innocent.
Proposed reform: As a trainee my universities malpractice insurance covers me for mistakes made at work. If a learner mistakenly harms a patient, then the university stands on their behalf. If the learner does something wrong under a teachers direct guidance, then the teacher is at fault. This makes sense logically as well as pragmatically. The state entrusts large amounts of money to hospital systems and universities to train resident physicians. A portion of this money is allocated to malpractice insurance. This should extend to accused impairment.
Suppose a training university was required to cover rehabilitation and monitoring of a resident of whom they claim is impaired. Alternatively they have the option of firing the trainee. This would reduce the number of innocent trainees being accused of impairment, make the process of rehabilitation more fair and provide a better use for tax payer derived dollars, which hospital systems are given to train residents. The truly impaired could still seek help, less false accusations would be made and with the employers having the ability to fire at the moment of impairment, there would be less chance of impairment at work.

I'm looking for a partner for a long-term romantic relationship. More than that, I'm looking for someone to be on a team with me as we work together on becoming our best selves. Someone with a common interest (could be any of a variety of things) that we work to become very talented at together.
I work in tech, and hope eventually to get into security research. I've played piano for over 24 years now (time flies), and play a bit of guitar also. I like cooking and baking. I also like spending time outside and working out.
I'm looking for someone to share some part of my world, and enjoy growing together. Alternatively, share some of your interests that maybe you think we could grow in together.
I'm looking for someone kind and gentle. The world is both a wonderful and terrible place, and I'd like to meet someone who is interested in making it better in some small way.
If you love music, that's wonderful. I would love to jam with you, I would love someone to have impromptu sing-alongside in the car and the shower with. If you play piano, we should play a duet.
Let's work out together? I lift weights most days during the week. Maybe we can go mountain biking and skiing together.
Other important things:
I have made a conscious decision not to drink. One of my family members has kidney disease, and may require dialysis within the next few years. I believe I will live my best life by not drinking. It would be very cool (although rare) to meet someone who also has made a conscious decision not to drink, or would at least be open to considering it. I also don't smoke or do drugs.
Center left politically, horrible dog allergies.
US only please. I'd like to be with you in person as soon as possible. Not looking for an online thing.
Let's chat.

I was diagnosed with vestibular migraines May 6th. I’ve noticed that I have this really weird sensation on the left side of my face..tingling kinda, but more so full..like full in the ear and the lower jaw. No visible headache really…just fullness in the face. When I take allergy meds it lets up a little but it’s been kind of persistent for about a day or so…I was prescribed 25 mg of Topamax, but quite frankly I’m so scared of the side affects..I’m basically fully healed from Bells (happened March 5th) and to be honest, the side effects from Topamax are way too close to having Bells…do you guys suggest anything? Any alternatives or do you think u should just take the darn meds?😩 does anyone experience this type of sensation? I can also kind of feel it in my neck..my doctor thinks it’s a sensory aura because it slightly happens in my fingers and hands on that side too…CT scans are all good..nothing to worry about there…just really curious

Hi! I’m being tested for possible autoimmune/MCAS so nickel and cheaper metals are unfortunately out of the question.
Does anyone know where I can get cheaper hypoallergenic metal splints? I’ve been unable to work because of allergies, POTS, and the worsening hypermobility so Unfortunately I am a bit tight on cash, and can’t get on disability rn. If they are worth the money though, I am willing to try to save up to make the investment.
I’ve tried the plastic splints, and they dig into my fingers because of my squishy skin. They don’t seem to fit right. I require the swan neck type for pretty much all the joints in my fingers as my hyper mobility in my hands is pretty bad.
Also, is it common for insurance to cover metal finger splints? I’m planning on asking my GP to write for my insurance to cover some, but wanted to ask here to see if anyone had any luck.
Any advise or alternative would be appreciated. Thanks!

As a pet parent, choosing the right diet for your dog is one of the most critical decisions you'll make. With the growing Dehydrated Dog Food Market and the various options available, it's essential to understand the benefits and drawbacks of each type of dog food: dehydrated, raw, and traditional kibble. This guide aims to help you make an informed decision that best suits your furry friend's needs.

Understanding the Dehydrated Dog Food Market

The Dehydrated Dog Food Market has seen significant growth in recent years, driven by pet owners seeking healthier and more natural alternatives to traditional kibble. Dehydrated dog food involves removing moisture from fresh ingredients, resulting in a lightweight and nutrient-dense product that retains much of the original nutritional value. This option is convenient, with a longer shelf life than raw food and without the preservatives often found in kibble.

Benefits of Dehydrated Dog Food

1. Nutrient Retention: Dehydration retains most of the original nutrients found in fresh ingredients, making it a healthier option.
2. Convenience: Lightweight and easy to store, Dehydrated Dog Food Market is perfect for busy pet owners and those who travel with their pets.
3. No Preservatives: Typically free from artificial preservatives, colors, and flavors, making it a cleaner choice for your dog’s diet.

Drawbacks of Dehydrated Dog Food

1. Preparation Time: Requires rehydration with water before feeding, which can be slightly less convenient than kibble.
2. Cost: Generally more expensive than traditional kibble, though often more affordable than raw diets.

The Raw Dog Food Trend

Feeding dogs a raw diet has become increasingly popular, driven by the belief that it more closely mimics the diet of their wild ancestors. A raw diet typically includes uncooked meat, bones, fruits, and vegetables.

Benefits of Raw Dog Food

1. High Nutritional Value: Raw food diets can provide high levels of nutrients, enzymes, and vitamins that are often lost in cooking and processing.
2. Improved Digestion: Many dogs experience better digestion and less stool production on a raw diet.
3. Shinier Coat and Healthier Skin: Raw diets can lead to noticeable improvements in coat quality and skin health.

Drawbacks of Raw Dog Food

1. Risk of Bacterial Contamination: Handling and storing raw meat can pose a risk of bacterial contamination to both pets and humans.
2. Nutritional Imbalance: Without careful planning, raw diets can be nutritionally unbalanced, leading to deficiencies or excesses.
3. Cost and Storage: Raw food is typically more expensive and requires proper refrigeration or freezing.

Traditional Kibble: The Convenient Classic

Traditional kibble remains the most popular choice among dog owners due to its convenience and affordability. Kibble is dry dog food made from processed ingredients, often including grains, meat by-products, and preservatives.

Benefits of Traditional Kibble

1. Convenience: Easy to store, measure, and serve, making it the go-to option for many busy pet owners.
2. Affordability: Generally the most cost-effective option, especially for large breeds or multi-dog households.
3. Dental Health: The crunchy texture of kibble can help reduce plaque and tartar buildup on dogs’ teeth.

Drawbacks of Traditional Kibble

1. Lower Nutritional Value: The high-heat processing can destroy many nutrients, requiring manufacturers to add synthetic vitamins and minerals.
2. Potential Allergens: Kibble often contains fillers and grains that can cause allergies or sensitivities in some dogs.
3. Preservatives and Additives: Many kibbles contain artificial preservatives, colors, and flavors that some pet owners prefer to avoid.

Making the Right Choice for Your Dog

When choosing the best diet for your canine companion, consider the following factors:

1. Nutritional Needs: Consult with your veterinarian to determine your dog’s specific nutritional requirements based on their age, breed, activity level, and health status.
2. Lifestyle: Choose a diet that fits your lifestyle and schedule. If you’re always on the go, kibble or dehydrated food might be more practical than raw food.
3. Budget: Factor in the cost of the food and any additional expenses, such as supplements for raw diets or higher-quality dehydrated options.

Ultimately, the best food for your dog is one that meets their nutritional needs, fits your lifestyle, and aligns with your values. The Dehydrated Dog Food Market offers a promising alternative to traditional options, but it's essential to weigh all factors before making a decision. By understanding the benefits and drawbacks of dehydrated, raw, and kibble diets, you can make an informed choice that will keep your canine companion happy and healthy.
Dehydrated vs. Raw vs. Traditional Kibble: Making Informed Choices for Your Canine Companion

As a pet parent, choosing the right diet for your dog is one of the most critical decisions you'll make. With the growing Dehydrated Dog Food Market and the various options available, it's essential to understand the benefits and drawbacks of each type of dog food: dehydrated, raw, and traditional kibble. This guide aims to help you make an informed decision that best suits your furry friend's needs.

Understanding the Dehydrated Dog Food Market

The Dehydrated Dog Food Market has seen significant growth in recent years, driven by pet owners seeking healthier and more natural alternatives to traditional kibble. Dehydrated dog food involves removing moisture from fresh ingredients, resulting in a lightweight and nutrient-dense product that retains much of the original nutritional value. This option is convenient, with a longer shelf life than raw food and without the preservatives often found in kibble.

Benefits of Dehydrated Dog Food

1. Nutrient Retention: Dehydration retains most of the original nutrients found in fresh ingredients, making it a healthier option.
2. Convenience: Lightweight and easy to store, Dehydrated Dog Food Market is perfect for busy pet owners and those who travel with their pets.
3. No Preservatives: Typically free from artificial preservatives, colors, and flavors, making it a cleaner choice for your dog’s diet.

Drawbacks of Dehydrated Dog Food

1. Preparation Time: Requires rehydration with water before feeding, which can be slightly less convenient than kibble.
2. Cost: Generally more expensive than traditional kibble, though often more affordable than raw diets.

The Raw Dog Food Trend

Feeding dogs a raw diet has become increasingly popular, driven by the belief that it more closely mimics the diet of their wild ancestors. A raw diet typically includes uncooked meat, bones, fruits, and vegetables.

Benefits of Raw Dog Food

1. High Nutritional Value: Raw food diets can provide high levels of nutrients, enzymes, and vitamins that are often lost in cooking and processing.
2. Improved Digestion: Many dogs experience better digestion and less stool production on a raw diet.
3. Shinier Coat and Healthier Skin: Raw diets can lead to noticeable improvements in coat quality and skin health.

Drawbacks of Raw Dog Food

1. Risk of Bacterial Contamination: Handling and storing raw meat can pose a risk of bacterial contamination to both pets and humans.
2. Nutritional Imbalance: Without careful planning, raw diets can be nutritionally unbalanced, leading to deficiencies or excesses.
3. Cost and Storage: Raw food is typically more expensive and requires proper refrigeration or freezing.

Traditional Kibble: The Convenient Classic

Traditional kibble remains the most popular choice among dog owners due to its convenience and affordability. Kibble is dry dog food made from processed ingredients, often including grains, meat by-products, and preservatives.

Benefits of Traditional Kibble

1. Convenience: Easy to store, measure, and serve, making it the go-to option for many busy pet owners.
2. Affordability: Generally the most cost-effective option, especially for large breeds or multi-dog households.
3. Dental Health: The crunchy texture of kibble can help reduce plaque and tartar buildup on dogs’ teeth.

Drawbacks of Traditional Kibble

1. Lower Nutritional Value: The high-heat processing can destroy many nutrients, requiring manufacturers to add synthetic vitamins and minerals.
2. Potential Allergens: Kibble often contains fillers and grains that can cause allergies or sensitivities in some dogs.
3. Preservatives and Additives: Many kibbles contain artificial preservatives, colors, and flavors that some pet owners prefer to avoid.

Making the Right Choice for Your Dog

When choosing the best diet for your canine companion, consider the following factors:

1. Nutritional Needs: Consult with your veterinarian to determine your dog’s specific nutritional requirements based on their age, breed, activity level, and health status.
2. Lifestyle: Choose a diet that fits your lifestyle and schedule. If you’re always on the go, kibble or dehydrated food might be more practical than raw food.
3. Budget: Factor in the cost of the food and any additional expenses, such as supplements for raw diets or higher-quality dehydrated options.

Ultimately, the best food for your dog is one that meets their nutritional needs, fits your lifestyle, and aligns with your values. The Dehydrated Dog Food Market offers a promising alternative to traditional options, but it's essential to weigh all factors before making a decision. By understanding the benefits and drawbacks of dehydrated, raw, and kibble diets, you can make an informed choice that will keep your canine companion happy and healthy.

tldr: do you ever wake up in the middle of the night confused and scared for seemingly no reason? and then the nausea and stomach pains kick in?
hi i think ive probably posted about this before, but whenever im in a flare i usually cannot sleep. if i try, i often jolt awake and im overcome with confusion and fear for a bit and this repeats until i just give up on sleeping. i think what ties into this a little is when i wake up im usually pretty nauseous and have the urge to go but struggle.
does anyone else get like this? its always so scary and its been a while since ive flared but im going on a trip out of the country and my allergies were so bad thag i thought i was getting sick, so in anticipation i took 2 antibiotic pills (12 hours apart) before realizing it was just allergies. stupid, i know. now im having diaherrea and nausea like a flare bc i fucked up my gut balance. my biggest fear is getting c. diff again, esp being out of the country, but my stool has been alternating between fluffy and solid, so im praying this means i wont get it.
its abt to be 4 am, i cant sleep, i feel like shit, and my family plans to leave the house at 11:30 am for our 2 pm flight to the dr which will be a little over 2 hours. i dont get anxious with planes but im just anxious (as all ibs havers are) that i wont be able to make it to a bathroom whether it be on or off the plane and ill feel like shit the whole time. idk, i always come to this sub to rant when im freaked and it kinda helps. i just wish this happened a week earlier bc i havent been eating, havent been able to properly sleep, i have terrible allergies, and i have POTS, so all of these circumstances together is making my heart rate go in to over drive and im scared ill either throw up everywhere, shit myself, or pass out and then throw up and shit myself 😭😭
theres nothing i can do abt it, ny family has been planning this trip for months and has spent sm money and its for my aunts wedding. plus id rather be miserable in the dr where i know my family is close by if i need them than stay home alone all by myself feeling insanely sick. idk. i just wish it could all go away magically for this week at least. i know i did it to myself w the antibiotics but why do i have to have such an unforgiving illness. idk im just gonna take some zofran and drink some gatorade and hope i start feeling better by the time i have to leave

We went to the vet today because my cat developed a hotspot on his neck since he started going in his catio again. She also checked for fleas (he was flea free), shaved his neck and gave me a topical steroid cream to use for 2 weeks.
She recommended I buy him a cat shirt to go outside in, at least until the spot heals. If it turns out that he has allergies to something outside though, the alternative to a shirt would be a long term oral steroid pill that could increase his chance of diabetes. I would prefer to not do that.
I had sewn him a neck cover to keep him from touching the spot but then I noticed him licking himself everywhere else obsessively. I put him in a "cat hoody" I bought a months ago and while I don't think he likes it much, he has stopped him licking himself.
I tried taking it off an hour ago though but he went right back to licking it so I put it back on :(
The cat t-shirt comes tomorrow and is more lightweight than the hoody but I'm wondering if anybody else has had to deal with an overly itchy or possibly allergic cat like this? Keeping him indoors is also not an option, he has a massive catio that he loves to death and spends almost all day in it.
I'm hoping it's just a seasonal thing that disappears closer to summer but I'm wondering if anybody has any similar experiences or advice?

Managing diabetes goes beyond monitoring blood sugar levels; it encompasses handling the various tools we use, such as insulin pumps and different insulin formulations. Throughout my journey, I have encountered numerous challenges, especially with skin reactions to different insulin types and pump cannulas. I hope sharing my experiences will help others facing similar issues make informed decisions.
Understanding Skin Reactions
Skin reactions in insulin therapy can stem from multiple sources and often develop progressively with more exposure:

• Adhesives: Adhesives are a common cause of skin reactions, characterized by redness, itchiness, and sometimes pain over the entire area where the adhesive was applied. Reactions can intensify and occur more rapidly with repeated exposure. These can be easily overcome by underpatches or completely removing the adhesive and replacing it with hypafix glued with hotglue.
• Cannula Material: Individual reactions to cannula materials vary. 'Plastic' cannulas (made from teflon) initially worked for me for about five years before they started causing reactions, prompting me to switch to steel cannulas. Cannula skin reactions are subtler than adhesive reactions, usually presenting as redness and bumps at the cannula site with intense itching.
• Insulin Formulations: Distinguishing an allergy to a cannula from an allergy to an insulin component can be difficult as both present similarly (itchiness and redness around the insertion site). In my experience, ingredients in insulin, particularly m-cresol, have triggered skin reactions. For example, both Humalog and Apidra contain higher levels of m-cresol and caused significant issues for me.

Differentiating Between Cannula and Insulin Reactions
One way to differentiate between an insulin skin reaction and a cannula skin reaction is to switch from a teflon cannula to a steel cannula. Unfortunately, with devices like the Omnipod, you cannot use a steel cannula. Instead, have your healthcare professional fill the pod with saline instead of insulin and wear it for 2-3 days to see how your skin reacts. If there's no reaction to the saline, it's likely the insulin causing the issue.
Investigating Skin Reactions: My Personal Journey
It's crucial to be vigilant when interpreting changes in symptoms, as improvement with a steel cannula may not necessarily indicate resolution of the issue. In my case, switching to steel cannulas initially appeared to resolve the problem. However, after about two years of use, I began experiencing local absorption site problems despite careful rotation of injection sites. To address this, I experimented with inserting the steel cannula more superficially by bending the Tandem trusteel needle at about a 45-degree angle. While this improved absorption, it also led to a recurrence of skin reactions. This led me to conclude that the teflon cannulas were not the primary cause of the reactions, but rather the insulin itself. Infusing the insulin more superficially, whether with a teflon or bent steel cannula, allowed me to observe the skin reactions more clearly, while deeper infusion masked them.
This hypothesis was confirmed when I conducted the saline test with Omnipod and experienced no skin reaction, indicating that the issue likely stemmed from the insulin rather than the cannula material.
The Role of M-Cresol
Research indicates that m-cresol in insulin formulations can cause skin reactions. Insulins with higher concentrations of m-cresol, like Humalog and Apidra, are associated with more inflammation. Studies suggest that removing m-cresol can lessen these reactions.
Detailed M-Cresol Concentrations in Insulin Formulations:

• Fiasp and NovoRapid: 1.72 mg/ml
• Humalog: 3.15 mg/ml
• Apidra: Approximately 2.8 mg/ml
• Lyumjev: Same as Humalog, 3.15 mg/ml
• Biosimilars: Like Admelog and Trurapi, mirror the m-cresol content of their originals, providing no benefit for those with sensitivities.

My Personal Journey with Insulin Pumps

• Initial Experience: I used a Tandem teflon cannula for about five years before developing skin reactions.
• Switch to Steel Cannulas: After switching to steel cannulas, I thought the problem was resolved. However, about two years later, I began developing problems with local absorption sites. This was exacerbated when I bent the Tandem trusteel needle to direct insulin more superficially, improving absorption but leading to renewed skin reactions. This prompted me to conclude that it might not have been the teflon causing the initial reactions but the insulin when infused more superficially.
• Saline Test with Omnipod: Conducting a saline test in the Omnipod confirmed no skin reaction, which reassured me that the teflon cannulas were not the issue.
• Experimenting with Insulin Types: I tried Humalog (Ademlog) insulin with an Omnipod, but after just 2 days, I immediately started experiencing local skin reactions, despite using FloNase before applying the pod.
• Switching Insulin Formulations: We then decided to switch to another insulin with less m-cresol, Fiasp. It worked wonderfully for about 2 weeks, but I then developed insulin resistance, a phenomenon described by many people after some time using Fiasp. Fiasp is the same insulin as NovoRapid, but it contains vitamin B3, which is used to facilitate faster absorption. Some people hypothesize that this vitamin may increase insulin resistance over the long term. Despite trying various strategies to mitigate this, such as combining Fiasp with other insulins or alternating between Fiasp and other insulins, I still experienced resistance and skin reactions.
• Transition to NovoRapid: I have now started using NovoRapid, which contains less m-cresol than Humalog, and everything seems to be going fine for now.

Skin reactions can be mentally taxing and complex. The best approach is to methodically test different cannulas (teflon/steel), different perfusions (insulin/saline), and different insulin types until you find the right combination. Research on removing m-cresol from insulin formulations has shown promising results in animal studies, offering hope for less inflammatory and equally effective insulin therapies in the future (https://pubs.acs.org/doi/10.1021/acsptsci.1c00047).
Also, if you keep having skin reactions even with insulin containing less m cresol, know that some physician were able to desentitize a children to this component so he could use insulin in insulin pumps https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-6-263
References
· https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9760098/pdf/nihms-1843053.pdf
· https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1398-9995.2007.01567.x
· https://link.springer.com/article/10.1007/s11095-017-2233-0
· https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-6-263
· https://pubs.acs.org/doi/10.1021/acsptsci.1c00047