Hi everyone, the title of the post sounds like a title for a scholarly article or novel, but I really just couldn’t think of how else to put it.
For some context, I’m fairly new to this community. I underwent an emergency D&C this past Wednesday after having an incomplete MA which unfortunately, led to me hemorrhaging. It was terrifying and traumatic. I lost a lot of blood. Apparently I made it into the “rare complications” club where this happens to less than 1% of people who have an abortion, per the nurse who put me under sedation. This was not only my first abortion, but it was also my first pregnancy. I was 7 weeks, with a supportive and loving partner, making a decision as difficult as you all very well know.
Since the D&C, I thankfully am feeling much better and have been able to process everything more in terms of my emotions. It was hard to do that after the MA when I was still feeling all the pregnancy symptoms but unsure as to why. The day after the D&C I felt like myself again. The nausea, heart burn, food aversions - every single symptom I had was gone. Even my breasts weren’t as tender as they had unbearably been.
This experience, thankfully, made myself and my partner of 4 years even closer than we ever have been. I’m very grateful for that. He’s been incredible throughout this entire process and has held my hand every step of the way. So, yesterday, as I’m feeling relatively back to my normal self minus some fatigue - I look at my partner, feel those butterfly feelings, and my immediate thought was, How in the fuck can you be horny after what you just went through? What is wrong with you?
I immediately felt confusion, guilt, shame, and an uncontrollable desire to feel close to him. I started googling: “sex drive after abortion” “is it normal to be horny after an abortion?” “Why do I have such a high libido after an abortion?” I really didn’t find much in the topic beyond a few Reddit posts and some old forums. It made me feel even more guilty, that clearly MOST women don’t want to be touched at all after something like that, but I couldn’t control what was going on with my body.
For me, my libido was fairly average prior to all of this, but for some reason yesterday I could not control my sex drive. It was driving me crazy for hours. I didn’t want to tell my partner because I was ashamed and embarrassed to be feeling how I was. I also know he’s been processing everything too and I felt like if I made a move he would be upset by it because why wouldn’t he be? That’s the normal response. I’m the odd one here and I’m the one who went through the damn thing, right?
Easy fix! I’ll just have some sexy self-care time, right? As long as nothing goes in and I just keep it external, I should be all good right? Come to think of it, the nurses and doctors didn’t mention anything about it. What does goggle say? Nothing, really. Mostly just websites and forums saying no PIV for a week or two. Nothing about masturbation. Will I be okay? Will my uterus fall out? What if I start bleeding even heavier? Will it hurt? Will it slow down healing or speed it up? Why am I even thinking about any of this at all?
Just more guilt. More self-shaming. More anxiety, more fear, and at this point - I’m STILL horny. Screw it. I didn’t read anything saying don’t do it, so let’s just do this, but wait until my partner takes a shower so he doesn’t know. And that’s what I did. I waited until he was in the shower so I could do it in secret because I felt that much shame and that much guilt. I was worried, but my sex drive was so high I truly didn’t care in the moment. That is, up until the moment where I hit the big O and there was some cramping. It scared the shit out of me. But. It was mild, barely anything, and the big O was probably the biggest I’ve had in a long time.
Immediately after I felt relaxed, relieved. Then I went to the bathroom and after having mostly spotted since the D&C, my stomach dropped when I saw bright red on the toilet paper. Look at what you did. What’s wrong with you. You’re going to bleed out again because you were horny? It will be your fault, again.
I spent most of last night scared, worried, scrolling google for answers, and feeling horribly guilty. However, I woke up this morning alive and well, back to the super light barely noticeable spotting. Then about half way through the day, the butterfly feelings returned. IM HORNY AGAIN?! WHY?!?
Without going through all the details, I went through the whole entire cycle I did yesterday again today. Now, I’m here typing this extremely long post. If you’re still here reading, I really appreciate that. I doubt I’m alone in my experience and feelings as it’s far more rare to have a singular, independent thought or feeling that no one else on the planet has ever had. However, I don’t see this experience talked about much and I’m not sure the reasons, or maybe I just wasn’t looking in the right places to begin with. But, I want you to know if you have felt this or are feeling this way after your abortion - it’s okay.
I know my hormones are raging. I know I just went through something horribly traumatic and it’s normal to have anxiety after going through something like that, along with the complications. I also know that everyone’s libido after this experience will drastically vary from person to person. I’m trying to remind myself not to feel guilty after that and if what I went through isn’t a shameful thing, then why am I shaming myself for any feeling I have afterwards or if I want my body and mind to feel good again with a little sexy time self-care?
Anyways, that’s it. Stay strong out there. You got this. Feel what you feel and don’t be ashamed for it either way.

I was born in a large city. My parents 21f and 24m were both university students when I was conceived, my mother was in 3rd year. I'm not sure what year my dad was in. I always get vague answers when I ask. My parents originally planned to become teachers after completing teachers college.
Instead they married largely due to family pressure early in the pregnancy. Immediately after that they backpacked around southern Europe and Morroco. They drank considerably and smoked Marijuana as often as they could. Their original intention was to teach English in Spain, but apparently changed their mind because of the hospital, cost seemed to be the main factor. They returned to our city with my father going back to school and eventually getting his teaching degree and his first teaching job when I was 3 or 4.
My mother seemed to resent having to care for an infant. During my childhood she would complain about the awful diapers and mixing formula, etc.
When I was approximately 2 -3 years-old I was diagnosed with cerebal palsy. Immediately after I was diagnosed my parents started trying to conceive another child. By the time my sister was 1 year old, my parents decided she wasn't as perfect as they thought she should be so they conceived my youngest sister.
My kindergarten teacher wanted me to repeat kindergarten because of my very poor motor skills mostly cutting and pasting but also my printing was very messy, which was mostly due to the tremors. I was intellectually able to do all of the work and I could already read. If had gone to senior kindergarten I would have been able to enter French immersion, which started the year after I entered school. Also I was the youngest child in my class because I was born late in the year. The French immersion schools were much better funded and had much better teachers and resources. I stayed in the original school which was one of the 2 worst schools in our region. My first grade teacher made me stand in front of the class to evaluate my reading, I was very shy and soft spoken, so I stammered slightly. From this alone she put me in the bottom reading group even though repeatedly showed her that I could read any book in the room. Standardized testing in 2nd grade showed that my reading and math skills were at 6th grade level. I know this because the guidance teacher showed my scores and explained what they meant when I was frustrated with the pace of the classroom and lack of mentally challenging work. My teachers would make me write things over and over because of the 'messiness'. This never worked and my printing would get worse because of fatigue and pain. I was bullied by most of the kids in my class because I was small, clumsy, physically weak, and somewhat odd looking, the fact that I was very smart also didn't help. My teacher wouldn't allow me to use the washroom when I needed it, since I had a bladder disorder related to my cerebal palsy, that meant I would sometimes wet myself. This only happened when I wasn't allowed to use the washroom when I needed to. This led to the other kids calling me diaper queen. Eventually I was exempted from most of my in class subjects and allowed to work independently in the library on whatever I desired. When I was in 2nd or 3rd grade my arm was badly sprained by a bully and I was prescribed a tensor bandage to support my hand and wrist. I noticed that my printing was better with it and I tried to keep using it. My mother found out and angrily took it away from even though I explained that it helped me. She would not listen and there was no explanation at all. She would send me to school no matter how sick I was, and would only let be at home when the school said I was too sick to be there. Our house never had a thermometer or bandaids or any other health related items, not even a hot water bottle or heating pad. When I was in 5th grade I developed a ganglion on the inside of my middle finger, it was very painful and made it even more difficult and painful to write. I saw a hand surgeon who said he could remove it easily and quickly. My parents, mostly my mother refused to allow me to have this surgery even though it would be completely paid for through our canadian health program.
Every few months we would visit family friends in the city each time before we went home my dad would go to a bank machine, except we always parked at the far edge of the parking lot and my dad would walk away and then be gone for 30 to 40 minutes. I realized later that he was buying amounts of Marijuana about a pound or two each. He and my mother would smoke it regularly, they I wasn't aware but I especially the air currents would waft the smell to my window.
Even though I asked repeatedly to be moved to a different school my parents made no efforts to do so. I could have been moved based on my disability and also my intellectual giftedness. I was not taken to a dentist until I was 8 years old. By this time I already decay in several of my teeth, partly because our water wasn't fluoridated. My dad could have added flouride to our well water for a very low cost, but was too cheap to do so. Another factor was I did not have a child size toothbrush so it made much more difficult to clean my teeth effectively.
My parents were home most of the time but spent very little time with their children. There was very little affection shown. I had very few clothes, with one or two items bought for back to school. And sometimes none since I was failure to thrive and grew very slowly. At Christmas my mother would buy the same toys for all 3 of us even though I was 4 1/2 and 7 older than my sisters. One year she bought all of us cabbage patch dolls, this was even though I had never had any interest in dolls or girly stuff. She did this again when the cabbage patch dolls came out.
My grandfather died when I was 9 years old, my grandmother remarried suddenly when I was 13. She lived with him in England for several months but then they moved back to town close to us. There were frequent family gatherings that included him. From almost the beginning he would find ways to trap me and sexually assault me by pushing me against a wall or into a corner he would then force his tongue into my mouth and rub his penis against me. He would also shove his hands into my pants... During my adolescence I was misdiagnosed with depression, when I actually post traumatic stress reaction because of the many things I'd dealt already, I was sent to a psychiatrist who didn't listen to me and wasn't competent, she kept prescribing different drugs when I didn't respond to them the way I 'should ' have. She put on lithium with no sign of bipolar disorder. I very developed severe lithium toxicity. She took me off it eventually. At some point she decided that since antidepressants weren't working it must because I was psychotic. She put on antipsychotics even though I repeatedly told I was not psychotic and I never was. She wound up convincing my parents to send to this inpatient program for adolescents with psychosis. I talked to the psychiatrist there once and he knew I had never been psychotic, he stopped my medication immediately and I was the only one there not on any medications and was not mentally ill at all. But I wound up spending 8 months there.
There were other things that went on with my family but this about as much as I can write right now. Am I wrong to distance myself from my family ? I feel little connection to them and they usually want to draw me into some drama that I don't want to deal with. tl;dr; childhood experiences, neglect

TLDR at the end
F28 with Ovarian Cancer I am really struggling with medical negligence not just from one doctor, but multiple. Just an FYI this is a long post about my overall experience since getting diagnosed with cancer and learning I have an underlying autoimmune disorder(s). I’ve been dealing with a lot of discrimination because I’m young and “healthy looking” and doctors constantly dismiss me or discriminate me for some reason and I’m tired of it. I’ve been sick and disabled since last November and I had a great job and was running my own business but lost everything because of negligent doctors and cancer.
I originally posted this on legaladvice because I thought maybe I had a case but at this point I don’t even know if I have a case or not and I’m starting to just accept that this is how this shitty system works. Anyways I thought I’d at least share my experiences with the medical field in the US specifically in LA California. I imagine I’m not the only person who has gone through this and that many people who are struggling with disabilities face these kind of obstacles when navigating the healthcare system here. I’ve had to learn how to advocate for myself and I only hope that my post and experience helps those struggling with their health.
In order for me to advocate for myself I’ve had to basically become just as knowledgeable about my condition(s) to get the proper care. I’ve had to fight for my diagnosis and proper treatment and had I not been looking up my symptoms, possible diagnosis, lab work results, I may have died or came to the verge of it had I fully trusted any of the doctors I’ve come into contact with. Always do your own research using trusted resources and have someone with you who can help advocate for you when you can’t advocate for yourself. Not only am I dismissed for being a female but also for being young and healthy looking despite having serious debilitating symptoms.
For two years I was seeing a rheumatologist for an underlying autoimmune disorder(s) like SLE OR MS and was diagnosed with Rheumatoid Arthritis, Primary immunodeficiency, dysautonomia, fibromyalgia, CIDP and still being investigated for more issues.
In November I decided to go on a LOA because my flares were starting to become more frequent and severe. My psychiatrist was the one who filled out the LOA paperwork for the time from Nov-Dec because I was hesitant to ask my Rheumatologist. I was told by my rheumatologists office that filling out LOA paperwork was $300 out of pocket and at the time I didn’t have that money so my psychiatrist signed it because I was also struggling with my mental health and family issues that time.
I was supposed to go back to work in January but at the start of the new year I got really sick and my flares started to ramp up again so I had to request a new LOA. My psychiatrist couldn’t help me with my LOA paperwork anymore because it was more health related now and told me to go see my rheumatologist. I was still hesitant because of the fee and then when I was about to see my rheumatologist again and get my bloodwork done I got a surprise bill from the lab where I get my bloodwork done for $400 after insurance. They wouldn’t let me get additional tests until I paid the fee and I couldn’t see my rheumatologist until I had my bloodwork done. I made an appointment with my rheumatologist anyways but the soonest I could get wasn’t until after the LOA deadline in March. I also couldn’t get any disability benefits until that LOA form was filled out by my doctor so I had no income to pay for any of this.
I ended up in the Emergency Room on 2/16/24 a little over a week before I needed to submit the forms for LOA and at this point my employer was threatening to fire me for failing to provide the LOA paperwork. I tried explaining the situation to one of my managers but he wasn’t having it and didn’t care.
When I went to the first emergency room I went in for multiple serious symptoms, they knew I had an underlying autoimmune disorder causing the flares and that I had surgery 3 years prior to remove ovarian cysts on my right ovary. I told the emergency room that I had a lot of abdominal pain across multiple areas, I was really weak, fatigued, dealing with vertigo, migraines, blood in stool, persistent bloating, frequent urination, appetite loss, rapid weight gain, insomnia, tachycardia, high bp, neuropathic itch/ polyneuropathy and my symptoms were to the point where I was losing my ability to walk. My partner was holding me the entire time so I wouldn’t fall.
The emergency room did a bunch of tests that included a basic blood panel, physical exam and a CT scan of my abdomen. They didn’t find the bleeding but instead found that I had a complex 14cm tumor on my right ovary which they deemed a dermoid cyst.
When they gave me the news they officially diagnosed me with a “dermoid cyst from birth” even though I countered their diagnosis and told them that was impossible because I had surgery 3 years prior. The doctor didn’t backtrack at all, just stuttered and continued to discharge me because it “wasn’t an emergency” just because I wasn’t bleeding out despite all of my serious progressing symptoms.
I angrily left the ER knowing it was utter BS and deep down I knew it was cancer because of how sick I was. I could literally feel I didn’t have much time but because I looked young and healthy and my basic blood panel didn’t throw up any huge red flags at them even they dismissed me and misdiagnosed me. I wasn’t even given anything to manage the pain.
I even told them I was already on a medical leave and that I’ve been really sick but that it was getting bad and I couldn’t see my rheumatologist. However I didn’t know about the tumor until then. I told them I needed help with the LOA paperwork too and had they admitted me I would have been able to get an extension and still have my job and benefits. I could have started treatment sooner and received disability pay but instead was forced to continue living with this pain. It was so large that I was at risk of torsion rupture and necrosis, Not to mention permanent nerve damage.
The next day I called up every gynecologist I could to see where I could go for the soonest appointment for an ultrasound. I found a doctor who took me as an emergency appointment a few days later and he confirmed it was most likely malignant and that I needed surgery ASAP. I talked to him about my LOA situation too because I was running out of time and I was too disabled to work. He also refused to help me sign my LOA paperwork because according to him, “ovarian cancer can’t cause systemic symptoms and you’re going to need to wait until surgery before I put you on leave”. I told him I had an underlying autoimmune disorder that I think is being exasperated by the cancer and I was just dismissed yet again despite needing someone to physically help me walk so I don’t fall. He also didn’t give me anything for the pain I was in.
I had to turn in my LOA that day but because of this I was forced to resign my position or face getting fired and becoming un-hirable so I had to quit. In quitting I lost everything, benefits, stocks, my job, my health, doctors. I’m now in debt with multiple cc going to collections because I haven’t been getting an income since January and I’m just starting chemo so I have no idea when I’ll be able to work again. I don’t know what to do here. I was going to try to settle my debt but with what money?? I might be forced into bankruptcy for 7 years now.
After I lost my insurance I applied for medi-cal but something with my application in there system wasn’t right and it was in a never ending pending limbo state(Took about two months to actually sort it out and I only sorted it out that quickly because my friend works for medi-cal). I tried waiting it out for two weeks, calling them sorting it out and doing it right by the system but every day I was getting sicker and weaker and I felt I was running out of time as I was bed ridden at this point.
Two weeks later I went to a different ER because at this point I couldn’t sleep, I couldn’t eat and I started getting migraines after doing anything. I was miserable from enduring all the symptoms and never ending anxiety and mood swings of possibly having an autoimmune disorder like SLE, MS and ovarian cancer.
The second ER I went to finally admit me for emergency surgery after a full day of being in the emergency room and they confirmed it was in fact a tumor. It also grew to 20cm by that point. By this time the tumor had already ruptured and twisted my ovary. The entire time I was there though it was a battle. I had been living with this for so long that I was perceiving my pain as a 6 when in reality I had nerve damage and the pain was likely higher. I seemed calm at first but anytime someone came in trying to tell me I was fine I couldn’t hold it together and would start crying because I was at my breaking point. I was suffering and no one was taking me seriously. I had to make it a point that because of the misdiagnosis from the last hospital, I lost everything and was in a position where I couldn’t get any care because of the issue I was having with my medi-cal application. It would’ve been months before I found a PCP, got referred to specialists, confirmed it was cancer, and scheduled a surgery. At one point during my time in the emergency room, the head of the ER came to me and literally told me, “I want to help you but you’re going to have to SELL it to me”. After that I kept having to tell them that my pain was like an 8-10 and that the pain meds weren’t working. They put me on gabapentin which didn’t really do anything for me actually. But then they started giving me morphine and while it helped tremendously I also found out that day that I either have an allergy or a sensitivity to morphine.
Anyways now to my current situation. I started chemo about two weeks ago and my current oncologist is also being negligent.
I found out the other day that she blindly prescribed a medication for nausea that interacts with a medication that I was already on. The interaction is known to cause arrhythmias apparently. During my first week of chemo I was taking both meds and mentioned that my chest had been feeling heavy and I had pain. I was told it was steroids. It continued and then one night as I was falling asleep my heart started to pound really hard for about 10-15 seconds. I told my doctor about it and again steroids.
That same day I went to pick up a prescription and just happened to ask if anything interacted and that’s when I found out that it was a major interaction and I literally could have died had I not luckily already been titrating off of the offending medicine. I stopped taking those meds and immediately the chest pain stopped and I haven’t had an episode like that since.
I am freaked out and don’t want to continue my care with her due to her negligence. This should have been a conversation at minimum and she didn’t even tell me she prescribed it let alone double check for interactions(she had the list of my current medications). I just got a notification from my pharmacy that it was ready. I also didn’t know about the interaction when it was picked up because my mom picked it up for me and she doesn’t speak English very well.
I talked to my care teams assistant and told her I wanted a change of doctors because I didn’t trust her after this and she said she was going to put in the request. They called me yesterday though and said they weren’t going to switch me because I had already started treatment. They refused to switch my doctors despite everything that’s happened even though she literally almost accidentally killed me. I am livid and don’t want to continue with them but they’re giving me no choice but to continue seeing her.
I already set up an appointment for a second opinion but that’s not for another two weeks before the appointment and I don’t want to interrupt the treatment.
I have a rare type of ovarian cancer with a high grade tumor. It was a germ cell tumor called an immature teratoma. They said it is stage 1 but because I had emergency surgery, the tumor had already ruptured, and everything was rushed I don’t feel this is an accurate diagnosis because I have pain in all of the surrounding areas where the tumor was pushing up against. (I also mentioned this to my oncologist but instead of running tests or anything else I was given a psych referral for anxiety because I have an adhd & bipolar diagnosis even though I’ve been stable for years and I wasn’t overreacting in this case). The tumor was exasperating all of my autoimmune symptoms and causing me to be in a never ending flare so my body has been heavily damaged. Im becoming disabled at 28. I have so much anxiety with doctors now because I’m traumatized from my experience with them dismissing me and discriminating against me. Like I’m young so I “must be able to tolerate more”. I have to constantly look up my lab results, medications, conditions, because of how much negligence and dismissal I’ve been dealing with over the years. I’m scared I’m going to die from something preventable and not cancer at this rate.
TLDR: F28 w/ ovarian cancer and pre-existing autoimmune disorders struggling to get care, proper diagnosis, treatment, negligence by multiple doctors, losing everything. US health care system is incredibly difficult to navigate and we need to constantly advocate for ourselves to get proper care in this for profit healthcare system.

After really heavy triggers, especially in exposure therpay, I end up falling into vertigo, spams, twitches and spasticity almost instantly. My psych has seen psychical PTSD symptoms but none as severe as me. After that it lasts for a long time, joints go numb on and off, essential tremor, nerve pain, eye issues, gait and balance problems, focal seizures. And mostly just seveeere fatigue, which combined with the night terrors is making life nearly impossible rn
I'm still dealing with this almost 4 weeks later and I was mostly fine before. I'm not diagnosed with MS yet but my doc said it's very likely I have lesions affecting my left side and I have a high genetic risk anyway. Waiting for MRIs etc so I'm curious about anyone here, I think a year of several severely traumatic events, non stop stress my whole life and 3 years of alcoholism (I'm sober) has triggered it. I think I had it before but it was milder

It's hard for me to start this post, but I think first I should mention what motivated me to share this in the first place.
Next week I will turn 24 years old, and I still haven't achieved anything worth mentioning in my life. I hardly finished high school, I couldn't make progress in any degree to get a title, I have been dealing with depression since 2018, I never had any true friends in real life, some people betrayed me in traumatic ways, my family don't believe in any of my projects (my father even mocked me to feel better about his purposless life), I can't stand official institutions when it comes to education and learning (because they make me get burned out very easily). Also I have ASD (officially diagnosed Autistic Spectrum Disorder) and that made me suffer in many different ways. I have always been an outcast who suffered psychological bullying (and physical to some extent). I have never really understood society and that's probably the main reason why I never had a girlfriend (I didn't even have sex or kissed a girl in my whole life). And all this makes me extremely bitter, it is the origin of my sexual frustration.
Furthermore I have always had poor health. The past 9 months or so have been awful. I suffered a bunch of infections, fatigue from antibiotics, finger injuries (I'm studying piano), food poisoning, insomnia, long lasting shoulder injury, back pain, acid reflux, panic attacks from cannabis and fluoxetine use, etc. I could even talk about my experience with psychologists and psichiatrisys. How I had 5 different useless psychologists (one of them blaming me for sexual harassement I suffered) and how over the years all the psychiatrist I had prescribed a total of 7 fucking different antidepressants, alongside benzos, olanzapine and lamotrigine.
Idk, it's such a massive pile of shit. I could have written way more, like my alcohol problems, but this is already too long.
I have had serious suicidal thoughts since around 2021. Each year it gets harder to control myself and avoid selfdestructive thoughts and actions (I avoid high places or getting close to the metro for example). I have taken drug overdoses a few times already and it's uncertain what day it will be fatal.
Right now I'm studying the piano degree, but I'm so extremely burned out from it that it is starting to make me hate music. And music is my life.
I used to want to be a scientist or mathematician, but I got so burned out I couldn't bear hear anything about it for 4 years, I hated it. But anyways I'm not good enough for it.
My dream would be to be a composer and create profound pieces of music that expand our human experience. I want to revive the world of classical music and inspire others. Also I would like to make ALL my content public, I hate to give a price to my content or make it unaccessible to people who might enjoy it. But well, all of us need money to live, so I guess I'm fucked. I can't earn a living from being a composer.
I know this post is a pitiful autistic rant, but I simply needed to shout at the void and rant about most of the thoughts that haunt me every single day.
Oh, and by the way, I did try to have a better mindset and work hard during months. I applied stoic values to my life, worked out, stayed disciplined, I saw the positive in everything that happened to me, I had humour, etc. But I just can't do it, I feel fucking empty and nothing seems to work in the end.
Now I'm just thinking about if it is worth to keep trying. And if not just plan my last months of life before I end it all.

What’s in the closet, Kirsty?
He knew I hid a secret.
I smiled, tried to look confused.
He waited, crossing his arms.
I worried that he'd already seen. He had.
What else could he think about the pile?
His wife’s a cheater. She has another life. Another husband. Children.
He’d never believe the truth: I’m not a cheater; there’s no other life; no other man; I don’t know who the children are who visit me at night.
But I did have a secret. And maybe it’s fair to say another life, even if was smaller and against my will.
I should have destroyed those frames, burned the photos within. Now it looked like I saved them, cherished them. The truth couldn’t be farther. I feared to touch anything to do with… whatever they are…with one exception.
“It started last Halloween,” I said to George, my husband, my real husband.
He stopped packing for a moment, working out the impossibility of this statement. “I’m taking the girls to my parents.” He resumed the tossing of shirts, pants, etc. into our big suitcase.
“It’s true,” I said, but weakly. The children in the picture are at least six and four respectively. They were born six months ago.
“They’re not… my kids,” I said of the boys in the photos. They’re not kids is what I almost said.
George stopped and squeezed the bridge of his nose between thumb and forefinger. “Kirsty,” he said slowly, “there are baby pictures. I saw them.”
“That’s-”
He quickly raised his finger, exasperated, angry, done.
“The first picture is you holding a newborn, and…” He swallowed painfully, his throat gone dry. It always does when he’s upset. “And the father in that picture, with his arm around you, isn’t me.”
When I couldn't deny it, he nodded like he knew all along our marriage would end.
We were happy. We really were. George and I had managed to overcome the typical breakdown that often comes with raising children. Only since last Halloween had distance been made by me.
I should have told him as soon as it started.
“Girls!” he called as I followed him down the stairs to the front hall of our lovely home. We’d scrimped and sacrificed to buy and keep this place, our dream by the lake. He’d been so proud. I couldn’t tell him I wanted to leave the first night sleeping there.
Cara and Ella protested through play, ignoring the adults, continuing to jump on an old box they’d long since flattened. Rays from the western sun placed my daughters into an inspired, hallowed light, and I started to cry. He was going to take my babies away.
George opened the door, intending, I’m sure, to drop the suitcase in the car before returning to physically carry the girls out.
But he hesitated in the doorway.
“George?”
The suitcase fell with a solid thud on the floor. “There’s no way,” he said.
“What?”
“There’s no way,” he said, with emphasis on the last word, “you would have had time for…this…”
Not defining "this" as cheating was progress. “Yes!”
He glared, quieting my desperate enthusiasm. I wasn’t off the hook. “Tell me. The truth.”
“I can’t.”
He reached for the suitcase.
“No, not because I don’t want to,” I protested. “I don’t know what’s happening!” I sat on the carpeted steps and stared through blurred vision at my trembling hands. The shriek I’d filled the house with - “happening!” - had put a halt to the box's obliteration. Cara and Ella hesitated for a few seconds before leaping into action.
Cara, the oldest, six, punched her dad in the buttocks. “You have to be nice!”
Ella, four, sat beside me and patted my trembling hands. “It’s okay, mummy.”
Such lovely daughters. Nothing like the boys in those photos when they were this age.
George grasped Cara's wrists and gently walked her back into the house, using his foot to kick the suitcase from the swing of the front door.
"It's alright, girls," he said with weak resolve. "Go and play."
"No!" Cara shouted. She kicked at her father and he pulled her close into a bearhug. Gradually, the girls calmed and were convinced to return to the box in the front room.
"Kirsty," George said, "you have to tell me." He sat down on the step beside me. "Please." I would do anything to take away the hurt in his eyes. "Please."
"I can't. But… I can write it down. Maybe." I took out my phone. We shared Google Drive. When I made a new document, he reluctantly started his phone. The man was a dream. He watched his screen, and waited patiently for my words to appear.
Without preamble, I returned to the awful moment when it all began: a strange and disturbing dream. Words came like an infection from beneath a torn scab. The wound had been opened. Nothing could stop this now.
Sex with another man has never been a desire of mine. I love George. He loves me.
Plus, the man in my dream was a stranger, and not particularly handsome. He has a plain face set to unwavering boredom and unkempt male pattern baldness. Our dream sex felt obligatory, just something we had to do.
I awoke on the wrong side of midnight. November 1st and I was craving ice cream instead of the girls' gathered candy. The freezer left by the previous homeowners came with unopened ice cream. Freezer burned or not, I wanted some.
After retrieving a spoon from the kitchen, I intended to destroy a brick of neopolitan. He waited in his flannel pajamas, barefoot on the concrete floor. His arms were crossed.
"Cravings?" he said.
I dropped the spoon. It clattered down the basement steps. Before I could run away, he disappeared like someone had erased him from head to foot in one clean sweep.
Had to be a dream. That's what I told myself. The spoon stayed in the basement until daylight. Ghost or nightmare, there was laundry to do the next day.
I crossed the concrete floor fast and only felt safer when I'd closed the door to the more modern laundry room. Never thought builder's grade tiles and track lights would make me feel anything but sad.
His voice caught me sorting.
"Kirsty!"
I dropped the cup of detergent all over the floor.
"Shit."
I came out of the laundry room, figuring George had been looking for me in uncharacteristically rude fashion. He hated speaking between rooms. Shouting throughout the house was highly impolite. It must have been important, I figured.
As soon as I stepped onto the bare concrete, however, deep sadness, the kind that seems to physically leech the strength from your body, dominated the room.
"Hello?" I don't know why I said that. The basement is a low ceilinged rectangle. There are no hiding spots except for the laundry room I'd come from. After a deep breath, I walked briskly to the stairs.
"Any day now," a raspy voice breathed into my ear. I jolted and slipped forward, falling and clipping my chin off a step. It made my teeth click painfully. Nobody there, of course. I ran upstairs and George had gone outside with the girls to play hide and seek.
I wanted to tell him. He looked so happy. It's hard to convey in words the kind of smile he showed me through the window. Imagine contentment mixed with unreserved joy and hope. Yes, it's difficult to picture. So few of us can ever have such a moment. Sort of like finding a natural view completely untouched by humanity. Beyond rare and precious.
I’m rambling now to avoid writing about what followed. The point is I couldn’t tell him. I hoped it’d go away and stop.
But, of course, it didn’t, and things got much worse.
I awoke in a great deal of pain. Having already given birth to children, the feeling was familiar. Despite getting up and gasping, George continued to snore in our bed. He’s a deep sleeper, but a quick and early riser. I’ve never heard him complain about getting out of bed either, especially when there’s an emergency.
I might have woken him up but I was disoriented and confused. Part of me believed I was still pregnant with Ella. It wasn’t until I’d gone all the way to the kitchen to avoid waking up the girls, that my brain caught up: Girls. Plural. Ella was asleep in her bed upstairs.
“Ohhhhhhhh shiiiiiiiiiiit.” I knew the signs of labour. This couldn’t be happening. “Ohhhhhhhhh.”
I was definitely going to wake everyone up if this continued.
My phone was upstairs by my bedside table. We don’t have a landline. I should have called 911. I should have woken up George.
Instead, I went downstairs where I could vocalize pain without disturbing anyone. Such a pathetically passive response. But that’s how I was raised. Keep it down, don't you frown.
His hands seized mine as soon as I descended the last step. Serious and bald without dignity is how to best describe his physical appearance. Cold and cruel is what he is. The lights turned off and, in the perfect darkness of the basement, he was all that I could see.
He produces a red light from his body somehow but his touch is literally frosty.
"Kristy, it's time," he said. No joy there. Just straight facts. Something was coming. I was going to give birth to it. In the dull red glow of his being, the first boy came.
"His name is Hadad," the man said, placing a large, infant boy with a lot of hair and, I swear, a hint of beard, on the bare concrete. Hadad looked like a three month old they use as newborns on TV. He didn't cry. He hardly seemed to breathe as his dark eyes roamed the darkness. His light resembled the man's, a less intense red.
I felt another contraction, and winced.
"She comes next," the man said.
I felt so weak. "Who are you?" I asked him.
At last, he smiled and I wished he hadn't. It made me feel small, insignificant, and beneath his concern. "You know who I am," he said. "I'm your husband."
Pain wracked my entire body. Something didn't feel right. The birth of Cara and Ella had been without difficulty.
"Push," my "husband" ordered. "She is upset with you, and will kill you if you don't get her out now."
"It has to be a nightmare," I told him. Sweat poured in streams down my face. The unborn "she" in question writhed and damaged my insides. I screamed. I couldn't help it.
"Push!"
I obeyed and the second boy spilled onto the bare concrete, coated in blood and dust.
"It's a boy," I said.
The man looked displeased. "The body is male. She is Hebat. No wonder she is angry." Like the other infant, Hebat appeared aware of her surroundings and had far too much motor control for a newborn. The light pouring from her body was dull silver. Her eye sockets were two pits of concentrated despair. I had to look away.
The babies were pressed into my arms.
The man stretched out beside me. "Open your eyes and smile." I resisted. "Do it. Now." What choice did I have? The flash from his cell blinded me. They were all gone by the time my sight recovered. Only the sweat remained as evidence of the ordeal.
It had to have been a hallucination. Some very bad food poisoning maybe. The source could be as simple as an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of underdone potato. I had been stress eating since we'd moved in. I stood up and took some comfort in a Charles Dickens' reference.
"More of gravy than of grave about you," I said. My words seemed consumed by the dreadful weight of the air. "Whatever you are."
Whatever you are: something bad in any case. At best, I'd hallucinated prolonged and traumatic labour and needed medical attention. Yet, when I limped up the basement stairs, all thoughts of waking George vanished. There on the kitchen island sat a propped frame containing the photograph taken only moments ago.
The man looked happy. Only Hadad appeared in this picture, which meant another one was somewhere. I didn't panic. I worried more about what George would think if he saw the photos. I had to find them all.
Hebat and his father and I were mounted in a dark wood frame by the master bedroom. It'd be the first thing anyone saw if they woke up. I plucked it off the wall and, together with the first photo, tucked it under some blankets in the dresser we'd shoved in the small walk-in closet.
You might not believe this, but I went straight to sleep after. I climbed under the blanket in my sweaty pajamas, shut my eyes, and didn't have enough time to deny what had happened. I was unconscious until morning.
George placed a coffee on my nightstand. That's what I remember. He rubbed my feet while I slowly awoke. The girls were watching TV downstairs, munching on apple slices. There was forty minutes still before we had to seriously consider getting ready to take Cara to school.
George would drop her off on his way to work downtown. He chose his hours and always chose convenience for his wife and kids. Ella and I planned to spend the morning gardening. Then we would nap much of the afternoon away until George and Cara returned. A life so perfect is so very rare.
I didn't want to spoil things with a very convincing nightmare. Besides, I felt fine. Not so good that I wanted to look in the dresser to see if those photos really were there, but not ill. So I remained silent again.
November started fine. Idyllic days and nights filled with laughter and joy and television. Just as I started to believe in the dream we'd made, they came again.
The wail of a child's hunger is a powerful call for a parent. When it's a chorus, even of two, it cannot be ignored. Only I awoke to Hadad and Hebat's cries for their "mother" from the basement.
Half asleep, I drifted into the kitchen and searched for their milk bottles. When no bottles could be found, I remembered they were newborns. Milk swelled in my breasts and made my nipples ache. Just like when Cara or Ella would awaken in the night. It was a relief to feed them.
But what the fuck was I doing?
I was acting like the man in the basement and the devil babies were mine. It'd been less than a week since Halloween and that horrible nightmare illusion. I had already taken on the beleaguered newborn mother role without question.
Their cries intensified and flayed the weak resistance of exhausted reasoning.
Don't wake George. Don't wake my babies, my real babies.
"What took you so long?" the man critized, his voice monotone, the question unrhetorical.
"I… was sleeping. I went to the fridge first." Under his severe gaze, I stopped in the midst of the dark room. Hadad had quieted. Hebat cooed as if laughing at her own joke. I couldn't see them because the lights were off. They liked the dark better. Somehow I knew that about them and him.
"You should sleep down here," he said. "A mother should always be close to her babies."
The statement was nonsense but not altogether wrong. I wanted to be close to my babies, the daughters sleeping in bliss upstairs, away from the evil fermentation in the basement.
"Kirsty," he said. "Are you listening?" His hand touched the small of my back. The gentleness surprised me. I squawked and flinched away. "What’s wrong with you? They're hungry." He pressed on my shoulders until I sat on the cold floor.
They came from the shadows, already walking. I wanted to go, but I knew he wouldn't allow it. He pulled my cat t-shirt off over my head and their fierce mouths suckled, relieving the pressure of excess breast milk quickly. It felt physically good and psychologically alien.
I looked down at them once and immediately regretted it. Their emanated light had intensified to a point where perception of them hurt.
Each time I blinked my eyes were drawn to some isolated part of their bodies. The vision got closer to the point of disgust. Everything is gross if you're close enough. There is no beauty under a microscope. If you think there is then you're not using the right magnification.
Hebat's eye drew me in. At first, I saw the dark sphere, and then the strands of her eyelashes. Her gravity kept pulling until the creatures that live in eyelashes were revealed: Demodex folliculorum. I looked the microscopic horrors up.
The babies had more parasites than any child should. They wanted to show me and could somehow do so.
I asked him about it. "Why are they showing me these worms?"
He smiled, contemptuously as usual. "Trying to impress mother. Neither of them understand your horror and insignificance. You are the ant who knows they're an ant. Lucky you. They think you will be proud of the life their corporeal forms produce and host. Give them a few hours. It will pass."
"Why are you doing this to me?"
"I'm not sure what you mean. We're married. Now, prepare to smile." His cell reappeared and I noted the lack of features; it might have been a singed rectangle of spent firewood. He frowned when I failed to smile. "Smile, Kirsty. These are your children."
I managed to stave off the tears and hold the babies close. The smile was more difficult. In the inevitable aftermath of their sudden disappearance, the frames depicted an exhausted, wrinkly woman smiling painfully. It took a second to recognize myself.
The things in the basement sapped my strength. I looked dehydrated, beleaguered. The scale in the bathroom said I'd dropped six pounds. I'd weighed myself the morning before.
"Whoa, you've lost weight," George noted, thinking I'd be pleased. "This place has been so good for us, eh?'
To produce another smile proved as draining as the previous night. "Y-yes," I stuttered too late for him to ignore.
"Hey," he said, touching my forearm.
I flinched.
"Whoa, you okay? What's wrong?"
I should have told him. "Nothing. Bad sleep. A nightmare. I'll be fine."
A lie is an agreement. George wanted to agree, I think. He wanted life to be fine because he was happy for once. We struggled so hard before we came to Bridal Veil Lake. It was supposed to be our dream.
Guilty if I told him the truth. Guilty because I didn't. I began to resent his happiness, though he had done nothing but be the wonderful man he'd always been.
To Cara and Ella I became a body in motion, No brain left to guide them away from harm or answer their questions about nature and the universe.
"I don't know." That's what I told them often.
So they began to treat me like a kind of butler.
"Can I have some juice, please?"
"Sure, sweetheart."
"Mommy, can I have a snack?"
"Of course." And I'd run off to fetch it.
"Cookies."
"Yes, dear."
When Christmas came, I had two and they induced the same level of joy. Visiting the basement to feed and nurture Hebat and Hadad became a nightly occurrence. I'd learned to awaken, if I could get to sleep at all, and go quietly.
He berated me severely if I missed a night, and there were subtle threats made casually.
"I may have to squash you yet," he said, his tone as deep and cold as always.
"It won't happen again," I promised. "They’re getting big." In fact, they were no longer infants. Both had grown to the approximate age of six or seven in a few months. Still, they never spoke. Their dark eyes watched me as they ate food from the kitchen upstairs, food I'd hidden from my family.
"More meat," the man demanded.
"Of course." And I ran to the freezer and gave them frozen sausages in the package. They never complained or demanded the food be prepared a different way. No objections from my "husband" either.
Hebat tore the styrofoam and plastic wrap away and flattened the row of sausages stuck together between powerful molars. Hadad contented itself with licking them like a popsicle.
I'd stay until the photo. Then they'd release me by vanishing. Always with an exhausted breath, I'd trudge up the stairs and search for the frames and hide them in the same place.
They only smiled in the pictures. At no other time did they express any kind of emotion unless indifference counts.
My own children and husband weren't doing much better. Their concerns about my fatigue and ruminating slowly ceased as I repeated the excuse: I’m just tired. It'll pass.
Of course, I did not know when the nightmare would stop.
"When will it end?" I asked him one night, while Hebat and Hadad exercised like they had a mission.
"What do you mean?" he said.
I was surprised he answered. He usually didn't. "This. This. When can I go back to normal and not come down every night? I'm so very tired."
He frowned and I thought some punishment must be coming. Instead, he looked more confused. "I don't understand. You aren't happy? Your children grow into power and strength and will take their place in the world. They will be great and you - you, of all the tiny things, made that happen. Ask yourself what you want out of life, and see if Hebat and Haddad aren't your answer."
Too many words, all at once, for an exhausted mother. I didn't speak for the rest of the night. The infernal trio vanished, and the latter moments of the ritual I carried out with his challenge in mind.
I want my children to be strong, happy, and safe.
"Juice," Cara demanded the next morning, a Saturday, while she watched cartoons.
"Get it yourself!" I hissed, from tired to angry in a second.
"But I can't," Cara accurately pointed out. She didn't look away from the TV. Looking at me wasn't safe, and she knew it. Her and Ella held hands and sat a little straighter. It broke my heart. What had I done?
George came downstairs, attracted by my shouting. "What’s going on?"
Empathy became sadness, and the constant burden rekindled to anger swiftly. "Just children treating me like a servant."
He smiled. "Ah, yes, and how are the royal princesses this morning?"
His levity irked me. "You would know if you didn't sleep in so much."
The smile vanished from his face, and instead of the fight I seemed to want, he mumbled a quiet apology and joined the girls. They climbed onto him as he wrapped them into a cuddle.
"What are we watching?" George restarted his smile, his calm, for the girls. I hated myself. It had to end. Tonight.
After another dreary day of going through the motions, and the girls and George had fallen asleep, I went to the kitchen and chose the knife I thought sharpest.
"Kirsty," he said, his voice a whisper rising from the depths of the house.
"Coming," I whispered back.
"Mom," said another voice, a girl's, and I knew that Hebat had, at last, found herself and the wholeness of her being had been corrected.
I started to cry. I went downstairs and there she was with her brother and her father. He looked tired but some of the grimness had cracked to allow the first real contentment I've ever seen him express.
"Is that for the cake?" he asked. "We already have one."
I remembered the sharp knife. "Meat," I said. "There’s ham in the freezer."
He nodded, seeming to accept the answer.
"Mom," Hebat said, "Do you think I'm…" She gestured to herself, her face, and her body, and I understood the question, born from doubt and a desire to be validated.
I pulled her close. "You are the most beautiful girl in the whole world." We cried together. Hadad cut into a poorly made, asymmetrical cake by the light of his aura. No one cared that he did so on the floor. I brought out the ham from the fridge and we ate slices with our hands.
"It's almost done," he said. "They’re nearly grown. They are strong, and they are happy. You've done a good job, Kirsty." He watched our children fight to smear icing on each other's faces. "I'm sorry if I was mean. Or cold. I've never done this before." And he meant raising children. "It was the hardest, scariest thing anyone can try. I shouldn't have blamed you for… Hebat… It wasn't your fault."
Before I could pat his hand, he and the kids vanished. Darkness so familiar couldn't extinguish a new fear. I went upstairs and found the last frame. I held my daughter in the photo, my beautiful Hebat. He must have taken the photo without my notice.
I took it upstairs but couldn't bring myself to hide it.
I didn't see that one, George wrote into the document.
I forgot he was watching.
He typed again: Are you saying there is something in the basement?
Yes, I replied.
He stirred in the living room. I hadn't moved from the stairs, but I could tell by his stomping how angry he'd become. All of his negative, violent traits he saved for those in the world who would harm his family. George the Protector was fearsome to behold.
But he had no chance against my other husband.
"Come out! Come out you coward!" George bellowed. At first, nothing happened. The moment before calamity, even when the specific consequences aren't known, is still in slow motion. He carried on shouting. The girls rushed into the hall and didn’t hesitate to investigate.
"No!" I shouted. "Cara! Ella!"
Their feet padded down the steps. A violent commotion followed, screams and raging voices, both deep and childishly shrill.
The most unsettling quiet followed.
I chewed through the fear and the horror tearing me apart and finally moved.
No evidence of violence could be seen from the top of the stairs. The concrete looked bare and dusty and the light revealed nothing more. They were gone, all of them.
"Hebat," I whispered. "Cara? George?"
Him, I thought of, the nameless husband and felt no hint of his presence. He'd always been there. I know that now. It had nothing to do with the house. His absence was felt more than his insidious presence. Yet, I felt no relief. George and the girls were gone. I sat on the floor and cried for all my missing children.
When I finally emerged from the basement, the whole house had been filled with night. Their photos were everywhere. The others were upstairs. I gathered them on the kitchen island. How could I explain any of this to the police?
I needed help. I called my parents. It took twenty minutes before my father picked up.
"Kirsty? What's wrong?"
"Dad," I whimpered. "George is gone. Cara. Ella."
"What? What did you say?"
"They’re gone, dad. George. The girls are gone."
I heard his bed springs protest as he rolled out of bed. My mom said something I couldn't hear, and he shushed her.
"Kirsty," he said, "are you alright? Are you hurt? Are you in danger?"
Why was it so hard to understand? "Dad. George is gone."
"Kirsty, who the hell is George?"
It was my turn to be confused. "He's my- you know him. My husband…"
"Kirsty," he said very slowly, "are you on drugs? Did you take something?"
"No. Are you?"
"Excuse me?"
I hung up.
I have their photos. I have all of their photos. That's what I brought to George's parents before the sun rose. They wouldn't open the door and spoke to me through an intercom.
"George is gone," I said.
"We'll call the police."
"This is your son. These are your granddaughters."
I heard my mother-in-law say, "Who is she?"
"We don't have a son," my father-in-law said. "Go away."
I left.
Back to the house. Our dream sat empty and I live there, but none of the people in my family photos are my family.
I remember but the world never does. My parents think I'm ill and that I used AI to create the family I apparently never had.
How did I buy the house without a job or income? With deep concern for my mental health, they showed me a news story. I had won the lottery the day I turned eighteen.
His influence there, payment for services rendered.
A lie is an agreement.
What had I agreed to? I'm afraid I know the answer: I never wanted a family.
God help me. God help them.
I don't know what to do with these pictures.

So it's me again, back for another rant! Life is tough, and I don't have anyone I can talk to. I'm just so tired of the way things are!
EDIT TO ADD: Because there's an argument in the comments section I'd like to clear some things up. I'm 30f, 5ft 6in, 210lbs (not a lightweight in terms of alcohol consumption). We started drinking at 7pm and my incident didn't occur until 3am, so it's not like I was pounding them back. I was prescribed antibiotics but mentally couldn't handle taking them, I took 2 doses but because they cancel out my muscle relaxers I couldn't bring myself to torture myself with them. Also I never take my last dose of muscle relaxers if I'm going to be drinking, that's been standard practice for years. I do have medical anxiety thanks to our hospital... the amount of times I've been misdiagnosed by one doctor (he's since been fired) was traumatic, I've had 3 traumatic birth experiences in that hospital, our hospital just sucks. Whenever I have something wrong that's reasonably able to be ignored I've ignored it in the past, now that I have an actual doctor I will go see her instead of wasting my time at our hospital.
Last night me and my bestie decided to have a few drinks and just unwind, it was actually a lot of fun. We had some drinks and sang along to some music, it was overall just great. Unfortunately if everything went good, it wouldn't be much of a rant would it. The night was going fine, I had 3 cans of Mike's Hard Black cherry (super yummy and definitely recommend it) and I had 2 glasses of rum & coke, so nothing all that crazy for me compared to how much I have drank in the past. Around 3am I got hit with some mild chest pain...
The chest pain turned into a really intense pressure through my chest that ended up radiating through my back, it was nothing like what I've felt before, I get stress chest pains and honestly this experience made them seem somehow diminished in comparison. As the pain got worse I noticed I was having trouble breathing, it got so bad that I started getting nervous. Within 20 minutes of the chest pains starting I got genuinely scared and asked my bestie to take me to the hospital, anyone who knows me knows that I will avoid it at all cost so she knew that it had to be serious enough. She went into panic mode and in spite of everything I managed to stay calm and take control of the situation. As we pulled into the hospital parking lot I started feeling an almost primal fear, the type of fear you get when you think you're truly about to die.
I got to the front desk and was immediately told to come in and take vitals, they couldn't get a BP despite having the cuff on my arm for about 10 minutes, she finally gave up and asked me the usual questions about pain and stuff. Weirdly enough my arms decided to shift between pain and numbness and I suddenly started slurring while trying to explain myself, that was when all "care" was off limits to me. Our hospital has a bad habit of sweeping people under the rug if they even remotely suspect alcohol use, but the thing is I was fine moments before going in... I was perfectly coherent and I actually felt completely sober thanks probably to adrenaline or fear. I was sent back to the waiting area and told to just wait my turn, and things went from bad to worse quickly.
I didn't know that I had passed out, my bestie filled in the blanks for me. Apparently while we sat there waiting I kept coughing roughly, my eyes rolled to the back of my head, and apparently I kept making weird movements with my tongue sticking out. She said the best way of describing it is "I was behaving like I'd been severely drugged and suddenly seemed to spiral quickly". When I came too I was still in the waiting room, freezing, in severe pain (I don't do well in cold environments and the hospital is always freezing), and feeling just beyond exhausted. When I asked her about if we were even checked on she confirmed my thoughts... we were left there, away from other patients, out of sight of anyone who could help if things got deadly.
After managing to stand up I looked at my bestie and said that I didn't want to be there anymore because no one cared about me, she agreed with me on the terms that if anything else happened we'd go back immediately. When I went back to triage to tell them I was leaving the nurse gave me a smug look and asked if I was feeling better or do I just want to leave, so I answered with "better isn't the word I'd use but dying at home seems like a better option". She ripped the IV plug out of my arm (which I frankly don't remember having one inserted), and told me to have a good day. I felt so angry! The experience triggered my PTSD from the last time I went to the hospital (long story short, I was kept isolated in a room soaking wet and freezing until the department I needed decided to take me in).
I could have died, and no one would've cared because they suspected I was drunk!!! What if no one came to check on me at all?! What if they only found out I died because my bestie couldn't wake me?! Would they have maybe cared than? Or would they have just said "oh well she drank"? It's infuriating to be treated like nothing just because there was a little bit of alcohol involved, like I said I wasn't drunk and actually felt sober! My condition deteriorated rapidly over the course of a 5 minute car ride. I spent the whole day just feeling rough!
After we left the hospital my body just doesn't feel right. My chest feels fuzzy/bubbly, I don't know how to better describe the feeling as well as feeling tight. My breathing still feels really labored like it's taking a lot of effort to just keep going, and small things are leaving me feeling winded. All day I couldn't shake this weird chronic fatigue, I'm just drained of all energy. And I've been noticing my arms go completely numb if I lean on them, which is super alarming. As long as nothing else happens in between I'm planning on following up with my doctor because at least she's taking me seriously, if something else does happen though were gonna take the 3+ hour drive to the next nearest hospital. The scary thing is, that weird primal fear still hasn't gone away and I'm nervous about that!

I’ve been experimenting with supplementation and biohacking for about 10 years now and I’m starting to wonder how much it has affected the way I view my own health.
I’m concerned that I may have become hypersensitive to my body to a point of mild hypochondria or even being psychosomatic.
Or maybe I genuinely have constant health issues.
I’ve been feeling envious of people who seem to never have any sort of discomfort or need for health intervention— do they actually exist?
Or do people bury it down because of societal expectations of appearing OK, or because they’re not overly in-tune to their body and so they tend to ignore issues?
Some recurring issues are:
Uncomfortable PMS symptoms like cramping, extreme fatigue, moodiness, anxiety, and bloating.
I’ve had a chronic bottom rib injury that limits my movement.
I’ve been seeing black spots in my vision for a couple of years now, usually when my heart rate is up, i’m feeling overly anxious, or I’ve had too much caffeine.
Ongoing stomach issues for years, like bloating, constipation, and pain.
There’s always some body ache I’m trying to solve, and some focus, emotional, or energy issue.
this just feels like a lot to me, especially for someone who takes care of themselves. I do have a lot of stress, but I manage it pretty well with my workout routine, diet, therapy, sleep, and other recommended techniques.
36F. I jog/run about 10 miles per week and I do hot yoga twice a week.
Edit to Add: I did have a traumatic/extremely dysfunctional youth. Diagnosed with chronic PTSD. I have one child. My dad is very unhealthy— overweight, smoker, diabetic, etc. My mother has always had “pain” and mental health issues. She’s been complaining of fibromyalgia my whole life. I have a history of substance abuse (prescription medication, other recreational drugs, alcohol, but stopped the hard stuff around 23 years old, almost completely quit alcohol around 30)
I do multiple forms of therapy, including structured/professional plant medicine sessions that have been immensely helpful.
I have never had my G.I. or hormones or anything else tested. After reading some peoples’ comments, I’m going to make that a priority.

Hi all. I had severe headache / head pressure / eye pressure and black shadows in peripheral vision happen. Ears ringing, blood pressure up, ears popping, salty fluid drip down in mouth, & severe dizziness happen over last 2 weeks that kept getting worse. Couldn't drive or take care of toddler. Went to er again last night and new er did a lumbar puncture. ( my first ever). Traumatizing to say the least. How ever I am feeling so much better, headache gone, eye pressure gone and no more shadows. Only thing is my pressure was only a 22 and they brought it down to a 15. Helped tremendously. Er doctor says iih and wanted to start on meds but called neurologist and neuro said no meds and wants to see me. Other er only did CT scan and did see partially empty sella In notes, but didn't mention it to me. Other medical issues are hypothyroidism, degenerative disc disease, tmj, intercystial cystitis , lymphadema in both legs, & adhd/depression/anxiety. Swelling in fingers and eye lids that is worse in morning. Joint pain sometimes in 2 fingers with little hard knots in same fingers. Fatigue, excessive sweating on only one side of face especially in morning. Eye test from opthalmology came back good but another test in 2 weeks without dilation. Dry eyes but dry eyes have been alot better since lumbar puncture. Can anyone please tell me what the heck is going on with me? Also seeing an endocrinologist and have ana panel that came back positive with antibodies showing 1:80 speckled and homogenous. Don't know what kind of auto immune disease I have yet. Also low morning cortisol. Thank you.

Over the course of my 4 year marriage to my partner, I have arrived at the position that I was abused, manipulated, and functionally enslaved to a mentally ill partner.
In simplest form, the progression is apparently observable. She was diagnosed with cancer in October of 2019 while we were engaged. Due to the diagnosis, we moved up our actual marriage date (our wedding was still set for mid-April) to December 1, 2019. Her surgery was December 13, 2019. In my compassion for her, I agreed to move our wedding date up to offset her anxiety around who would be responsible for her if things went south with her surgical treatment.
Our first month of marriage was straightforward; she was on pain meds recovering from surgery, so the main engagement that occurred was me walking her up and down the hospital hallway as she recovered and trying to meet her base physical needs of hygiene, food, and presence. We stayed in the hospital for 2-3 weeks (with recurring hospital visits for complications).
Quickly after we figured out our marital living situation in her small 3-bed apartment with 2 roommates, our relationship devolved. Specifically, she was irritable because of the pain she was in, causing her to lash out at me with regular frequency for small things. If I didn’t put clothes away in the right place, didn’t anticipate her needs (without her communicating them), or ate the wrong food in front of her she would shout at me and decry me for my thoughtlessness.
These small, critical engagements were wounding and created a distance between us – and there was no upside. She was never kind, never paid mind to needs I might have, and started down a path of cultivating a root of bitterness in her soul. She quickly revealed herself to be venomous, hateful, and vindictive when she felt like she was wronged — and any observation of concern about our marriage resulted me in being accused of being mean or insensitive, even if I spent hours or days calculating the best way to share my concern (and I have a master’s degree in communication where I focused in studying disagreement — I know how to carefully package concerns).
During this time, I worked hard to provide for us, foreseeing a significant time period where I would have to be primary financial provider and caregiver. I increased my income each year we were married by around 25%, finishing our marriage at >$80,000 in yearly income, compared to starting our marriage at a modest $42,000 salary (including dramatically improving our healthcare). Frankly, I increased my income to provide for us in spite of the lack of support at home.
But to be clear: I don’t think it would have been particularly difficult to provide financially if I had an ounce of support at home.
However, the relentless criticism and expectation of mind-reading continued through the years. I rationalized this abuse for the first year of our marriage because of all the excuses to be cruel, she had a good one – she had cancer. I hung onto a hope that it would stop. Contrary to my hope, as the years went on – and our expenses climbed – and I continued to work myself to the bone – she continued to relentlessly critique and even started being more emotionally demanding, expecting me to take responsibility for her inability to cope with her emotions – I was drowning. She was asking too much of me. There was no deliverance from her abuse.
I was exhausted. In the peak of the abuse I endured at her hand, I was working multiple jobs, sleeping 10+ hours a night and napping frequently during the day around meetings and work, then coping with alcohol to numb myself to the abusive dynamic and fall asleep with no support from her. The only time I could approach her sexually was when I was intoxicated, with inhibitions lowered. The only time I could have a conversation with her was with a counselor in the room. Without something to mitigate opportunity for her to be cruel to me, either a mediator or self-medication, I was scared.
I lived at home in a constant state of alert and cognitive fatigue. No matter how I tried to make sense of my home life, I couldn’t. When she looked at or touched me, I would recoil in fear, anticipating some sort of incisive critique or demand expressed. Then she would criticize me for not responding warmly to her, exacerbating the cycle.
I couldn’t meet her needs – I was utterly exhausted. When I would tell her of the exhaustion I experienced in marital counseling, her responses were typically something along the lines of not believing me, denying what I was saying was true, or calling my exhaustion an ‘excuse’. I could interact happily with my friends… why not her?
I did not deny her demands were legitimate; rather, I expressed my inability to meet them because of how fatigued I was. I said ‘I can’t’ so many times. I realize her demands were small; affection, saying ‘i love you’, complimenting her. But it’s disorienting to be consistently berated and belittled by a person and then asked to compliment them and tell them you love them.
The push and pull of abuse is exhausting to a person who is not mentally because it does not make sense.
Further, in counseling I realized that I have forgotten that I have needs. I have lost the tools to even evaluate what my needs might be because, implicitly and explicitly in my marriage, I was told my needs don’t matter.
My marriage made no sense; I was obviously drowning, exhausted with the demands our life imposed on me. I was doing everything I could to get straight. I was in individual therapy, marital counseling, pastoral counseling, trying different antidepressants (4 in total – all with no effect), changing eating habits, trying to reduce my drinking, getting medical tests to see if I had health issues causing my fatigue, and being vulnerable in my friendships in an attempt to invite others in to process and move forward and figure out my marriage. I desperately shared everything I could about my marriage, hoping someone else would crack the code where I couldn’t.
None of my efforts worked. I could not get out of the exhausted state I was in. It’s worth noting here that within weeks of separating I almost completely cut out alcohol, got into a regular sleep schedule, was waking up at 6-7am every day and reading multiple hours (which I couldn’t do in marriage due to cognitive fatigue/distraction), and experienced a resurgence of energy. I have felt the duress I was under lift and lift and lift and the weeks and months have went on.
In retrospect, I was experiencing cognitive fatigue because I was taking the demands my wife was placing on me seriously, but no matter what I did I could not make sense of them. How could she not see that I was doing everything I could to make ends meet – the ends which she was imposing on me? I did not have additional energy left. She would ask me ‘Do you love me?’ and I didn’t know how to respond. How is my work not at least some symbol of love? My dream was to be a poor professor, which she knew – instead I was grinding myself to the bone, working in digital marketing with multiple freelance projects, picking up a bartending gig and a teaching gig on top of full-time employment.
The last straw was when she accused me of abuse. I took that accusation seriously, and weighed it against my experience. ‘Am I an abuser?’ I asked myself. I sorted through my behavior and how I treated her. I came to the conclusion that I may be a poor husband in serious ways; but I am not an abuser. And the abuse question opened the door to the question… ‘I may not be an abuser… but is there abuse in our marriage?’ And the answer quickly became ‘Yes.’
When we were married, I understood that she wasn’t going to work much for a while. However, she worked the bare minimum she could for 4 years, earning at most in a single year $18,000. As the years went on and my income climbed, our debt continued to climb as well. She was still contributing the same, yet spending frivolously on useless knick knacks for our home and a cat. As I packed up our home to sell, the majority of items were dozens of boxes of useless junk she’d accumulated.
She lived a life of mania around finances. We would go to marital counseling and she would regularly express, ‘I would rather be poor and happy than rich and sad’. We were poor and sad. Sure, my income was the highest it’d ever been – but we were still drowning, with debts climbing. At the end of our marriage, we’d accumulated about $20,000 in consumer debt between credit cards and personal loans.
It was traumatizing (and abusive) to go to counseling and be told by my partner she would ‘rather be poor and happy and than rich and sad’ when the factual scenario we were living was neither. She actively denied reality – both my lived experience and the reality of our finances – at my expense. It was killing me, trying to make sense of what we were going through but being unable to make sense of what I was being told and what I was experiencing.
Throughout this time, it is worth adding that she also leveraged my spiritual leadership to ‘set me straight’. I was in a conservative Evangelical space, believing that men are the ultimate provider in a family unit and primarily responsible for the status of the marriage. Because I was not doing what she wanted me to (lavishing her with affection), I was muscled into multiple groups and meetings where pastoral care intervened to restore our marriage. In the moment, I submitted to my pastoral care because of my trust for them and my faith in God. Now, I believe this dynamic was abusive; my pastoral care did not care in any sense for my soul; they only cared about fixing my marriage. No questions around ‘why’ my marriage was so bad were asked; only what was going on and how it could be fixed. I relish the thought of my pastoral care being held accountable for the abuse they exercised upon me during this time on judgment day, albeit through a shaken faith in a God that would enable this dynamic.
With my spiritual community, I shared that I felt like she was my tormentor; that she it felt as if I were on the ground due to exhaustion, and she was standing on my throat, telling me to ‘get up’ and ‘tell me you love me’; that our metaphorical life was a boat, sinking, and I was desperately bailing out water. All the while, she stood at the other end of the boat, desperately bailing water in and looking at me like I was a maniac.
And yet, because there was no adultery, there was no category for divorce. We had sworn an oath before God and were required to fix this.
As I reflect upon my marriage (and the ongoing divorce proceedings), a few things are clear.
She is an abuser. I don’t think she intends to be, but impact matters. She is mentally ill and unable to reckon with basic reality.
She is a manipulator. She manipulated my spiritual community against me. I was viewed as someone to be corrected while begging for help from my trusted friends and pastoral care, whom I now regret being vulnerable with due to their abuse and denial of my reality because I didn’t fit neatly into their thin theological categories.
She is an enslaver. In divorce proceedings, she is doing everything she can to get every dollar from me, leveraging student loans I did not co-sign, my continually increasing income due to my hard work, and denying every claim of dissipated assets she can.
It is truly a mind-breaking experience to see your compassion leveraged against you for money. I had to sit under an attorney proclaiming to a judge that, since I consented to move up our marriage date before her cancer surgery, ‘I knew what I was getting into’. That she is entitled to large sums of money (that do not exist; we never had more than $3000 in our bank account during marriage) due to that decision.
Even apart from the abuse, I did not know what I was getting into. Including the abuse, I am full of remorse for having invited such an evil, hateful person into my life.
This experience has been the most challenging to my faith. As I endured abuse from her, I trusted God in a few ways. That the compassion I showed would maybe be rewarded – or, at least not punished. That my spiritual community wanted what was best for me. That God was not a punitive, hateful God (like my partner). I do not believe this trust was well placed, but am open to shortcomings in my views here.
I struggle to consent to a God that allowed my experience to occur. I’m open and processing in some kind of faith, but I really don’t know what it looks like to find a place to put this pain and betrayal that I’m experiencing.
I am a survivor of abuse, and the abuse I endured was mind-shattering. I sacrificed everything to support a partner diagnosed with serious bodily illness, which drove her to hate me and deny my lived experience because she could not reconcile it with the hatefulness she cultivated over our marriage, choosing bitterness over any positivity for four years, poisoning my well-being in the process.
What I envisioned to be the most compassionate moment of my life — marrying a person with cancer and promising to support and love them — has become nothing but a symbol of pain and remorse. I envisioned a life where my partner and I would fight against the terror of cancer; instead she hopped to the other side, choosing her ongoing health issues as the ally and myself as the enemy.
It took me 4 years to realize it. And as she drags me through court to leverage every dollar out of me I can, my only regret is that I didn’t leave my abuser to her own devices sooner; self-pity, hatefulness, and a sheer disregard toward taking responsibility for anything.
I am grateful but drowning. As we are negotiating settlement, the end is near, and my abuser will soon be unable to execute any influence in my life.

Emergency physicians, PAs & NPs are not the kings and queens of "burnout" because of a lack of yoga or insufficient grit. They are dissatisfied with jobs that don't allow them to deliver high-quality acute care (which they trained for years/decades to do) while their workplace's systems-level decision-making is handed to finance-first administrators.
Enter ACEP's new "Well Workplace" policy. It appropriately puts the onus on employers to create workplaces that work for emergency physicians and their patients. The policy:
Although the individual has responsibility for personal wellness, the primary emphasis should be on how the organization impacts the wellbeing of healthcare workers.¹ This includes, however is not limited to, fully sponsored initiatives directed at:
Organizational Influences

1. Provision of adequate site resources to meet patient needs at all times.^2,3,4
2. Attention to facilities, addressing essentials such as lactation rooms,⁵ break rooms,⁶ and charting space.³
3. Intentional policies addressing workplace safety and violence prevention for patients, families, and healthcare workers.³
4. Leadership strategies to enhance physician engagement, satisfaction, and retention.⁷
5. Fully transparent sick call, paid time off/vacation, bereavement, substantial family, parental and medical leave,⁸ and elder care policies consistent with state legislation.⁹
6. Supportive environment with adequate mental health Early recognition strategies to identify moral distress, physician impairment, mental health issues, and physician suicidality. These may include peer to peer¹⁰ and/or employee assistance programs.¹¹
7. Provide training in and address in real-time:
   1. Critical Incident Stress Management, Post-Traumatic Stress Disorder, adverse events, challenging cases.¹²
   2. Mitigation of Compassion Fatigue, Second Victim Syndrome.¹³

Practice Environment Influences

1. Full staffing of all workers in the department required for patient care, including ancillary staff and non-departmental employees such as transportation, environmental services, laboratory, radiological services, and security.^3,4,14
2. Directed critical efforts with institutional leadership at the highest level to measure, report, and solve boarding¹⁵ and overcrowding burden.¹⁶
3. Establishing physician-led on-site teams to adequately supervise non-physician providers if provided.^17,18
4. Prioritization of Diversity, Equity, and Inclusion for all.^19-21
5. Attention to improving operational flow through human factors engineering.^3,22
6. Best possible employee nutritional options available 24/7.⁶
7. Burden reduction of administrative tasks:
   1. Focused electronic medical record²³ systems optimization, with paid on-line training and paid off-shift chart completion.^24,25
8. Reduction of non-essential communications, meetings, and email.²⁶

Culture

1. Anonymous, comprehensive, and objective evaluation of wellness outcomes and departmental leadership by staff to ensure accountability to address, maintain, and improve workplace wellness.²⁷
2. Transparent and equitable compensation, promotion, due process policies and clearly defined reasonable and sustainable productivity metrics.²⁸
3. Establishment of effective departmental/hospital wellness committees.
4. Culture of teamwork, with expectation and enforcement of interdisciplinary respect, empathy, and collegiality.
5. Support programs that include, but are not limited to addressing:
   1. Recognition of the relevance of aging physicians in the workplace; retirement planning.²⁹
   2. Litigation stressors.³⁰
   3. Financial issues.³¹
   4. Mentoring and/or coaching.^19,20,21
6. Individualized schedule optimization.³²

References

1. Manfredi R, Krywko ~From Self to System: Being Well in~ ~Emergency Medicine.~ ACEP Wellness Guidebook. 2024.
2. Model of Clinical Practice of Emergency Medicine. ACEP Web site. Published June 2023. Accessed March 1, 2024.
3. Safer Working Conditions for Emergency Department Staff. ACEP Web site. Published April 2021. Accessed March 1, 2024.
4. Emergency Department Planning and Resource Guides. ACEP Web site. Originally published December 1985. Updated and approved April 2021. Accessed March 1, 2024.
5. Support for Nursing Mothers. ACEP Web site. Originally published February 2020. Updated and approved October 2013. Accessed March 1, 2024.
6. Food and Drink for Staff in the Emergency Department. ACEP Web site. Published April 2020. Accessed March 1, 2024.
7. Kase J, Doolittle B. Job and life satisfaction among emergency physicians: a qualitative study. PLoSOne. 2023;1892):e0279425.
8. Family and Medical Leave. ACEP Web site. Originally published June 1990. Updated and approved August 2022. Accessed March 1, 2024.
9. Assignment of Benefits. ACEP Web site. Originally published April 2006. Updated and approved January 2024. Accessed March 1, 2024.
10. Physician Wellness Hub. Peer to Peer. ACEP Web site. Published June 2020. Accessed March 1, 2024.
11. R. 1667 - Dr. Lorna Breen Health Care Provider Protection Act. Congress.gov Web site. Published March 18, 2022. Accessed March 1, 2024.
12. Disclosure of Medical Errors. ACEP Web site. Originally published September 2003. Updated and approved March 2023. Accessed March 1, 2024.
13. Physician Wellness Hub. Compassion Fatigue. ACEP Web site. Accessed March 1, 2024.
14. Emergency Department Nurse Staffing. ACEP Web site. Originally published June 1999. Updated and approved April 2022. Accessed March 1, 2024.
15. Boarding of Admitted and Intensive Care Patients in the Emergency Department. ACEP Web site. Originally published October 2000. Updated and approved February 2023. Accessed March 1, 2024.
16. Crowding. ACEP Web site. Originally published January 2006. Updated and approved April 2019. Accessed March 1, 2024.
17. State Board of Medicine Regulation of Non-Physician Practitioners Practicing Medicine. ACEP Web site. Published April 2023. Accessed March 1, 2024.
18. Guidelines Regarding the Role of Physician Assistants and Nurse Practitioners in the Emergency Department. ACEP Web site. Published June 2023. Accessed March 1, 2024.
19. Workforce Diversity in Health Care Settings. ACEP Web site. Originally published October 2001. Updated and approved June 2023. Accessed March 1, 2024.
20. Maximizing the Potential of Women in Emergency Medicine Women in Medicine. ACEP Web site. Originally published October 2014. Updated and approved February 2020. Accessed March 1, 2024.
21. Overcoming Barriers to Promotion of Women and Underrepresented in Medicine (URiM) Faculty in Academic Emergency Medicine. ACEP Web site. Published October 2020. Accessed March 1, 2024.
22. Wears R, Perry S. Human factors and ergonomics in the emergency department. Ann Emerg Med. 2022 Aug;40(2):206-12. doi: https://doi.org/10.1067/mem.2002.124900
23. Patient Medical Records in the Emergency Department. ACEP Web site. Originally published January 1997. Updated and approved June 2022. Accessed March 1, 2024.
24. CME Burden. ACEP Web site. Originally published April 2016. Updated and approved January 2022. Accessed March 1, 2024.
25. Compensated Time for Faculty Academic Administration and Teaching Involvement. ACEP Web site. Published June 2019. Accessed March 1, 2024.
26. Health Information Technology for Emergency Care. ACEP Web site. Originally published October 1998. Updated and approved April 2021. Accessed March 1, 2024.
27. FSMB Policy on Physician Wellness and Burnout. Federation of State Medical Boards Web site. Published April 2018. Accessed March 1, 2024.
28. Compensation Arrangements for Emergency Physicians. ACEP Web site. Originally published 1988. Updated and approved April 2021. Accessed March 1, 2024.
29. Considerations for Emergency Physicians in Pre-Retirement Years. ACEP Web site. Originally published June 2009. Reaffirmed January 2021. Accessed March 1, 2024.
30. Protection of Physicians and Other Health Care Professionals from Criminal Liability for Medical Care Provided. ACEP Web site. Published June 2022. Accessed March 1, 2024.
31. Medical Practice Review and the Practice of Medicine. ACEP Web site. Originally published May 2018. Updated and approved January 2024. Accessed March 1, 2024.
32. Emergency Physician Shift Work. ACEP Web site. Originally published September 1994. Updated and approved September 2003. Accessed March 1, 2024.

Hi everyone. I recently had a horrible experience with a gynecologist and I’m wondering if I should leave a Google review to warn other women.
So here’s the story:
I have insanely painful periods to the point of vomiting. This last one kept me bedridden for two days. I recently moved and was looking for a new OB. I was recommended one by a staff at my primary doctors office. She said this OB was so amazing and they’re a husband and wife team etc. So after being miserable for three days at this point I decided to call and make an appointment with the wife. Luckily they could take me that day.
I show up to my appointment and the doctor walks in. First thing she says is “You’re 30.” I confirm. She goes “How many children do you have?” I say none. She goes “ok what’s going on.” So I describe to her my symptoms (for context: extremely painful cramps, heavy bleeding, vomiting, EXTREME fatigue, etc. etc.) She then responds with “Why dont you have kids? You don’t want them?” I nervous laugh because it threw me off and I say I’m not sure if I want children. She literally mocks my laugh and says, “You know you don’t have all the time in the world?” I say yes, but I’m here because I’m concerned I might have endometriosis. She responds with, “Even if that’s the case there’s nothing we can really do. Go home and get pregnant. You know why?” I respond with “Well obviously if I get pregnant I won’t have any symptoms.” She responds with “Haha yes! You’re so smart!”
The conversation proceeded for another 10 minutes with me trying to bring it back to my symptoms and my concern that it’s something serious and her continuously telling me to get pregnant. This is the medical advice she was giving me.
I have never been so dismissed by a medical professional in my life. I left feeling so defeated and honestly traumatized from the experience. I literally got home and sobbed.
It's days later and I'm up at 4am still reliving the experience.
Should I post a google review to warn others? I know this question might seem ridiculous but I’ve never left a review in my life so I almost feel scared to.

I was hit by a car while riding a scooter (motorcycle type) last fall. I hit my head. I was unconscious for an unknown amount of time. Less than 5 minutes? I’m not sure. Worse than getting hit by the effing car has been the pure trauma of the medical system and how I’ve been passed around and treated. I’m a single mom and went from working constantly and earning a lot for my family to watching my whole savings go away. Many of my physical injuries are resolving but the vision piece is fucked, if I were to use clinical terms. I love to read- but haven’t read a book since the accident. I would need a whole ass nap after every chapter. I can micro-dose the internet and read emails but I’m still on work restrictions and making almost no money. My MD says the vision won’t improve without vision therapy. Which has been scheduling out for months. I’m to start mid- June. The problem is ANYTHING with my eyes flares up my symptoms. I don’t do my eye exercises because just to do life all my energy gets used up. If I do the exercises- no life gets done. Single mom, over here, no external support, it isn’t an option to not function… I’ve isolated myself because I’m a walking, talking bummer. My friends seem inconvenienced at my lack of ability to go out and do things and I’m tired of talking about it. It was traumatic and I don’t want pity. But nobody understands what I’m dealing with. I’m struggling to manage the anger of the aftermath (honestly mostly providers, insurance, and lawyers) and I feel like everything is too big to even try. I used to be really active and at the gym after working a 10 hour day. Now I can work about 6 hours and I’m ready for bed. And no gym. I’ve gained hella weight and feel like shit. I also feel like my body is trying to process the trauma and I’ve had so many stupid pop up issues as a result. Skin sensitivities, vaginal issues, hemorrhoids, like- my migraines and extreme fatigue aren’t enough to manage. People tell me, “Just go for walks outside in your neighborhood for exercise” when they see I’ve gained weight or I say I miss the gym and I want to punch them in the face. There are days I get ready to go to a show- theater tickets- and I’ll shower and get dressed and only make it to the couch. I sit and stare because I’m done now. I miss the show. This has happened more than once. Anyone been through vision therapy? Did it help or just flare you up? How do you get over your lack of activation?

Hello,
I am hoping for some recommendations for herbal remedies for these conditions. I had to get off of psych meds due to excessive side effects (gave me a chronic acid reflux disease which affects my voice box and makes me lose my voice and I am a singer so it has been tough, plus many more side effects.)
I am very prone to irritability and anger due to CPTSD and ADHD. My life has been full of continual trauma since I’ve been little and it’s been one traumatic event after another, with no break to even get over the previous events. (I am in therapy, but not sure how much it is helping or if my therapists approach is appropriate) Apologies if this sounds at all like ranting, I am just trying to be honest with my symptoms.
I cannot get into a normal routine, my relationships are affected, I cannot sleep regularly due to a crazy work schedule, and I feel like my nervous system is completely shot to the point where I cannot even handle simple stressors without feeling like I’m going to implode or my body is going to collapse. I’m exhausted and I just want to live a normal life where I can get things done and accomplished so I can get to a better place financially, but my executive function and fatigue are so bad right now I can hardly focus or retain information.
This cycle is leading me into a depressive state as I feel I can’t get anywhere and I feel completely stuck. I have been sober from alcohol for 4 years and am starting to question it as I am feeling so low and am starting to give up. I know I am an intelligent and capable person and I have so many goals and such strong ambition to learn but my brain just does not want to work anymore and my body literally rejects any form of medication that is not from the earth.
Please, any recommendations on affordable holistic alternatives or herbal remedies would be so greatly appreciated as I am desperate. I have tried so many things but nothing has been remotely life changing besides cannabis and psilocybin, but even still I’m in a slump.
I’d love to hear what works for you if you have any recommendations. Thank you so much!

Hi, I need some help as I'm really confused. I spoke to a support worker, but they weren’t very helpful.
I was diagnosed with Alopecia Areata when I was 17, and it has progressively worsened. I consulted a specialist and am currently on methotrexate, which was a last resort after trying many other treatments.
While the medication has been effective, it causes severe nausea, occasional vomiting, and extreme fatigue as side effects.
My specialist and I tried discontinuing the medication to see if my condition would improve, but my hair loss rapidly worsened. Currently, I have lost about 40% of my hair.
Losing my hair has been incredibly traumatic. Witnessing clumps of hair fall out and seeing the bald spots has made it difficult for me to leave my house. I've had to resume the medication, which forced me to quit my job due to constant sickness and exhaustion.
Would this situation qualify me for any assistance with payments? I have an appointment with my specialist in two weeks to discuss it, but I'm unsure if they will have the information I need. Although I choose to take this medication, I can't lead a proper life without it. This situation is breaking my heart, and I don't know what to do.

Hello everyone, remember when Jordan Peterson dreamed about having sex with his grandmother. And H3 reacted to it. I actually have an explanation for that. It is called Vicarious Traumatization.
https://en.wikipedia.org/wiki/Vicarious_traumatization
Basically, when you are a psychologist, you spend many hours per week listening to sexual assault victims telling their stories. As you are listening to these stories, the images plays in your head, and you can try to not think about it, but it will eventually appear in your dreams. In other words, you don’t have to experience a traumatic event, in order to feel traumatized. You can feel traumatized vicariously, simply by listening to stories or watching pictures or videos of traumatic events. That’s why I hate it when H3 fans spam that quote of Jordan Peterson’s dream. It’s not a joke. It’s an actual trauma response.
Many SA victims think to themselves “Maybe I wasn’t raped. Maybe I enjoyed it.” They would rather believe they enjoyed it as a coping mechanism to numb the pain. That’s why JP is enjoying sex with his grandma in his dream. Because in real life, some kid got molested and thought to himself “maybe I enjoyed it”. That’s what H3 are laughing at. They are laughing at a trauma response.
The whole point is not me defending Jordan Peterson. The point is H3’s vocabulary is “loser, idiot dumb”. But I want all of you to start using Vicarious Traumatization in your daily vocabulary.
Also, they say many Reddit mods have vicarious trauma. If you spend many hours reading the unhinged ramblings of maniacs. It messes with your head. It’s an entire ordeal. Because they say Reddit mods deserve free therapy paid for by Reddit, all because of vicarious trauma.

Complete remission of depression and anxiety using a ketogenic diet: case series

Front. Nutr., 14 May 2024 Sec. Clinical Nutrition Volume 11 - 2024 https://doi.org/10.3389/fnut.2024.1396685
Background: There is little data that describe the use of ketogenic metabolic therapy to achieve full remission of major depression and generalized anxiety disorder in clinical practice. We present a retrospective case series of three adults with major depression and generalized anxiety disorder with complex comorbidity, treated with personalized ketogenic metabolic therapy, who achieved complete remission of major depression and generalized anxiety disorder and improvements in flourishing, self-compassion, and metabolic health.
Methods: Three adults, ages 32–36, with major depression, generalized anxiety, other anxiety disorders, and comorbid psychiatric conditions were treated for 12–16 weeks with personalized whole food animal-based ketogenic metabolic therapy (1.5:1 ratio) in a specialized metabolic psychiatry practice. Interventions included twice-weekly visits with an experienced ketogenic registered dietitian; daily photo journaling and capillary blood BHB/glucose/GKI monitoring; virtual groups; family/friends support; nature walks and talks several times per week, and community building. Successful adoption of the ketogenic diet was defined as the achievement and maintenance of capillary BHB ≥ 0.8 mmol/L and GKI < 6. Remission was assessed by GAD-7 and PHQ-9, and quality of life was assessed subjectively and with validated scales for flourishing and self-compassion. Metabolic health was assessed by laboratories/biometric measures.
Results: Two patients achieved remission of major depression (PHQ-9 ≤ 4) and generalized anxiety (GAD-7 ≤ 4) within 7 weeks of therapeutic nutritional ketosis; one required 12 weeks. Anxiety responded and remitted more quickly than major depression. Flourishing and self-compassion increased steadily. Patients lost 10.9 to 14.8% of their initial body weight within 12 weeks and improved metabolically; one achieved optimal metabolic health.
Conclusion: Complete remission of major depression and generalized anxiety disorder occurred within 7–12 weeks of therapeutic nutritional ketosis during treatment with a personalized animal-based ketogenic diet (ratio 1.5:1) in adults with complex comorbid depression and anxiety engaged in a specialized metabolic psychiatry program.

Introduction

Emerging brain-based research in psychiatry and neurology has focused on identifying fundamental metabolic disturbances within neurons and throughout the body involving insulin resistance, inflammation, oxidative stress, and alterations of the gut microbiome (1). All four of these fundamental metabolic disturbances are present in major depression (2), and underlying anxiety disorders (3) and can be directly modulated through the use of ketogenic metabolic therapy (KMT) (4).
As psychiatric disorders have risen over the past several decades, the prevalence of metabolic syndrome has sharply increased, with only 12.2% of U.S. adults meeting the criteria for optimal metabolic health, leaving 87.8% metabolically compromised (5, 6).
Metabolic syndrome affects almost a third of individuals with major depression (7). It is a significant contributor to their morbidity and mortality (8) and is rooted in impaired glucose metabolism and utilization. Insulin resistance has been well described in many tissues, including the brain (9), where it is being investigated as a link between metabolic health and mental health conditions. Preclinical models demonstrate that glucose intolerance is directly associated with anxiety and that insulin resistance triggers depressive behaviors (9). In brain tissue, insulin resistance results in cerebral glucose hypometabolism and a vicious cycle of unmet energy needs (10). In human studies, cerebral glucose hypometabolism is a feature of major depression (11, 12) and generalized anxiety disorder (GAD) (13).
KMT, also known as the therapeutic ketogenic diet, or KD, is a low carbohydrate, moderate-protein, high-fat diet that supports a fundamental metabolic shift from glucose to ketone bodies as the primary fuel source (14). Classic KMTs are formulated with strict macronutrient ratios, most commonly 4:1 and 3:1 (fat: protein + carbohydrates), and have demonstrated efficacy in intractable epilepsy and genetic disorders. More recently, modified classic KMTs with lower macronutrient ratios of 2.5:1, 2:1, and 1.5:1 have been utilized in research and clinical practice (15, 16). These allow more variety in the diet, meet micronutrient needs except vitamin D (17), and are easier to sustain for extended periods of time.
KMT exploits the body’s natural ability to produce ketone bodies (d-beta-hydroxybutyrate (BHB), acetoacetate, and acetone) in the liver from fatty acids by keeping carbohydrate consumption very low. Acute and sustained production of ketone bodies produces a fundamental shift in fuel energetics within cells, particularly neurons, which can radically re-route and quickly rely on readily available BHB and acetoacetate for cellular energy (18). Ketone bodies also increase vascular density at the blood–brain barrier, which can strikingly increase the availability of ketone bodies for brain energy metabolism by 40-fold (19). Ketones are a preferred energy source in the CNS (20) and neurons will choose ketones over glucose when available.
Nutritional ketosis (10) using a KMT is a natural, not pathological, state (21) where the body’s energy and protein synthesis needs are met with a high-fat/moderate-protein/low-carbohydrate diet, resulting in sustained elevations of serum ketones and fatty acids and normal glucose without acidemia. In both acute and long-term nutritional ketosis, ketone bodies have a number of biological effects that directly change the brain’s cellular energy status (15), increase mitochondrial density (22), and improve mitochondrial morphology, which has been shown to be altered in mood disorders (23, 24). Mitochondrial abnormalities have also been postulated to be responsible for changes in synaptic function and neuroplasticity, potentially associated with symptoms of depression and anxiety (19).
Recent research shows that a ketogenic diet (KD) reduces neuronal firing rates, modulates ion channels and cell signaling cascades, and stimulates the biochemical synthesis and neurotransmission of GABA by inhibiting glutamate decarboxylase, a major inhibitory neurotransmitter involved in neuronal firing and anxiogenesis (25, 26). BHB activates the transcription of antioxidant-related genes by inhibiting histone deacetylases, triggering long-term adaptive changes in gene expression. In addition, at physiologic concentrations, ketone bodies reduce neuroinflammation through direct action at G-protein coupled receptors (25). KD also favorably alters the gut microbiome (27). Perhaps most importantly, KD directly increases NAD+, which reduces reactive oxygen species and increases mitochondrial ATP production. It is also utilized as a substrate for sirtuins and PARP enzymes associated with DNA repair and longevity. A sustained increase in NAD+ may underlie the pleiomorphic benefits of KMT across multiple neuropsychiatric conditions (28). In terms of the frequent abnormal alarms set off in the amygdala during anxiety, nutritional ketosis may provide an acute and long-term intervention to reduce generalized anxiety, panic attacks, obsessive doubt, and symptoms of post-traumatic stress disorder (PTSD). For apathy, anhedonia, amotivation, and abulia seen in major depression, therapeutic nutritional ketosis may provide higher and more sustained intraneuronal energy and repair (29, 30).
There is no published data that describes the implementation and use of personalized KMT for adults in real-world clinical practice who present with major depression comorbid with GAD and complex psychiatric comorbidity.
The aim of this case series is to examine the response to the treatment of major depression and generalized anxiety with whole-food animal-based personalized KMT in adults with complex psychiatric comorbidity and varied metabolic status. We conducted a retrospective review of three cases from our Metabolic Psychiatry Registry that demonstrate a consistent response and remission of major depression and generalized anxiety among patients who are psychiatrically and metabolically complex, despite differences in the initiation and adoption of KMT, and varied metabolic dysfunction. We describe the evaluation process and prescription of KMT, baseline metabolic workup and monitoring, elements that fostered treatment engagement and adherence, and challenges encountered during 12 weeks of KMT. We correlated capillary BHB/GKI with time to the remission of major depression and GAD and the achievement of metabolic health.

Discussion

Although KD was first shown to produce antidepressant effects and alleviate “behavioral despair” in preclinical studies more than 20 years ago (20), there is little clinical data regarding KD in major depression and anxiety disorders.
A retrospective analysis of 31 individuals with primary diagnoses of major depression (N = 7), bipolar II disorder (N = 13), and schizoaffective disorder (N = 12) who had failed to respond to conventional psychiatric care was treated with KD (75%–80% fat, 15%–20% protein, 5% carbohydrate) for 12 weeks in a psychiatric hospital (31). Of these patients, 22 were voluntarily admitted for the initiation of KD, and the remainder were offered KD during their inpatient hospital course. Change in depression was measured by HAM-D and MADRS in 6 of 7 patients with major depression and 12 of 13 patients with bipolar disorder. Notably, 100% of patients given the HAM-D showed statistically significant improvement in depressive symptoms (mean HAM-D decreased from 25.4 to 7.7; mean MADRS decreased from 29.6 to 10.1). However, serum ketones were not measured; urinary ketone measures were obtained once in 28 patients during the 12-week intervention; 18 patients (64%) showed positive urine ketones (31).
Bipolar depression was included in a recent randomized controlled pilot study assessing the safety and feasibility of KMT as adjunctive therapy, and reported safety and feasibility with excellent adherence and maintenance of ketosis (mean BHB 0.88 ± 0.99 mmol/L for 12 weeks) (32).
One case report utilized KD (65% fat, 25% protein, 10% carbs) with a time-restricted feeding window in a 65-year-old woman with major depression and type II diabetes and reported remission of depression (PHQ-9 17 to 0), normalization of HbA1c, decrease in estimated average glucose from 216 to 96 mg/dL, improvement in HOMA-IR from 9.4 to 2.3, and TG/HDL ratio from 4.7 to 1.2 over 12 weeks. The only measured serum BHB reported in the case was a mean of 1.5 mmol/L by week 12 (30).
A recent meta-analysis of low carbohydrate diets used in controlled trials that evaluated symptoms of depression and anxiety, not disorders, in varied metabolic and inflammatory conditions reported that the symptomatic response of these symptoms was inconclusive (33). The conclusions may not apply to KMTs; the meta-analysis was limited by grouping varied diets with higher carb intake and higher protein intake than usually associated with diets formulated to induce nutritional ketosis; serum or capillary BHB was not reported; and primary and secondary outcomes varied across studies.
In anxiety, preclinical research shows that exogenous ketone supplementation reduces anxiety behaviors (34). There is one case report of a self-administered Atkins Diet for weight loss in a woman with panic disorder (35) but no reports of KMT in panic disorder, OCD, or PTSD. Case reports of KD addressing anxiety describe two cases of decreased anxiety symptoms in a woman with women, one with bipolar I disorder and another with unspecified mood disorder, comorbid emotional dysregulation, body dysmorphic disorder, and eating disorder (36, 37), and one case report that describes the elimination of anxiety symptoms in a man with bipolar disorder (38). Anxiety and obsessive preoccupations improved in weight-restored anorexic women, in one case report describing complete remission of anorexia (39) and in a retrospective case series where animal-based KD was adopted without dietary prescription and monitoring (2); however, ketone measures were not reported. One small pilot trial where KD was followed by ketamine infusions reported a significant lessening of obsessive preoccupations in weight-recovered women with chronic anorexia; here, ketosis was measured by breath acetone (40).
Finally, all three patients had comorbid ADHD, which may be important. Approximately 65–89% of adults with ADHD experience one or more comorbid psychiatric conditions, and ADHD often occurs comorbid with anxiety and depression (41). Preclinical studies in murine models (42) of ADHD with hyperactivity suggest that KD may improve symptoms via alteration of the gut microbiome. Preclinical studies in dogs with epilepsy displaying ADHD-like behaviors treated with a medium-chain triglyceride KD have shown decreased pathological behaviors (43). Further research exploring the effect of KMT in humans with ADHD should be considered to understand the mechanisms of action and assess short- and long-term risks and benefits.
There is little research regarding the selection, implementation, and treatment course for KMT use as adjunctive or sole treatment in individual psychiatric conditions. Given the potential benefits of therapeutic nutritional ketosis and the restoration of metabolic health (44), there is a pressing need to identify the biological underpinnings of KD in psychiatric disorders and delineate factors associated with the successful adoption and adherence of KMT and responses in common psychiatric disorders such as depression and anxiety. In clinical practice and real-world settings, where patients often present with multiple comorbidities, consideration of KD can seem daunting to clinicians.
Despite that, this case series illustrates complete remission of both major depression and GAD in three adults with complex psychiatric comorbidity and previously unrecognized metabolic dysfunction using whole-food, animal-based personalized KMT. Anxiety responded first and time to remission occurred rapidly within 7–12 weeks, despite varied challenges, including preferences for time-restricted eating, slow adoption, inconsistent monitoring, and emergent fatigue during strenuous exercise, which occurred many weeks into KMT due to low serum carnitine and spontaneous reduction of protein intake rather than keto-adaptation or “keto-flu.” All patients improved metabolically, and one patient achieved optimal metabolic health (6).
These patients were representative of many adults in clinical psychiatric practice who present with persistent, serious symptoms interfering with several life domains. They each had five DSM-V psychiatric disorders: severe unipolar major depression, GAD, at least one other anxiety disorder (OCD, PTSD, and/or panic disorder), and ADHD, and two had binge eating disorder. They had all failed at least two previous adequate trials of medications and psychotherapy and were seeking relief. All had family histories of mood and anxiety disorders and documented metabolic disease in first-degree relatives. Extensive laboratory testing and bioimpedance evaluations were eye-opening because, although they were overweight, they were not aware of the extent to which they were already metabolically ill; we suspect it enhanced their motivation to adopt and maintain KMT.
This case series is limited by describing only three patients, which limits the generalizability of our results as well as the inherent selection bias, as they were interested in KMT after failing standard therapies. In addition, they were selected because their complex psychiatric comorbidity reflects the complexity seen in the majority of our outpatient psychiatric practice. This degree of complexity may limit the generalization of these findings, although it is important to note that outpatient clinical psychiatric practice as a whole has seen an increase in complex psychiatric comorbidity over the past two decades (44).
As a retrospective case series, there may be additional limiting and confounding factors, including the lack of a control group. Some rating scales and digital data are missing, which may impact the completeness of the analysis. Time to consistent nutritional ketosis and delays in obtaining necessary labs requiring intervention may have contributed to a longer time to response and remission; response and remission may occur earlier than reported here, and this deserves further research. Finally, it is not clear to what extent immersive treatment (see Supplementary material 1) and additional interventions during KMT, such as close digital monitoring, frequent clinical contact, group supports, and nature walks, contributed to the rapidity of response/remission of anxiety and depression, or to overall treatment success, independent of the biological effects of KMT, and which of these elements were most critical; more research is needed. Carefully designed prospective studies and randomized controlled trials providing higher levels of evidence are needed to examine the use of KMT and time to response and remission in individuals without comorbidity and determine the extent to which comorbidity may confound or alter these (8).
As metabolic psychiatry moves forward, we need both preclinical and larger, well-controlled clinical studies examining the pleiomorphic effects of ketone bodies in the brain and in the body to understand how we can best leverage whole foods to optimize brain energy, enhance genetic expression, reduce neuroinflammation, optimize metabolic health, and safeguard the promise of our future.

So sorry in advance for the long post. I just need to get this out.
TW for talk of suicide and depression
If you’re my partner and you see this - please don’t read this. I promise you are a wonderful support but I know my venting hurts you because you want to fix things and you can’t.
Edit to add some probably important context: I was misdiagnosed with BPD when I was 19 after a traumatic experience. And while every mental health professional I saw after told me it was wrong and was actually PTSD and CPTSD, it was not actually “officially” diagnosed on record until the hospitalization, at the start of my ADHD assessment. But, the psychiatrist that ordered the assessment is the first doctor to ever bring up ADHD or neurodivergence. Just to demonstrate how many people missed these things over the years, how many “second opinions” I’ve had to get. Not in any way dissimilar to my experience seeking diagnosis for my physical health issues.
I feel such immense grief and rage. I don’t even know where to begin, so I guess I’ll start at the start of this “health journey”. When I was 16, I became incredibly ill. I was vomiting all the time, exhausted to the point of sleeping 14 hours a day from the time I got home from school til just before I had to leave for the bus. I don’t remember much from this time period because of the brain fog and genuinely don’t know how I passed my classes. I was gaining a lot of weight, too, and hadn’t had a menstrual cycle in 6 months, and was so so depressed. My mom ignored the health issues because she thought I was just being dramatic (there is much deeper context with the issues there but it comes down to I am now NC as an adult), but when I said I needed to see a doctor for my depression she did. My then-family doctor was wonderful and listened, and to be safe decided to run some blood tests though I hadn’t described to her my physical symptoms aside from the oversleeping I attributed to depression. I was diagnosed with autoimmune thyroid disease, or Hashimoto’s. I started medication and my symptoms improved though some things, like the weight gain, never reversed.
I ended up going into remission for a time and no longer needed the HRT. But when I was around 20/21, I started having health problems again. I started experiencing numbness and tingling in both my hands and wrists, which I thought was from repetitive movement working as a cashier, though the symptoms only appeared about 6 months into that job and in hindsight it probably isn’t normal to develop that quickly that way. But I ignored it because I didn’t think it was serious as it was “just” carpal tunnel, and began wearing wrist splints regularly. I did not ask my doctor, as during this time I was having difficulties hearing at work and the hearing test I requested came back normal and I was dismissed and I didn’t want to reinforce the belief I have unreasonable worries about non-issues - later, I learned this was actually an auditory processing issue, which was never brought up by any medical professional I saw as a possible cause.
In 2020, when I was 24, I began experiencing the same autoimmune symptoms I had when I was first sick at the age of 16. I fell asleep at work which had never happened before and it worried me. I went to the ER on recommendation of Telehealth, where the doctor didn’t believe my symptoms and ordered just an EKG that came back normal. He told me I didn’t fall asleep/pass out while actively working, and simply “took a nap” and it’s normal. Follow-up with my GP after was unsuccessful, until I pushed for thyroid testing. I was found to no longer be in remission and put back on HRT, and once again my symptoms improved but did not resolve.
At the same time, and for the year or so that followed, I experienced extreme digestive health issues. I had visible yellowing of the skin, very dark under eye circles, issues with itchy and red patches of skin, and was passing undigested food and eventually became obviously malnourished as a result. I had what seemed to be a kidney stone that passed before I could get in for the ultrasound so it couldn’t be confirmed. I alternated between constipation and diarrhea, and always felt pain. My GP told me it was “probably just IBS” and had me do an elimination diet (twice) that did not work. He dismissed my concerns telling me I’m fine, until I sent a novel of my symptoms and saying I know he thinks I’m a hypochondriac but I am unwell and need to be looked at. The liver tests I pushed for came back normal. He offered to test me for Celiac but advised against it due to the cost of the blood test, so I didn’t. He did, however, refer me for a colonoscopy but the pandemic made this severely delayed. During the wait, I found some relief of my symptoms by cutting out gluten and dairy from my diet, and the yellowing of my skin and dark circles went away as did, eventually, the skin patches my doctor insisted was “just eczema”. I was off of gluten for a full year when I had my colonoscopy in fall 2022, the results came back normal and that doctor reiterated that it is “probably just IBS”. I learned later that I should have been consuming gluten for at least 3 months prior in order for it to be an effective test for Celiac, and my doctor failed to tell me this.
In early 2022, the joint pain had become frequent enough and painful enough in the knuckles where my hands meet my fingers, and in my wrists with definite carpal tunnel in both wrists as well, that I went to my GP. However, he is busy, and it’s often easier to book an appt with his assistant who is able to assess many conditions. At this time I also believed he would be more likely to listen and take me seriously. I went to the appt, described the nerve and joint pain issues. I had an exam where he confirmed bilateral carpal tunnel and arthritis in my hands. He said no testing was needed. I pushed back, stating that I am only 25 and there is no normal reason for the inflammation, and I have Hashimoto’s which has very high comorbidity with RA and I was concerned due to the fact the inflammation was symmetrical. I was dismissed, told the only test that could be done is an x-ray which was pointless as all it would do is confirm the presence of arthritis which he already confirmed with the exam. He told me to keep wearing wrist splints, keep taking ibuprofen and acetaminophen for the inflammation and pain, told me taking them was risk-free, and told me to come back when the redness and swelling of my joints got worse. I didn’t feel comfortable going to my GP for fear of being marked further as a problem patient, and assumed he would tell me the same information his assistant had based on my experiences with him and the fact his assistant is his staff that sees many of his patients.
My depression worsened during these years, coming to a head in early 2023 when I attempted. I did not succeed due to a mistake I made, fortunately. I was hospitalized for a time, where I was finally officially diagnosed with PTSD and CPTSD. And for the first time, a doctor asked if I suspected I’m neurodivergent. I was assessed and diagnosed with ADHD, which explained a significant amount of non-health related issues, though it also explained some like my KP and teenage cystic acne as they are common comorbidities. It’s important to note that I have a younger sibling that was diagnosed with ADHD as a child, and I was viewed as the “normal” child and any issues were dismissed as my sibling had higher support needs and was the priority and I was always viewed as simply being overdramatic and wanting attention. I was told the cause of my depression was trauma, including childhood trauma, as well as 26 years of undiagnosed and unmanaged ADHD I had been forced to deal with on my own. I was told I had done the best I could but they were not surprised it reached the point it did, as sadly the mental health system in Ontario is not what it should be and often people do not receive help until they’re long past the point of needing it. And for many, it’s too late. I am fortunate that it wasn’t too late for me, I’m fortunate I survived.
Prior to my stay at the hospital, I had gotten to the point of needing to take ibuprofen daily for the inflammation. When disclosing my medical history and medications, I was asked if I had received a formal diagnosis for my arthritis and what tests had been performed. I told them I had been assessed for and diagnosed with arthritis, but that no tests were performed. It was clear they did not believe me, and I wasn’t provided ibuprofen during my stay. They did not follow-up with my GP regarding the arthritis either, though to be fair I was in the psych ward and non urgent physical ailments were not their concern.
Now we get to 2024. It’s a jump, but I don’t feel anything between is significant. I do not go a day without pain, and havent for 3 months. The pain has now reached every joint in my body, I feel fatigued and foggy, I feel horrible all the time and have had 3 UTIs since February. The last one reached my kidneys rapidly, and coincided with the worst full-body arthritis flare of my life - this was 2 weeks ago. I woke up every 2 hours sobbing in agony because my body and knees in particular were so warm and painful and stiff. For a full day I was unable to get out of bed and ran a low grade fever with chills I assumed were due to the infection but now I’m not so sure. Since then, I have been in constant pain though not as severe as then. My knee and hip pain keep me up at night, and/or wake me up often due to the pain and stiffness. Regardless of my larger joints, my hands and wrists always hurt now. I feel ill in the way I did with my Hashimoto’s. Ibuprofen and acetaminophen aren’t doing anything anymore, and I rely on cannabis for relief which isn’t always suitable. My partner got me a topical ointment that has been incredibly but isn’t affordable enough to be sustainable with how much of it I need in one go, and I need to use it sparingly when I absolutely need it. Despite not feeling that my joints are red and swollen enough to go back (because I see them every day and they look normal because they always look like that), I stuck with my plan to see my GP. I first tried to book in February, but only saw him this week.
I described all the physical symptoms asking about my lower leg/ankle swelling and to have my thyroid levels checked for potential med increase need, and I described my joint issues. He assessed my hands, and told me my knuckles are red and swollen. I’ve realized after in research and really looking at my hands that the top knuckle on one of my fingers has a lump on it, albeit a very small one. He immediately said he is testing me for RA with blood work, and in my research I’ve confirmed the req form is thorough, and also includes urinalysis and an EKG. However he told me for the inflammation marker test to go for it when it’s at its worst, and with my work schedule I can’t, and I’ve waited so long for this I refuse. I’m going for it as soon as I can. I’ve waited so long to be listened to and believed. And as many as half of people with RA test negative on the blood tests so I’ll end up needing imaging tests anyway either way and I want this process to be as fast as possible. Even if it’s not RA, I need them to figure out what’s wrong with me and give me the appropriate treatment. He was alarmed and visibly displeased to hear that I had seen his assistant 2 years ago for an assessment - though I forgot to mention to him that that appointment was also for bilateral carpal tunnel (which I now know is an early sign of RA due to compression of nerves). It wasn’t explicitly stated but it was clear that I should have been tested 2 years ago. And wasn’t.
I’m tired of being in pain. I’m tired of being sick. I’m just plain tired. I feel so failed by the system that’s supposed to care for us. I’m so frustrated with people insisting that doctors are all-knowing and infallible and if they tell you you’re fine, you are. I’ve been fighting for years to be heard and have only been left to feel like I’m losing my mind and imagining these problems and am just overdramatic after all. I feel vindicated that I was right all along, but it’s too little too late. RA is a progressive disease, and the earlier it’s diagnosed and aggressively treated the better. I’ve had at minimum 2 years of progression that cannot be undone. The damage can’t be reversed. I am angry and devastated. The grief is so f*king immense.
I’m 27. I don’t know what my future looks like anymore and that scares me. I’m worried about the damage this disease has done to my internal organs. I worry having kids is no longer an option for me, due to my health. I worry that my physical capabilities will continue to deteriorate. I am so angry that I’ve been written off as an anxious hypochondriac when I knew something was wrong.
Diagnosis of an autoimmune disease or any illness really, apparently doesn’t negate medical misogyny and ageism. Advocating for yourself doesn’t go anywhere when you’ve been labelled crazy and a problem patient. The most it’s gotten me is my doctor “offering” to send my files if I wanted to switch to a different GP, which I can’t with the GP shortage. I have to live with the lifelong consequences of doctors failing me. And it f*king sucks.