It’s not forgetting, it’s measuring with your heart.

And Karen repeatedly murdered all of the foster children she adopted over that six year timeframe by skinning them and feeding them to the local geese. Her neighbor began noticing about 2 years in that the children would all go missing within weeks of arrival. Over the next 4 years this neighbor filed multiple complaints with the police, CPS, and the foster care agency, but all of them just said the children probably ran away. It turned out this was because Karen’s grand-step-aunt twice removed was head of the city hall floral arrangement sub-comittee…

Water aerobics and yoga are usually the best options. I would try to find a yoga instructor skilled in physical therapy / disability modifications to the poses. Water aerobics is typically specifically designed for physical rehab so you’re more likely to find most of those classes are geared towards that. If affordability is a problem you may find that your health insurance, even or possibly even especially if it’s public health insurance. In the gym though you want anything that’s low impact and low intensity like maybe an elliptical on the very lowest resistance setting.

Well the downside to the “you break [the virginity] you buy it” mindset (aside from the literal objectification) is that having to formally marry the child also means the child is formally married to (and stuck with) the pedo. At least the informal version is probably less legally complicated to flee from.

I went into nursing instead of astrophysics. Decided I wanted a job that would outlast the apocalypse.

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Eeeeh. I kinda get why it fell out of favor. For context, the weird thing about the nursing perspective vs the MD perspective is that you don’t get as much of the benefit of large studies, but you also aren’t as sensitive to big pharma marketing studies either which… good AND bad. Like for school I had to take a class on evaluating the validity of drug trials and one of the studies mentioned was taking advantage of the fact that there’s basically no equivalent doses between different antipsychotics but you can also look at the doses from an experienced clinician perspective and be like huh they’re saying this drug has less side effects compared to 20mg of Haldol daily, but literally ANYTHING has less side effects than 20mg of Haldol daily; that dose is insane. The nursing perspective also tends to be more sensitive to variations in the needs of local populations, you’ve lived in an area and worked within that specific demographic and environmental setting for a few decades vs the doctors main body of knowledge often even includes studies from across the world. Just giving some background as to the upsides and downsides of my perspective.

So back to my point, I can tell you I associate lithium with being a last resort med for really sick patients who nothing else cuts it for. I associate it with horrible side effects including crazy weight gain and thyroid problems as well as fluid and electrolyte balances, and depakote and tegretol aren’t gonna cause that last one at all and also do have that advantage of blood level monitoring. I don’t see tegretol prescribed as much but depakote is probably what I see as the most prescribed med even before lamictal. Now lamictal I completely understand why I’m not seeing in the inpatient setting; you can’t rapidly titrate without risking the death rash (SJS/TENS), and the objective of inpatient care is always rapid stabilization with tweaking to occur in the community. And also maybe I’m associating lithium with all these horrible side effects because I’m seeing it used for patients suffering from both the direct effects of severe mania, especially those with the cumulative effect of multiple manic episodes over time, as well as all the other horrible things those episodes put them at risk of such as homelessness, substance abuse, and general increased risk of injury and illness due to decreased capacity for self care.

I guess the TLDR is, it wouldn’t shock me if the inability to patent salt was the reason lithium isn’t preferred, but I also associate it with being a pretty old-school heavy hitter like thorazine is for psychosis, and while my perspective has the advantage of being more experiential, that comes at the disadvantage of being less empirical (but its also often difficult to tell how empirical some studies are due to the influence of capitalism on the development of pharmaceuticals).

Yeah like tbh the original comment thread wasn’t worth banning them. Kinda silly but whatever. Literally everything after that was worth a ban though. They picked a molehill and just… fought to the last breath on it.

Yeah when I got that report and responded all I could think was “this thread is basically incomprehensible. Why are these people arguing poetry vs theoretical physics? It’s like arguing whether or not TMNT is enjoyable based on it not being an accurate depiction of turtle biology???” There is a time and a place to get this heated about the fundamental concepts that define the universe we inhabit but a lemmy post about a Tumblr post that’s written like an overly dramatic fanfiction just ain’t it. The last time I got into an argument that dumb (somewhat coincidentally also on tumblr) was literally over half my life ago!

Well said. This is the only person I’ve ever personally banned and it’s because they went out of their way to start multiple fights over silly shit.

I recently listened to “A Wizards Guide to Defensive Baking” recently and I was NOT expecting YA fantasy fiction to go that hard on the subject of “heroism” being a term used to excuse the phenomenon of pushing people into dangerous jobs way too young to cover for the systemic failures and often outright corruption of existing power structures. I had a good few years experience in Healthcare beforehand but I graduated nursing school mid-covid and that book really spoke to me.

Somewhat coincidentally iirc it was actually released mid COVID as well, and I imagine had been worked on for years beforehand. So it’s interesting to me that the author picked up on the already existing manifestations of this phenomenon in a way that would speak so well to the epic clusterfuck that ultimately occurred.

I’m surprised that particular aspect of the side effect profile comes into play with acute usage.

Well obvs. It’s basically,“idk which receptor is making them _____ (punch people, refuse to eat or drink, or whatever other immediate harm to themselves / others), but we need it to stop 3 days ago and can figure out the details or a potential cross-taper to something better later.”

Ah, yes, this happens a lot. No, I don’t work in the medical field at all. I just know things, for reasons.

Color me fascinated, lol. My guesses are personal experience / reading up on your own treatment or that of a loved one, tangential relation to the field such as clinical research, or just plain personal fascination. Given you linked to a drug that appears to be in trials my first guess is actually the second one. Hadn’t heard of it, and I’m hopeful, but after seeing abilify get approved for acute agitation I’m… skeptical.

i.e. the psychosis has done so much cumulative damage at this point that you need to fall back to the typicals. That explains why the third-gens are useless.

Yeah a lot of people don’t realize the damage is additive, both people w/ these disorders and unrelated laypeople who think “talented artist stops taking their meds and continues to be talented but starts creating art with weirder subject matter as their brain boils” is a cool story.

I’m mostly replying to add though that risperdal also has the distinction of being avaliable as a long-acting injectable, and if you’re trialing oral meds before committing to an LAI, your options are somewhat narrowed. Zyprexa does have an LAI available, but I’ve actually never seen it used and while I can’t tell you why for certain, I do have a guess.

If you have a patient sick enough that you’re considering an LAI, you don’t want to take benzos off the table for an entire month, especially if it turns out to be inadequate after discharge and they wind up in an ED agitated and unable to report their own med hx and get B52ed and stop breathing. I’ve had a pharmacist tell me considering that interaction is going out of style but a history of that kind of adverse event is difficult for a med to shake. Accutane still has suicidal ideation in adolescents listed as a side effect but I have a strong suspicion that it’s less causation and more correlation with the impact of pizza face on the self and social esteem of a teenager.

Dude sometimes we still give thorazine. And tbh ime the 3rd gens don’t do shit for my typical patient. For context also though, I’m essentially providing ICU level care, so when you say the word “symptom control” it’s often referring to like, fists.

We had a Lady maxxed on Haldol BID one time and she managed to cheek for a week and eventually she just hauled off and rapid fire punched a nurse in the head three times. She legit thought a man was entering through her window every night on a beam of light to forcibly impregnate her and deliver the baby. She kept demanding to see the 50 babies she had up on L&D from the past few months. I’ve actually seen quite a few pregnancy delusions and they’re almost always completely wild psychosis. Another was such an angry manic but high insight enough that when she couldn’t take it anymore she would just come scream at me for the thorazine.

I’m unsure if you don’t work inpatient psychiatry or you just work somewhere significantly classier than I do. I do work in an inner city area that’s flush with people stuck in a cycle of drugs / homelessness so I’m also not going to tell you that any of this is the best solution, just that it’s the only one avaliable to any of us right now due to shitty government policies.

To the extent that men can lactate! It’s one of the possible side effects of risperdal, which I have to be aware of because I give it fairly regularly. It’s all the same structures it’s just a matter of the hormone signals they’re getting.

an oldie but goodie

Soap is decreasing friction. The dental floss done correctly should apply compression to the tissue and force fluid out of the area. This is especially helpful if a lot of tugging has resulted in swelling.

If you’d like to edit the thing I wrote for free at 2am to include your edits for clarity and more localized bureaucratic knowledge, I’m happy to link right to you at the beginning. Other than that, you’re welcome.

If you’re as disabled as you say and either you have documentation (such as state benefits) or it’s just obvious I would try APS (adult protective services) over the cops. Things will move faster and more effectively if you do some of the legwork (hypothetically speaking) for them ahead of time.

1. Get in touch with the family that might take you in. Try to find three options who confirm they will take you. Write down or keep in a Google doc or whatever their: full names, phone numbers, email addresses, and physical addresses. The number one thing I see holding up cases like yours is housing, and if you have all those details worked out ahead of time a caseworker can do a lot more for you a lot faster. A lot of the time our psych social workers can get someone a uber / lyft or bus ticket easily enough, the problem is figuring out where they’re going. If you have the contact info of someone they can call right there and then who has already agreed to take you, you are a slam dunk open and shut case. Get three so you have backups.

2. Arrange for a ride locally such as a friend or acquaintance or literally anyone else who has a car and is willing to help you for 24-48 hours. This should not be hard to talk someone into. Many people want to help a person like you but don’t have the resources to house someone for weeks or months. For this acquantaince you are an easy way to help and feel good about themselves. Use that. Tell them to wait for you to contact them. Again, try to get three options set up so you have two failsafes.

3. AFTER you’ve done that, call your local APS (adult protective services) or file a report online. Do whatever you can to keep your family from knowing you called because it might take a few hours up to maybe even a day or two for them to get to you and you don’t want your family tipped off in the meantime. Tell them you’re being held by your family and kept from accessing your legal identifying documents like your birth certificate. If you get state benefits your documentation or papers regularly mailed to you may also have a compliance / abuse reporting hotline number somewhere on it. You could also try a crisis hotline through an organization that does community outreach. Tell them they have abused you in the past and you are in fear for your life. Tell them you HAVE A PLACE TO GO you just need help getting your documents. Again, you are easy to help in this situation, they don’t need to worry about setting you up with benefits or housing or anything, just transport maybe. This is what the numbers and addresses are for, they may want to confirm you have somewhere to go and even have options. Just play up the danger and that they’re keeping you from your documents. If you get an asshole worker wait six hours and try again (change of shift) or try calling a different agency or the next town over. You may also be able to find other places to call or worst case scenario call 911.

4. The SECOND they show up and if they’re able to get you those documents, get the hell out to that person who’s helping you locally and block your family and do not tell or hint or give them any other indication of where you’re going. Don’t even tell the person giving you a ride if you think it will get back to them. If necessary tell them an entirely different final destination and just get them to get you to the airport / bus terminal and get out.

5. while you’re waiting, get all your medications, medical equipment / supplies, any valuables or sentimental items, and 3-5 changes of clothes all in the same area of the house. Make sure to pack sentimental clothing but especially pack accessible clothing that’s easy for you to dress yourself with. Get them into a bag if you think you can do so discreetly, but a box or even just a pile in an out of the way corner is fine. If you have any special skin safe shampoo or other non-medicine but important toiletries stash them too or just make sure they’re all in the same place in the bathroom. Get everything into 1-3 discreet / hidden piles so you just need to throw them in a trash bag and go. If there’s any valuables you think your family will try to dispute ownership of, try to get any receipts or photos of you wearing or using them or texts from someone who bought them for you or whatever else you can find and put them in a Google drive folder or email to yourself. Worst case scenario though, be willing to leave some things behind if you have to.

Good luck and godspeed. :)