Salty Rainbows

Various thoughts and reblogs (disabled, white, queer, nerd) 

[stelladuck-blog]

The concept for the Somewhere project is a response to years of listening to how some people, media outlets (especially recently), politicians, and even health care professionals speak about individuals with mental health issue. I cannot count the amount of times I have heard the phrase “they should be put somewhere”. Sometimes it’s said in reference to the latest disgraced child star, or the man who mumbles to himself on the bus, or whispered behind the back of the emaciated university student. I know it’s been said about friends of mine, I know it’s been said about me, and regretfully I know I’ve said it about other people. 

Somewhere seeks to disrupt received notions of mental health consumers by juxtaposing images of extreme humanity and personhood with anonymous representations of institutionalization. In this way, it lays bare casual assumptions of what both illness and cure are supposed to look like, asking the viewer to reconsider what it really means to be “put somewhere.”

There is no somewhere. There is no limbo where people who are sick, or disruptive, or different can be placed so society doesn’t have to deal with them. The intended impact of this work is to shatter the well preserved illusion that the appropriate response to people with mental health issues is to simply ignore them, or have them put ‘somewhere’.

[akindplace]

Katfishdraws

[anxious-and-in-pain]

[ID: a drawing by @catfish’d of a seal sitting low in the water with the words “you are not a burden for struggling”. end ID]

[potsiepumpkin]

Useful information

[zillycripple]

[VIDEO TRANSCRIPT:

"All your tests/labs came back clear! Isn't that great?"

American healtcare is a business, and you are the customer. Here's something you can say:

"It's great that we ruled out X, Y, and Z with these tests. However, I'm still having these symptoms, and they're effecting my daily life in these specific ways. So what's next on your list of differential diagnoses?"

And if that doesn't get you anywhere, you can say something like:

"Okay, we've ruled out all of the common causes for my symptoms. So when do we start exploring more rare explanations?"

And if that still gets you nowhere, you're going to document their refusal to do further testing in your chart, because they don't want to have to put that in writing. Keep going, you're worth it. I love you, mean.

END VIDEO TRANSCRIPTION.]

[obedientlyviolentshepherd]

Transcription edit: After they say "I Love you" they blow a kiss to the camera and make the "mwah" kissy noise, not "mean"

[spoons-up-my-ass]

Broke and Broked

a guide for managing the Big Ouch as a poor person

DIY

ICE ROLLER: need an ice roller for sore muscles joints and all other bodily ails, but you don't want to pay for one of those massager thingys? buy a pack of styrofoam cups, and fill them up halfway with water. stick those bad boys in the freezer, and when they're done peel off the styrofoam until you get to the beginning of the frozen bits. BAM, now you have an ice roller. if you wanna get really cool with it? you can add coconut oil and essential oils to help ease the stiffness as well.

HEATING PAD: cant afford an electric heating pad/dont have access to one? you need an old sock, (preferably of the long tube sock variety), and about four cups of rice. youre going to wash your sock, fill it up with the rice, and tie a knot at the end of it. stick her in the microwave, and now youve got a heating pad that conforms to the shape of your ouching spot(s).

TIPS

STRETCHES: if you are at all able to, then please please do your PT exercises. i know some days the pain gets so bad that you cant get out of bed, and on those days you should listen to your body's limits. but, like most things, you can build up to it, and find ways to modify them. if youve had the privilege of a diagnosis/or access to a physical therapist, then you likely already have a list of stretches and movements meant to help you. do those, if those dont work, call your doctor. you deserve things that actually help. However, if youve not had that privilege, i suggest very very tentatively looking up stretches for the places that hurt and attempting those. LISTEN TO YOUR BODY. if it hurts considerably worse afterward, that is a no-go. note: im not a flippin doctor guys

MASSAGE: if you are able to reach the places that hurt, or have a partner willing to do it for you, using some baby oil (available at your dollar tree) and watching videos on massage therapy meant for your type of pain may be very helpful when it comes to combating the tightness that often occurs in sore joints and muscles. again, listen to your body.

JOURNAL: No, im not going to tell you to journal the pain away, or preach about how talking about it might help. for me, thats BS. i do, however, suggest a chronic pain journal, or a sort of symptoms tracker if you will. this can be in something as cheap as a composition book, or something more like a leather journal, whatever suits your fancy. its main purpose is to track pain levels, pain location, doctors appointments, medications, medication side effects, meals, activity levels, and whatever else you may desire. i plan to make an entire guide with links to premade journals, bullet journal examples, and printouts you can just glue into a notebook if thats more your speed.

PAIN BOX: you never know when youre going to wake up and have a flare-up, so personally, i like to have a shoe box with the things i will need if i cannot get out of bed. this includes a day's worth of medication, a sealed water bottle, sustenance, lidocaine cream, a book, lavender oil, lidocaine patches if i have them, and something to crochet/knit so i have a distraction from the pain. modify this to whatever works best for you.

PAIN BAG: similar to the previous idea, but kept in a purse/backpack, or if youre me, in the basket of my rollator. i bring pain meds, creams, lavender oil, a heat patch, my collapsible cane in case of inaccessible buildings, and a few other things.

OVER-THE-COUNTER MEDS: Ibuprofen and Acetametiphin can be taken together HOWEVERRRRR, i personally would try and cycle them or split the dosages up by two hours because routinely taking them together is hard on your body. consult your flip fuckin doctor before taking my advice

VITAMINS AND THE GOOD SHIT: okay, this is likely my most expensive tip, but try and get your hands on vitamins youre deficient in, and maybe a green mix. i fucking know just how hard meeting nutrition needs is when you're dealing with chronic pain and chronic fatigue, and can only imagine just how bad it can get. this is the best solution i can come up with. note: talk to your doc, broskis, they can tell you about med interactions and they may be able to prescribe some things and get them covered by insurance.

"CHEAP" PAIN MANAGEMENT:

LIDOCAINE CREAM: Lidocaine patches are expensive, especially if like me you tend to use more than youre supposed to. In comes my personal best friend, lidocaine cream. does it work as well? no, not necessarily, but it works quicker and is considerably cheaper than patches would be.

EPSOM SALT: this SHIT. HOLY FUCKS. if you have a bathtub, or if your pain is somewhere that can be kinda dunked oreo style, i absolutely recommend buying yourself some of this. Not Dr. Teals, fuck that, you're just paying for the brand. look for the walmart or off brand versions. (personally, i would go for lavender and magnesium and chamomile because those are what ive found relax spasming areas most)

TIGERS BALM: okay, this is more for the sore muscles type, and is a little more on the pricey side. this stuff is like straight menthol, and once you get used to the slight burning feeling can be really distracting from your bigger more pressing ouches. note: dont use after a bath or shower for at least 30 minutes, unless like me the burning agony is better than the pain.

ICY HOT: basically lidocaine patch and tigers balm fucked and had a child. this is what youd get. not for me, but works for some folks.

ESSINTIAL OILS: good ones for pain include lavender, peppermint, chamomile, and sandalwood, but there are others too. note, always mix pure oils with a carrier so as not to cause irritation

please feel free to comment more tips and tricks and cheap alternatives

(note: im working on a similar post about CFS and Mobility Aids, and a breakdown of chronic illness/pain notebooks)

[authorizedpope]

like, medical gaslighting isnt just having your concerns dismissed. doctors being dismissive is actually still awful and gets people killed so im definitely not downplaying the seriousness of doctors just not giving a shit. but when i say i was medically gaslit i mean i literally had doctors trying for years to convince me that i was mentally ill, and that as a result of that mental illness i could not trust my own senses and lived experience. and then denying me care on the basis of the mental illness they invented. i feel like sometimes when i say to people that ive experienced medical gaslighting they think im saying that my doctors were dismissive or called me a liar, which did also happen and was also fucking awful. but they also very much, very literally, completely fucked up my perception of my own lived experience and my ability to contextualise basic aspects of my physical reality to the point where my understanding of what Pain actually is was totally warped by adulthood.

And because nobody who hasn't been through it actually takes it seriously when you tell them what its like to live as someone with a complex, difficult to test for chronic illness, or just as Literally Anyone of any marginalized group trying to access Healthcare... i didn't even know that what happened to me growing up was a form of medical abuse. because when you tell someone 'my doctor said this horrible thing, can you believe that?' their automatic response is 'well.... but like.... they have a medical degree. do you?' so the power dynamic that puts you, the sick person, as the lowest most untrustworthy authority on your body is just reinforced constantly by a society that desperately needs to believe that if they were the sick one, of course their doctor would help them and treat them with compassion and care. and they cant believe that if you're out here existing as living proof of a broken system. so yeah 'do you have a medical degree? no? well, idk, maybe the doctor is right and you're the one who doesn't get it. i mean, medical degrees equal omnipotence and completely negation of human bias, right?'

im lucky because i had parents who kept taking me to the doctor when i asked, even if the doctors told them nothing was wrong. im lucky because my mum always remembered the time she had hepatitis as a kid and nobody believed her until she was hopelessly ill. or how her sister had a collapsed lung and the doctor sent her home saying she was exaggerating and just had a cold. im lucky because even when my mum did actually believe the doctors that there wasn't really anything wrong with me because she didn't really know better, she kept that thought to herself and still listened to me, every time, just in case. just so i knew i was being heard. im lucky because im a stubborn, anti authoritarian bitch by nature AND nurture, so i came out of all this with a strong capacity for self advocacy.

and even then, it STILL fucked me up in ways that im only now beginning to understand. im starting to realize why every time i feel im not being listened to, i get so angry i could scream and i stay angry for a ridiculous, disproportionate amount of time. why a friend questioning me when i talk about something ive lived, even lightheartedly, makes me lose several nights sleep and ill still be thinking about it months later. why every time a doctor hears my diagnosis and preemptively assures me they believe me (because they know how many of their colleagues would have said otherwise) i immediately start sobbing. i never even recognized these things as triggers until recently. because this abuse was at the behest of a system, and perpetuated by many people and not a single individual, i didn't conceptualize of it as being abuse. i didn't conceptualize of it as being trauma. but it was. i think im finally getting it now, that being in pain my whole life and being told over and over that it wasn't real and there was something fundamentally wrong with me for thinking it was... yeah. i think that was traumatic to a developing mind. shocker, right?

medical gaslighting is gaslighting, in the real sense of the word. it has lasting effects on a person's sense of self and capacity to trust in authority of any kind, especially medical professionals. especially when you do that shit to a little kid, who has no way to know what 'normal' feels like because they were born sick and never knew different.

and the irony is, i actually DID have serious depression growing up. but because all of my physical symptoms were so readily dismissed as mental health issues (not that i was ever actually offered mental health care, mind you. they didn't want to help me, they wanted me to be someone elses problem) I knew that if i ever admitted i had depression, my chances at treating my physical illness would be 0. they would never ever listen to me again. so i was forced, as a kid, to hide life threatening depression because if i admitted to it, i would lose access to any hope of treating my physical pain. thats a hell of a choice to put on a child. im still scared to admit having occasional depressive episodes to doctors because im afraid that if i do, they'll take away all my medications, even though my condition is diagnosed and well documented by now. and some doctors absolutely try to do exactly that, but i know enough now to find a new doctor as soon as anyone tries that shit.

but it shouldnt have to be this hard. and im white, seen as a cis woman (actually nonbinary but i dont tell them that), relatively thin, and in a country with universal Healthcare. for anyone with any additional axes of marginalization, especially if they are Indigenous or black and especially if they are fat, it's so much worse. for any kid with parents who don't know better than to blindly trust doctors. for anyone who's response to trauma is to get quiet instead of getting mad. for so many people, medical gaslighting is not just an obstacle, it's an impenetrable fortress that cuts them off from ever getting the care they need or having the tools to advocate for that care. and that can be a death sentence.

[potsiepumpkin]

Useful information

[identitty-dickruption]

the broader crip community would benefit, I think, from the concept of “compulsory abledness”. the concept evolved out of the intersection between queer theory and crip theory, so it’s mostly based on the idea of compulsory heterosexuality (which I’m sure many of you would be familiar with)

in essence, it’s the idea that society assumes a level of ability of everyone. ability to go to work/school, to form relationships, and to generally live a specific kind of “normal life”.

compulsory abledness is what has disabled people pushing themselves too far, and then feeling ashamed when we can’t do the same things (in the same way) as everyone else

BUT! just like compulsory heterosexuality, it’s also a helpful tool to use to question the naturalness of “ability” as a category. if to be abled is a natural category, rather than a location on a spectrum, why does abledness have to be enforced by ableist tools?

this isn’t to say that there’s no such thing as ability/disability… it’s just that the assumptions society makes about what it means to be abled are constructed assumptions. basically. the idea that being abled is the “norm” prevents us from living our best lives as disabled people and prevents the rest of the world from questioning the arbitrariness of the abled/disabled divide

[notabled-noodle]

normal vs disordered: fatigue edition

normal: feeling tired at the end of a long day

not normal: feeling tired regardless of what you’ve done that day

normal: waking up tired every now and then due to stress or lack of sleep

not normal: waking up tired most mornings

normal: getting a little tired after standing for long periods of time

not normal: not being able to stand for very long without tiring out. being stood up drains your energy

normal: being tired more often during times of peak stress and lack of sleep, but otherwise fine

not normal: being tired/exhausted consistently for over 6 months

normal: melting into the sofa after a long day, and then struggling a little to get up

not normal: being too exhausted to move, to eat, to talk, or to do anything a person might be expected to do in an evening

normal: not liking to get out of bed in the morning

not normal: having mornings where you physically cannot get out of bed, or struggle greatly to get out of bed

the key thing is that it is not normal for you to spend most of your time being too tired to do daily tasks, and it is not normal to exist in a constant state of exhaustion. if possible, you should seek help if you’ve been experiencing fatigue for a while

[raisedeyebrowemojii]

Help save my life (2nd post)

Hi,,it’s Jay again. I’m deemed terminally ill by my doctors here. I’m in my 20s, with chronic kidney disease, and can’t face the fact that I’m dying just yet because I got ahold of one of Canada’s most renowned nephrologists and she said she’d be willing to take on my case. I just need to be able to get there and pay for accommodations. Your help would mean the world.

We are trying to raise $6000 overall, which is the cost of the trip, accommodation, food, etc.

PLEASE SHARE. I need support. We are using my friends PayPal and will update what we got frequently. We already got $500 raised.

**Make sure to send funds as a ‘friends/family’ transaction so my friends account isn’t flagged as selling stuff like a business**

$500/$6000

Go to paypal.me/troublethecat807 and type in the amount. Since it’s PayPal, it's easy and secure. Don’t have a PayPal account? No worries.

[salty-rainbows]

You may want to check out the charity Hope Air, which pays for medical travel expenses in Canada.

[potsiepumpkin]

I’m trying harder than the specialists at this point.

[salty-rainbows]

In my experience the same 5-15 generic blood tests will be run over and over again, but if you ask for a different test there will be complaints of "unecessary medical testing."

[jupiterjames]

Hey! Saw your post about getting a doctor to clear the hold that was placed on your meds by your insurance. You mentioned a genetic test for psychiatric drug tolerance - how did you get one of those? My SO has been prescribed lots of different psychiatric drugs and most either don’t work well or have lots of negative side effects, so I’m wondering if this test would be useful (his doctors have never mentioned it to him before)

Absolutely! Now, I'm in the US, so if you're not, I have no idea how it would work besides straight up asking your doc if they know who and how to get one, but if you are in the US, I hope this helps.

My psychiatrist suggested the testing because she is not fond of a patient having to play medication whack-a-mole more than few times, and has experienced this phenomenon many times over the years, so she knew. And it was covered by my insurance and done by a company called GeneSight. They have a myriad of genetic tests, which is AWESOME. Your doc or psychiatrist may not know about the specific tests for medication tolerance (it's basically a very targeted liver enzyme test), so maybe float the idea to them. As a provider, they can order a test for you, OR you can straight up order one yourself and pay out of pocket and possibly be reimbursed by filing an insurance claim yourself.

HOWEVER, please keep in mind that if you or your doc orders the test (it is a cheek swab that will be mailed to you and that you can mail back) FOR THE LOVE OF ALL THAT IS HOLY, check your insurance to see if you need pre-approval for coverage, a doctor's approval for coverage, and/or if you can just submit a claim after you get the bill, OR if your insurance will cover any genetic testing at all (most do for some things). Most docs will probably be more than willing to send your insurance a pre-approval request. Out of pocket, these specialized tests can cost upwards of $3-5K sometimes because they are so targeted. But also, if your SO is like me, and run the gauntlet of failed meds, insurance hates that too, so approving a test could be super easy. In my case, it went right through no hassle.

When you get the results, you will have an actual list of brand name and generic drugs in ALL psychiatric categories (even the ones that don't apply to your mental health needs) labled in a green (well-tolerated), yellow (eh, side effects that will probably resolve), and red (poorly tolerated or contraindicated.)

If you do this yourself, take the copy to your doc and discuss what's on the green list (or yellow if you're like me and have only 2 on the green list) and discuss what's appropriate. If your doc orders the test, they will also receive a copy of the results.

Anyway, this helped me A LOT. I immediately went on the SNRI that was in green, as well as anxiety meds in green (different category list) and felt a ton better.

Y'all stay as healthy as possible, okay? :D

[jupiterjames]

Did I just employ the "Treat Them Like You are A Kindergarten Teacher Again" method with my insurance company today? I surely did. Did it work? Probably better than intended because I made an actual doctor feel contrite.

So, my insurance has been trying to not cover my SNRI because it is new on the market and no generic available yet, so pricey.

I apply for a refill and the request gets locked for review. Again. For the 3rd time.

This time I call and immediately ask to speak to the actual doctor making these clinical decisions. Very politely. Must be a slow day because they allow it.

ME: [Teacher voice] I'm calling in regards to the SNRI you have placed a lock on. Why was this decision made?

DOC: Well, there are dozens of other medications on the market in that tier, and far cheaper for you and [insurer]. We have sent a request to your doctor to consider alternatives.

ME: I am aware of that. So, can you do me a HUGE favor and look up my prescription history really quickly and tell me how many SSRIs and SNRIs were only filled once in 2022 for me, showing they were poorly tolerated?

DOC: It looks like eight.

ME: Great job! Now, can you please look at my genetic test for psychiatric drug tolerance and tell me how many medications are listed in the safe category?

DOC: Two.

ME: Awesome! Now, can you tell me what type that other drug is that I'm not taking?

DOC: Yeah, totally, it's an MAOI.

ME: That's correct, you're really knowledgeable! Should I be taking something as dangerous as an MAOI with my other medications, or even just in general?

DOC: It's contraindicated for sure.

ME: It is! So true! So, last question since you've been incredibly smart and helpful. Is it less expensive for [insurer] to pay out for the medication knowing they already get a huge manufacturer discount anyway, or is it more expensive for them to pay for me to need potentially long-term inpatient psychiatric care?

DOC: I'll clear the code, ma'am and flag it as medically necessary. I'm sorry about this.

ME: I appreciate you SO MUCH. You have a great day now.

WALGREENS PHARMACY TECH WITH 5 NOSE RINGS AND PURPLE HAIR STARING AT ME: ........... OKAY! It'll be ready in five minutes. You wanna come work here?

[salty-rainbows]

Doctors: are you seeing any new sexual partners? Could you be pregnant?

Patient: no and no

Doctors: =orders pregnancy tests and STI testing= =orders bloodwork that's been done five times before=

Patient: Can I request this testing?

Doctors: No, we really have to avoid uneccessary medical tests.

[andhumanslovedstories]

If there’s one thing I feel I can unambiguously brag about, it’s that I’m great with patients who are in pain crises. I’m tenacious and stubborn about lowering 10/10 pain to something more manageable. I got a patient in “25 out of 10” pain at start of shift down to a 4 by midnight and it only took opioids, Tylenol, muscle relaxants, ice packs, warm blankets, fresh coffee, repositioning, an abdominal binder I scrounged up, a phone call to the surgeon to get lidocaine patches ordered, and some serious chit chatting with the patient while we waited for all that to kick in. We didn’t end up needing IV medication, we didn’t have to increase opioids, we didn’t need to add any medication that would potentially delay discharge, and the majority of what I did is all stuff she can also do at home so it’s a sustainable pain management plan. This is my absolute favorite thing with nursing, I love love love managing pain, I know I talk about it a lot but it’s the most satisfying thing in the world. I love watching someone emerge from a horrendous haze of pain until they feel like a person again. Also I’m scheduling this to post well after my shift is done so that I don’t jinx anything, also while I was writing this post I had to take a quick break for two hours half way through because someone started having a seizure. My job is wild. I used to be a barista.

[andhumanslovedstories]

@irrellavant oops you activated my trap card of asking about something I care about, please enjoy this monologue. Also it’s not comprehensive, can’t stress that enough, this is a just a lil long tumblr post made by a just some nurse who isn’t a palliative care expert and is also writing this on her cell phone on break. Some of this stuff is gonna be pretty obvious! I just would feel remiss if I left it out. And also please anyone who has pain or addresses pain, please feel free to add on. I'm always looking for new ideas and new insights, especially from the patient side so please please do chime in if you like. Okay SO

For me, the biggest thing is conveying to the patient that you care that they are in pain and that you are trying to make it better. I remember I had a patient who was in horrible pain all night, we never got it down, we never got her comfortable, but at the end of the night she thanked me so sweetly for trying and she said that knowing I was taking her pain seriously helped her feel better even if it didn't make her hurt less. Just because someone is in pain, it doesn't mean they have to suffer, if that makes sense. I think one of the worst things about pain in the hospital is the feeling that you've been abandoned to experience it. Someone gives you a pill (or not even that) and says "okay bye" then you go back to writhing in agony. I make sure that before I leave the room of a patient who is still in a pain crisis, that I let them know what the plan is and what the next step is. "You just got 5 mg of oxycodone, which will take up to an hour to take full peak effect. If your pain doesn't get better after that hour, I can give you another dose" or "I'm going to go page your doctor to see if I can get you an additional dose" or "I need to step away right now, but I'll be back in 20 minutes to see how you're doing and if the heating pad is helping." I tell the patient "we're gonna try X, which should do Y, but if it doesn't, the next step is Z” and then I make sure to follow up with them.

I also try to be honest. I never promise that they'll be pain-free, just that we'll keep trying. We aim for small but achievable goals. If it's acute pain, like you just had a surgery or something, I try to contextualize it for the patient. "We're not gonna get you pain-free ten hours post surgery, but we can get you more comfortable than you are right now." Patients are usually fine with being a six outta ten pain if they’ve been otherwise sitting at a nine. Since I’m night shift, I often tell them my goal is for them to get at least a couple hours of sleep and ask them how that sounds.

Then pharmacologically, I look at the meds I do and don't got. If a patient is having incisional pain, lidocaine patches on either side can be great for just numbing the area up. If the patient can get oxy every 6 hours but routinely gets very painful again just three hours after taking the med, then maybe the dose or the timing is not right. Maybe under prns we've got so many opioids and not a single NSAID, and there's not a contraindication. Maybe their pain is caused by muscle spasms, in which case a muscle relaxer could be a great addition. Maybe the pain is nerve pain that would respond much better to gabapentin instead. Or maybe you need IV dilaudid to quickly get the breakthrough pain down to a manageable level so that the other meds have a fighting chance to do anything. If meds aren’t available, these are things you can page the doc about and discuss with them.

I'm also a big fan of around the clock medications for patients that have had poor pain control. Ask patients if they want to be woken up for pain meds (again, patients that have been that painful usually say yes). Explain how it's easier to keep the pain low than it is to play catch up after pain spikes. Pain control works best when you avoid the spikes in the first place. There's no point getting someone out of a pain crisis if you then withdraw all your cares until they're in a pain crisis again.

I also try plenty of non-pharmacological methods of lowering pain or enhancing comfort. (Sometimes you can't lower pain! Sometimes all you can do is enhance comfort!) Does the patient have a topical cream that helps with pain? Could it be applied while gently stretching the muscles and really going to town with a foot massage? Has the patient just thrown up and would like a bed bath to feel clean again? Would they benefit from heat? Or ice? Or warm blanket? Ice and then on top of that a warm blanket? Do they want some pudding? Do they need a little candy from the nurse station candy drawer? If their lower back hurts from being in bed so long, can we get them out of bed? Even if it's three am and we need to lift them with a Hoyer to their recliner, that might still be the best intervention. I had a patient where the only thing that helped her hip pain was going on walks so over the night we went on a bunch of walks. Worked better than any meds.

What about conversation? Do they need someone to cry with? Do they want to talk about pets or their diagnosis or the bizarre TLC show that's playing on the TV? A lot of this is feeling out conversation, and I don't have great advice for that besides if you make yourself obviously available and interested in people, they tend to open up to you.

Also I’m a big fan of asking if there’s anything I can do while we wait for the meds to kick in. That’s usually when I do a bunch of those non-pharm interventions, because it’s efficient (we are in fact waiting for the meds to kick in) and it makes the waiting less miserable. I think it also makes the waiting feel less helpless. We aren’t just waiting an hour for the dilaudid to do something, we’re also tucking you in with a warm blanket and giving you the finest jello I could scrounge up.

And obviously, I ask the patient if the pain they're currently feeling is uncommon for them, either in the type of pain or the intensity. This is good for general assessment stuff and to figure out if the pain itself is the problem to be managed or if there's something new causing the pain. If the cause of the pain can be managed, that's my priority with pain medication as a supportive therapy because like if you're a paraplegic and suddenly you're complaining of an intense pounding miserable headache, giving tylenol isn't the right intervention when what I should be doing is assessing for autonomic dysreflexia.

And I ask them about the type of pain they're having and if they know what works for them to manage it. Plenty of chronic pain patients can tell you what is and isn't effective. Maybe at home they're on 50 mg of oxycodone a day, but right now in the hospital they're only prescribed 40 mg. Or hell, they're still getting 50 mg but they're here because they’re sick so their baseline level of opioids isn't gonna be enough because that's to manage their every day pain and not their new super hell hospital pain. Or they know aspercreme works like a dream on their legs but not on their back. Or patients know that ibuprofen works better for them for this type of pain than a fentanyl patch does, or they don't want to take dilaudid because it makes them nauseated, in which case you can try premedicating them with an antiemetic.

Also when your shift is done, write down all the stuff that worked to control pain in your nursing note so there’s a record of it in case someone needs to do it again.

If there’s one thing that I have found successful though, and I know this might sound cheesy, but it is CARING and showing the patient that you care. You care that they are in pain, you are working with them to get them more comfortable, if something doesn’t work you will keep trying, because pain sucks and you care that they are in pain. Even when you have to leave their room, you let them know that you will come back. They aren’t left totally alone to suffer. Again, sometimes you can’t decrease pain but you can increase comfort. I believe there is genuine comfort in knowing that someone is trying very hard on your behalf to make you feel better, even if they don’t make you feel better.

[spoonsforminutes]

I’ve had chronic pain for 16 years, and this is most reaffirming perspective on pain I’ve ever heard from a healthcare worker. Thank you for caring and doing everything you do; it seems like such little things but to those with chronic pain, it means the world.

[conarcoin]

i will never understand the insane takes against having games be more accessible

[conarcoin]

“does every game NEED to be accessible to disabled people? 🤨” yeah, actually

[conarcoin]

also the pissing and shitting over difficulty settings. just play the game on the normal difficulty dumbass it’s not for you

[demonicae]

Same with stuff like screen shake, particle effects, flashing/lightning effects: “But the game would look terrible without them!”

Then Just.... Don’t turn them off then, dickface...

Meanwhile, *having the option to turn them off* would greatly increase the number of people able to play the game.

[awkward-teabag]

People earnestly say that if someone else can enjoy a game and not have to have perfect parrying or who plays on a lower difficulty, it will reduce the amount they can enjoy the game.

The single-player game.

The single-player game with no global leaderboard or multiplayer option.

But they state that a theoretical person somewhere in the world enjoying the game is enough to all but ruin the game for them if they don't know about it or see the person, just the thought of someone playing differently is enough to ruin the experience for them.

Because it's only recently video games had different difficulties and they never, ever included cheat codes so you could do things like give yourself god mode and play for the story/experience. /s

[neurosciencestuff]

Scientists develop new technique for studying mitochondria

An advanced imaging-based method from scientists at Scripps Research offers a new way of studying mitochondria, which are best known as the “powerhouses” of cells.

In their report, in the Journal of Cell Biology, the scientists described a set of techniques that enables the imaging and quantification of even subtle structural changes inside mitochondria, and the correlation of those changes with other processes ongoing in cells.

Mitochondria are involved not only in energy production, but also in several other critical cellular functions, including cell division and cell-preserving responses to various types of stress. Mitochondrial dysfunctions have been observed in a host of diseases including Alzheimer’s, Parkinson’s disease and different cancers, and researchers are eager to develop treatments that can reverse these dysfunctions. But the scientific tools for studying the fine details of mitochondria structure have been limited.

“We now have a powerful new toolkit for detecting and quantifying structural, and thus functional, differences in mitochondria—for example, in diseased versus healthy states,” says study senior author Danielle Grotjahn, PhD, assistant professor in the Department of Integrative Structural and Computational Biology at Scripps Research.

The co-first authors of the study were Grotjahn lab members Benjamin Barad, PhD, a postdoctoral research associate, and Michaela Medina, a PhD candidate.

Mitochondria are one of the many membrane-bound molecular machines, or “organelles,” that dwell within the cells of plants and animals. Typically numbering in the hundreds to thousands per cell, mitochondria have their own small genomes, and have a distinctive structure with an outer membrane and a wavy inner membrane where key biochemical reactions occur. Scientists know that the appearances of mitochondrial structures can change dramatically depending on what the mitochondrion is doing, or what stresses are present in the cell. These structural changes therefore can be highly useful markers of cell conditions, though until now there hasn’t been a good method for detecting and quantifying them.

In the study, Grotjahn’s team put together a computational toolkit to process imaging data from a microscopy technique called cryo-electron tomography (cryo-ET)—which essentially images biological samples in three dimensions, using electrons instead of light. The researchers’ “surface morphometrics toolkit,” as they call it, enables the detailed mapping and measurement of the structural elements of individual mitochondria. This includes the bends of the inner membrane and the gaps between membranes—all potentially useful markers of important mitochondrial and cellular events.

“It allows us essentially to turn the beautiful 3-D pictures of mitochondria we can get from cryo-ET into sensitive, quantitative measurements—which we can potentially use to help identify the detailed mechanisms of diseases, for example,” Barad says.

The team demonstrated the toolkit by using it to map structural details on mitochondria when their cells are subjected to endoplasmic reticulum stress—a type of cell stress that is seen often in neurodegenerative diseases. They observed that key structural features such as the curvature of the inner membrane, or the minimum distance between inner and outer membranes, changed measurably when under this stress.

With their successful, proof-of-principle demonstrations of the new toolkit, the Grotjahn lab will now use it for studying in more detail how mitochondria respond to cellular stresses or other changes induced by diseases, toxins, infections and even pharmaceuticals.

“We can compare the effects on mitochondria in cells treated with a drug versus the effects on untreated mitochondria, for example,” Medina says. “And this approach is not limited to mitochondria—we can also use it to study other organelles within cells.”

“Quantifying organellar ultrastructure in cryo-electron tomography using a surface morphometrics pipeline,” was co-authored by Benjamin Barad, Michaela Medina, Daniel Fuentes, Luke Wiseman, and Danielle Grotjahn, all of Scripps Research.

[slowlikehoney1996]

grounding techniques, ok 5 things i can see. ugly man. shitty palm tree. clear evidence of air pollution. conservative bumper stickers. roadkill. why do i feel worse

[kittwalker]

I used to do the 5 things you see, 4 things you hear etc with my daughter when she was spiralling, but it had a low success rate. Just didn't engage her brain, was too easy to just list shit things that made her feel shit.

I had to get creative.

Now we do shit like:

5 things you can see that you could easily steal without being noticed

4 things you think might be sticky if you licked them

3 things that you could fit in your mouth at once

2 inanimate objects that in another dimension, might fall in love

1 thing you can see that isn't made of cheese, but would be better if was

Obviously not those ones every time, I gotta keep mixing things up, else she doesn't have to really focus. Your mileage may vary, but it mostly works for us.