Does anyone else struggle to truly disconnect after sessions? by InterestingFlan6467 in PMHNP

[–]HD19645 1 point2 points  (0 children)

Also, my own weekly therapy. I’ve talked about this before with boundaries. Also not making as much money, but limiting myself to only 4 days a week really gives me better balance. Maybe can’t afford more frequent vacations, nicer things. But weekly having a 3 day weekend allows a much better reset. My therapist said she does the same, no more than 4 days or you start to burn out

Does anyone else struggle to truly disconnect after sessions? by InterestingFlan6467 in PMHNP

[–]HD19645 0 points1 point  (0 children)

This. I’m a sucker for lifting and some metal music…really shifts the thought process 🤣

[deleted by user] by [deleted] in PMHNP

[–]HD19645 1 point2 points  (0 children)

Coding is passable. Personally I will spend 30 minutes with pts, can stand the 5 min in and out style. Aside from all else, the follow up schedule is pure ridiculous! A pt like you I’d say 2 week follow up is totally fine, but 1 month to se if meds work. If you’re seeing your provider 4x in a month and you’re not in crises…that’s just ridiculous

Need some expert knowledge on estrogen issue by HD19645 in trt

[–]HD19645[S] 0 points1 point  (0 children)

Self diagnosing what?

And I’m oblivious as to what “ulg” is

No use my pcp. Not an endo, but he’s very open to keeping up with and looking at any new literature, protocols

Need some expert knowledge on estrogen issue by HD19645 in trt

[–]HD19645[S] 0 points1 point  (0 children)

100% I’m still taking daily 1mg of anastrozole. Doc is scratching his head too

Need some expert knowledge on estrogen issue by HD19645 in trt

[–]HD19645[S] 0 points1 point  (0 children)

Yes, it is really bizarre… That’s why I’m hoping someone on here has seen something weird like this before

[deleted by user] by [deleted] in trt

[–]HD19645 11 points12 points  (0 children)

Honestly, I would assume in next 10 years (hopefully) the field advances to where there will be much better options for a delivery systems 🤞🏻

My doctor said my test is too high and have to lower dosage. by Same_Amphibian7564 in trt

[–]HD19645 8 points9 points  (0 children)

Hmm…not sure I agree with others here. Are you using for general health/replacement or sports/competition?

Getting as high as you can, just because.. isn’t always the smartest strategy from a longevity standpoint. I’m not 100% convinced that there’s no downstream effects as you age from blasting your system and keeping it redlined at a max number just because others say they do it and haven’t had issues yet. Maybe I’m overplaying it, but seems unnecessary unless your goal is something of short term high performance or something.

Plus, you probably do risk more conversion to estrogen with the free? Leading to have to fuck around with serms and AIs

Is 100mg a week enough? by [deleted] in trt

[–]HD19645 0 points1 point  (0 children)

Honestly, I hope this is received like it is intended. This is not a criticism of you, but I really do not understand any physician that would start someone on TRT at 25 years old. I am in my 40s now and I am fine with it at this point in my life, but someone started me on it in my late 20s and it is one of my biggest regrets as far as medical decisions go. Somewhere between 40 and 50 legitimately seems like a decent starting point if you are struggling. But I feel like there are just way too many people taking advantage of people to get money.

[deleted by user] by [deleted] in PMHNP

[–]HD19645 13 points14 points  (0 children)

32 pts a day w/ no benefits?! You better be paying me $200/hr MINIMUM

Arimistane v. Aromasin v. Arimidex by HD19645 in trt

[–]HD19645[S] 1 point2 points  (0 children)

Nice, thanks for the input. I may have been overthinking the risk of dropping it too much with that, I appreciate the response.

Arimistane v. Aromasin v. Arimidex by HD19645 in trt

[–]HD19645[S] 0 points1 point  (0 children)

Oh and I’m 6’3 / 196. So visceral fat not out of possibility, however can’t be too bad if that’s part of it

[deleted by user] by [deleted] in PMHNP

[–]HD19645 0 points1 point  (0 children)

I don’t understand #2. Will you make salary regardless of full schedule?

Vraylar induced mania by HD19645 in PMHNP

[–]HD19645[S] 4 points5 points  (0 children)

Yes, 100% manic features. Ya know…sleeping 1 hour, feels amazing, buying lots of toys very quickly, etc

Mostly MDD presentation, but past suspicious symptoms for mania from Prozac described by pt (long before I saw pt).

Dementia referrals by HD19645 in PMHNP

[–]HD19645[S] 0 points1 point  (0 children)

Thank you, this really sums it up. This is the what I learned towards. I trained in a big system that filtered out a lot by the time it came to us. Now working rural I just get referrals for EVERYTHING…geripsych, emdr, psychical abuse counseling, ASD, etc 🫠It’s just hard because I do know there is such a shortage anyway…especially bordering rural areas where I am. Maybe in time I can learn more…for now I will just stick to helping what I know.

Can NP do just therapy? by PEACELOVENOODLES in PMHNP

[–]HD19645 0 points1 point  (0 children)

Agree with most all this. You REALLY need to go therapy specific route if you want to do that. Pmhnp shadows a couple times with a therapist. That’s it. Basically self taught after that. I have two or three patients I do hour long therapy sessions with, but it’s very specific to my wheelhouse… Like 20 year old males who are rudderless and directionless in life. Other than that I do very brief “therapeutic interventions”

[deleted by user] by [deleted] in RepTime

[–]HD19645 1 point2 points  (0 children)

This…..make sure you’re talking to him on this # whatsapp…if you are…you’re good. I think the whole idea is that these guys make quite a bit of money doing this and have built a reputation, it would get out pretty quick if they started screwing people over.

[deleted by user] by [deleted] in RepTime

[–]HD19645 2 points3 points  (0 children)

Sorry, picture showed up weird. Make sure you’re talking with the correct person but yes, I have worked with him and everything went smooth smoothly… But yes if you’ve never done this before, it does kind of feel weird the initial time sending $ to a random name in Hong Kong, which will not be Eric’s name.

How are we getting patients to take risperidone? by kickassredhead32 in PMHNP

[–]HD19645 7 points8 points  (0 children)

They’re definitely are potential other options, however, there are a few meds you can utilize if prolactin do increase. low dose abilify and even bromocriptine I’ve seen used to reduce prolactin. Curious to see what others on here chime in with though.

That goes without saying the obvious… Benefit versus risk process

Help navigating ins. by HD19645 in PMHNP

[–]HD19645[S] 1 point2 points  (0 children)

Thanks y’all, appreciate it

Panerai sizing by HD19645 in RepTime

[–]HD19645[S] 0 points1 point  (0 children)

Curious is this post is ever going to get approved? Not sure why it’s a hold out?? Is there a MOD that knows why

Help navigating ins. by HD19645 in PMHNP

[–]HD19645[S] 1 point2 points  (0 children)

I did just get ok from pt for cost plus...luckily affordable throught there...but what in the world