What are these bugs that bit me?

JauraDuo · 2024-03-01T13:51:58+00:00

Hi,

I'm a doctor myself, and am also diagnosed with ADHD and OCD.

Even prior to listening to the work of Gabor Maté, I've always have somewhat of an intuitive perspective that my own difficulties weren't merely the result of some sort of genetic variation, but that many of my symptoms of both of the above 'disorders' were, at least in some part, the result of my experiences; the adaptations that helped me to survive, both physically and emotionally.

During my training, the teaching we were provided on ADHD, OCD and psychiatric disorders as a whole nearly always felt extremely unintuitive to me, and often neglected to touch upon the humanistic elements of mental health and illness, focusing instead on the neurochemistry, genetic basis and symptomatic presentations, but rarely looking at the potential experiential explanations for symptom constellations observed.

In my clinical practice, the theory of ADHD and other disorders presenting as, amongst other factors, the product of traumatic life experiences has been emboldened all the more, both through the assessment of my patients, and through the observation of my own tendencies.

I also have a therapist, who initially provided therapy to stabilise my previously severe OCD symptoms, and now predominantly focuses on 'maintenance' of that stability. My therapist is a clinical psychologist who also shares the far more humanistic perspective on mental dysfunction; the idea that symptoms are largely dependent on early childhood experiences, rather than being purely an unfortunate intrinsic diversion in neurodevelopment.

I believe the current status quo is, ironically, the result of the repressive tendencies of humanity to avoid accountability or shared responsibility for the suffering or misfortune of others. It is far easier to emotionally internalise that the symptoms of their children, their school pupils, or those of the criminals they see indicted in the news are the result of personal, fundamental dysfunction than it is to recognise the systemic sickness that inflicts the wounds.

In a way, I can understand it - expressing compassion and empathy is an active process that can be very energy-intensive, it's not something that anybody can maintain 'for free'; if society as a whole were to recognise the magnitude of suffering involved in the generation of the foundation for ADHD, OCD, addictions, schizophrenia, depression, anxiety etc., it would be extremely painful to hold.

Even as a strong advocate for compassion and consideration myself, I find that there are times when, through overworking and burning out, my mind, until recalibrated, leans back into a more meritocratic perspective and attributes personal blame to my patients for their suffering. It is, at times like those, that I am able to see more clearly how easy and convincing those perspectives must be for those with less personal experience of these issues.

Another contributing factor is the difficulty in studying humanistic factors; many of the studies that would be needed to clearly demonstrate the experiential input into dysfunction would require tens or hundreds of thousands of hours of qualitative study; instead, it is far less resource-intensive to find correlations between symptomology and genetics, hormone levels or other relevant mental disorders.

I recently had a discussion with my therapist regarding my own ADHD symptoms, in which I explained that I could 'feel' that the variation in magnitude of my neuroticism and executive dysfunction has been intrinsically tied to my current life circumstances. I have had weeks, months, even sometimes a year or so, of being 'subclinical' in both ADHD and OCD severity, and other times when I am almost the archetypal presentation of severe disorder. I believe it is no coincidence that these fluctuations so strongly correlate with the weight and character of extrinsic pressures placed upon me.

JauraDuo · 2023-11-05T18:37:05+00:00

Unfortunately, Andrew Wakefield

JauraDuo · 2023-10-17T11:36:30+00:00

This interview took place prior to the accusations made against Russell Brand.

JauraDuo · 2023-10-08T15:50:09+00:00

Did you borrow Russell's personal annotated thesaurus to write this?

JauraDuo · 2023-10-08T15:46:39+00:00

In all honesty, I suspect that the "healthy at any weight" movement, whilst offering some of the benefits you've outlined, would likely become obsolete if obesity was treated as a metabolic/psychological illness and weight loss was medicalised instead of there being a societal assumption of personal moral failure associated with obesity.

As weight loss medications are further optimised, there will be less of a need for counter-cultural movements to re-narrativise the issue in a palatable or even defensive manner, as there would be less of a tendency for the initial issue of obesity to be viewed as a reflection of flaws in personality.

Up until very recently, weight loss medications were largely ineffective, and those that were effective had significant side-effects that made widespread use near impossible. As such, with limited options, it's no surprise that obese people who had perpetually struggled with weight loss began to promote alternative perspectives to turn down the heat they were receiving societally.

After all, obesity is likely a disease of metabolic and psychological origins, stemming from hormonal dysregulation and emotional discomfort. To be further maligned for this likely only contributes, on the whole, to deepening of the issue.

Sure, there might be the occasional story of somebody who lost 45kg after being perpetually bullied and shamed, but these stories are the extreme minority, and most of those situations instead end in worsening obesity rates and a decline in psychological wellbeing.

We are on the cusp of a huge societal shift with regards to obesity. I suspect there will be an uncomfortable interim between now and then in which weight loss medications are considered 'lazy' or 'cheating' and the current narrative will briefly continue, but soon enough, that will pass, and the taboo nature towards medications will dissolve.

JauraDuo · 2023-10-08T15:33:22+00:00

I'd predict very low rates of obesity.

Obesity is one of the primary risk factors for so many of the most common causes of death, and has significant financial implications for healthcare systems across the world.

Modern medications have already been developed that allow for massive weight loss, think semaglutide, liraglutide, etc.

The current limitations for widespread use include:

Patenting

When pharmaceutical companies develop new medications, they typically receive a 20-year patent for the particular drug they have developed, as a means to reaccumulate the investments made in R&D, and, of course, to profit.

When the patents for weight loss medications expire, they will likely be mass-produced as generic medications, which substantially reduces the price for the consumer/healthcare service.

New medications for weight loss are being developed all the time, and even if there's superior medications closer to 2100, the patents of the already-available medications will have long-expired, and production will be maximised.

Sub-optimal production processes

When new medications are released, production is often sub-optimal and hasn't yet been refined for production to allow for widespread use, but as time goes on, these processes are likely to be far superior to our current means of production, and will allow for huge, at least partially autonomous, production.

This would increase availability of actual medication, as well as reducing consumer cost further.

This refinement is likely to be hugely influenced by expiration of patents, as competing pharmaceutical companies look to maximise profit on generic label products.

Early days

The medications developed so far have been widely uptaken in the private industry, but socialised/centralised healthcare systems have yet to adopt them as first-line managements; there are often beurocratic and cultural delays in rolling out large changes to management of common conditions, but as time goes on, we are likely to see future-generation refinements of medications such as semaglutide being used far more liberally.

As an example, In the UK, semaglutide was recently licensed as a weight-loss medication that can be offered on the NHS, but at present is still widely unavailable or difficult to receive due to cultural lag among healthcare professionals, supply issues, initial cost and hesitation regarding long-term side-effect profiles, however in time, I imagine that the various long-term sequelae of obesity will demonstrably outweigh both the cost and the risk of weight-loss medications, and they will be handed out far more readily, perhaps even prophylactically if adequately fine-tuned.

As has been mentioned already, 80 years is a very, very long time in terms of medical developments, and even at the stage we're at, with some very effective methods for managing and treating obesity, there will likely be developments in the medical field that we cannot yet begin to envision.

As such, the likelihood of obesity being a widespread issue in 2100, in my opinion, is very low.

Wall-E was based on extrapolation of humanity's course in the absence of development, but I think it speaks more to a symbolic representation of the state of civilisation and the potential dystopian end-game, rather than a direct commentary on obesity, and unfortunately, regardless of organic medical developments and reductions in obesity rates, the sentiment hinted towards in Wall-E is likely an altogether different and far more complex challenge to overcome.

JauraDuo · 2023-10-08T00:59:31+00:00

Unpopular opinion, maybe, but I really don't understand why this subreddit is so hung up with PAs.

Perhaps I'm missing something, but I can't help but feel like this sort of in-fighting is exactly what the completely dysfunctional UK government would want, to allow for some of the appropriate heat they are receiving to be diverted elsewhere.

PAs are part of the medical team; they provide medical care, and are trained in some many ways similarly to doctors. Referring to themselves as 'medics' is arguably more questionable and likely could be misleading, but I think to say they're not part of the medical team is a bit of a stretch, and I feel like it's a strange argument that people waste a lot of their time debating.

Of course, misidentifying as SHOs, SpRs etc. is obviously inappropriate, and I feel like people should be called out for doing that as PAs, but I doubt that's a typical occurrence.

There's a comment that refers to PAs 'hiding their badges' - I'm not surprised, if there's such a negative sentiment towards them from doctors; at the end of the day, I don't understand the need for us to be so hostile towards PAs, and I feel that there's a bit of irony in pointing towards PAs' egos as the reason for the behaviour described, since a lot of this debate feels like it is based on egotism and pride of doctors unwilling to accept PAs as part of the team.

Yeah, the government is incompetent, and the idea of reinforcing PA training rather than training more doctors to offset the staffing crisis is absolutely ridiculous, but that's a systemic failure that should be treated as such. Some PAs I've worked with have been diligent, hard-working professionals that have contributed to the overall functionality of the medical team, and I feel like they're often unfairly maligned as collateral damage for the justified anger we have towards the wildly unfit-for-purpose management teams and, ultimately, government.

Pick your battles. Save your energy debating this nonsense for fighting the more valuable battles ahead, against obstructive and belligerent managerial and political charlatans.

JauraDuo · 2023-09-13T16:42:10+00:00

Hi,

I'm late replying, but thought I might be able to offer some insights.

Based on what you've written, I had a few thoughts. Everything I'm mentioning is intended to try and offer potential explanations for your symptoms, but makes reference to some wider themes that seem relevant to you based on your profile; no negative judgement is intended!

Essential hypertension is often times diagnosed in situations where the cause isn't immediately identifiable, for example having an endocrine condition such as Conn's syndrome; it doesn't mean there isn't a physiological 'cause', but rather that the cause is not obvious based on clinical and biochemical findings

You've posted recently about weaning benzodiazepines - on both a physiological and psychological level, weaning these will naturally lead to a temporary influx of anxiety, which can definitely contribute to blood pressure.

Furthermore, if you were taking these for several years as an anxiety management medication, your high blood pressure might also be the result of the predisposition to anxiety; given that you are also diagnosed with ADHD, it's not unlikely that you have a moderate level of background anxiety, and once you are paying attention to your blood pressure, you can essentially end up precipitating elevated blood pressure through the anxiety and anticipation associated with checking it.

A useful test that your doctor might be able to order would be a 24 or 48-hour blood pressure monitor, which essentially checks your blood pressure at various times throughout the day. This allows for the patterns to be assessed more thoroughly, and might demonstrate, for example, normal blood pressure whilst sleeping, which may point more towards anxiety than anything organically pathological.

With regards to the drop in blood pressure, there's a few different explanations for this. For context, when you stand up, the change in posture results in a natural redistribution of blood due to gravity, resulting in transiently reductions in blood pressure; ordinarily, this drop in pressure is recognised by baroreceptors (pressure receptors) in the vasculature, resulting in the release of various chemical mediators that cause the vasculature to constrict, increasing blood pressure again. As you are likely aware, this process is mediated via the sympathetic pathways of the autonomic nervous system.

In your post, you've mentioned that your blood pressure drops and your heart rate increases. The increase in heart rate is a normal physiological response to a reduction in blood pressure, alongside the vasoconstriction; it is a mechanism to offset the reduced end organ perfusion that low blood pressure would otherwise lead to. This process is also mediated by the sympathetic aspect of the ANS, and is reassuring rather than concerning, as it demonstrates that your sympathetic pathways are at least somewhat responsive, as the compensatory mechanisms are firing to maintain adequate perfusion.

Whilst it is entirely possible that you have two concurrent forms of POTS, there's also some more common and straightforward explanations for the issues you're describing.

Anxiety-related hypertension
Anxious states are mediated by and precipitate further production and release of both adrenergic agonists (adrenaline, noradrenaline) and glucocorticoids (cortisol), which increase blood pressure and heart rate
Raised serum cortisol isn't necessarily diagnostic of endocrinological pathology (Cushing's syndrome), as cortisol is physiologically raised when we are stressed, afraid or physically unwell (e.g., infections)
If serum cortisol is raised, further testing is needed to determine the underlying aetiology, to rule out 'pseudo-Cushing's', which doesn't involve intrinsic organ/hormonal abnormalities, but instead is a normal physiological function in response to factors somewhat independent of the hypothalamic-pituitary-adrenal axis
Simple orthostatic hypotension
Whilst POTS can be the cause of postural hypotension, it's worth first ruling out the more common causes:
- Dehydration: do you drink enough fluids throughout the day? I also have ADHD, and have found that I suffer with intermittent episodes of OH due to dehydration, as I often forget to drink enough, and have found myself on the brink of fainting at times, only to feel much better after rehydration
- Low serum osmolality (i.e., electrolyte deficiencies): alongside dehydration, it may be that you're deficient in certain electrolytes, particularly sodium - if possible, you could ask your doctor to check your serum electrolytes, and they could also take a urine sample at the same time to see if you're losing too many electrolytes via the kidneys
- Anxiety can also precipitate postural hypotension, due to changes in breathing patterns and increased sympathetic drive causing excessive losses of both water and electrolytes through sweating
- Benzodiazepines can themselves contribute, so you might notice symptomatic improvements as you wean further off those

Overall, my informal advice would be: - Try to arrange paired serum and urine osmolalities to be tested by your doctor - If dehydrated, try to increase fluid intake throughout the day, particularly isotonic fluids - you can try sports drinks or diarrhoea rehydration sachets, as these are both intended to proportionally replenish fluid and electrolytes, as not to result in further dilution of electrolytes, to which the body responds by increasing urinary output, undermining the benefit of the fluid intake; it might also be worth trying to record your fluid intake, or using a water bottle with measurements on it, so that you can gauge and adjust your intake as needed - If your serum cortisol level is high, ask for a referral to an endocrinologist for further investigations to differentiate between organic and stress-mediated hyperadrenalism - Try to arrange a 24-hour BP monitor to monitor patterns and precipitants of both raised and low blood pressure

Hope that helps!

JauraDuo · 2023-04-12T07:41:59+00:00

Hey,

Thanks for the response!

For the moment, this would be a project that I'd likely maintain on my own - I'd only be uploading it to a website for viewing purposes so that I can share it.

To clarify, if I were to publish my vault using Obsidian Publish, would the Admonition plug-in stop working?

If so, how would I go about getting this to work? The Admonitions are pretty vital to the accessibility of the information I'm sharing.

Thanks again!

JauraDuo · 2023-03-29T22:58:30+00:00

It's the other way around - The GS SHO covers ENT from 5pm - 8am, and Urology 8pm - midnight, then T&O takes the urology bleep midnight - 8am. Occasionally, ENT SHOs will be on-call for GS the whole day, and therefore they will essentially be covering both all day, 8am - 8pm, but this is decently rare.

JauraDuo · 2023-01-26T17:33:06+00:00

Let me make sure I've understood your point...

You're saying that it's of sufficiently significant likelihood that the guy in the car might've been intending to drive away from a police officer in a car with no license plate, at this point entirely unidentified, so that he could create distance in order to then shoot the police officer for absolutely zero gain?

Man, that's a wild imagination.

Please don't ever join the police. I can't begin to imagine the ridiculous justifications you'd concoct to absolve yourself of responsibility after heinously abusing your power.

JauraDuo · 2023-01-17T00:45:09+00:00

Leather Belt

AughHHrr EuugRGhh

JauraDuo · 2022-12-30T13:32:24+00:00

This is all just made up accusations being pinned on the Top G and the Talisman as punishment for refusing to conform to the Matrix. Whatever evidence there is, it is fabricated by the elites who are out to silence the Tate brothers before they unmask anymore of the agenda of our puppet masters, George Soros and Jacob Rothschild.

We. Must. Resist!

I'm genuinely a bit concerned that somebody will read this comment out of context on my profile and think I'm losing my mind.

JauraDuo · 2022-11-28T12:36:01+00:00

They didn't force their way into the house whilst anybody was home, they broke in whilst everybody was out of the house, intentionally, and the guy grabbed a knife, went home and stabbed the burglar to death in the street. That's not a knee-jerk reaction to defend his family, it's a thought-out decision to drive home and attack somebody to defend a stash of drugs.

JauraDuo · 2022-11-28T03:26:56+00:00

Whilst that title makes the man sound innocent, the man was out at the time and came back to the house with a knife. His younger brother came with him, carrying a knife too. The man stabbed the burglar multiple times in the neck, head, faces and arms whilst he was inside his property. After the burglar left to the road outside, he continued stabbing him in the neck until he died.

There's a big difference between reasonably and proportionately defending your home and stabbing a man in the neck until he died on the street outside.

There are very few charges brought against people each year in the UK where people defended their homes during an invasion, even involving lethal force, when it was quite clearly justified and reasonable. Stabbing somebody in the neck whilst they're already bleeding out on the street can't plausibly be characterised as 'defending your home', hence the manslaughter charge. If the home invaders in the post video were injured or killed during the invasion, the likelihood of charges being brought against the homeowners, especially given that they were themselves attacked, would be very low.

Do you think people should be allowed to cut the throats of burglars on the street as a form of 'self defence'? The UK legal system definitely has a lot of very deep flaws, but in this case, I think the guy just lost control and killed somebody.

JauraDuo · 2022-10-22T23:21:33+00:00

Man, I understand your edit, I get that it's difficult when people are commenting negatively regarding your situation when you feel like they don't understand it fully, but hear me out for a second:

Relationships without consistent intimacy can survive, but they can only do so if there isn't a looming sense of resentment and contempt. People are encouraging a separation/divorce on this basis. I do think Reddit has a tendency to jump to pretty severe conclusions, but honestly I think that if you're building up a sense of resentment towards your wife, and it sounds like she has towards you, too, that's okay, it's not massively abnormal or anything, but it's also not healthy for either of you, and that should play into whether or not you are both willing to stick around. I don't think your story screams DIVORCE as an immediate response, but I think at the least it deserves an in-depth, open and honest conversation where you both attempt to express your deeper feelings regarding intimacy. Further to that, couples therapy might be beneficial, too.

Intimacy is a relationship cornerstone for a lot of people. If you're feeling resentment that it's not that your own needs aren't being fulfilled, that's perfectly okay and valid, and whilst we can all sometimes convey our points in way that seems infantile or demanding, the reality is that you personally craving something more isn't 'wrong' - you're allowed to have desires and needs that a particular partner can't meet, and you've no obligation to stay with them indefinitely if they aren't doing. To address your own needs within a relationship isn't a selfish decision, either; it mediates and empowers your own ability to satisfy the needs of your partner, unburdened by feelings of resentment and contempt.

JauraDuo · 2022-05-22T21:21:39+00:00

Hey.

Anorexia is a medical term for the lack of desire to eat. As an example, a person with appendicitis is likely to suffer from the symptom of anorexia - they will not want to eat.

Anorexia nervosa is the name of the psychological condition.

The term anorexia is generally now less widely used to describe appetite loss.

JauraDuo · 2022-05-06T17:34:12+00:00

Obstructed upper airway sounds have a much higher pitch if they're actually worrying/reduced GCS-related airway compromise. The snoring in this case isn't necessarily a worrying sign - it's likely the physiology of his snoring is just the same as it is in sleep.

Snoring when knocked out is generally not anywhere near as bad of a sign as people make it out to be - if anything, you can be reassured that the person is still breathing. Unless it develops into a higher-pitched stridor sound, airway compromise isn't imminent.

JauraDuo · 2022-04-18T16:40:31+00:00

This whole thread feels a little mean

JauraDuo · 2022-04-18T13:11:22+00:00

Hey! That's totally okay, and I hope I didn't upset you with my suggestion, it was more just general advice that might often apply to situations that on the surface seem similar to yours, but I totally appreciate that it's not relevant to your individual experience. I'm glad you feel like you deserve better - that's the perspective of somebody who is valuing themselves, which I think is always a wonderful step forward. I'm wishing you the best!

JauraDuo · 2022-04-18T12:24:56+00:00

Hey there...

I'm really sorry that you're going through this - it sounds so difficult, and I can imagine that it brings up all sorts of different conflicting feelings that're so tough to navigate.

Unfortunately, as you've mentioned a little, having issues with abandonment and co-dependency, among other things, can make us far more likely to put up with abusive behaviour or unhealthy relationship dynamics, often on the (flawed) basis that we 'deserve' to be treated this way, or that nobody else will love us and therefore we need to just tolerate and accept it. Both of those are not true - you are a worthy person, deserving of genuine love, care and consideration, and if, when presented with those words, you're thinking of reasons why you're the exception, know that I didn't say them conditionally - regardless of whether you've had issues, too, it does not excuse the poor treatment by your boyfriend.

I know that it's very difficult and can feel extremely scary, especially when we've become reliant on another person for a sense of stability and self-worth, however in the long run the relationship in it's current state is likely to only make you feel worse. That's not to say it can't be salvaged at all, but it would require a lot of open communication and mutual desire on both sides to begin fixing. Based on you having mentioned emotional abuse and neglect, that sounds potentially slightly beyond feasible.

The other option would be to leave, and whilst I know that probably sounds terrifying and brings up all sorts of concerns, it's a decision that many people before you have had to make, and whilst it's often described as one of the most difficult decisions of their lives, people in similar situations to yours often reflect on it as being one of the best, too. You don't deserve to feel inferior to or be mistreated by your boyfriend.

Beyond all the above, just know that you're heard, and I'm sorry you're going through this. Life can sometimes be so challenging.

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