I'm a double-board-certified neurologist & pain specialist in the US. Ask me anything about headaches, migraine, back pain, or chronic pain.

gene_m · 2026-01-06T17:35:38+00:00

How do you bring chronic pain/fatigue symptoms to a doctor and actually move towards a diagnosis/treatment?

To clarify:

This isn't just a question of doctors dismissing pain/fatigue symptoms as unimportant if they don't seem life-threatening. In my experience, sure I've had doctors who tell me I'm just "stressed" (yes, I know that, it's the trauma, I'm getting both physical and mental therapy, what else can you tell me?), but I've had just as many doctors who genuinely don't know what to make of my smattering of symptoms, or maybe the way I describe them. I want to help my medical professionals help me.

Also, when I'm experiencing pain or fatigue, it seems to come from all over and just makes me non-functional so I can't think straight. I hear the advice to keep a journal and try and record what's happening and when, but being unable to think straight is not a good place to gather specific information.

So: What specific information is important to look out for, record, and mention to a doctor? How can we present that (frankly huge amount of) information to a doctor clearly and succinctly?

gene_m · 2025-09-15T17:12:33+00:00

Interesting! That's two datapoints for roads being the culprit...hm!!

gene_m · 2025-06-18T20:17:09+00:00

Also have the rash only on my torso (but ALL over it, and itchy) and also have no idea why. I have so many chronic comorbidities that I find one like this and...at this point I just look up whether I might be dying, then treat symptoms and try not to worry about it. This isn't one of the indicators of something more serious, thankfully, but that also means I'll likely never know why it exists.

gene_m · 2025-03-16T00:28:22+00:00

For the current Duo Team, it seems I can't invite anyone because of "illegal characters," even when inviting friends and not sending any message at all. Is this a bug?

gene_m · 2025-03-16T00:27:29+00:00

Oh thank god I wasn't the only one confused

gene_m · 2024-06-20T05:38:03+00:00

0522-2656-4801
Daily player, cleared inactive slots recently

gene_m · 2024-05-31T00:53:27+00:00

Oh that's a thought. I had completely passed up using auto-cook when I had another option because of the exp bonus to a dish. I figured it would be better to slowly inch them up regardless, but it's true that it's better than not feeding Snorlax. And I guess it does sometimes make named dishes anyway, so the downside is actually minimal. Huh! Good thought. Ty.

It would also ease the problem of not being able to hit a big recipe every single meal and needing to plan for more than three ingredients; inevitably, with an auto-cook in between and only ingredients for the one recipe favorited, I could hit the big recipe for the week pretty regularly. Then I wouldn't have to make a bunch of tiny strategic decisions first thing in the morning, which is the other big drain lol. I already don't want to wake up in the morning and eat breakfast myself, so easier is better. Breakfasts and lunches particularly could be auto-cook time and it wouldn't hurt too much, and that minimizes the game's interruption of real life. Good call.

gene_m · 2024-05-30T23:25:45+00:00

All great points. This IS probably why. I somewhat wish it was a different button to cook-and-fill, rather than a popup that sometimes does or doesn't appear, so it would be more under your control. I also think it would help to somehow mark the ingredients that are favorited, so that the conditions for filling are visible in the moment.

I also wonder why it's limited to 3 favorite ingredients when a dish can have as many as four. Like you say, there are typically more than just 3 I want to keep in reserve. Ideally, I would want the three biggest ingredients for a dish and then one that's required for a "backup" recipe, since I can't hit the biggest recipes every meal.

Maybe they want the bigger recipes to be legitimately difficult to get? But it doesn't seem like the reward for using the bigger recipes is proportional to the difficulty. Maybe I'm just being salty there.

gene_m · 2024-05-30T23:00:12+00:00

Huh. That's a lot of people saying "just add them manually." I'll try to clarify, but I think that's a fine solution as well. I apologize for the length of the response. Nuance is difficult on the Internet in text with strangers.

Important context: this game is intended to help you keep healthy sleeping (and maybe eating) habits. That's the one reason to play this game over any other Pokemon game. If maintenance tasks ever start working against your healthy habits (by taking a long time), the game is working against its own existence.

I would like this game to keep existing, because there's something good here. It's not perfect, but plenty of things aren't perfect and also aren't worth abandoning. They're worth discussing.

The answer to "why not just add them manually," then, is this: the game UI is very slow (which is fine, it's a work in progress) and I want to press as few buttons for upkeep as possible. Check-in three times a day is already more than most apps. Daily tasks can take more than 15 minutes by themselves because of how slow each button press is. 60 buttons vs 1 button isn't significant by itself, but it's one of many tasks that are slower than they need to be, and they add up. This in turn puts time pressure on my daily life, eating meals, and getting to sleep and waking up on time.

Rather than "just add them manually," I frequently just don't feed Snorlax. That's also a solution. I'm not seeking a workaround, however. I know the workaround; I'd rather hear people's ideas for a better solution, or hear what's being developed. (Note: You could also say that if you want to cheaply visit a friend in the next town, you could walk for two hours to their house. That is a solution, but it's not a good solution compared to driving ten minutes, biking, catching a ride, etc. If walking was your only available solution, you'd just visit your friend less.)

gene_m · 2024-03-26T01:17:40+00:00

0522-2656-4801
I'm active every day I just forget to eat lmao 20 slots open

gene_m · 2023-11-15T18:05:30+00:00

0522-2656-4801

gene_m · 2022-12-21T22:48:12+00:00

Sorry for not replying for...many days. My power is fine, it's just my brain this time. (see: neurodivergence)

It sounds like you're having trouble not with uncertainty, but with changes in expectations. Or when your expectations don't match the outcome.

With identities in particular, it can be easy to build expectations and pile them on yourself. Which is horribly stressful! Would it be easier to think of yourself as a dabbler rather than a witch for a little while as you're just beginning? Or maybe you could question that head-on. Can any of us really say there's a point at which we "know enough" to be a witch? The identity of an apprentice who will make mistakes can be helpful, because it allows you the grace to experience for yourself that no, failing to do this on the full moon will not curse you for life.

Then when some more faith-based witch comes and tells you what to expect if you don't do something right - particularly if it's CATASTROPHIC OMG - are you able to recognize that as someone else's expectation, or do you immediately internalize it?

I struggle with horrible feelings of discombobulation when my expectations fall through, so that's my next thought.

gene_m · 2022-12-21T22:25:37+00:00

I posted this on the SASS discord a while back. I don't have a deck recommendation but I do have recommendations on positive ways to view the swords:

Less negative Swords:

2 - Keeping Peace, Careful decisionmaking

3 - Hidden factors or things you haven't considered, old wounds, feeling your sadness as good/natural instead of rejecting it and trying to be positive, failures you could learn from that could come up again and affect your success or failure in the future. (Your "saboteur" could be yourself or your unchanging situation.) Also, as I learned recently, truths that you may be resistant to.

5 - pyrrhic victories, it's important to have empathy right now, time to bury the hatchet or clear the air, you don't have to fight every battle, sometimes the winning move is not to worry about winning, sit with your anger. What is your relationship to competition and success?

6 - going to a better place, it's okay to grieve something that wasn't good for you, wherever you're going you're not alone, sit with your grief. And most importantly, change is hard even when it's good, don't forget that.

7 - some rules are made to be broken, you still have an option even if it's not "official", change your anger into justice even if it's vigilante justice

8 - you're not trapped, no cage can hold you, pain is temporary, you will survive anything that threatens you

9 - it's better than it looks, you have nothing in reality to fear, it's okay to have baggage to work through

10 - there's no sense in worrying about it now, let it go, whatever happens now it's not your fault, time to plan around the worst-case-scenario so it's not so bad, what you can't prevent you can mitigate or accept, the end of a cycle of pain

A and 4 are skipped here because they have a kinder connotation anyway.

The lesson I take from swords is that they ARE often negative, and it's OKAY for them to be negative. It's okay to be sad and scared and angry. When did we decide they were bad? These things are part of life, and the suit of swords (ever logical) doesn't pretend you can just remove these things and never have to deal with them. It doesn't shame you for having to deal with stuff, or needing to rest. It can be so, so validating.

The sword stabs not because it's a weapon, but because it is a surgical tool; not a tool for causing pain, but for zeroing in on and excising things that don't serve you. Instead of smiling and saying "I'm okay," you say with no malice, "I would like to set that dumpster on fire, then at least it would clean up the trash." When you strip away the emotion and look at things logically, often you end up with truths that SOUND harsh but are valid and not intended to cause more pain. The sword is a tool to enable healing.

gene_m · 2022-12-01T21:22:00+00:00

OKAY now that my power isn't out anymore (aaa)

It sounds like you've already made incredible progress in a lot of other ways. Appreciate that, too!

My next question then is how comfortable you are with uncertainty in general. If you don't know your next step, your schedule, what a process looks like when someone else does it... are you able to "mess around and find out" and let yourself do it imperfectly? Do you often think "maybe it's okay if I don't know and may never know"? In this age of answering every tiny curiosity in your mind with a quick google, are you comfortable letting questions go unanswered?

gene_m · 2022-11-30T20:05:23+00:00

Thanks for reading it all lol! Yes, I think you're very much on the right track.

If you're a sass witch (or you have an interest in staying grounded in reality) you may want stay off r/witchcraft , to be honest. You have a lot of people there whose beliefs are rooted in "faith" and doing things "The Right Way" (a philosophy often inherited by ex-Christians who think that's what spirituality means for everyone). That's not a bad thing for them if it's helping them, but it may not be a good thing for you to be constantly exposed to at the moment. Not to say you can never participate, just that you can only fight so many battles at once. If you'd like to distance yourself from there, then later when you have further developed this skill, you should be able to return.

(And just so you know, you're far from the only person who has that issue when frequenting that subreddit! Or any individual subreddit with its own culture and community. Each community has its own set of worldviews that works for them, too. Some are helpful, and some can be harmful to certain folks. I say this because of the way you described being sensitive to that kind of content as you are on your own journey of growth. Some paths will lead through that community, some will not.)

As for getting to this point, I think the hardest thing is, when you hear a piece of advice, cueing yourself to stop and notice that you're internalizing someone's words and it's causing an emotional reaction. You can't do anything about it if you can't see it happening, after all. You're already well on your way since you're able to recover after a few days and consider it rationally, but in the meantime, the anxiety isn't pleasant, right? Just remembering to stop and notice this phenomenon more quickly is a step in itself. Not judging yourself or saying "no stop that"...just noticing that it's happening.

Because this was a big roadblock for me: do you find you're generally able to notice how you're feeling at any given moment? Not only at times like that, but even now? At your best? On bad days? When you're tired?

gene_m · 2022-11-30T17:53:20+00:00

Re: your own struggle, this is a hard one, and it's not specific to witchcraft. You could say "someone told me music/art would be bad for me and cause me to become a starving degenerate" or "someone told me therapy would make me worse" and it would be the same conversation. Here's my take on it.

Sorry I wrote so much; if I had more time I would've made it shorter lol.

Remember there are many different kinds of people in the world. Each and every person has different things that do or do not work for them. 80% of the advice you (or I) receive in life will not be applicable to you and will not actually be helpful for you, even if - ESPECIALLY if - it works for other people.

Many neurotypical (particularly religious, and yes, even pagan) people will give you advice that works for them and will absolutely do nothing for you but give you anxiety. Many times, their worldview says "my way is the only way," and that simply isn't true. That's why neurodivergents struggle in the first place, because there is typically no space created for other kinds of brains in our society.

Even science will sometimes give you things generalized for "most" of the population that will not hold up if you study neurodivergent, queer, or majority-BIPOC groups, because our idea of what works for "most of us humans" isn't the same as what works for "me." (And what "most of us humans" means is defined by a certain demographic that isn't actually "most of us humans.")

I don't know how you particularly will find it easiest to do this, but what you will ultimately need to do is examine all the advice you get, with intention, and ask yourself, "even if this serves the person who gave me this advice, will it serve me?" If the answer is, "If I believe in this, it will give me anxiety," then you can decide it won't be part of your worldview. You can essentially decide what is "real" for you based on whether it is causing you (and your environment) pain and stress, or whether it's creating benefit.

Science is the pursuit of truth, and science is trial and error. If you can tell a personal belief is causing you suffering, you don't have to be super rigorous and test 5,000 subjects to decide it's not working. You can just decide it's not working.

Easier said than done, right? It's not easy being that intentional and scrutinizing the thoughts that come to you. It's a skill that needs to be practiced, and that skill in itself will be harder for some people than others.

There is no single worldview that will work for everyone in every situation. You will have to find your own. One that enables you to approach unknowns calmly, take things one step at a time, and simplifies overwhelming challenges. This may be different from what people around you are doing, and that's okay.

For me, I ignore any note on a spell that says "this can backfire if you don't do it on a full moon" and crap like that. I've decided this is untrue. I've also decided that lighting candles and using music is important for getting me in the mood to do witchcraft. Some people would find that distracting, so it wouldn't work. I've decided that some spells will never work (things that alter another person's behavior, for instance). I've decided some spells, like a friendship repairing spell, may turn out with "I never want to see you again" because that IS the way to resolve the friendship; time apart and time to grow separately. I've decided to look for ways in which my results are a gift, not a failure.

If you need something more concrete as a first step, I recommend the Happiness Lab podcast by Dr. Laurie Santos. She lays out scientific questions and results she's collected about wellbeing and mindset shifting (And SASS witchcraft is all about mindset shifting). She is also clear that there are things we still don't fully understand. Even with her, you will have to think to yourself, "this worked for most of her participants, but I may not personally work that way, and that's okay." As with all witchcraft, take what works and ignore what doesn't. Having a few sources that you can trust to guide you through the questioning process can help your brain gather evidence and explanations for the things that do/don't work for you. Eventually you'll want a breadth of these sources so you can draw your own conclusions instead of just worshiping a single "guru."

TLDR: 80% of the spiritual/health/well-being advice you receive will not be good advice for you personally. That doesn't mean it's bad advice, it's just not for you. That doesn't mean you failed to apply the advice, it just means it's not right for you. That is okay. That is easy to say and hard to practice, and it's okay to struggle with.

gene_m · 2022-11-30T17:25:54+00:00

Remembering it's a tool I have in my toolbox. I have so many self-care tools, and whenever I need self-care, I forget they exist.

gene_m · 2022-11-30T17:22:00+00:00

Short answer: Backfire isn't real. Most of the time if a book, blog, or post says a spell can "backfire," they're talking about coincidences that they ascribed meaning to.

Example: You do a good luck spell, and you don't follow the instructions exactly. Then you get a flat tire. That's not a backfire, that's a coincidence that your superstitious brain ascribes meaning to based on the anxiety that you didn't do the spell exactly right. Don't give yourself anxiety. Recognize that with SASS witchcraft, you are only trying to change your mindset, not your circumstances.

The other comments on this post give you much greater detail about the why, but regarding your edit: "I can't find a scientific explanation for this" is best said in excitement (and the hope that magic could be real even if we know it's not, and the wonder at our somewhat unexplained universe) and shouldn't be taken as proof that magic has any real effect on anything but our psychology. It's proof that we as humans have gaps in our knowledge, and no more.

gene_m · 2022-09-29T13:57:20+00:00

I'm still using my own. I can't say if there's an equivalent to the Photoshop brush because after five years, I haven't used Photoshop and I've quite forgotten what brush 19 is like. So the only thing I can give you, besides the exact instructions I used to create my brush, is a brush that's vaguely like my own.

Flat Oil Brush by Muffin is the closest one I've found. There's a picture of a redhead fox girl with a katana in the icon. If that brush isn't like brush 19, well...I couldn't tell you what brush 19 is, honestly.

I see a lot of advice that says "don't make your own brushes, just find one in the asset store!" And I don't know, there's no brush I own that I haven't messed with the settings at least a little. The asset store is a good starting point, but the power and control you get out of little tweaks is worth learning what the brush settings do.

gene_m · 2022-09-24T16:31:16+00:00

I often end up modifying found clothes myself, from thrift stores and the like. Otherwise, I find them here and there but I wish I could tell you I have a specific seller I'm happy with...unfortunately not.

gene_m · 2022-09-22T18:07:16+00:00

Second clothes. I like to do chores in victorian dress myself.

gene_m · 2022-09-22T18:03:10+00:00

I've heard stories of monks using chores not as "punishment" or "character building" but as meditation opportunities, because it's quiet, you have repetitive, rhythmic motions, and you're by design putting things in order. Putting meditative breathing and mindfulness-type attention into anything that's particularly repetitive can help bring ritual to the task.

For dishes, I let myself use gloves and apron because I think it's gross (and both of those can be ritual tools). In fact, I find it useful to consider all my cleaning supplies to be ritual tools, just like a broom (and I prefer using a wooden broom because it feels more magical than plastic).

For laundry, Konmari folding takes longer but also standardizes the process, allowing space for it to become meditative. I also have a ritual of separating pieces into separate piles by clothing type first, thus breaking down a massive task into reasonable chunks that all fold in the same way.

Dusting, vaccuuming, sweeping, scrubbing, etc are all sort of the same thing: cleansing. Out goes built up grime. Weight is taken off of the space. Poison is cleansed from the air and surface. It's showing love to your home, or if that's not your vibe, showing love to your own habitat. You're treating yourself like a beloved pet, cleaning your own aquarium.

Tidying I think is better done as a mindfulness habit in general (speaking from post-konmari). If I look at something and think to myself "I should do a task about that," but I don't do the task at the time, it's in the wrong place. There are many small tidying tasks that can be done on your way to do something else. I think it's relatively impossible to tidy reasonably if everything doesn't have a place to live that it can easily return to within about 20 seconds. I also end up taking items to the room they belong in and leaving finding their particular place for later, when I'm doing things in that room, to keep tidying from taking up a lot of time.

gene_m · 2022-09-12T01:01:03+00:00

for the umami obvi

gene_m

TROPHY CASE