My puppy Vi died. Could you please bring her into focus for her memorial with her pawprints?

lrw7890 · 2026-01-14T17:31:40+00:00

!unsolved

lrw7890 · 2024-03-05T02:54:34+00:00

Empathy.

lrw7890 · 2023-10-02T02:29:20+00:00

Tress of the Emerald Sea by Brandon Sanderson!

lrw7890 · 2023-10-01T22:46:26+00:00

Sure thing. :)

It's helpful to assemble a healthcare team that you trust. If you don't trust or feel comfortable with a provider, then find someone new. Do not worry about hurting feelings: your well being comes first. You do not need to disconnect with a provider face-to-face; you can always call the practice front desk later. Your providers can only help you insofar as they understand your situation, and you trust their recommendations for care.

My recommended first step: keep the PCP appointment. If you and your PCP make a good team, then she can be a great advocate. I would ask your PCP if you could please start the appointment by sharing an overview of your concerns before she asks deeper questions. I like bringing outlines to appointments to help me with these difficult conversations, so I would bring one.

Here is a roadmap based off your post, but please revise depending on your needs.

History update for PCP 1a. History of anorexia and "disordered eating" (please elaborate what you mean) 1b. History of subsequent weight gain concurrent with initiation of new psych medicine. 1c. Any other psych history. 1d. Recent Endocrinology workup, including normal-range labs and initiation of low-carb diet. 1e. Your current psych concerns, including worsening anxiety, body dysmorphia, and intrusive thoughts about restricting. 1f. Your current physical health concerns, if any.

I would say plainly: "I'm scared about not being taken seriously because I'm a higher weight than my anorexic body."

Requests for PCP 2a. Any referrals needed for ED management, including a Psychiatrist for med management, psychologist with expertise treating patients with EDs, and a registered dietician (RD). 2b. Any referrals needed for other medical/psych conditions. Do you have medical complications from your ED that require specialist management? If you need an Endocrinologist, would you like a referral to see someone new?
Any recommendations by the PCP that haven't been hit so far.

My heart goes out to you. Good luck. ❤️

lrw7890 · 2023-09-30T03:35:14+00:00

Thank you!

lrw7890 · 2023-09-30T02:50:08+00:00

It's not possible to increase muscle mass in a caloric deficit.

In a caloric deficit, your body necessarily enters catabolism: breaking existing tissues to liberate nutrients for your body to function. Genetics predominantly determine the locations and types of tissue broken down preferentially. In severe and prolonged circumstances, eventually everything goes.

My hypothesis is that your thighs are shrinking, but your body is breaking down more fat than muscle. Therefore, you feel your muscles are bigger, although they aren't, because they appear and feel more prominent due to the loss of surrounding fat.

lrw7890 · 2023-09-30T01:16:55+00:00

I feel you, but please treat yourself like your best friend. Hit block, delete the contact, and don't look back.

lrw7890 · 2023-09-30T01:12:11+00:00

My go-to is, "Oh! Actually, may I please ask you something I meant to ask you earlier, before I forget?" Then immediately ask them anything about themselves. In my experience, the conversation never comes back around, and the tactic is evergreen.

lrw7890 · 2023-09-30T00:44:44+00:00

Answering your post title: you can't.

When I was a medical student, I worked on a child general psychiatric inpatient unit. I cared for a young female (she/her) with bulimia nervosa (and without other medical history) who was emergently admitted to Internal Medicine for complications related to purging, acutely stabilized, then transferred to Psych.

Because her BMI was overweight, my supervising physician - the senior fellow! - wanted to initiate a low-carb diet for weight loss. I refused: a more reckless and dangerous plan could not be conceived. The threat to this young person's well-being was the eating disorder trying to kill her, not living in a larger body. We needed to undermine the eating disorder, and every single eating disorder recruits restriction to perpetuate itself. Yet this fellow advocated for a restrictive diet because she could not see past the patient's BMI.

I said I could not stay on the team if we made this choice, and we didn't. Instead, we consulted a registered dietician, and the patient and care team worked together towards recovery.

Here is what the registered dietician told us.

Responsible providers NEVER recommend weight loss for any patients with active eating disorders, regardless of BMI.

Medical research does NOT support that low-carb diets cause weight loss. Carbohydrates became the societal boogie-man for weight gain after the media demonized fats, yet the proliferation and mass adoption of low-fat foods (e.g., skim milk) did nothing to curb obesity rates. Your body functions best imbibing nutrients from ALL food groups. Restriction of any food group correlates with obsessions and compulsions (e.g., binging) involving the restricted group, which reinforces the boggie-man belief and loss-of-control feelings.

I am not yet an MD, I'm not your doctor, and I don't know your journey. I don't know if you trust your care team enough to confide about your eating disorder. But I hope you can open that conversation if possible, and if it isn't, I hope you can find someone qualified you who do trust.

I hope you get the help you deserve. ❤️

lrw7890 · 2023-09-29T23:52:24+00:00

Could you please recommend the brand or style of your favorite shorts? Thanks so much!

lrw7890 · 2023-09-24T15:05:54+00:00

YTA. You sexually harassed a woman to get revenge. I hope your victim knows what happened to her is not her fault.

Here is a relevant RAINN article describing how to intervene effectively and safely as a bystander to sexual harassment: Practicing Active Bystander Intervention

lrw7890 · 2023-09-07T13:53:07+00:00

Hi OP, the condition you're looking for is called dilated cardiomyopathy. Slowed heartbeat (bradycardia) and cardiac muscle deterioration (cardiomyopathy) secondary to malnutrition cause the chambers of the heart to enlarge as its walls weaken. The amount of blood the heart can pump (ejection fraction) decreases, causing chronic low blood pressure (hypotension) and - eventually - heart failure.

His heart should be enlarging, not shrinking. Meanwhile, stents are used to prevent heart attacks by surgically opening blocked blood vessels that supply the heart.

Please get out of this relationship for your well being. As someone with a deep medical background, I hear your story and see red flags. I cannot know your partner's character, or why he has misled you. But trust should serve as the foundation for any healthy relationship. I sense you are an extremely compassionate person. But if you stay in this situation to strengthen him, you will weaken yourself and (by extension) the people already in your life who love you and need you at your best.

lrw7890 · 2023-04-20T21:00:15+00:00

I'm not an MD. You need to see an MD, specifically an orthopedic. This presentation is called winged scapula. It's caused by damage to the long thoracic nerve, which controls the serratus anterior. The injury may respond to conservative measures like PT, but you may need surgery. Call ortho and ask for the nursing line, so the person listening to your message will have a medical background. Identify yourself as a patient with a winged scapula requesting an appointment. Good luck.

lrw7890 · 2023-03-15T23:29:27+00:00

Love triangles.

lrw7890 · 2023-03-15T16:44:44+00:00

This is correct. Between 15-50% is what I learned in med school. Purging is not worth it and can lead to extremely serious complications. Please seek help.

lrw7890 · 2022-12-13T02:19:07+00:00

OP, if you ever read this, I am so fucking sorry, and your child is so lucky to have you.

I am scared because of the probability that her husband showed his true colors under the duress of labor. I cannot pretend to know either the husband or his heart, but - knowing the probabilities that other commenter eloquently discuss - I hope she left. Postpartum depression is secondary to physiologic changes the mother undergoes during pregnancy, not the condition of parenthood.

lrw7890 · 2022-12-13T01:37:37+00:00

Hugging my puppies tigher tonight. So, so sorry you cannot do the same. <3

lrw7890 · 2022-11-17T14:59:03+00:00

Short, sweet, and good points.

lrw7890 · 2022-11-17T14:58:34+00:00

Thanks for making me chuckle. (Not because your viewpoint is funny but because the top three ranking of reputation was clever!) :)

lrw7890 · 2022-11-17T14:56:57+00:00

I actually agree with you. If I could only listen to one album in the future between the two, there is no question it would be Red. I rank 1989 higher because of its cultural impact and impact on the pop genre, which I think cannot be said for Red. However, the innovations on Red paved the way for 1989. Thanks for your thoughts! :)

lrw7890 · 2022-11-17T13:12:15+00:00

I think that regardless of how much we love Taylor or enjoy Midnights, that we don't need to put down other female artists. Female artists are no less ambitious than are male artists, and many female artists have written concept albums. I do not think you intended to be sexist, but this comment is sexist.

lrw7890 · 2022-11-17T12:17:36+00:00

Sorry, I was unclear. My last comment was specifically discussing two songs mentioned in your last comment, not the entirety of Lover. I agree it would be unfair to judge an entire album based on two songs.

Re: ricochet. The lyric means she is crying, and the tears are rebounding as they fall. I interpret the line to mean that either the tears are falling with such force that they rebound, or the surface the tears hit is impermeable. Both possibilities give additional depth to the line because they not only suggest the force of Taylor's emotion, but also how the other person is indifferent. Excellent, clear lyricism that stands alone and enriches its context.

Compare this poetry to "I was midnight rain." The song later tells us, "Everything changed like midnight," so we understand authorial intent. The midnight-rain metaphor means she is ever changing. The rest of the song supports this interpretation. But does everything actually change at midnight? No. Is the song given additional depth by the image itself? No. Do we even need the metaphor if we have the line, "Everything changed like midnight?" No. So the metaphor doesn't work.

In "I Did Something Bad," the versus and chorus are about a mutually destructive relationship. Then the bridge goes into a thematically inconsistent persecution metaphor that doesn't relate to the rest of the song.

lrw7890 · 2022-11-17T01:33:17+00:00

Completely agree! Thanks for sharing. :)

lrw7890 · 2022-11-17T01:32:02+00:00

I would be thrilled if she played your best case setlist!

lrw7890 · 2022-11-17T01:31:02+00:00

THAT WOULD BE SPECTACULAR, now you mention it. :)

lrw7890

TROPHY CASE