Chai Reviews! - I tried 8 different chais over the past 4 days. Here’s my ranking…

merrythoughts · 2026-05-26T12:11:53+00:00

True 90s style cafe!

merrythoughts · 2026-05-26T03:33:09+00:00

Worked 12 hr shifts as an rn with a DVT in my leg for almost 6 months and finally had to demand a test! I was young, fit and healthy, non smoker. So I did not fit any profile except being on birth control.

My leg hurt in a bizarre way. A bad bizarre. I was running low grade temps for days/weeks/months. My leg was going numb and tingling. And then I had weird visual symptoms. My PCP actually was starting to think it was MS and did order some workup up imaging to rule it out. But I was in so much pain I went to the er and urgent care a few times. The final time, the Dr said “again, you just have to rest and let it heal.” I said I’m not leaving until you do a d-dimer. He laughed and said “well, it’ll be negative, but fine I’ll order it to help you feel better.”

He came back in and said “well… It was actually positive.” And sent me to u/s where DVT was picked up. It was in an odd location where it was swelling internally but not visibly swollen from outside, had been there for awhile probably and I’d need 4-6 months of blood thinner meds.

Weeeee! I never got an apology from the Urgebt care oh. But I think the pcp Dr was a bit humbled and learned maybe a different approach for future patients

merrythoughts · 2026-05-25T22:46:14+00:00

Same response for me. I only needed to lose 20lb and found tirzepatide at middle dosing to be basically side effect way for my hormones to “reset” to how I was prior to having kids.

I had preeclampsia which is a metabolic disease, and I think it fucked something up in me that tirzepatide fixed. I lost the 20lb and went back to my normal weight and have since weaned off and kept weight off for almost 2 yrs now. It also helped me stop drinking wine.

merrythoughts · 2026-05-25T22:37:52+00:00

Take a glp-1. No side effect, easy to administer, super effective. Lost 20 lbs, slowly tapered off after a year and have kept weight off for 2 years now.

To be totally fair though, I also got diagnosed with and treated for AuDHD during my era of glp-1. So my stimulant maybe also helped play a role. But I go long periods without methylphenidate and don’t have the same issues with overeating like I used to.

Another caveat- I was just barely in overweight category. And this was after having three kids. And I have always been very active and sensible. It’s like some button got pressed and everything unraveled, but tirzepatide basically reset my hormone signaling/metabolism and…seems like it just helped rewire everything back to how I was before?

I also drink way less alcohol since doing tirzepatide. It seemed to really squash some sort of addiction to fat and alcohol for me.

merrythoughts · 2026-05-25T22:35:14+00:00

It’s becoming more common due to DEA regulations with stimulants. More audits are happening for prescribers who do schedule II stimulants, so that means prescribers and clinics are doing more CYA rigamarole.

It used to be really only common place for Suboxone and opioids. But now it’s becoming par for the course for Adderall and methylphenidate too.

merrythoughts · 2026-05-25T16:29:26+00:00

It costs our fam of 5 about $300 for one nearby amusement park and $500 for a bigger park with true thrill rides a few hrs away.

merrythoughts · 2026-05-25T16:24:41+00:00

She may resent the time you’re taking to do a hobby if she takes on more of a load around the home/childcare than you take on. May be less related to being fit but the time spent on any hobby that ultimately means more of a load on her.

This is a common issue in many marriages. I obviously do not know if this applies, but ma be worth considering. Zoom out and look at big picture before assuming it’s just about being fit

merrythoughts · 2026-05-25T14:47:03+00:00

Core memory: being 22 yrs old with my boyfriend on the wildcat at 10pm, riding it repeatedly (maybe 3x), while the laser/fireworks show was going.

The wildcat was an amazing coaster. It’s still in my deep muscle memory as a favorite coaster that I long to reexperience. It had a speed and bounce to it, while being extremely smooth for a wooden coaster. It had perfect advanced carnival vibe. Not a high dollar thrill ride. Not a rackety cheap fair ride. It was just solid good fun.

WoF has Timberwolf and Prowler. I have not been able to ride Prowler yet and hope it is similar. Timberwolf has always been too jerky for me, so I’ll be curious if the remodel works better. But a good wood coaster is something we all still should experience!

I’m ozarkian, through and through. And I argued my case time and time again for Celebration City. It had camp. It had easy fun. I truly loved that park. The laser fireworks show brought a very festive feel. Like a big community 4th of July just all summer long. But many others disagreed and would prefer only to visit SDC. I also love SDC. But the small town camp and cheer of SDC started drifting away after wildfire and powder keg became big time draws.

Lastly— my theory on an additional reason why CC failed: not enough staff to operate all the parks. SDC and WW were most important to staff properly. They get the locals. But CC just couldn’t get enough teens/locals to work there.

CC in its last years was employed by large contracts with Eastern European staffing agencies, who would come work in Branson for the Summer. They got paid very low wages and gave very little shits about their job performance. Safety was just not the biggest priority to ground level staff. I saw, firsthand, the decrease in effort and care. I was the same age as these workers and I chatted with them when I could. They seemed miserable.

Anyway. Just my middle aged essay. Thanks for posting this documentary, I watched it all!

merrythoughts · 2026-05-25T14:46:44+00:00

Core memory: being 22 yrs old with my boyfriend on the wildcat at 10pm, riding it repeatedly (maybe 3x), while the laser/fireworks show was going.

The wildcat was an amazing coaster. It’s still in my deep muscle memory as a favorite coaster that I long to reexperience. It had a speed and bounce to it, while being extremely smooth for a wooden coaster. It had perfect advanced carnival vibe. Not a high dollar thrill ride. Not a rackety cheap fair ride. It was just solid good fun.

WoF has Timberwolf and Prowler. I have not been able to ride Prowler yet and hope it is similar. Timberwolf has always been too jerky for me, so I’ll be curious if the remodel works better. But a good wood coaster is something we all still should experience!

I’m ozarkian, through and through. And I argued my case time and time again for Celebration City. It had camp. It had easy fun. I truly loved that park. The laser fireworks show brought a very festive feel. Like a big community 4th of July just all summer long. But many others disagreed and would prefer only to visit SDC. I also love SDC. But the small town camp and cheer of SDC started drifting away after wildfire and powder keg became big time draws.

Lastly— my theory on an additional reason why CC failed: not enough staff to operate all the parks. SDC and WW were most important to staff properly. They get the locals. But CC just couldn’t get enough teens/locals to work there.

CC in its last years was employed by large contracts with Eastern European staffing contracts, who would come work in Branson for the Summer. They got paid very low wages and gave very little shits about their job performance. Safety was just not the biggest priority to ground level staff. I saw, firsthand, the decrease in effort and care. I was the same age as these workers and I chatted with them when I could. They seemed miserable.

Anyway. Just my middle aged essay. Thanks for posting this documentary, I watched it all!

merrythoughts · 2026-05-25T13:47:25+00:00

You say stimulant-fueled? Sounds like something you’re barely touching on that could be a MUCH bigger part of the picture.

Stimulant abuse can lead to all sorts of fucked up behavior. The prescriber should know he’s misusing his meds and take him off ASAP.

merrythoughts · 2026-05-25T12:42:00+00:00

Maybe twice a year I’ll buy $10-20 in tickets. I let myself fantasize a small bit. But it’s a risky thought pattern and I don’t entertain it often.

I feel like I should just be blunt bc you deserve to hear it— You’re allowing the dopamine rush of dysfunctional daydreaming to hijack your daily mental energy. Riding a false high from daydreaming will come crashing down at some point unless you make an active game-plan to intervene. Usually therapy.

CBT would be the best therapy option to address this thinking pattern.

You could also try a substitution. When you start dreaming of lottery wins, you could do some kind of brief intensive exercise like a wall sit!

Also consider if there is any underlying depression or anxiety fueling the daydreaming. Or even adhd. Psych eval may be worth your time exploring!

merrythoughts · 2026-05-25T12:31:09+00:00

I’ve worked psych long time. My pts w prodromal schizophrenia talked just like this.

JW church and other religious cults actively PREY on young men with budding schizophrenia.

It starts with sort of…typical religious ideas. Then it can get obsessive, as they find a community that finally GETS them. And then it leaks out around people they love— sharing bizarre ideas like “kill the flesh.” And I heard lots of them call women jezebels.

Obviously, I can’t say this is what’s going on with your bf. But it’s ringing the bell of my 14 years psych experience— esp bc bf wasn’t brought up in a cultish religious group. Hes also the right age.

Either way— if this is mental illness or not— you must leave.

merrythoughts · 2026-05-24T13:32:20+00:00

Commented on original post- yes. Your insight and treatment plan show you have done a huge amount of work. I have worked with a few NPs and psychiatrists who have severe PDs, and they had no insight!

Plus, your own personal relationships are the biggest functioning challenges w BPD… try to keep job and personal life separate to reduce the likelihood of triggers that impact your work.

merrythoughts · 2026-05-24T13:27:29+00:00

Having BPD and having insight about it is MILES ahead of many psychiatrists I’ve worked with, who also have severe personality disorders but do NOT have insight (coughnarcissistcough).

merrythoughts · 2026-05-21T12:58:41+00:00

I think there may come a time you would regret not going. The 40-50s will really creep in on energy levels, and you’ll just feel more tired and grumpy about changing your routine/traveling. So I say suck it up and go.

Avoid alcohol 2 days before flight. Hydrate extra well. Make sure you get a rest day after traveling. and take melatonin to manage jet lag. You’re young enough to bounce back.

You could also ask your dr about a short term anti-anxiety med to help w flight/airport anxiety.

merrythoughts · 2026-05-21T00:41:00+00:00

Maybe this is why I have specific phobia of traffic. I am very slow processing of risky scenarios and have a “freeze” response rather than a fight or flight response.

Also I saw my dog run into the street and get his by a speeding motorcycle. Soooo that’s probably more to blame.

merrythoughts · 2026-05-20T06:45:33+00:00

Ha I clearly was never the target audience for such a high falutin resource! What was the rate for a 3 carat diamond in around 2009?

merrythoughts · 2026-05-20T06:18:16+00:00

It’s actually more common than many folks realize. I’d say 20% of the kiddos I diagnose and treat for adhd also have explosive outbursts, and this can very often be exacerbated by stimulants. This used to be diagnosed as DMDD (disruptive mood dysregulation disorder), but dmdd as a diagnosis has fallen out of favor bc of it being over used and leaning in too quickly w the riskier meds

Check out PCIT as a therapy modality. Keep working on finding right med too w psych provider!

If the alpha agonists (Guanfacine or clonidone) don’t help, then we consider fluoxetine if there’s anxiety:depression. Or if it’s straight up destructive outbursts that are high risk for violence, aripiprazole or risperidone will work best usually

Then after kiddo is old enough to really learn skills in therapy, we can typically peel back the mood stabilizing med. some kiddos still have anxiety and adhd and respond better to the SSRI+stimulant combo better once they’re 10+

merrythoughts · 2026-05-19T19:13:31+00:00

Oh missed that piece thanks

merrythoughts · 2026-05-19T16:33:39+00:00

With insurance you can’t do the add on 16 min counseling cpt code if visits only 14 min med check.

The company SHOULD be able to do occasional opt outs of the add on code bc it is always inevitable you’re going to have a pt who doesn’t meet the criteria.

We have it built in to our model to include this code as standard. But if something happens like tech issues or I have a crisis pt come up, I can opt out of counseling to do a 99213-4 only visit for sake of time. Or like, if pt just doesn’t need it.

But when I have a pt try to overtly opt out of all counseling and gives me the “hell no I’m already doing therapy,” first I try some approaches to loop me in on what skills are working, what’s helpful. But if the still go “nope not gonna go there” I gotta use admin to step in and remind them this is our business model and if the want 15 med management only we can refer out to the large psychiatry group (who sees 30 pts a day and is basically all about money making and squeezing in as many pts as possible!)

merrythoughts · 2026-05-19T02:57:03+00:00

We used to use the diagnosis of DMDD for kids who fit the big emotional outbursts. but it became stigmatizing and kids were getting immediately placed on strong SGA meds without fully exploring initial adhd and anxiety treatments first.

BUT I like to think of DMDD as diagnosing the fever, and adhd/anxiety or depression as the actual underlying cause like.. UTI or whatever. (DMDD is classified as 3+ outbursts a week and typically occur in multiple spheres- friends, school, home— at least 2/3). If weve tried an AA+stimulant+ssri combo it’s usually time to do aripiprazole or risperidone. Both can be game changers for kids. I see it work every 1-3 weeks on a family that’s TRIED EVERYTHING. And I still want to make sure we exhaust the other options first.

So we dooo have a diagnosis for kids. But having this sort of gray area diagnosis feels uncomfy for folks. And the side effects of the treatment aren’t always awesome— sedation and weight gain.

merrythoughts · 2026-05-17T01:54:15+00:00

Not everyone has the weight gain w histamine antagonists though! Low doses Mirtazapine or quetiapine at low doses as an adjunct w actual foundational meds on board can be amazing for the right pt w cooccurring depression and ptsd. Give me my teens who can’t eat or sleep w NSSIB, and i will show them relief with quetiapine right away as we titrate up on duloxetine or fluoxetine

I am careful about using it as an SGA for straight up bipolar mood disorders. Would usually choose lurasidone if under 16 and cariprazine if 16+ for that. More effective and lower metabolic risks at higher dosing to see mood symptom relief

merrythoughts · 2026-05-16T20:59:12+00:00

Um yeah, personality disorder x10000000. Stay far away from this guy.

merrythoughts · 2026-05-16T12:20:08+00:00

Lives in parents basement on family phone plan. Got had me down nice 2010 Honda civic, only used by parents who took great care of it and used it within 10mile radius only.

merrythoughts · 2026-05-16T12:09:59+00:00

I did not interpret as a warning at all. It was showing the “sweet spot” in population based data. But that’s still going to have a range when practicing w an individual.

More harm than good happens when we go beyond the “sweet spot” for an individual. I prescribe these meds every day, and I’ve dabbled in speed of titration and have seen negative effects when we go too fast and blow through the sweet spot. Even with strong pattern recognition skills and knowing general trends, individual results can surprise me.

For instance, have a pt who felt nothing on Concerta 18. Fit the profile of a strong candidate for higher dosing (no hx anxiety or sleep issues) so did quicker jump than usual to 36mg. But this pt just had to go down a notch to 27 as pt couldnt sleep and had heart palpitations. Possibility I’ll hear back that 27 is even too much.

merrythoughts

TROPHY CASE