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Kurgarra Queen posted:Happy New Year everyone. It’s the first year of grad school for me. It’s gonna suck but maybe I’ll make, well….not *great* money, I’m going for a MSW, but, well, *good* money in a few years. you're gonna do great! its hard but we're much smarter at this age than we were at 19 and we know how to liek study and poo poo
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Jan 1, 2024 16:00
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38 with nothing 
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Jan 2, 2024 17:20
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trilljester posted:Anyone here from Nashville? Wife and I are thinking of going in March and we want to know what's fun to do there. ahhhh man Nashville is the biggest tourist trap east of the Mississippi. It's a way bigger, less drunken, classier Gatlinburg. Number 1 city in the country for bachelorette parties. Nashville has good restaurants, stupid tourist poo poo to do everywhere, and of course live music and bars. I think the last time I was there I did some like...printing museum place? Which is cooler than it sounds. The person I was with was really into printing, I guess. They have a full sized model of the Parthenon from like the worlds fair a century ago. Broadway is a spectacle. You just meander through bars that all have live music and the performers can play anything you throw at them. At night it's a spectacle. It's very expensive now and a Coors light costs like 14 bucks on the weekends but it's definitely worth seeing. Food is fantastic. The marquee item is Nashville Hot Chicken which is forgettable. West Nashville is where all the cool kids hang out. Tons of over the top tourist joints, world class wine and dines, some of the best drunk food youve ever had in your life. Nashville is a great place to spend two nights every few years.
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Jan 3, 2024 11:15
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Re: kid chat, my gf and I have touched on the convo a few times. She’s 28 and in no rush and that’s totally understandable (she doesn’t want to think about marriage until 30), and yeah guys dont have the clock women do, but my parents are getting older. My dad had a TIA a few weeks ago that presented as about a day of complete amnesia. He’s on eliquis too, and he had a workup that lasted three days inpatient that came up with nothing, which is either reassuring or terrifying depending on how you look. Dad is slowing down in general too. Nothing anyone not a family member but it’s there. One of the reason I moved to Asheville was to be here as they got older. My sister is on the other side of the country. I just don’t know if hitting them with a newborn at 73-74 would be helpful. They’d be thrilled of course and do everything they could, but that’d become a lot as they got older. Eventually I’ll be in charge of everything. my girlfriend’s parents are worthless. Frankly I wouldn’t want a kid with them unsupervised. Then there’s the whole “should I even bring a kid into this world?” conundrum. Things are going to get interesting here in the next few years. Maybe I’ll adopt, I dunno. I think I’d make a good dad.
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Jan 3, 2024 13:03
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Has there ever been a parent who said “yeah my kid is loving dumb”
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Jan 3, 2024 13:59
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Siri show me depressing as poo poo https://x.com/unusual_whales/status/1742921575559508244?s=46&t=JBd6ZXmGQ3LmWL-ineTnAA
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Jan 4, 2024 17:49
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I was never a picky eater per se but I definitely didn't clear my plate and my mother at one point had tons of bloodwork ordered on me to make sure there wasn't a problem. She was so confused that whenever we'd go to a restaurant I'd inhale things, or I would literally be CRAVING fast food whenever we went on car trips. Or that I started eating more at home when I realized I could cover everything in A1. It somehow never occurred to my mother that she was a terrible cook with a bizarre aversion to any kind of spices. She could make presentable meals, but it was just the blandest poo poo in the world and I probably had low blood pressure or something and was craving sodium. Mom's top recipes included - Medium-Well London Broil marinated in low sodium newman's own italian dressing (A1) - Hand made perogies without spice (A1) - Squishy, bland quiche (absolutely not) - Boiled veggies from a can (A1) - Turkey and veggie casserole with a cup of cheddar cheese But writing this out every thing with her is the blandest thing imaginable. Her preferred drink is a 7&7. She thinks Arugula is fancy. We never EVER went to a mexican restaurant growing up because it was "too spicy." Of course my sister married an indian dude. Anyway I do all the cooking in the house now whenever we get together and everyone is better off for it.
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Jan 5, 2024 01:00
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Pain of Mind posted:I fell ice skating 9 days ago, chest has been bothering me a bit so after prompting from a friend and my dad I went to urgent care. I expected a 20 minute appointment where I am told to rest some, had x-rays and I am now draining an IV bag to go get a CT scan. I have 3 broken ribs and based on where they broke they want to make sure my liver is ok. This is much more involved than I anticipated. how bad did you fall? Did you pull a Derulo? 
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Jan 6, 2024 22:56
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That was such a good looking burger.
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Jan 8, 2024 13:58
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Android Apocalypse posted:Started testing my 1 rep max this week. Neither of those differences is substantial and can just be explained by variance. You’ll hit them again. Epstein logs dropping…..
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Jan 8, 2024 20:10
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I want to be SB when I grow up.
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Jan 9, 2024 15:57
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Hbd skwirl Also lmao https://x.com/huinguillaume/status/1744724351013069284?s=46&t=JBd6ZXmGQ3LmWL-ineTnAA
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Jan 10, 2024 18:20
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Our favorite local lovely Italian joint does this thing where you get a golden envelope every time you dine in during the holidays. You come back during January and open it in front of the waiter and get like a free app or whatever. Last night while we were there (BOGO entree) someone started screaming because they won a car. Couple in their fifties or so. The restaurant owner happened to be there and brought out the title for them. 1996 Honda civic with 400k miles lmao
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Jan 10, 2024 19:04
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oh my god the medical director at one of my facilities had a root canal last wednesday, fever friday, hospital saturday and dead sunday. Just some random loving super bug from an oral procedure that killed him deader than hell. Dentists: not even once edit vvv lol FizFashizzle fucked around with this message at 20:43 on Jan 10, 2024 |
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Jan 10, 2024 20:33
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LeeMajors posted:Best ever. Goddamn. 
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Jan 11, 2024 00:11
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https://x.com/WhitlockJason/status/1649372549115936768?s=20
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Jan 12, 2024 00:56
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I got high and watched the creator couple nights ago That movie loving sucked rear end
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Jan 12, 2024 14:51
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TITTIEKISSER69 posted:I'm awaiting delivery+assembly of my new bed. Should I consider tipping the delivery team? It's currently -27°F (RealFeel -38°F) in Calgary. In Celsius that's -33/-39. of course.
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Jan 12, 2024 20:49
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Yes I got out of my car to take this picture https://x.com/formerlyfiz/status/1746577082782560440?s=46&t=JBd6ZXmGQ3LmWL-ineTnAA
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Jan 14, 2024 18:12
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Android Apocalypse posted:
I’d put that down sub 10
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Jan 14, 2024 20:30
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Air Skwirl posted:I saw this and now you all have to also. Apologies in advance. Listen I know the last feeld update crashed the app but this isn’t necessary.
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Jan 16, 2024 12:31
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swickles posted:I mean I am not gonna lie, would. Her: Mind if I put someone on tv to help with the mood? Swickles: hell yeah, go for it /the worst deviantart caliber Disney sex begins playing on the television Swickles: whelp, I’m here.
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Jan 16, 2024 16:00
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Could be a good opportunity, Ross. Force you out of your comfort zone a bit, make you try new things. And it’s never as bad as you think it is. That’s just midlife ennui creeping up on you.
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Jan 17, 2024 12:30
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As a scorpio losing myself in process is how I deal with all my life stress Well, that and revenge plotting. But again, process.
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Jan 17, 2024 14:04
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Got a Looft lighter in my monthly “man box” or whatever it’s called. This thing loving rules.
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Jan 18, 2024 12:18
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Ornery and Hornery posted:How many of you make $200k or more? I could. My current gig is inpatient psych has me managing multiple inpatient facilities. I have 12 facilities that I see every two weeks. I go to them in the morning, see my dudes, then come back home and chart. A couple of facilities I see weekly, but most are every two weeks. To get to 200k, I'd need to add a couple facilities and see the really in depth ones half as much, which would make those days brutal. Overall I'd need to see 26 patients a day. I'm paid per patient, and obviously that invites some perverse incentives and no not all of these patients need to be seen monthly but this is per Medicare guidelines and I do right by them. I don't just snow people. That seems like a lot of patients, but I'm working in chronic care; i see these patients at least monthly. I know them very well, and without bragging I'm good at this. I can get patients stable. It's a ton of work up front, because in every facility I'm taking over for someone incompetent. For example I took over an entire VA long term care facility and the previous provider was an imbecile. It took me about 2 months to get everyone stable, and now the place is a cakewalk. It's just a cash cow for me now, and I'm fine with that because I killed myself to get it there. I go there, shoot the poo poo with my patients, let everyone play with Addie, and go home and chart. I'm doing well but lifestyle creep is absolutely a thing and I have a ton of projects that aren't going to pay for themselves. I'm trying to keep perspective on things and I am worried about my work life balance. I do not like charting from home; when i go home I want things to be done, and WFH leads to me just kinda working a little all during the week. I'm already seeing more psych patients than any other psych provider in the company, six months in. they don't even bother me about not attending zoom meetings because I'm too busy. they're paying me for acute consults because, frankly, how incompetent other providers in this company are. Ive never smoked weed regularly in my life and I'm currently getting high every night to relax because I know they can't randomly drug screen me and even if they did I'd laugh at them and dare them to fire me. this is toxic as poo poo So yeah, I'd need to increase my patient load by about 20%, add facilities, and go through the process of stabilizing them all, and honestly I just don't think it's worth it. i loving hate this job, I hate this loving company, I hate working from home, I hate my coworkers saying stupid loving poo poo like asking what dopamine is (yes I am serious yes I am horried) and i hate hate HATE when patients ask me to help them with other problems because Im the only person they trust. I hate not having in person coworkers and I miss the camraderie of working in the hospital or an office where we all know we're getting hosed but we're getting hosed together so gently caress it. Next step for me is... a.) either private practice psych where'd I'd absolutely make over 200k and have an office. Id be bored as hell but it'd be easy. b.) inpatient neuro. i love it. it's what i like doing. it would not pay that great compared to what I could be making in psych c.) say gently caress it and work at that psilocybin/mdma/ketamine psych facility 20 minutes outside of town anyway wow this took off uh sorry
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Jan 18, 2024 20:11
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Leperflesh posted:oh yeah I forgot there is one obvious line of work where you can make 200k and still be a lazy rear end in a top hat, and that's cops lol Are you suggesting sitting in your running car at a highschool football game while sending revenge porn isn’t working!?
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Jan 18, 2024 21:30
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Salvor_Hardin posted:I noticed ketamine clinics in Minneapolis and, like, is that referal only for serious problems like treatment resistant depression or PTSD? Or can I just pay them like $100 to get K-holed for a few hours? There’s a couple of answers to this. Those little clinics that you see on the side of the road technically require a referral. These are all at infusion centers like the kind of place you go if you got a hangover and just want an IV with Toradol in it or something. You can receive a referral to go to one of these places. I have called in ketamine infusions before for patients with refractory migraines, and also people I just didn’t know what the gently caress else to do with them. The amount of ketamine, these infusions and quality that you receive is going to be highly variable. if you can’t get a prescriber from an outside physician, a lot of these places, have an on-call nurse practitioner or something like that. They can prescribe it to you when you’re there. Or they have someone on telehealth who can do it. It’s about as rigorous as those Websites that would diagnose you with ADHD during Covid. These places are mostly harmless. Swickles can speak more about this, but ketamine overdose doesn’t stop your heart, it stops your respiratory drive so you simply stop breathing. I had an ER doc tell me once that you could treat this just with an Ambu bag, but I don’t know how accurate that is and I don’t really want to know. So much of these ketamine infusion clinics are just for rich people who want to do drugs, and say that they prescribed so it doesn’t count. I can’t really speak to the efficacy of these long-term treatment, resistant depression. If you really have treatment resistant depression, you should be seeing a dedicated psychiatrist, not getting referrals to strip mall, ketamine infusion centers. On the other hand, there was a girl I went to grad school with who was assaulted by her boyfriend, and she got a referral to one of these because she was so traumatized by it. She told me to save her life. she sincerely believe that if she hadn’t gotten ketamine, she’d be under a bridge in Knoxville somewhere shooting fentanyl. To your last question, you won’t get enough to get enough ketamine at these places to put on your space boots or anything. Some people say that they feel good for several days afterwards. But again, in my experience, the people that most frequently use these are the ones that have been on Xanax for 30 years and are used to being legally high. overall, I’m skeptical. I’ve mentioned this before, but I was involved with the trials when I was in grad school for testing nasal ketamine for treatment, resistant depression. To get on this, you have to failed multiple appropriate trials of some serious medication. Like you’ve had to try Vraylar and Rexulti and Abilify, and it almost always Hass to be through an actual psychiatrist. Primaries won’t prescribe those drugs anyway. The way we did that was take the patient into a quiet room, let them squirt, nasal ketamine up their nose every five minutes, ask them orientation questions, every 10, and when they started to trip balls, we would pull back a little bit on it. That’s your therapeutic dose. Generally, you would take it like 3 to 4 times a week. It is very tightly controlled and if the “dog eats it” you do not get more into your next month. This is very, very effective, and literally save peoples lives. I am very much an advocate for it, and unfortunately, in my current role, I don’t really get prescribe it. But it Hass to be done appropriately and monitored. I know some people think medical providers are gatekeeping drugs like this, but it’s just very easy to get hooked to it and abuse it. There are some people just loving love ketamine, like Elon musk. Also, ketamine abuse eventually leaves urinary continence, and I’m fairly certain Elon wears briefs. The main thing we’re figuring out about drugs, like ketamine or sic sib is that they’re neural regenerative. PTSD, specifically destroys the connections, because the event is so traumatizing that our brain doesn’t want to think about it anymore. That’s what disassociative spells, amnesia, things like that. It’s our body trying to keep things from us. Unfortunately, just like scar tissue you can’t ignore injuries. You have to work it out. For psychiatric stuff, this involves therapy of various kinds, Medication, assistance, and more more we learning things like sin that can actually help put the brain back together. It’s just like tearing your ACL. Any surgery, you need things for pain and inflammation, and you need physical therapy.
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Jan 19, 2024 15:47
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Pain of Mind posted:My wife and I make a decent amount of money, but we are in an odd place where we bought our house when markets were relatively down and have a low interest rate (2.6), but we have also outgrown our house. It does not make sense to buy a house where the monthly cost is 4x what our current place is just for 400 more sqft, but we also make much more money than is necessary to afford our current house so we are accruing a ton of money that is more than anything else would need, but still not enough for a nicer house (SF bay area prices go brrrrrrrrr). Just dragons sitting on a pile of gold at the moment. Got enough property to build?
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Jan 19, 2024 17:03
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Aaaaaaarrrrrggggg posted:
We use it to put kids under conscious sedation if I have to set a bone or something. I always ask them who their favorite Pokémon or whatever and tell them to think about them. I always tell parents not to watch, and they laugh when they come back and the first thing the kid says is “I met machamp”
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Jan 19, 2024 17:55
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B52 takes too long.
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Jan 19, 2024 18:07
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LeeMajors posted:Yeah but it really really works. Bring back Thorazine imo Really does feel like the copper wiring is being torn out, sometimes.
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Jan 19, 2024 18:39
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3 DONG HORSE posted:So I did an experiment and went off my Vraylar for 2 weeks just to see how I would handle myself. I felt good and more active, like I wasn't being subdued mentally (also I ate less). But I noticed I was also more prone to spending and mood switches but nothing extreme happened thankfully. I'm scared to bring this up with my shrink (though I know I should) because she'll probably get mad at me, but I feel like this is a sign I need to rejigger my dose or supplement my meds somehow. I don't know. Bipolar is weird. I might have just been in a good mood by default and just got lucky nothing bad happened in my life to spiral me. gently caress. It's hard to explain but I feel like the Vraylar, as useful as it seems to be at stopping manic episodes, leaves a slightly gray shade over my life. Bring this up. They will not be mad. If you want a more indepth convo with someone on the internet, DM me.
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Jan 19, 2024 21:41
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The first Matrix for me when I was in highschool. I saw it with my dad. For some reason my mom made him buy me khakis before, so he booked tickets to a theater near an old navy. I did not know what this movie was about, only that the teaser trailer looked cool. I was a pretty sheltered middle class white kid growing up and this theater was not our usual nice, lily white regal experience. We were the only white people in the audience. It was the most fun I'd ever had in a movie. Everyone, ourselves included were screaming at the screen the entire time. We started chanting "bullshit" when Morpheus was captured. So much fun. Independence day on a friday night premier was incredible. Multiple "USA" chants, cheering, all that poo poo. When they asked "who can even fly this thing?" someone yelled out "THE FRESH PRINCE CAN" which was the funniest moment of my life up to that point. Snakes on a Plane midnight premier two miles from Georgia Tech. Obviously people screaming the entire time, but like 20 people showed up with multiple bed sheets attached end to end in a bad snake costume. Lots of people throwing rubber snakes. More recently Everything Everywhere All at Once. I saw it in a little indy theater here in Asheville that only has old couches to sit on. It's a cool environment to see a movie. No one really knew what it was about yet, and you could feel how everyone hanged on every single moment. Different, but I remember in highschool me and some friends went to see a show of King Arthur which was just a godawful movie. It was a mostly empty theater and we riffed on it the entire time. People came up to us after and said we made the movie watchable. In retropsect that movie is such a complete disaster that it's worth a watch. All the knights of the round table have their own unique fighting styles that are clearly inspired by the Final Fantasy job system. You've got a monk, a ninja, dragoon, a knight, etc. Keira Knightley is a dark elf rogue. Madds Mikkelsen plays a loving Samurai and is introduced by the whole "draw a sword surrounded by enemies take them down 1 by 1" trope https://www.youtube.com/watch?v=vNOTYuUhWlI&t=125s
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Jan 21, 2024 16:33
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DaveWoo posted:And by "before Tuesday" we mean... Endorsed Trump lmao
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Jan 21, 2024 21:21
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Amy Pole Her posted:Absolute piece of poo poo move to change the law so he could stay. Man do I hate that dude Wait, he's not term limited anymore? I thought he just changed the law so he could run for president and not resign as governor.
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Jan 21, 2024 23:47
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Sleep chat Disclaimer: talk to your pcp for insomnia and try to get a referral to a sleep certified doctor if it’s bad enough. My first supervising physician was sleep medicine certified and I saw all of his patients after they established with him. I’ve treated a LOT of insomnia. Insomnia is very common in men and women as they approach their late thirties/early forties. For men; this is generally an age of behavioral transition. This means that a lot of the things they have always done are starting to be more than they can compensate for. This isn’t just in sleep, as I’m sure all of us understand. We simply become much more sensitive to the things that can keep us awake. BASICS Generally speaking, the most important things for good sleep quality are 1. Minimize stimulants after 3 pm - we can’t consume caffeine (or alcohol but more on that later) like we could when we were younger. It just doesn’t clear like it used to. Also the effects of caffeine become less noticeable as we age, which leads to us needing more to get the same effect. 2. No screens 30-60 minutes prior to lying down for sleep. Light is very stimulating for the brain. It tells us to get up and go farm or whatever. We don’t want to lie down and wait to get to sleep. You should be ready to fall asleep when you lie down. Average time for sleep initiation is 4-6 minutes. If you’re lying in bed for 45 minutes, you were probably looking at your phone as you walked into the bedroom. 3. Exercise. Your body needs a reason to go to sleep. 4. Regular schedule/routine. Go to bed every night at the same time, wake up every day at the same time. People will bitch that they can’t sleep in anymore as they get older, but this is a good thing! 5. Cool, dark room. A cool dark room! 6. Minimize napping - daytime hypersomnia is often a symptom of sleep problems. Try to minimize napping if at all possible. ANXIETY do you wake up at 2-3am every single morning (on nights you haven’t drank) completely wide awake? Or do you lie in bed “unable to turn your brain off?” This is anxiety Every. Single. Time. You are either thinking of something that happened or something you’re going to have to do. Without going down a psych rabbit hole, there are a few easy ways to address this. 1. Journal before bed. This will help you organize your thoughts and plan your day. Journaling has been shown to help sleep quality and get people into deeper, more restorative sleep. 2. Pet a dog/cat. It releases serotonin which can help with sleep initiation. 3. Look at a fire. I’m serious. We spent two million years of evolution ending the day by looking at a fire. It calms us. I have no proof of this but I’ve recommended this several times and patients have said it works. Also if you want the best comedown from shrooms in your life, watch a fire and listen to this song. https://www.youtube.com/watch?v=fSRTHbtlLFc SUPPLEMENTS As always talk to your pcp about starting supplements, because there are some things like St. John’s wort that can literally kill you if taken with other medications. Melatonin: this is very mild stuff and comes in a million formulations. It’s over the counter. In my experience this isn’t very effective for people that aren’t elderly. It’s most useful for stabilizing sleep/wake cycle in patients in long term care settings. But go hog wild. Some people say this gives them vivid dreams, but I never really buy that. People that receive sleep treatment and report crazy dreams are usually just dreaming for the first time in god knows how long. You can’t overdose on this or anything. I don’t recommend it. Unison: just melatonin and some other bullshit. It’s not very efficacious. I dont recommend it. Gummies: I don’t have any clinical experience with this. Generally indica is considered more sedating. Indica = in da sheets, sativa = stimulating. Just know that THC is gabenergic, meaning it increases GABA. GABA is the inhibitory neurotransmitter for glutamate, which is excitatory. As my GABA level increases from meds/alcohol whatever, my body increases glutamate because it doesn’t like that imbalance. As my GABA lvls return to normal, depending on how big a dose or how long I’ve been doing it, my glutamate lvls will lag behind. In the short term, if something is wearing off at 3 in the morning, this will wake me up. Ever had a big night drinking and wake up at 2-3 in the morning, wide awake, sweating, heart beating? That’s elevated glutamate levels. This is the same mechanism of action that causes alcohol withdrawl seizures. So ymmv. THC has been proven time and time again not to be addictive so go hog wild if you don’t have a history of psychosis. Be very careful where you get it from as there is very little quality control. Don’t buy drugs from the gas station. NARCOTICS I’m not going to go into them here because I don’t want anyone to think I’m giving out narcotic advice unsolicited. Generally, drugs like ambien or lunesta are very similar to benzos. For example 10 mg of ambien is essentially 1 mg of Xanax. You do not want to start taking these if you don’t have to. They should always be last line. These should not be prescribed for sleep or long term out of a PCP office. TCAs also go here. No goon is willing to give up smoked meats and cheeses. DRUGS Just a couple mild ones that are fine to get from your pcp if they think it’s appropriate. Trazodone - very mild. Serotonergic. This will not make you tired. This med only helps with initiation. You have to take this and lie down and be ready for sleep. No one ever tells patients this (or knows) and they end up taking like 200 mg at 7 pm and not go to sleep at 10. Gabapentin - Put it in the drinking water. Non habit forming. Easy up easy down. Effective at low doses. Lasts six hours. Good for anxiety, restlessness, people that toss and turn in their sleep. Does not interact with any other medication. No real contraindication unless you’re in kidney failure, and even then nephrology is getting overruled (they always do). Generic so it’s cheap as poo poo. If gabapentin was invented today it’d cost 1000 dollars a pill, just like aspirin. Occasionally someone will say it makes their feet swell. DO NOT DO THIS Drink Benadryl/Easy sleep/nyquil - addictive as poo poo. You don’t want to get addicted to these. Plus, antihistamine withdrawl can give you Parkinsonisms short to medium term. Drink alcohol - if you’re drinking to go to sleep, we have a problem. If you’re waking up and have to drink to go to sleep, please DM me. Smoke cigarettes - Jesus goddamn Christ Not wear your CPAP - WEAR YOUR GODDAMN CPAP do that weird thing where you only sleep 90 minutes at a time 4 times a day. We evolved to wake up with the sun, sleep with the moon. This is bullshit. So yeah; that’s my posting between workout sets effort post. Sleep well goons! DM me with any questions. And as always, ask your PCP before starting a medication/treatment regimen.
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Jan 23, 2024 13:19
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Forrest on Fire posted:. I'm almost 30 https://www.youtube.com/watch?v=_EVUPCJwQwA
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Jan 23, 2024 13:45
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Forrest on Fire posted:There's a real chance I'm burying a sibling this year buddy, I already know ahh dude im sorry. wasn't trying to be insensitive, just trying to make a turning 30 joke.
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Jan 23, 2024 14:28
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"I will curb my drinking by just getting really into making my own craft cocktails." /spends a fortune on liquor /drinks more
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Jan 23, 2024 17:39
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