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annakie · 3 years

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Warning, pet illness and sadness within. This is for me to pour out my emotions somewhere.

Friday, everything was fine.

Leela demanded pets all throughout the day, to the point where I had to ask her to quiet down a time or two while I was trying to work. She ran and jumped onto the counters in the kitchen and bathroom when I went, yelling at me to turn the water on so she could, and did, drink out of the faucets. She demanded dinner at dinnertime, and a day or two before that, she asked for extra dinner when the bowl she and Pemily share most nights ran out.

When it was time for treats, she purred up a storm, excited, as always, for her treats. She gets extras, she always does. She starts with four before Pemily and Fry get any, and if she catches up to me while all three of them are getting their first five treats, round-robin, one at a time, I’ll usually give her two. She gobbled them up.

Yesterday, I noted late in the day that she hadn’t run into the bathroom or kitchen with me during the day, but that’s OK, she doesn’t always. But then she didn’t care about dinner, even though they were having the flaked tuna, which they all love. Not long after, she puked, and it was all water. Then, I started to worry.

She pooped right next to her bed... which she has done occasionally, but rarely. She had puked earlier in the week, necessitating me to wash her bed, but that wasn’t extremely unusual. But several non-hairball, non-food pukes later, I was very concerned.

Then she didn’t eat treats.

It wasn’t the first time she’s gone a day or so not wanting food, but got better after maybe a hairball or something. So I decided to sleep in the living room, close enough that I could hear if anything went terribly wrong. I tried moving her bed into the living room but she was having none of it, she only likes being in Her Spot on the desk in the office. Right within arms reach of me all day while I work from home and all night when I game, scroll tumblr/twitter, chat... or whatever else.

I have loved always having her this close since in early 2018 I made what most people would use as their living room into my office and moved my huge desk from work into my house when they let us take the now-unwanted office furniture home. Immediately after this desk was set up, she jumped into that spot... and just stayed. She staked her territory. I put a small blanket down for a day or two until that weekend when I went and got two more cat beds to supplement the one we already had. Leela’s was the smallest, perfectly Leela-sized for the tiniest cat. I’ve never seen her so expressively happy than the first time she got into it. Purrs and biscuit making, and she has spent nearly all her non-eating/drinking/bodily function time right there in that bed ever since. Occasionally she’d come hang with Fry, Pemily and I in the living room while we were watching TV, but rarely.

But anyway, I digress.

I woke up several times during the night and each time she was a little more listless. I’d called the emergency vets near me and they said I could bring her in but it’d be several hours for her to wait unless it was critical, they’d gotten slammed and one had to do emergency surgery and was sending all the patients to the other one. So I decided to wake up early and take her in. I called ahead and they said they were not backed up anymore.

So Leela’s favorite blanket and Leela went into the carrier. She was strong enough to put up a little fight and complain about it. I told her I loved her and the doctor would make her feel better as we drove. I hated that I couldn’t even take her to my vet, the vet she’d seen her entire life, but they’re closed Sundays and I knew waiting longer would be bad.

Due to COVID, they wouldn’t let me go inside with her. Sensible. I waited in the parking lot for an hour and a half as they took her in, called me to take her history, ask what’s wrong, and eventually the vet called, and asked permission to do labwork, and that I should go home if I was still in the parking lot.

I did. I laid down with Fry and Pemily and tried not to worry. An hour later they called and said her labwork looked bad. Her kidneys are failing. They want to admit her for 24 - 48 hours. I held it together through the labwork results and the vet asking for permission. A few minutes later they called back to get a deposit on the payment ($2000.... so grateful I haven’t been spending money for the last year, money isn’t yet an issue.) and then asked me the question I was dreading and not prepared to answer. Do I want a DNR?

She’s sixteen. She’s frail. She’s already traumatized from all this, I’m sure. Do I want them to take extreme measures to save her life? My breath hitched as I said what I felt was the better answer -- No. I lost it, barely making my way through the rest of the call.

Cried for the last couple of hours. Just went to bed and sat there and sobbed, rehersing in my mind... what if they call and she died suddenly and I wasn’t there? Am I sure I made the right decision? What if she doesn’t get better and I have to make the call to put her to sleep? Will they let me even be there then?

She’s my Itty Bitty Leela Kitty. She’s the one who will always take affection, who begs for it like no other to the point where I have to ask her to stop. She cries for love. She’s been a pain in the ass since day 1 because of bathroom issues, but I wouldn’t trade her for anything, especially since I figured out the compromise to keep us both happy with it. She’s sweet, and just the cutest little thing. She’s the bravest of all my cats, nothing phases her. She’s fearless of strangers, accepting pets from all and sometimes even asking for them from those she doesn’t know. She just wants to chill out in her bed and get loved on. She’s great at telling time. She weights less than 5 pounds and she’s 80% lungs.

She’s bullied by Fry and Pemily but they’ll miss her too, and always respected that her bed is her space, and she’s allowed on countertops to eat and drink, too. Just, you know, not on the floor.

I’d been thinking the last few weeks that one time when she WOULD have her once-daily run around the house and scream time, late morning when Fry and Pemily were settled in for daytime naps, I needed to record it because as annoying as it could be when I’m in work meetings, I knew someday I’d desperately want to hear it again. And I never did, and now I’m terrified I will never hear it again.

There’s nothing to do now but wait and hope. I so badly want her to come home and have just a little more time. Hear her mewl for attention. Just a few more treat times. Just a few more times to hear her yell at me to turn on the faucet for her to drink. wrap her in my arms in her bed and listen to her breathe and kiss her head and tell her I love her. I did that a lot last night but I should have done it more this morning. And if it is her time, please just let me be there next to her as she goes.

#personal post tag thingy #pet illness tw #my pets

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fingertattoos · 3 years

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Hi I don't know if this might help because it seems like they already did all the bloodwork and labs and such, but my cat who's 12 years old had a similar problem it turned out to be a UTI and the doctor gave him 2 prescription medicines to help dilate the opening so that he could pass the stones as well as help dissolve the stones to become passable. We did this treatment in him twice and he hasn't had a problem since and it cost me under 100 dollars rather than doing all the labwork (cuz hes otherwise a healthy cat). Were they able to try that before they put him thru all those tests? Just thought I'd share!

he ended up having a bladder infection and was given medication to clear it up and help him pass urine but i was warned it could come back if it was a stone, but his symptoms stopped when we gave him antibiotics so i didn’t think anymore of it. they said UTIs are rarely the case and bladder infections are more serious. he ended up having to be held overnight and given fluids because they couldn’t get a urine sample from him which contributed to the cost. He’s also 12 pounds and they said losing 2 pounds would help prevent it from coming back so he has prescription food which he only gets 3 times a day so idk.

he has an appointment tomorrow to get looked at and potentially get an x-ray but i haven’t seen him squatting or going in and out of the litter box in a couple of days so we’ll see what happens. theyll probably insist on an x-ray to be safe.

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tmitransitioning · 5 years

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Thank you for this wonderful blog! Do you have any advice for someone brand new to the world of health insurance? I’d like to start hrt but I’m only covered by emergency-only insurance. I could probably manage out of pocket if I’m careful, but I’d like to investigate my options. Also is there a way to know much appointments will cost before settling on a doctor? (Sorry if these are silly questions, but I’m 19, clueless & scared)

without insuance (or insurance that covers your treatment), it’ll probably be cheapest to go to a sliding scale treatment location, like Planned Parenthood (if there is one in your area that offers HRT) or most LGBT+ clinics (just google the name of your nearest big city and LGBT Clinic). for some people, it could mean taking a greyhound or driving a couple hours every couple months and that’s STILL cheaper than seeing a full-cost provider in their own town. back when i was transitioning, nobody really did it in our city, but in Chicago they did (and offered informed consent- no therapy letters), so we would take a 25 dollar bus ride (or gather up friends and drive together), and get our appointments together then go home. You can call these types of places (planned parenthood, lgbt clinics) to ask them to help you figure out what your estimated costs would be- they can give you paperwork that usually tells you based on your income what you’ll have to pay- but make sure you’re clear you want to know Everything you would have to pay, including labwork.

If these above aren’t an option, you’ll have to go with what’s available to you. Call your insurance just to double-check that they don’t cover it. the number on the back of the insurance card is the people who work with them. Tell them where you live and what type of doctor you need to see. you don’t have to tell them your medical problem (”hi my name is bob and i need to see an endocrinologist, does my insurance cover this, and are there any in-network by me?”) Sometimes you think you don’t /do have coverage for things and that’s not the case. They will tell you what you need to know. If yes: ask what the cost will be (either a copay- a set fee for seeing a specify type of provider- low cost for normal doctors and high cost for “specialists” which an endocrinologist is; or a co-insurance- a % of the total cost “your insurance pays 50% of the cost”-- or more often “your insurance pays 50% after you meet the deductable”) IF you have a deductible, check what that is too. ($5000 means you have to have that many medical expenses before they start paying “anything”- but lots of times that’s not true- they’ll often pay for things like preventative care- one health screening doctor’s appointment a year, a flu shot and other prevention vaccines, a yearly gyn apt, these types of things. ASK THEM- cause if it’s free healthcare, you want to get it!!)

Once you know what your insurance is covering, if anything, and who they prefer you to go to (if they care), then you can call your doctors (if you have specific ones. if not just start making calls). Ask them if they accept your insurance (even if your insurance said they do) and what the cost for an apt is (so you know what the 50% cost would be). if you can pay it, schedule it. If you don’t have any insurance coverage, you’ll ask instead if they can accept any “sliding scale private pay” clients. lots of times they will say “no” but sometimes they are more than willing (sliding scale means you pay based on what you make; private pay means you pay instead of having insurance pay-- sometimes they prefer this because they can tell you what you have to pay, instead of the insurance telling them what they have to accept- and they can make more money. this can seem greedy, but honestly, lots of times the insurance companies will charge 70 dollars then give the doctors 15 so the companies can make huge profits. if the doctor instead charges you 20, they make “a lot more” money, without as much paperwork, and you don’t have to pay the 35 dollars you’d have to pay if you were doing the 50% split. it can be a good deal). If they say no, they’re often willing to tell you how their healthcare organization does discounts (we don’t do sliding scale here but if you meet minimum income requirements you can apply for a discount through our XXX program). It’s worth your time to file that paperwork (usually you just have to send in your tax form or paystubs) before the apt, so you can know- you’ll get charged full price, then the bill will be discounted.

Finally- MOST places will allow you to set up a payment plan. as long as you can stick to the payment plan (set it up on autopay, make sure there is enough money in your account by the day it’s set to come out) they’ll let you keep scheduling new appointments usually. So- you’re paying 20 a month to pay it off, and you’re going in every 3-6 months and getting new charges that you add to your payment plan. You might get tax money and pay that down a little faster when you get some extra cash, but mostly you only just pay that 20 a month. and the doctor is okay with that because you’re reliable and you’re not skipping out on your bill. AND it’s helping you to build credit at the same time!

This is way more info than you asked for but hey, you said you’re young and clueless- here’s some good places to start!

Mod mayhem

#Anonymous

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prayingforlove · 4 years

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Goodbye Kodi

This is one of the most difficult posts I’ve ever had to write. It’s been just over 9 years since I lost my cat, Pumpkin, who I grew up with. My parents put down the family dog just before Christmas in 2015. And now 5 years later, I had to unexpectedly say goodbye to my baby, Kodi.

This past Friday morning at 8am I dropped Kodi off for a dental cleaning - the second one he’s had with this vet. I’d had anxiety about it for a couple days leading up to it, but for the most part I was worried about giving Kodi the pain meds that follow. Justin had a bad feeling that morning and kept checking in with me for status updates, so in general we somehow knew something was going to go wrong. They did all the standard pre-op exam and labwork, and nothing looked out of the ordinary. During the dental, the vet had cleaned one side of his mouth and started the process of removing 2 of his teeth when they noticed a significant heart murmur that had not been heard before. The took him off anesthesia immediately but his heart continued to deteriorate. The vet said he went and they gave him 4 rounds of epinephrine, 3 directly to his heart to try and bring him back but nothing worked. I received the call just after noon that he was gone. I’ll never forget the sound of the vet’s voice as he said “I have really hard news, we lost Kodi.”

I called Justin immediately after, and we both took the rest of the day off and waited for a call from the vet so we could go say goodbye. We returned to the vet office around 2pm where we were let inside a small room. The vet who had been performing the dental talked with us about what had happened, then a tech brought out his body for us to hold one last time and say goodbye.

On Sunday, the practice owner called us to discuss what had happened. He thinks Kodi had undiagnosed hypertrophic cardiomyopathy, a type of heart disease common in cats, and especially male cats. It’s genetic, and most often caught due to a heart murmur or other apparent symptoms, none of which Kodi had. I still catch myself thinking I never should have scheduled the dental, even though I know it was the right thing to do. I also know that the vets did everything they could do for him. We at least know that he was under the effects of anesthesia when he passed so he was never in any pain.

I adopted Kodi at just a few months old in July 2013. He was 3 pounds of fluff and stretch out across my lap with ease. He eventually grew into the 14 pound lovable boy who had to settle with laying next to me most of the time because my lap just wasn’t big enough for him.

He was the sweetest thing who begged around dinner time a little bit, but mostly he just liked to stare at me. Judging. Because how dare I not have gotten up to feed him yet. But mostly he understood “no” meant to back off from my food, and had very little interest in people food to begin with.

He loved when I bought the leash out because he knew it meant he would get to go outside for a bit and enjoy the grass, or hunt small critters. We spoiled him with more and more toys, but he always went back to his favorite plastic jingle balls that he loved to play fetch with. Though crumpled paper did the job too, if he was bored.

Kodi was skittish of people for a while, but recently he’d opened up more and actually ended up being the more social one when we had people visit. He was such a mama’s boy and cuddlebug, and absolutely had to sleep above my head every night. He knew that when my pillow was placed flat, it was time for sleep and that was his spot. Yet he also loved to sunbathe in the window, and sleeping on the pillow nearby, or the pillow on Justin’s side of the room, or lounging in the hallway.

He didn’t always get along with Eevee, but I know they enjoyed each other’s company at times, and they did love to play tag almost every night. Until she would get too rough, he loved chasing her and being chased around the apartment.

He gave kisses every day and would purr immediately from the slightest touch, or even the promise of a touch. He was vicious when you pushed his limits, but only to me. He somehow knew that it was okay with me, but other people were off limits for scratching and biting. On the whole though, Kodi was so full of love, and would make circles to come back for pets, stretching in between each lap, throwing himself at you for head rubs or butt paps.

The night before his dental cleaning, Kodi cuddled with me on the couch for a couple of hours and I am so glad I had that time to just enjoy his company one last time. People always say animals know more than we do, and I don’t know if that’s the case here, but I am so grateful to him for giving me that time to look back on.

He had his issues like all pets will, and his quirks, and his adorable qualities. He took some time for Justin to warm up to, but in the end he was so loved by both of us that we still can’t really believe he’s gone.

We picked up his ashes today from the vet. They charged us for a portion of his dental and the epinephrine, but did cover the cost of a private cremation for him. Kodi is the first pet I’ve had cremated, since we buried Pumpkin in my parents’ yard. I didn’t know what to expect, so I was surprised with how heavy the box was (but then he was 14 pounds). The vet also took an impression of his paws in clay, and clipped some of his fur which they gave to us in a small plastic bag. We also received a small cat figure from Chewy.com today, after I removed Kodi from my account and wrote what had happened.

The outpouring of love from our friends and family has been incredible. No one truly feels the loss that we do, but I know many are pet parents themselves and understand what we’re going through.

There’s still so much I could say, but I’ll leave it here for now. I’ve had a few days at this point to grieve, and start to accept that he’s really gone. It’s still hard, and we feel his absence at every meal, every night when we go to sleep, every morning that he’s not waking us up to play. He was truly a special cat and was so loved. We’ll miss you Kodi. Thank you for being a good boy.

#personal #Kodi #cat #pet #death #Justin #Him

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purplesurveys · 5 years

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546

Are we alike?

You pretty much always have a cup of tea or a bottle of water with you. I do bring my Hydroflask with me to school everyday. I love my water, lol.

You think enjoying the moment is more important than catching it on camera. I mean, it kinda depends. There are some moments that I know are way too significant, so I’d take one or two photos just so I’d have some sort of souvenir that would, over time, be more reliable than my memory. Case in point, I definitely danced my heart away at my Paramore show, but I took 15-second videos for a couple of songs I really liked. You enjoy watching documentaries. I don’t have the time nowadays, but I love them. The last one I watched is Netflix’s docu about Fyre Festival. You spend most of your time alone and have no close relationships. As shy as I am, I like being around people. You joined Pottermore and were sorted into Gryffindor.

You have a dry and sarcastic sense of humour. I can. Long, dark winter nights drain you. Summer is by far your favourite season and lifts your mood a lot. If I’m not otherwise spending a day at the beach, I HATE summer. A lot of the time you have to laugh at your own bad luck. I always catch the red light. I’m ALWAYS the first car in line that’s caught behind a red light. Gabie knows this for fact that whenever it happens we just laugh it off. Your mood plummets if you don't follow a health and fitness routine. Your favourite ever music video is Lana Del Rey's Ride. I don’t care for Lana Del Rey. You love lazy summers spent going for walks and lounging in the garden. Meh, not really. I don’t like being alone with my thoughts, which is what walking and lounging would do for me. I prefer going out with a friend or two. You love to spend your time lost in a good book. I like when books are able to catch my attention for long, but it’s not my favorite pastime. You watch American Horror Story and Asylum is your favourite season so far. You've overcome a lot over the last year but have slipped up recently. After N passed, my backlog grew bigger because I didn’t want to deal with work after losing someone so suddenly. You prefer sitting exams to completing coursework. I usually feel lazy to do fieldwork or labwork, and my strong suit is memorizing stuff and writing essays, so.

You love long car journeys spent listening to music. So long as it’s music I find pleasurable, or something I can sing along to. You find learning about how people lived in the past interesting. That’s why I’m taking an elective this semester called Social History of the Philippines. That class is literally about how Filipinos used to deal with hygiene, how they used to cook, the games kids played, how they dealt with sicknesses before modern medicine took over. It’s one of my favorite classes that I’ve ever taken.

Your parent's closed-minded attitudes frustrate you. I mean, anyone who is close-minded can be frustrating.

You've grown very used to loneliness. I had no friends for many years, so yeah. I mean most days I like being around people, but there are still some times I do want to shut the world out, delete all my social media (except Tumblr so I can keep taking surveys ha), turn on airplane mode on my phone so no one texts, and spend the whole day with my coloring books. You prefer getting up early and having productive mornings. I always hated getting up early, from all the way back in kindergarten. You try to enjoy dancing in public but you still feel very awkward. This, especially in parties. Even when I’m already drunk I still hate it, and I prefer being with my friends at the side of the dance floor. You can't even be bothered to hold grudges and find them pointless. Winona Ryder is one of your favourite actresses. She’s not my FAVORITE favorite but I have a soft spot for her. You don't find award shows very interesting. You have no patience for people who are glued to their phones. I once saw this Expectation/Reality comic on Facebook, with the Expectation side showing people all glued to their phones while riding the bus and how it’s ~ruining society. The Reality pane, in actuality, shows that all these people on their phones were actually talking to their loved ones – one was saying how she was on her way to the hospital and can’t wait to meet her newborn niece, another was congratulating her friend for passing an exam, another was complimenting her friend for her pretty plant. Ever since then when I see people on their phones, I don’t get as annoyed about it cos for all I know they can be having a very special conversation. You're a bit of a hypochondriac. You enjoy warm evenings spent doing yoga in the garden. Sunsets are one of your favourite things about the planet. You prefer to avoid medication but appreciate it's necessary sometimes. I avoid it because it’s expensive, and I know my parents won’t be willing to help me out with mine because there are more important things to pay for. I do realize that I may need it, though. You find talking to older people easier than talking to ones your own age. It’s very hard to find older people who are pleasant to talk to in this country, because almost every Boomer and X-er are close-minded and conservative. You're naturally quiet and content with being that way. I can sit with someone somewhere, not talk for hours, and it wouldn’t mean that I don’t like them. Your handwriting seems to change every time you pick up a pen. It’s been pretty consistent through the years. You dislike the thought of ever being dependent on anybody. Texting bores you and you'd rather just make a phone call. You like to hear about other people's music tastes. Talking about music bores me, lowkey. You prefer to keep your living space clean and tidy. It’s certainly more relaxing to look at. Anxiety controls you more than you'd like to admit. I’m very aware of just how much it controls me lmao. You can hardly even cope with being around people because of it. You can't decide whether you prefer cities or countryside. Cities. Always. You're pretty much incapable of ever relaxing. 7 classes for this semester, thesis year, and executive positions in both my org and our college’s graduation committee. Weekends like this where I can take more than one survey are ridiculously rare. You like discovering and being introduced to new music. Your favourite song by The Smiths is What Difference Does It Make. You procrastinate things you don't feel capable of doing perfectly. HAHAHAHAHAHAHAHAHAHAHA yeah these ones I keep to the very back of the line. You keep pretty much everything to yourself. I don’t think so. I tell my best friends everything. You have quite a temper but you're good at controlling it. I’ve done things while angry before and regretted them, so I’ve learned to control my temper. You much prefer skirts and dresses to jeans. Welp I hate skirts, but I like dresses. And I HATE jeans. You're not really a fan of alcohol anymore. Your parents let you down when you needed them the most. This only applies to my mom. You have a pretty awful relationship with your mum and it upsets you. It doesn’t upset me; I’ve grown used to it over the years. You dream of finding a sense of belonging somewhere. You're a fan of The Cure. You love doing toning exercises, especially stomach workouts. I hate exercising. Patience is definitely not a trait of yours. You don't expect anybody to take an interest in you or be there for you. Keyword being expect. The Devil and God Are Raging Inside Me is one of your favourite albums. You're a university student. Yeah huh. And expected to end in a year, too. You waste too much time on Tumblr and the internet in general. Not so much on Tumblr, but we do need the internet to do nearly everything now, don’t we? You're an Arctic Monkeys fan. You've read and loved The Outsiders by S.E Hinton. Based on this, are we alike? I think I left more entries than I bolded, so it’s probably safe to say not really.

#survey #surveys

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kinoglowworm · 7 years

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Maternity Jeans, Never Used

XL Drabble for Day 3 (Maternity Clothes) of Knock Yuuri Up Week [A03]

They weren’t even nice jeans. The soft, black band at the top didn’t really make any sense with the dark-wash denim, but Yuuri supposed it wasn’t really meant to be seen. By the time these jeans would have been relevant, they would have been paired with long, flowing tops every time, the kind designed to mask the awkward change in the lines of his body, to drape just so across the midriff and its round, growing swell.

Yuuri had been more looking forward to the kind of outfit that said, “Fuck you, look at my belly. It’s big and you can fucking deal.”

He'd had actually been surprised how comfortable he’d been with his growing body, in a way he’d never been before. Even when parts of him were too tender and sensitive to touch. Even when his weight was up sixteen pounds from where it was twelve weeks ago. He’d already been right on the cusp of where his in-season weight reached off-season levels at the beginning of that. Even the sticker shock of that didn’t phase him at the time.

Viktor had taken such delight in surrounding Yuuri with treats over the last few months, coach’s hat set aside as he played the doting partner instead. The steamed fish and vegetables were still there, but alongside them were the dumplings and desserts that were usually reserved for special occasions, for celebrations. Each meal felt like one, though. Even the confusing ones at four AM. Yuuri had more than once accused Viktor of talking to the dumplings when he snuggled up to Yuuri’s belly and started whispering to it in a voice just loud enough to be clear that it was for Yuuri’s benefit as much as his own. They’d even started referring to it as “the dumpling.”

Yuuri had eaten his mother’s katsudon once a week for the last six weeks. He’d had the same satisfaction as if he’d won a medal each time. Somehow, it was easier to believe it was happening when he was eating, which made eating that much more appealing.

He wondered how much of the weight he’d lose with the procedure next week, and how much would be up to him to work off before it came around to trying again.

The jeans had been Yuuko’s idea, about two weeks ago. She’d caught Yuuri trying to surreptitiously unbutton his pants while sitting on the train. She was one of the very small handful of people who knew, and she knew him too well besides. Even as she tried to wrangle the triplets around her, she caught the look on his face just after, the awkward mix of relief and worry that people would know his pants were undone without knowing why. They weren’t even his in-season pants. But even that discomfort was only physical, bypassing the shame that had always come before from ill-fitting clothes.

He dropped the jeans limply onto the bed beside him. That tightness had been one of the first things that really made him believe it was true. All the rest of it - the exhaustion, the soreness, the hunger masquerading as vague nausea - was too easy to explain away as circumstantial. The labwork was harder to dispute, but blood and urine was just that. Any story it told was one that was written on a page or a screen; not one that was written on his skin. Not yet, at least.

Yuuko complained about the stretch marks that wrapped around her belly after the triplets, but Yuuri had quietly envied them for years, since before he had really even thought about it in terms of wanting his own child. The scarred fingers of stretch marks already cradled the edges of his own hips; a combined gift of a teenage growth spurt and the off-season softness of his belly reasserting itself. Yuuko’s, at least, seemed honestly gotten to him. Yuuri had imagined himself in her position, confidently explaining them away: “Oh, well, you know what children do to your body.”

Even holding the strange jeans up to look at them in the store, Yuuri had felt like something was wrong. But if he wasn’t ready to tell most people about his pregnancy, he was even less willing to confide his uncertainty about it. Besides, what was he supposed to say? I’m worried because I don’t feel low-grade like shit all the time anymore?

Not that he was uncertain about wanting it to be true; he had surprised even himself with how confident he felt about being ready for parenthood. Instead, the same nagging feeling that had followed him around for most of his life, the one that wouldn’t let him believe in good things happening to him, had taken up this cause with full force. The feeling that told him to hold his dreams at arm’s length when they seemed too close to coming true. It had whispered in his ear at every competition, whether he had won or he had bombed. He knew better than to believe it, but it wasn’t wrong every time, either.

That voice had kept him from telling almost anyone about it. Viktor hadn’t been able to contain himself and told a wide swath of his friends and family almost immediately after they had found out. They were all on different continents, though. The distance made it easier somehow.

Yuuri had told Yuuko and his mother. That was it.

Yuuko had been so thrilled when he’d told her, jumping straight into stories about how sick she was with the triplets and all the moments where she was convinced she had a bellyful of angry aliens rather than tiny humans, poking their sharp edges into all parts of her. He wasn’t sure how he was going to tell her it was off.

His mother had surprised him when he’d told her this morning, just the two of them as they worked through folding up a load of clean towels. Apparently she’d been through her own miscarriage, sometime between Mari and him being born, though it was earlier on than this was. When he asked why she had never mentioned it, she had simply asked him, with that gentle smile of hers, when the right time would have been. Yuuri didn’t have an answer for that.

He hadn’t even told Mari or his father. He’d tried, a couple times, but his mouth came up dry on each occasion. Viktor had offered to start the conversation with them, to say for him the words that stuck like wet paper on Yuuri’s tongue. But he also listened to Yuuri when he said he wasn’t ready. Next week. He had planned to tell them next week. Once he had proof that this wasn’t just something his mind had managed to dream up, despite all evidence to the contrary. Once he had proof that he wasn’t going to break anyone else’s heart with a false start.

Yesterday was supposed to be the proof: a heartbeat, a tiny shadow of a figure dancing inside of him. Instead there was just an empty space that kept growing to accommodate something that had apparently given up long ago, but which his body still seemed to refuse to let go.

He winced as he felt the tears building up in his eyes again. He was past the big, wracking sobs that had come out as soon as he’d gotten home yesterday and buried himself in bed. He’d held it together long enough to send Viktor to the grocery for something. He couldn’t even remember now what he’d asked for, only that it was easier than asking to be alone.

Yuuri had held it together through each of the appointments yesterday, his neutral face a matter of pride as he talked with each of the doctors and nurses, with the ultrasound tech, the receptionists who checked him in and out. Viktor had been the one with tears on his face when Yuuri was up on the table being examined, but he probably would have been crying even if it had been good news. If it had been good news, Yuuri might have been crying, too. Those tears wouldn’t have been a burden on anyone else.

Yuuri had been over the worst of it when Viktor came home and found him cocooned in the heavy quilt on their bed, curled tightly into himself. Viktor slipped in behind him and wrapped himself around Yuuri and his blankets, and it had started all over again. They’d cried together there holding each other until they’d fallen asleep, the afternoon sun laying warm fingers around them as it angled itself through the window.

The tears had come and gone since then, almost at random. They seemed silly, on some level; the ultrasound had shown that there wasn’t even really anything with a shape worth grieving in there, just shreds of tissue that had barely been recognizable under extreme magnification. He could almost feel them sitting inside of him now, in a way he never could when he thought they were becoming a person.

There had only been a few brief moments when he’d allowed himself to imagine what it might be like past this point; imagining the alien feet poking at his skin from the inside like Yuuko had told him about so many times, brief glimpses of what it might be like to cradle that tiny person against himself. Imagining what it might mean to show up at the beginning of the skating season in the fall, proud of his unignorable belly, what New Year’s would look like with a newborn.

Those felt too much like a promise he wasn't sure he could keep though. They felt like guilty indulgences in the moment, the way imagining meeting Viktor once had. He tried to keep himself in the moment, putting maybe too much value on each rice ball he pulled out of the fridge after waking up in the middle of the night, each wave of nausea that sent him sitting with his head between his legs, each time his pants didn't quite fit right. That much, at least, felt real.

The pants had been on clearance; it’s not as if he could return them. It would be a waste to throw away a garment that had never been worn before. Yuuri hadn’t even tried them on in the changing room at the store. They wouldn’t have fit right now anyway. Not the way they were supposed to. Not even with the firm rise in his belly that had pushed him to undo his pants on the train, that would still be with him for the next few days.

Yuuri folded the pants neatly, smoothing the creases out across his lap. Maybe he was too hasty thinking about how he could get rid of them. There was nothing about this situation that suggested any difficulty in him getting pregnant again later. The doctor had said that they don’t really even worry until this happens at least three times. Give it another cycle, and then they were clear to try again. Maybe he’d have a use for these at some point anyway. He just couldn’t look at them right now.

They really are hideous, Yuuri thought as he tucked the unworn pants into a far corner of the closet’s upper shelf. Next time, he promised himself, he’d find something that fit his style when it came time.

#fic #knock yuuri up week #day 3 #maternity clothes #Yuri on ice #pregnancy loss #miscarriage #i'm so sorry yuuri

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nitewrighter · 7 years

Note

Are you doing prompts? How about "Nightmares", with gency or tracer after the incident?

All right! This ficlet takes place a couple of days after ‘Confession!’

—

“The day after tomorrow, then?” said Genji, sitting in his usual spot next to her infirmary bed.

“If I had my way I’d be getting out now,” said Mercy with a slight smirk, folding her arms, “But it’s going to take a day for the lab work to confirm all the nanites are gone, and… I suppose it is the safest decision.”

“I’m glad,” said Genji, looking around, “I can only imagine how frustrating being cooped up here must be.”

“I’m pretty sure you can do more than imagine,” said Mercy, folding her arms.

It took Genji half a beat to catch her drift and he chuckled. With all of the work and maintenance for his prosthetics, he had all but lost track of how much time he had spent in Watchpoint infirmaries and labs. “In any case, I’m looking forward to seeing you back on your feet again,” he paused, “What are you going to do first? When you’re out, I mean.”

Mercy huffed. “Well, since everyone insisted on taking my tablet away so I could ‘rest’ I’m likely woefully behind in all my labwork and correspondence at this point, so that will probably eat up a lot of my time. Ana and Jack will need appointments—Goodness knows how long they’ve been keeping themselves going with those canisters and that rifle… with how few resources they’ve been operating with, I wouldn’t be surprised if they’re terribly malnourished and of course Jack will be a stubborn old fool about it and I’ll have to—” she caught herself and looked at Genji, “I–I’m sorry that’s probably not what you meant.”

Genji shrugged. “That’s… probably the best thing to do…” he conceded.

“Did you have an idea?” said Mercy with a smile.

“Nothing very specific,” said Genji, giving a glance over to the window. It was dark now, and while he had been avoiding looking at the clock for a long time, he knew he would have to leave soon to let her rest. “I just thought… Volskaya was so cold and cloudy, and as soon as you got back you were stuck in here, maybe you’d like to go somewhere. Get some sunlight. Not too long, just an afternoon or–Oh.” He felt fingers brush up against his faceplate and turned and found Mercy was sitting up more in her bed, leaning towards him.

“I would like that,” said Mercy.

Genji had a short, almost nervous chuckle as her fingers trailed up along his jawline to the back of his helmet. His hands went up and guided hers to the catches to his faceplate and he loved the feeling of her fingers pressing down on those point, releasing his visor and faceplate with a slight hiss of steam. She was already moving in but by the time he got the visor off, she stopped, her eyes widened, and she drew back slightly. “Genji, you look terrible,” she said.

Genji was caught off guard by this for a moment. He forced a chuckle and rubbed at his scars. “I–I’m afraid I’ve looked like this for a while, Angela—”

“Ach du–You know that’s not what I mean. You look exhausted.”

Genji’s eyes widened slightly. “Ah… yes… I suppose… that’s finally catching up with me.”

“Finally–? What are you talking about?”

Genji gestured vaguely, “Just… some trouble sleeping. Nothing new. It happens with the prosthesis sometimes—”

“Genji,” she was staring at him straight in the eyes. He always did feel more vulnerable with the visor off.

“It’s just some bad dreams,” he said quietly, glancing down.

“Of Volskaya?” said Mercy. Genji looked up.

“Yes,” he said. Mercy’s face softened and a pause passed between them.

“I get them too,” said Mercy at last, sitting back a bit and hugging her knees, “Most of my time here they’ve had me on enough painkillers so that I don’t dream at all but these past two nights…” Her lips thinned, “I keep seeing his face, and that brings back Zurich and I hear him screaming again and the world is all burning and collapsing on me and then that brings me back to my parents and they all just fall into each other and—” she exhaled sharply, then forced a bitter chuckle, “And it’s a mess.”

“I dream of you,” said Genji.

Mercy’s eyes widened.

“I dream I don’t get there fast enough,” he went on, “I dream that Zarya’s not there when Reaper raises his gun and shoots me and the last thing I see is the light going out of your eyes. I dream we’re able to defeat Reaper but Ana doesn’t get there in time and you still…” he brought a hand up to the side of her face and tucked her hair back with his thumb, “There were a hundred ways I could have lost you that day and my mind keeps running through all of them when I sleep.”

“You didn’t lose me,” she said softly, putting her hand over his. Genji’s hand slipped from her face and she suddenly found herself in a tight, yet gentle embrace from him. His head was at her collarbone. She wondered if he was listening to her heartbeat, as if he needed the additional confirmation that she was here.

“I know,” said Genji, “I know I didn’t but…” he trailed off and she bent kissed the top of his helmet, then leaned back in his arms a bit. His embrace loosened with some hesitation.

“Here,” she said, scooting over in her infirmary bed and patting the space next to her.

Genji blinked a few times. “I–I shouldn’t. You need your rest. You shouldn’t worry about…”

“Genji,” her voice was warm and she smiled a little.

“Are you sure?” said Genji.

She nodded. “You’re always going on about how I’m not sleeping enough,” she said with that same slight smile.

Hesitantly, Genji edged onto the bed. He couldn’t really go under the sheets in his armor since that ran the risk of overheating, but his armor thermoregulated—he didn’t have too much trouble getting comfortable. She kissed his forehead as they wrapped their arms around each other. She liked being a bit more propped up against the pillows, but Genji was happy just to curl into her, his head against her collarbone like earlier. He fell asleep listening to her heartbeat, trying to match the words in his mind to that beat. We’re here. We’re here. We’re here.

#gency

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pommedeterre889-blog · 5 years

Text

Did you go potty for me?

So I have been staying with my mom and her boyfriend. This has been extremely difficult on its own. Not to mention I I lost my sweet angel baby xmas eve. I forget if I had brought that up. I’ll start crying everytime I think of her or hear her name, but the support I’ve gotten from old (and new) friends has been great.

I had an appointment with the liver and kidney doctors practitioner, she was very nice and knowledgeable. I had some labwork done and everything is looking good. Good news first: My bilirubin is way way down - that's what makes your skin look yellow with jaundice. I never really had it that bad except for a couple of days. ***queue to me looking for taco sauce and asking the lady stalking the isle where it was.... “ARE YOU SICK? DO YOU HAVE JAUNNDACE” me = triggered.... “and who are you?? who just asks someone that, i’m sick and just got out of the hospital. I don’t want your PRAYERS. Lady wont stop talking or apologize, my mom comes to my defense and the woman walks away with her tail between her legs.

As I was saying.... bilirubin is down but my kidney function went down also. (not a good thing in this case. The doctor suggested drinking a lot of water, keeping a low sodium diet ( less than 2000 MG a day..... psh easy. Keep in mind my pouch was restricted again when my scope was done. In an effort to not make this extremely wordy as I am oh so good at doing here are so gripes I have about dealing with my mother.

1. Can you go potty for me, please? you haven't peed since I got home - DON’T TALK TO ME LIKE I’M ONE OF YOUR DOGS. I WILL GO WHEN I HAVE TO. JUST BECAUSE YOU HAVENT WATCHED ME WALK TO THE BATHROOM DOESNT MEAN I HAVENT GONE

2. *me goes into the bathroom* less than 2 minuets later.... *knock knock* did you go pottty? I AM NOT ONE OF YOUR DOGS - I CANNOT LIVE UNDER YOUR MICROSOPE.

3.drink this, you’re supposed to have some protein before bed she said.- ok just pour a little into a glass and I will drink it, hands me a small glass, perfect amount.... (have you had ensure before? its THICK, DENSE AND HEAVY) **mom comes back into room after 2 minuets and two sips. “YOU NEED TO DRINK THAT!!!!” DUDEEEEEE I WILL DRINK IT, BUT I CANT CHUG IT” - “DRINK IT, ITS NOT ENOUGH ANYWAY” ------------I CANNOT CHUG IT!!!!!!!”

4. 5 mins earlier: We need to come up with a way that we can communicate and I don't feel like you are being too in control or putting me under a microscope. This is personal stuff ---mom, walks out of room and says I need to stop “pounding on me (she yells this by the way because her bf is in earshot and she wants to make me look bad.

5. I set one major boundary over here and that is my door with be shut and locked. after getting sick the 2nd time I agreed to keep my door unlocked as long as she KNOCKS first and I give her the ok like “come in” with in less than an hour that was broken, first by no knocking at all, 2nd by knocking and opening at the same time. I NEED PRIVACY

6. idk if anyone elsees mother is like this, but I doubt im not alone here.... *mom walks into room* things are where you put them, in a place where I can easily find them and then she comes in and moves shit around. the way my pillows are on my bed, where I put my shorts to wear under my nightgown to wear when i’m not sleeping.

7 im sure there are several more but I don't have the energy to put into this right now. ………...oh wait did you know my mother is a a libra? we were going to go run errands and she wouldn't let me wear my hair up, so I took it down.... she walks over to me with a brush and is just like “no” and styles my hair the way that she wants it to be done.

Im sure I could make another list of things her bf or her and her bf do that's extremely toxic but I think I've said enough tonight. I need to cleanse and get this negative energy out of my space. its a two way street though and I can’t do it alone, and only one of us is willing to try to change or work on the relationship.

I just have one last question.... will you go potty for me?

OK I have to put a quick #8 in because it just happened. she just came into my room to say goodnight and took my empty glass of ensure.guess who walks back in with MORE ensure because she thinks I need to drink all of it. and gets defensive when I get angry. she has also been bringing me unpeeled clementines which I love but #1 I am FULL and #2 they are very acidic I had two earlier and my stomach started to hurt. all she wants to do is bring me food and I DONT/CANT HAVE ANY OF IT. BRB proving a point and dumping out the ensure. Thanks for reading xoxox

#liver #kidney #sick #Cleveland clinic #chronic pain #potty time #smother #toxic relatiionship #toxic parent #rny

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alphabrucebanner · 7 years

Note

"five times kissed"? haha -buckysomega

@buckysomega, I genuinely loved writing this so much.

1. Bruce had been visiting Kati and her friends for the past week, getting to know them while he spent time relaxing. She had welcomed him with open arms, despite him being a perfect stranger apart from a dodgy-at-best reputation. Her kindness had struck him; very few people were comfortable having Bruce around even when they knew him personally, so there was a stark contrast between the way the public reacted to him and the way Kati and her family unit did. So he stuck around for longer than he thought they'd let him, making himself useful and offering help to those who needed it. For the first time in years, he had felt like a person, not Dr. Banner the mad scientist. By the time he was called back to the lab, Bruce was more comfortable in his own skin than ever. With a grin on his face, he had visited the main cabin one final time to say goodbye. He knew that he and Kati had the same hesitancy when it came to physical touch, but that didn't stop him from leaning in to kiss her cheek kindly, smiling down at her. "I promise I'll be back. You can't get rid of me now."

2. He could tell the moment he saw her that something wasn’t okay. As a person who had come to understand emotions better than most, Bruce could feel the dissonance in the air despite the smile Kati wore. She was always so strong, capable, levelheaded. But as anyone who stood so tall knew, every so often you fell from that pedestal- it was human nature, after all. No one was exempt from it, though others had a tendency to believe their leaders were. Without hesitation, the scientist was by her side, frowning softly in concern. She didn’t say anything- she didn’t need to. He knew exactly what she was going through. As she had done for him so many times, he wrapped his arms around her and pulled her into a comforting embrace, as if trying to shield her from her demons. Pressing his lips against her forehead, he stood there silently as he allowed her the time to let go and be whatever she needed at that moment.

3. Tony had decided to throw a rather unnecessary party, deeming it crucial to team bonding and whatever else; in truth, Bruce hadn’t paid attention to the reason. It was a way to blow of steam, no matter what the other man said. Everyone had a bit of a rough time lately, and needed the time. What Bruce hadn’t expected was to be handed a couple dozen extra invitations for “whoever he wanted,” though he appreciated the gesture and promptly sent them to Kati and her friends- his friends, he had to remind himself, still adjusting to having them. He made sure to be the first to greet her when she entered, knowing that if Tony got a hold of her she’d get her ear talked off about ridiculous things Bruce had done in the lab; he didn’t need that embarrassment. He led her around the room, showing her where everything was and introducing her to everyone else. The band had started to play by now, and when a swinging song by Frank Sinatra filled the room, Bruce couldn’t help himself. In a gentlemanly gesture, he took her hand with a kind smile, pressing a kiss to her knuckles. “May I have this dance?”

4. It wasn’t unlike him to be a little goofy… Or a lot goofy, really. Especially when he was overtired and overworked. Bruce hated how punch drunk he became after a few days with minimal sleep and tried to avoid it at all costs, but sometimes it was unavoidable. This was one of those times. Fresh out of a four day labwork binge, the scientist was making his way to his room finally when he spotted Kati walking towards him, no doubt having come to check on him. She was talking to him, but he wasn’t really paying attention, the lopsided grin on his face surely making him look insane. As he approached her he managed to cut her off mid-sentence, booping her nose lightly before giving it a soft peck and strolling away, leaving her confused and a little concerned. If anyone asked the next day, Bruce wouldn’t remember ever doing that, but also agreed it most likely happened.

5. Bruce was feeling incredibly touch starved. He could usually hide it well, but today was not his day. He craved cuddles and attention, and was ridiculously needy about it. The only person he expected to understand was Kati, and he sought her out before anyone else. Pouting like a child, he extended his long arms out to reach for her once he’d caught sight of her, making grabby hands like a true toddler. She laughed softly at him for it, but pulled him in anyway with an endearing smile. His large frame usually towered over her, but today he was hunched down, his cheek pressed against her shoulder as he clung to her as if his life depended on it. He melted when she started to stroke his hair; Kati always knew exactly what to do. Instinctively, he pressed a kiss against her shoulder before nuzzling against her, eyes closing in content as he mumbled quietly. “Thanks, Kati. You’re the best.”

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the-rift1 · 7 years

Text

@ that anon who asked me about the “talk about” post

1: Talk about the first time you watched your favorite movie.

I have a lot of favorites… mm I’d say inside out was probably my most favorite. And the reason why was well, it was the first time I met Aaron, which was cool, but also it was a movie that had like a headspace, although a lot more creative, and it was almost representative of how my mind works.

2: Talk about your first kiss.

My first kiss was in 7th grade on a field trip, when all the girls in my dorm room (just 3 other peaps) figured out that I never had been kissed. So when we played truth or dare, I said dare and one of the girls dared another to kiss me. God I was an awkward mess, and then I basically had a crush for like 4 years on that girl who kissed me. (yike) 3: Talk about the person you've had the most intense romantic feelings for.

Jesus, uh, well, they’re the love of my life and even though it’s been rough from the very beginning, they mean too much to me for me to let go, and even though they live like a thousand miles away from me I still want to have a life with them eventually, and just, I want them to be happy. 4: Talk about the thing you regret most so far.

I regret nothing, really. It’s kind of my philosophy to do things so I don’t regret never doing them. Well, I guess there’s one thing. I regret never being able to stand up to my mom when I was younger, but I don’t think that would have been possible if I was younger since I was still unable to put any distance between me and her, and her temper was very very short. So I guess there’s not much to regret.

5: Talk about the best birthday you've had.

It was my last birthday where I got to get together with my friends and we had a brunch and then they gave me two tiny derg plushies that were absolutely adorable because they were mini versions of my big Martin plushie and they’re Ginko and Safier. And I also got a handmade birthday card from Aidan which was neat cuz it had a derpy peridot n stuff. And then we went over to Aidan’s house and @fishdetective was there too and we had a hardcore battle of monopoly and then also played chessclock jenga. A couple days either after or before, I also got my first car!

6: Talk about the worst birthday you've had.

It's a hard tie between when I turned 15 or 16 and my parents just completely forgot my birthday or when I had to give my final senior honors project presentation which ironically fell on my birthday.. But I got to have tiramisu cake afterwards, so, I guess it wasn’t too bad.

7: Talk about your biggest insecurity.

I’m always afraid I look dumb in front of other people, idk. I try not to think about it and just tell myself that I really don’t care. Also when I wear new clothes, even if it’s like, a different type of flannel, I get pretty nervous. But after a day of wearing it or something, I’m fine.

8: Talk about the thing you are most proud of.

It would either have to be my own computer that I made which is an absolute gaming and art monster if you ask me, or my 6 foot long drawing, or my carey mask. I have a GTX 1080 with an i7-7700k core and also 24 gbs of ram, and about 2.5 TB of storage that fits in like, a small workstation tower with a budget of about 2000 dollars. And I’m going to make an even smaller one with about the same specs for my mom later this month cuz she has an 8 year old laptop and idk honestly how she gets anything done on that. I think I’m also pretty proud of Martin Dovohd and the creation of his adventures with Avery and Safier and Quinn, although we’ve never pinned anything solid down (because I’m a busy person and a lazy artist).

9: Talk about little things on your body that you like the most.

Whaaallle I like my hair cuz it’s rad but it needs a trim cuz it’s getting too long.. mm I like my hands, even though they’re tiny, but they function pretty well.

10: Talk about the biggest fight you've ever had.

I’d say the biggest fight was more like a physical and verbal beatdown from my mom and me silently taking everything because I was basically 12 years old…. Good times….

11: Talk about the best dream you've ever had.

Best dream? I was able to shapeshift into a dragon and do all kinds of shit. It was pretty long ago so I can’t recall, but I remember having an epic battle against another bigger red dragon and barely winning.

12: Talk about the worst dream you've ever had.

Um, probably one of the ones where I was raped or lost forever, or in a world where I was forgotten and people like close friends n stuff just don’t know who I am, or that one where I was being chased constantly by a murderer. Being shot by my best friend, straight in the head, on my knees. I got pretty dramatic dreams lol

God I just remembered last night’s dream which was fucking WILD because I was on this colonial ship, and idk if I was a stowaway or something, but I think there was this disease that started to spread and everyone was dying, so the captain decided to send me off on an escape pod and I was cryofreezed. So I ended up in a completely different solar system but I was sent to a prison since I wasn’t properly admitted and it was considered trespassing. I just remember seeing a sliver of a window to the outside world of the planet, and it was so vibrant and green.

13: Talk about the first time you had sex/how you imagine your first time.

It was alright, neither of us came actually.

14: Talk about a vacation.

Ok since it wasn’t specified, DREAM VACATION: Going to Japan, seeing cherry blossoms, trying out their hot springs, going to Tokyo, mmm idk. I don’t really have a specific itinerary planned. And then I would want to also go to Quebec city, and try out all the cool food they got and also go cross country skiing, and check out the snow festival. And then there’s that one place where it’s a snow hotel or something? Maybe that’s in France. I don’t remember. Also, I would love to road trip the entire US in a tesla. Specifically a self driving one cuz who wants to be at the wheel all the time lol. I also want to go to Sweden where I think they have a museum dedicated to machines playing music and it’s so neat. Oh yeah, I can’t forget about Yellowstone. And camping out there a night or so, when the sky is clear, and you get to see a million stars. Of course, this wouldn’t be worth anything if I couldn’t do it with someone tho. I think that’s where it’s the most fun.

15: Talk about the time you were most content in life.

In Rowan’s arms, when we first met. God, all I could think about then, was that, “I made it. I really made it. And it wasn’t all for nothing.” One of my dreams came to reality, and the only thing that I could have asked for more, was more time with him.

16: Talk about the best party you've ever been to.

Mmmmmmmmmm I’ve never really been to a party like a frat party, so, uh idk

17: Talk about someone you want to be friends with.

There’s this person at one of the dining centers that has really rad blonde hair and they just give out rad vibes and I just want to talk to them but I am just a bad nerd derg who can’t amount to their level. So. Yeah lol…

18: Talk about something that happened in elementary school.

I said fuck in third grade because my ‘friend’ wouldn’t stop singing “three little pigs” despite me saying please stop, and I got really frustrated and yelled, “Would you please fucking stop?” lol I broke down crying afterwards because everyone was staring at me in silence.

19: Talk about something that happened in middle school.

Rumors started spreading about how my friend who was a boy, that we “liked” each other, when in fact, we were just really good friends, and we agreed on the matter that that’s how it was and that people were trash. God he could make me laugh anytime even when I was super sad. It sucked that he had to transfer out when it got to high school though.

20: Talk about something that happened in high school.

Man, high school was fucking rough.. socially. I lost almost all of my middle school friends by the time I was a sophomore and I basically stuck to tumblr for comfort, cuz the school is very small and people already formed cliques that was already too late to join. I also wasn’t interested in them, since no one was a weeb like me. I really don’t want to talk much about this. Sorry.

21: Talk about a time you had to turn someone down.

On what? What does this imply, relationship? Mm I broke up with Aaron but for the most part, literally everyone else leaves first. Or just straight up rejects me, it’s pretty lit.

22: Talk about your worst fear.

I have a lot of fears and one of the worst ones is that I lose my hands, or that I lose my precise motor functions and I can’t draw, do labwork, or play the piano, etc etc…. Also abandonment, and just ending up as an old hermit. No, actually, I think my worst fear is just rejection. If I knew that there wasn’t a possibility of being loved n stuff, I think I would be pretty content with just myself and just living in the woods with a solid internet and my computer and maybe some doggos and other pets.

23: Talk about a time someone turned you down. Lord, alright. So I think one summer, I applied to five jobs as like a cashier or something and they all rejected me so I think that was pretty weird, and then on the other hand a day after or so, I see one of my peers working as a cart pusher and I just felt so annoyed. Not at them, just exasperated.

24: Talk about something someone told you that meant a lot. Well, someone told me that they would always love me. I find that hard to believe, personally, maybe because my mom told me that no one would love me unconditionally unless they were my parents. And some part of me always believed that, and another part of me always wanted to find evidence to refute it.

25: Talk about an ex-best friend.

Ahsdkjflajhfdkljs how about let’s not

26: Talk about things you do when you're sick.

Lay in bed, groan, eat soup and produce a lot of mucus. I would usually game and watch movies if I had the luxury to, or just do hw. And also feel sad because I probably wouldn’t be able to see anyone and couldn’t hang out with ppl.

27: Talk about your favorite part of someone else's body.

Hands are really interesting. And also the worst to draw. But there’s just so much variance in people’s hands, which I think is cool.

28: Talk about your fetishes.

Um 29: Talk about what turns you on.

What 30: Talk about what turns you off.

Thrussy

31: Talk about what you think death is like.

Dark. Cold. Nothingness. Just, a stop. Maybe I get to be reincarnated as a rock or something. Or there’s a place for souls. No one knows. Idk.

32: Talk about a place you remember from your childhood.

I remember that there was a lake, like a block from my house and on special days with my Gramps I got to take out my toy motorboat and play with it but most of the time it got caught on the algae.

33: Talk about what you do when you are sad.

I game. I just distract myself to the point that I forget everything else. And I also watch cartoons n stuff.

34: Talk about the worst physical pain you've endured.

Probably that one time where I fell and the gravel gouched out a cubic centimeter of my knee. I bled pretty consistently and my mom had to pull out bits of rock when I got back home from that.

35: Talk about things you wish you could stop doing. I wish I could stop wasting so much time and actually doing important work lol. I don’t particularly have any nasty habits, really. I never bit my nails or sucked on my fingers.

36: Talk about your guilty pleasures. hoarding chocolate. Hoarding food in general, and buying unnecessary tech stuff for myself. Also buying games when I already have too many to play with.

37: Talk about someone you thought you were in love with. I’m pretty sure I was in love with the people who I “think” I were in love with? I don’t really understand this. Is this about like, past ex’s? I know who I love. Or I could interpret “in love” as a crush? Mm okay. Let’s have it that way. I had an infatuation with this girl who low-key reminded me of betty boop but like a better, sexy version of it. Her makeup was always on point and just had a really good aesthetic, and then I also found out that she liked hardcore metal, which is cool, but not my taste. So, like, super amazing aesthetic that was probably incompatible with mine.

38: Talk about songs that remind you of certain people.

There’s a lot of songs that remind me of people, but mainly Rowan and Aidan. Anything by Porter Robinson reminds me of the time when I was with Aaron. The Muppet song where they go “mnah mnah doo dooooo do do do” reminds me of Hila and that used to trigger me for a while but I’m chill with it.

Some main ones that remind me of Rowan:

Paradise Valley by Honey and the Sting

Honeybee by the Steam Powered Giraffes

I Know You're Out There by Stephanie Mabey.

Ones that remind me of Aidan:

Give Up by the Postal Service

BGC418 by Big Giant Circles and also their entire Imposter Nostalgia album

any song by Wintergatan

39: Talk about things you wish you'd known earlier.

I wish I figured out what feelings were. Like, when I was young, I never made the connection between the words and the emotions that those words described. For the two years of me crushing on that girl I talked about earlier, I didn’t understand what my attraction meant. And that it was also okay to be gay. Yeah I wish I knew about that whole ordeal, and also how to socially navigate my way through high school n shit. I also didn’t understand the connection between the word guilt, and the feeling. I just knew I felt super awful and it was a really terrible pain in my chest and hands and that I just wanted to die from it.

40: Talk about the end of something in your life.

I don’t know, I’m pretty young, and there’s a lot of things that are just starting. I guess you could say it’s the end of the number of bad things that’s happened to me in grade school and the end of the ridiculous amount of bullying I had there, and hopefully never comes back.

#ask #thanks anon #took me a solid hour #anonymous #dragon talks

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yung-cringe-blog · 7 years

Text

Acne Occurs In A Minority (10 ) Of Patients - Acne Conglobata Acne Fulminans Acne Vulgaris

Went away in 3 days. Actually I got a bad breakout this past week even forcing myself to stay home being that I was emotionally wrecked about itbut it turns out it was folliculitis!!! Additionally, clinical evidence supports use of following OCPs for acne. Alesse, 'Diane 35', and Yasmin. Rare but more serious complications include thrombophlebitis, pulmonary embolism, and hypertension. Hormonal therapy is an established secondline treatment for female patients with acne. Needless to say, Oral contraceptives will be used cautiously in patients that smoke, have a history of hypercoagulable states, or breast cancer. Just think for a moment. Common consequences from combined oral contraceptive pills include nausea, vomiting, abnormal menses, weight gain, and breast tenderness.

The clinical signs of nonclassical CAH result from impaired aldosterone and also cortisol mediated negative feedback control of ACTH secretion.

Similarly treatment of acne in nonclassical CAH, that is often severe, cystic and refractory to antibiotics and isotretinoin, consists of low dose oral glucocorticoids which counteract adrenal androgen production, specifically, low dose oral prednisolone or dexamethasone.

Treatment of CAH therefore consists of substituting cortisol and/ or aldosterone daily. Still, patients must sign a consent form acknowledging they are aware of this potentially lifethreatening risk and physicians should monitor for signs and symptoms of depression throughout course of treatment. A true causal relationship between two has not been proven. Data regarding a possible association between depression and an increased risk of suicide during treatment with isotretinoin is unclear. In contrast to pical antibiotics, microbial resistance to BPO has not been reported. Actually, It is therefore preferable to pical antibiotics for 'long term' use and maintenance therapy.

So it's effective when used alone or when combined with pical retinoids, as previously mentioned. Benzoyl peroxide is a potent bacteriocidal agent that primarily works by reducing acnes within tofollicle. Nodulocystic acne and is commonly used in any significant acne unresponsive to therapy that results in significant physical or emotional scarring, it had been 'FDA approved' for patients with severe pyoderma faciale, and acne fulminans. While reducing presence of acnes and exerting 'antiinflammatory' effects, Isotretinoin works by normalizing epidermal differentiation, markedly decreasing sebum production. Therapy is generally initiated at a dose of 5 mg/kg/d for 4 weeks, after that, increased to 0 mg/kg/day as lerated and continued until a cumulative dose of 120 150" mg/kg is achieved. Negative psychological outcomes like anxiety, depression, and social withdrawal, are widely reported among individuals with acne and acne scars.

Now this should be noted and an appropriate referral to a psychologist or psychiatrist can be necessary if severe, So in case patient complains of significant anxiety or depression.

That said, Therefore if a patient notes ingestion of a certain food exacerbates their acne, that food can be avoided in that individual.

In most patients with acne, specific changes to diet are not recommended. The data on effects of diet on acne is still shouldn't be a substitute for standard acne treatment. Can be warranted if acne is very abrupt in onset or accompanied by other signs of hormonal or metabolic imbalance similar to hirsutism, hair loss, and akin signs of virilization, labwork is rarely necessary in diagnosis of acne, especially in adolescent population. Onset of acne in midchildhood always warrants a complete evaluation for causes of androgen excess. Of course to Now please pay attention. Patients might be asked about presence of hair loss, hirsutism, irregular menses, and arthritis, that are commonly associated features of these syndromes.

There are a few complex syndromes where acne or acneiform eruptions should be a regular presenting feature. Warning signs to suggest that acne can be part of an underlying medical syndrome include acne that is very severe, treatment resistant, diffuse in presentation or sudden in onset. One must entertain possibility of PAPA and SAPHO syndromes, if there are arthritic complaints. Vigilance for possibility of hyperandrogenism should allow clinician to consider PCOS, 'HAIR AN', SAHA, and CAH syndromes. Triamcinolone acetonide is injected into selected cystic lesions using a 30 gauge needle. The maximal percentage of corticosteroid used per lesion shouldn't exceed 1 ml.

The risks of corticosteroid injections include hypopigmentation, atrophy, telangiectasias and needle tract scarring.

Treatment is generally only effective when used chronically and relapse was shown to occur shortly after cessation, there are currently unlikely to be 'cost effective' options for most patients, as mechanism of action of many current light treatments and lasers is by suppression of acnes activity.

It can be an ideal adjuvant therapy for strong link between diet and acne remains to be proven, A high glycemic diet was stipulated as a potential aggravator of acne. Genetic influences can influence severity of disease. Consequently, Additionally, while patients often report that their acne flares during periods of high stress, a strong causal association has not been shown. Dairy, particularly skim milk, has also been implicated as a possible aggravating factor in acne. These data need to be corroborated by clinical trials before recommendations to patients can be made. You should take it into account. As microcomedo is precursor to all acne lesions, so it is particularly important both comedones and papules/pustules.

Retinoids are anticomedogenic, comedolytic, have significant direct and indirect anti inflammatory effects, and prevent formation of new microcomedos.

Yeast, including Malessezia species, are thought to play a pathogenic role.

It generally resolves spontaneously. Neonatal acne affects about 20percentage of healthy newborns and typically presents as small inflamed papules and pustules on cheeks and nasal bridge. Consequently, Neonatal cephalic pustulosis is an alternate term used to describe this benign neonatal eruption. Just keep reading! Comedones are not present. Usually, whenever dissecting cellulitis of scalp and pilonidal cysts, Acne conglobata is included in follicular occlusion tetrad gether with hidradenitis suppurativa. Recurrences may occur, isotretinoin is most effective treatment. For instance, This form is notoriously difficult to treat and residual scarring is quite severe. Acne conglobata is another kind of severe, nodulocystic acne.

Numerous nodules melt gether into suppurative plaques. Combined adapalene and BPO has greater efficacy than monotherapy with either product alone with a cutaneous lerability that is comparable to adapalene monotherapy. For deep and inflamed cystic lesions, intralesional injection of corticosteroid can quickly improve both appearance and tenderness of these lesions. Larger nodulocystic lesions may require incision and drainage prior to steroid injection. It is thought to result either from elevated circulating androgen levels or increased sensitivity of pilosebaceous unit to androgens. Treatment consists of lifestyle modification, oral contraceptives, insulin sensitizing agents, and antiandrogens. Essentially, SAHA -The association of seborrhea and acne with hirsutism and also androgenic alopecia characterizes SAHA syndrome.

Acne occurs in a minority of patients. However, seborrhea is always present, The full clinical spectrum rarely occurs. Look for secondary changes just like scarring and postinflammatory pigmentary changes, as we are looking at important clinical findings that may alter your treatment strategy. Nevertheless, this may affect chosen formulation for pical medications, Note topatient's skin type. On physical examination, carefully note lesion morphology, including presence of comedones, inflammatory lesions, and nodules. Notice that Patients might be advised that local erythema, dryness, and itching commonly occur within first weeks of usage but these effects decrease with continued use. I know that the use of sunscreens is advised. I'm sure you heard about this. Additionally, a pustular flare of acne throughout the initial '34' weeks of treatment may occur, however it resolves spontaneously with continued usage. Irritation and thinning of stratum corneum may increase touser's susceptibility to sunburn, with continued use of pical retinoids. Fact, Laboratory studies should include TSH, LH/FSH, prolactin, '17hydroxyprogesterone', serum DHEAS, and tal and free testosterone. Essentially, A pediatric endocrinologist should've been consulted to evaluate child if any abnormal parameters are found.

The presence of acne in this age group warrants evaluation for hyperandrogen states including.

A full physical exam looking for secondary sexual characteristics, review of growth charts, and a bone age will be performed.

Additional evaluation includes ultrasound and MRI as indicated. Nevertheless, Cushing syndrome, congenital adrenal hyperplasia, premature adrenarche, gonadal or adrenal tumors, and precocious puberty. Of course Mid childhood acne presents after 1 year to 7 years. Anyway, For instance, acnes contains 'light sensitive' porphyrin compounds, that absorb visible light at a couple of wavelengths, particularly between 400 and 700 nm. Whenever causing formation of reactive free radicals, that damage lipids in cell wall of acnes, resulting in destruction of toorganism, Absorption of light excites porphyrin compound. Light decreases acnes levels by interfering with its normal metabolism. Many lasers and light sources emit at this desired wavelength, including intensed pulse light devices, PDLs, KTP lasers, orange/red light lasers or light sources. It is Women with PCOS frequently also suffer from acne, central obesity, hirsutism, alopecia and infertility. Biochemical markers of hyperandrogenism include elevated serum testosterone and an increased LH/FSH ratio greater than 2Treatment consists of weight reduction, insulin sensitizers just like metformin, and oral contraceptives.

PCOS should've been suspected in women whose acne is severe, persistent and resistant to conventional therapies. Acne is present in '23 35'percentage of women with PCOS. Side effects are 'dose related' and include potential hyperkalemia, irregular menstrual periods, breast tenderness, headache, and fatigue. These include trimethoprim sulfamethexazole, amoxicillin and identical penicillins, cephalosporins, and azithromycin. Data on their efficacy and safety ain't well established and their use in treatment of acne is generally discouraged. Several other oral antibiotics was used for treatment of acne. Of course, The androgen receptor blocker spironolactone is another second line option for females with inflammatory acne. It works by inhibiting 5ɑreductase and at doses of '50 100' mg twice daily, it was shown to improve acne. Salicylic acid is available in numerous over counter concentrations of up to 2 in lots of delivery formulations, including gels, creams, lotions, foams and solutions. It is available as a pical cream. Azelaic acid is applied twice daily and its use is reported to have fewer local consequences than pical retinoids.

It inhibits growth of acnes and improves both comedonal and particularly inflammatory acne.

Azelaic acid is a naturally occurring dicarwriteylic acid found in cereal grains.

Additionally, it can on the basis of age of patient as well as morphology and distribution of tolesions. It is available in a 10 lotion, either alone or in combination with 5percentage sulfur. Now look. Sodium sulfacetamide is an alternative well lerated pical antibiotic that is thought to restrict growth of acnes through competitive inhibition of condensation of paraaminobenzoic acid with pteridine precursors. Now let me tell you something. By nature they provide improved patient convenience, that may translate to improved adherence. Currently, adapalene is one pical retinoid to be formulated with BPO. Fixed dose' combination products with a pical retinoid and an antimicrobial are available. The first step is to complete a thorough history and physical examination. On p of that, Note clinical responsiveness and lerability to any prior treatments. In female patients, a menstrual and oral contraceptive history is important in determining hormonal influences on acne. Considering above said. Specifically ask about all prescription and overthecounter medications used for acne and similar conditions.

This will aftereffect to counsel patients on include gastrointestinal upset, most commonly experienced with doxycycline. They should also be avoided during pregnancy as they can negatively affect bone and cartilage growth of tofetus. Rare hypersensitivity reactions including serum sicknesslike reaction and DRESS syndrome are reported. Furthermore, All tetracyclines can cause photosensitivity and can cause staining of toteeth. Pseudotumor cerebri is a rare consequences seen with tetracyclines as well. Some patients noted health benefits beyond improved in acne like decreased facial oiliness, decreased hirsutism, improvement of premenstrual syndrome symptoms, decreased metrorrhagia, reduced endometriosis pain, and increased libido. Seriously. Again available data does not suggest a causal association but patients gonna be counseled appropriately on possible risk.

Similar controversies surround isotretinoin and risk of inflammatory bowel disease.

Whenever releasing lipases and identical enzymes, They are proinflammatory.

They also induce innate immunity inflammatory cascades, through 'toll like' receptor 2 and metalloproteinases. They was shown to activate inflammasomes as well. Increased colonization of acnes. Tretinoin/clindamycin is also available as a fixed dose combination product. Both clindamycin and erythromycin are available in pical combination formulations both with BPO which all had comparable efficacy and significantly reduced acne lesions. Topical BPO/erythromcyin will be refrigerated, that could impact adherence. These include. Basically, Systemic symptoms often accompany acne fulminans. Consequently, Scarring, often severe and keloidal, is inevitable. Acne fulminans is a severe, eruptive type of acne that primarily occurs in teenaged boys, ages '13 The' acne appears abruptly over face and upper body with uniform papules and friable nodules that can coalesce, suppurate and bleed. There is a lot more information about it on this site. Whenever affecting clavicle or sternum most commonly, can be associated, Osteolytic bone lesions. Anyways, Eythema nodosum is reported with acne fulminans as well. Ok, and now one of most important parts. Bleach resistant bedding is available at some major national retailers.

Patients will be advised that benzoyl peroxide is a bleaching agent and whitening of clothing, towels, and bedding can occur. Development of contact dermatitis to benzoyl peroxide is possible, and will be suspected in patients who develop marked erythema with its use. It is also important to speak frankly with patient and determine what effect acne is having on their quality of life. Stress is also often associated with flares, and So it's common for students to report that their acne appears to worsen around exam time or finals. Ask use of about cleansers, toners, and moisturizers, as harsher products may affect tolerability. Female patients may report a worsening prior to their menses. Patients may also report an exacerbation with certain foods although a clear association between any particular food and acne has not been proven. However, Five to 20 women percent are thought to suffer from this disorder. That's interesting right? Polycystic Ovarian Syndrome -The most common syndrome associated with acne is PCOS, an endocrine disorder characterized by polycystic ovaries, oligo and anovulation, and biochemical and also clinical signs of hyperandrogenism.

PCOS is also strongly associated with insulin resistance.

It is also less drying and has a milder after effect profile.

Patients going to be advised to use this in tomorning, as tretinoin is susceptible to oxidation by BPO, if BPO is also being used. Besides, Patients may be instructed to apply a 'peasized' quantity of retinoid all over their face, not merely active areas. Adapalene is light stable and resistant to oxidation by BPO, unlike tretinoin. If tretinoin has been used it must be applied at night to prevent early degradation as it's photolabile. Tetracycline absorption is affected by elemental ions including calcium, aluminum, iron, and zinc and therefore shouldn't be ingested with meals particularly those involving dairy products or antacids.

Minocycline and doxycycline are less influenced by foods and generally can be taken with food. Reconsider if patient isn't responding to oral antibiotic therapy as expected, as individual absorption rates and influences can vary widely. Their use and efficacy in treatment of acne isn't fully established. Other agents used for their anti inflammatory properties include nicotinomide, both pically and orally, and zinc. So use of pical retinoids, particularly tazarotene during pregnancy is discouraged, as retinoids are known teratogens. I'm sure it sounds familiar. Patients could be started on a lower concentration retinoid with gradual increase in strength and frequency as necessary, in order intention to minimize excessive dryness and irritation. Now regarding aforementioned fact... Frequency can be increased in stepwise '34' week increments as tolerated, alternatenight to every third night application should be necessary initially. Actually, Several medications are known to cause acne or acneiform eruptions.

A detailed medication history should always be taken, including use of vitamin, protein/muscle building supplements.

It can be important to ask about use of anabolic steroids in athletic young men.

B2, B6 and BIt is important to ask about use of pical cosmetics and hair products, as Surely it's useful to ask about patients' occupational history, including their hobbies, as these may result in aggravation of acne. Keep reading! Poor adherence to acne treatment plans is a typical cause of inadequate therapeutic response. Did you hear about something like that before? Discussion with patient about what they do not like about a certain product and substituting accordingly may will be clearly ascertained that patient was adequately using prescribed medication consistently and correctly. These include bar soaps, washes, gels and lotions that are available in concentrations of 5percentage, 5 and 10. The formulation is also an important cofactor in toproduct's irritancy. Many preparations of BPO are available in both overthecounter and prescription formulations. Higher concentrations of BPO should be more irritating and not necessarily more efficacious than lower concentrations. Notice, It is also a mild chemical irritant that works in part by drying up active lesions.

Salicylic acid is a comedolytic and mild antiinflammatory agent.

Patients with acne gonna be discouraged from using tanning as a treatment for acne.

Shortterm benefit is outweighed by to'long term' photodamage and increased risk of skin cancer, while tan may mask toacne. Oftentimes many sunscreens are labelled as non oily or 'non comedogenic', as with cosmetics. Sensitivity and phototype of topatient, when recommending a sunscreen for patients with acne consider tooiliness. Use of sunscreen in patients on medications that can cause photosensitivity, similar to retinoids or doxycycline, is a must and their use will be advocated with every visit.

This disorder affects approximately 1 of general population, is marked by signs of hyperandrogenism.

Additional signs in females include unrecognized genital structural defects, abnormal menstrual cycles or infertility.

This form is due to partial defects in '21 hydroxylase' and severity of presentation is highly variable. Adapalene is 'lightstable' and resistant to oxidation by benzoyl peroxide, unlike tretinoin. When applied to toskin, Tazarotene is also a synthetic receptor specific retinoid that is converted to its active metabolite, tazarotenic acid. This is where it starts getting very intriguing. Tretinoin was first pical comedolytic agent developed for treatment of acne. The most commonly utilized pical retinoids include. Adapalene is a synthetic retinoid that specifically binds retinoic acid receptor Ɣ. Current COC formulations combine an estrogen with a progestin with intention to minimize risk of endometrial cancer that is known to occur with unopposed estrogens. Of course, Patients going to be advised that clinical response to OCPs generally requires at least 3 months before one is able to determine efficacy. Oral contraceptive formulations with lowandrogenic progestins similar to drosperinone, norethindrone and levonorgestrel are preferred, because progestins have intrinsic androgenic activity.

Additionally, true acne vulgaris will be differentiated from acneiform eruptions. These include. Epidermal growth factor receptor inhibitor- induced eruption. In neonates, following differential diagnosis will be considered. I'm sure you heard about this. Adult acne is far more prevalent than originally thought. Women with hormonal abnormalities as well as diseases of insulin resistance just like polycystic ovarian syndrome, are at risk for development of acne. Besides, while affecting up to 85 of '1224' year olds, Acne is a similar disorder in adolescents. A patient with severe acne has high chances to report a family history of severe acne. On p of this, Additionally, these groups tend to have acne that is more severe and less responsive to traditional therapy. Other groups with an increased risk for development of acne include those with hyperandrogenism, hypercortisolism, precocious puberty and those with XYY genotype.

While postadolescent acne predominantly affects women, Adolescent acne appears to show a slightly more male predominance while.

Genetic influences and ethnicity also impact risk.

The reported prevalence of acne in women aged 30 39 years is 35. The use of makeup has not been shown to adversely affect a patient's response to acne treatment. Patients gonna be instructed to look on label for a 'water based', 'non comedogenic' formulation. Use of cosmetics can be very beneficial in covering up active acne and improving patient quality of life. Eventually, Additionally, it's crucial to counsel patients to discard any liquid make up that is expired. Now please pay attention. In darker skinned patients, post inflammatory hyperpigmentation is often present and can last for a couple of months after resolution of inflammatory acne, and in rare instances should be permanent. Known Scarring most often results from more severe inflammatory acne lesions but can occur with milder forms as well.

Additionally, it's vital to note presence of secondary changes of acne.

Keloids may form in 'at risk' individuals.

Can occur in fairly mild cases as well, they usually arise in cases of severe nodular acne. Lighter skinned patients may show postinflammatory erythema that also can take many months to improve. Fact, In women of childbearing age, two negative pregnancy test results are required before therapy can be started. Generally, Contraception counseling should also be seriously discussed and two effective forms of birth control gonna be used in women who are sexually active. Strict adherence to FDA mandated risk management program iPledge is vital, Additionally, isotretinoin is a potent teratogen. Several serious consequences of isotretinoin therapy exist including acne fulminans, formation of excessive granulation tissue, and an increased risk of cutaneous infections. Treatment involves oral glucocorticoids, that concomitantly helps treat toarthritis, pyoderma gangrenosum and acne conglobata. Keep reading! It results from mutations in gene that encodes prolineserinethreonine phosphatase interacting protein 1 and is part of a related group of inflammatory disorders that includes inflammatory bowel disease, uveitis, and psoriasis.

PAPA -The triad of sterile pyogenic arthritis, pyoderma gangrenosum, and acne conglobata characterizes PAPA syndrome. Disease modifying agents, biologic therapies and dapsone have also been shown to be efficacious. High rates of resistance been correlated with high outpatient use of antibiotics and selection pressure can affect other more pathogenic bacteria in addition to acnes. Additionally, antibiotic monotherapy either for acute treatment or maintenance therapy should've been avoided. With that said, Additionally, totetracyclines, particularly doxycycline, was implicated as a possible risk factor for inflammatory bowel disease duration of antibiotic use should've been limited to 3 months if possible and clinical response and need for continuation frequently assessed. Bacterial resistance is of concern with oral antibiotics, as with pical antibiotics. Oral dapsone can be used as a 3rd line treatment for severe acne in patients who can not take or have failed oral tetracycline and isotretinoin therapy. Now please pay attention. Patients should've been checked for G6PD deficiency prior to starting and monitored for hemolysis. Actually, I know it's preferable that pical antibiotics alone be avoided as monotherapy and could be paired with BPO, since of risk of antibiotic resistance.

They are available in various formulations from creams and gels to solutions and pledgets. Other commonly used antimicrobials include pical antibiotics like clindamycin and erythromycin. Spironolactone after effect are dose dependent and can also be minimized if therapy is initiated with a low dose and gradually built up as necessary. Similar to COCs, clinical response may take up to 3 months. Effective maintenance doses are in range of 25 to 200 mg/day. Mild consequences are often seen with isotretinoin use including. It has greater efficacy in treating inflammatory acne lesions than comedones. Topical use is safe in G6PD deficient patients and in those that are sulfa allergic. Use with BPO can cause a 'yellow orange' staining of skin and hair. In comment section. Topical dapsone is used for its antiinflammatory properties in treatment of acne vulgaris. Needless to say, most of us are aware that there is a risk of feminization of a male fetus if a pregnant woman takes this medication, as long as So it's a 'anti androgen'.

This potential risk can be minimized by combining spironolactone with an oral contraceptive, and has added benefit of combating potential symptoms of irregular menstrual bleeding, most common after effects of spironolactone.

The use of a couple of other systemic agents had been reported in generally in complicated cases of severe, refractory acne.

These include anti TNF alpha agents, entanercept and infliximab, and antiandrogens, just like flutamide. Eventually, Chemical peels are used both in treatment of comedonal acne and acne scarring. A various preparations in varying concentrations including glycolic acid, alpha and beta hydroxy acids and salicylic acid, have all been used. Comedo extraction can improve cosmetic appearance and aid in therapeutic responsiveness to prescribed comedolytic agents. Remember, Monthly pregnancy tests must be continued throughout the entire course of treatment. Although, Baseline laboratory testing before isotretinoin therapy is also recommended and generally includes cholesterol and triglyceride assessment and hepatic transaminase levels. These values could be rechecked once patient is at a steady dosing.

Hormonal therapies have demonstrated efficacy in adult women with persistent inflammatory papules and nodules that commonly involve lower face and neck.

These women also commonly report that their acne flares prior to their menstrual periods and consists of a few tender deep seated inflammatory papules and nodules.

As long as latter block both ovarian and adrenal production of androgens, In such patients, oral antibiotics can be discontinued and hormonal therapy with oral contraceptives initiated. These patients often note little improvement in their acne despite multiple courses of various antibiotics. Nodules and nodulocystic lesions are seen in more severe disease. While affecting up to 85 of 12 24 year olds, Acne is an exceptionally common disorder in adolescents. While involving toface, chest, shoulders and back, are hallmarks of acne vulgaris, The presence of inflammatory papules and pustules with comedones. In fact, most patients can accurately diagnose themselves. Secondary changes, like scarring and postinflammatory hyperpigmentation or erythema are common and could be documented, as they impact both management and disease outcomes. On p of this, Patients on isotretinoin are followed monthly for duration of their treatment in compliance with iPledge system.

Mild to moderate cases can be followed up at 3 4" month intervals once treatment is initiated.

Interim visits can be useful to establish lerability and compliance.

The patient 'followup' will depend on acne severity. Basically, If a patient does not appear to have adequately responded to treatment you have initiated after 2 3 diligent months use, an alternative treatment strategy gonna be considered. It may be stressed that significant improvement may not occur until 8 week mark or longer. Severe cases will be followed up more closely, at 23 month intervals. Cryotherapy represents another surgical option for treatment of comedonal acne. That's where it starts getting very interesting. The contents of open comedones can be expressed by use of a comedo extractor and toSchamberg, Unna and Saalfield kinds of comedo types expressers are most commonly used. Actually, Additionally, nicking surface of a closed comedo with a 18 gauge needle or a no. Notice, The algorithms below provide a treatment overview followed by specific algorithms for treatment of mild, moderate, and severe acne.

Evidence in sort of randomized control trials to prove clear effectiveness of these therapies is lacking.

There is also little standardized information available about longterm effects of such therapies or optimal device settings, or frequency of administration in active acne.

In addition there're no studies that actually compared lightbased treatments with current standard of 'carecombination' therapy with a pical retinoid plus one or more antimicrobial agents. SAPHO -This syndrome is a rare disorder, Ortho 'TriCyclen', and Yaz. Now regarding aforementioned fact... Additionally, light may also have endogenous antiinflammatory properties via action on inflammatory cytokines. Oftentimes They can also be used for scar revision once acne is under control. Light based treatments work by reducing acnes levels and also disrupting sebaceous gland function.

In addition to photodynamic therapy, YAG laser, '1450nm' diode laser. There are many surgical treatments available for treatment of acne including various lasers, like pulsed dye lasers, 1064 Nd. Treatment is indicated, as scarring commonly occurs in this age group. Acne in this age group is due to elevated androgen levels, including DHEAS resulting from an immature adrenal gland. Comedones are present, with variable inflammatory lesions. There's more info about this stuff on this website. Boys may also have increased testosterone production. Now look. Infantile acne generally occurs between 3 and 6 age months, lasting throughout first and into second year of life.

Apert syndrome -This congenital disorder is also known as acrocephalosyndactyly and results from mutations in FGFR2, that encodes fibroblast growth factor receptor.

Patients with Apert syndrome present with widespread acneiform papules, including entire extensor sides of toarms, buttocks and thighs.

This autosomal dominant disorder is also defined by disfiguring synostoses of bones of hands and feet, vertebral bodies, and cranium. Normally, however, isotretinoin was beneficial in severe cases, acneiform lesions of Apert syndrome are highly resistant to pical therapies. Some information can be found by going online. Light electrocautery and electrofulguration have also been reported as effective treatments for comedones and electrofulguration has added benefit of not requiring prior use of a pical anesthetic. On p of that, Laboratory studies are nonspecific but reflect degree of inflammation. That's where it starts getting really entertaining, right? Treatment of acne fulminans is aimed at controlling inflammation quickly while preventing an isotretinon associated flare.Typically oral corticosteroids are started with a gradual introduction of isotretinoin.

Abnormalities include leukocytosis, anemia, elevated erythrocyte sedimentation rate and proteinuria.

Pustules are similarly sized and filled with thick, white, purulent fluid.

Nodules are greater than 5cm and can be indurated and very tender. The clinically inflammatory lesions seen in acne vary from papules and pustules to more severe nodules and nodulocystic lesions. Papules are less than 5cm in size. The presence of nodules often correlates with greater acne severity. Forming large suppurative plaques that can result in persistent scarred sinus tracts, At times, nodules can combine. In adolescents and adults differential diagnosis is extensive and includes. Doesn't it sound familiar? Pseudofolliculitis barbae/acne keloidalis nuchae. The pathophysiology of acne vulgaris centers on pilosebaceous unit and is multifactorial.

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