#unfortunately this line also triggers if you are under 5% health and its sort of ridiculous then

[followthebluebell]

FIP: Feline Infectious Peritonitis

Sprinkles contemplates some birds.  We’re re-doing the catios right now, so they’re all closed off.  I think she’s looking forward to being outdoors again.

I’m putting a cut here because this is a LENGTHY READ and, in case of further developments, I’d like to be able to easily update this article. 

In October 2019, she was diagnosed with ocular FIP (Feline infectious peritonitis), which is a mutation of feline coronavirus (FCoV, which is very distinct from SARS-CoV-2, the virus that causes COVID-19).   FCoV is ubiquitous in the cat population: almost every cat has it or is exposed to various strains of it.  Most cats get over it just fine with only mild diarrhea.  In a small percentage of cats (we’re uncertain on the percentage, which I’ll get into later, but it’s theoretically somewhere between 5-10%), it goes fuckwhack apeshit and mutates into FIP.

We don’t know why it spontaneously mutates.  There seems to be a genetic component to it.  It’s believed to be more common in purebred cats, but we’re really not sure--- since FIP is a diagnosis by exclusion, there often is a hefty vet bill attached to the diagnosis and a person who can afford to buy a purebred cat from a cattery is more likely to be able to afford that bill.  It MAY be triggered by stress.  It’s much more common in younger cats, often appearing in kittens ranging from 4 months to 4 years.  This doesn’t mean older cats are safe; I know of at least one case in a 12 year old cat.

Sprinkles was diagnosed at 3 and a half months.  She didn’t have a particularly stressful event before developing symptoms.  She’s not a purebred.  I don’t know anything about her genetic history, so I can’t cross that off the list.

Mickey, my second FIP kitten, was diagnosed at 4 months.  I know slightly more about his health records but it’s still scant.  He arrived with an unusual skin ailment: sarcoptic mange.  Hypothetically, this could indicate an already delicate immune system that left him vulnerable to this sort of FCoV mutation.

FIP is deadly and remains, to this day, the most horrifying disease I’ve ever personally encountered.  Thankfully, FIP itself is NOT contagious.  FCoV is highly contagious but, as previously mentioned, it’s fairly common in the cat population.  There was a study done to see if separating kittens from their mother at 7 weeks (approximately the period when a mother’s antibodies begin to wear off and the kittens have to begin producing their own) would prevent cats from catching FCoV from her.  This was effective but the social drawbacks are too heavy a cost for it to be considered regularly.

There is a vaccine for FCoV but it’s largely ineffective and most vets don’t recommend it.

FIP comes in two primary forms: wet (effusive) and dry (non-effusive).  Usually, FCoV exists only in the gastrointestinal system.  It’s really the only place it can replicate itself with ease.  Once the virus mutates, it can’t replicate itself as well, but it CAN infect macrophages.  Macrophages are highly mobile white blood cells.  They go pretty much everywhere, and ones infected with FIPV (Feline Infectious Peritonitis Virus) will carry the virus along for the ride. 

The early symptoms are vague.  These cats are lethargic, listless, have low or no appetite, weight loss, and a fluctuating fever.  The first symptom I caught in Sprinkles was complete avoidance: she was actively avoiding other kittens and other kittens were avoiding her.   Mickey’s only symptoms were lethargy and diarrhea.  I only got suspicious about possible FIP because the other kittens in his playgroup didn’t have any diarrhea at all. 

And this is where we see a split in the forms of FIP.

Effusive FIP is characterized by the accumulation of fluid within the abdomen and is more common.  It happens very quickly.  Cats with effusive FIP develop breathing problems rapidly.  The fluid drawn from the abdomen is usually straw-yellow.  Effusive FIP is said to be more common, although only one of the 5 cases I’ve seen in the last few years was wet FIP. 

Thankfully, effusive FIP has a few distinct traits that makes it easier to diagnose.  It’s important to remember that FIP itself is generally a diagnosis by exclusion. 

Measuring the protein in the effusion is a good first step.  If it’s less than 35g/l, FIP is generally ruled out.

The albumin to globulin ratio is considered next, via a blood test. If it’s less than 0.4, FIP should be considered.

Finally, examining the cells in the effusion is valuable.  If they’re primarily lymphocytes, FIP is excluded.

Non-effusive FIP is more difficult to spot, because the symptoms are so varied.  Granulomas (inflammatory cells) form in various organs, which produces an extreme variety of symptoms.  The most commonly affected symptoms are the ocular and neurological symptoms.

Ocular FIP happens when the virus crosses the blood-ocular barrier and is characterized by slightly opaque white films on one or both eyes; these don’t cover the entire eye.  They’re often just a small section.  This was the first distinct symptom I saw in Sprinkles. It’s considered a distinct enough sign that her ophthalmologist was able to tell me that she was 99% certain it was FIP.

Neurological FIP is my own personal hell.  The virus crossed the blood-brain barrier and infects the brain.  The first symptom is usually a limp or a slight tremble in the head.  The paralysis often begins in the hind limbs and it travels upwards.  The cat eventually loses all mobility.  If the cat is lucky, they’ll begin to have seizures instead and die soon afterwards.  Like I said, it remains the single-most awful thing I’ve ever seen. 

Non-effusive FIP is harder to diagnose than effusive FIP, especially if the cat fails to develop ocular or neurological symptoms.  In these cases, the only symptoms the cat has are fevers, diarrhea, and other non-specific issues.

Once again, the best bet is to consider the albumin to globulin ratio.  The same rule of ‘if it’s under 0.4, FIP should be considered’ holds true.

Unfortunately, checking for antibodies is fairly useless.  A positive FCoV test just means the cat has been exposed to FCoV.

FIP is deadly.  While there are some isolated cases of cats seemingly recovering from it, I think it’s more likely that those were simply misdiagnosed cases.  As I’ve said before, FIP is a diagnosis by exclusion, so a misdiagnosis can happen fairly easily.  A cat with wet FIP is gone in days.  A cat who’s unlucky enough to develop neurological FIP may linger for weeks until they die of starvation, oxygen deprivation as the lungs themselves are paralyzed, or dehydration.  Ocular FIP generally spreads into the brain, causing seizures. 

Sprinkles is very, VERY lucky.  I had been following the study very closely and I had an acquaintance who recently started treating her foster cat for FIP.  I was able to get into contact with some folks and obtain experimental treatment for my kittens.

GS-441525

In February 2019, there was a very promising study on a specific drug called GS-441524.  Most of the cats involved with the study made a full recovery.  The company (Gilead-Sciences) behind the drug wasn’t interested in getting it FDA approved for cats out of concern that it would affect its approval for human use.  See, if it’s used officially for cats, Gilead-Sciences would be obligated to report any negative side-effects and that could impact getting it approved for human use down the line.  “One of the rules in drug development is ‘never perform a test you don’t have to, if the results could be problematic,” isn’t an uncommon saying.  It’s one of the reasons why I fell out of research and development myself.

I had some pull and was able to get experimental access to this drug for Sprinkles and, later, Mickey. 

Both kittens went through three months of daily injections and a further 3 months of observations before they were deemed FIP-free.  After seeing 3 other cats die from it, it’s been a blessing to see them recover.  They’re both especially lucky that they finished their treatment cycle JUST before COVID-19 hit American shores since I couldn’t, in good conscience, continue using a very promising antiviral in cats when it would likely be needed by humans.

It’s definitely not a perfect system.  Three months of daily injections (or pills) is not ideal for the average owner for several reasons.  In addition to the difficulty of injecting a cat with an EXTREMELY painful drug daily, it also requires a lot of math; the dosage has to be adjusted daily to take weight gain into consideration.  Even the concentration has to be adjusted at times.   I haven’t used the pills at all, but I know a lot of people have had problems with cats biting through the pills.  In addition, the pills seem less effective against neurological or ocular FIP.

Gilead-Sciences has refined GS-441524 into GS-5734 (named Remdesivir), which is supposed to be more efficient.  Hypothetically, the addition of the phosphate groups should make it easier for it to get across barriers and be absorbed more easily.  Hopefully this will result in a shorter treatment time, although I suspect it will be more expensive than GS-441524.  This is already a substantial cost attached to GS-441524, with the treatment of a single cat or kitten over 1,000 USD.

As of writing (April 20, 2020), neither Remdesivir nor GS-441524 are available to the average public legally.  Remdesivir has been approved for use in humans with COVID-19 in emergency cases.  

[sigmalied]

Sig’s Anthem Review

Verdict

BioWare’s Anthem is a genuinely fun and engaging experience that sabotages itself with myriad design, balance, and technical oversights and issues. It is a delicious cake that has been prematurely removed from the developmental oven - full of potential but unfit for general consumption in this wobbly state. Anthem is not a messianic addition to the limited pantheon of looter shooters because it has somehow failed to learn from the well-publicized mistakes of its predecessors. 

Am I having fun playing Anthem? Absolutely. Does it deserve the industry’s lukewarm scores? Absolutely. But this is something of a special case. The live service model giveth and taketh away; we receive flexibility in exchange for certainty. Is Anthem going to be the same game six months from now? Its core DNA will always be the same, but we’ve already begun to see swift improvements that bode well for the future. 

Will my opinion matter to you? It depends. When I first got into looter shooters I was shocked at how much the genre clicked with me. They are a wonderful playground for theory crafters, min/maxers, and mathletes like myself who find incomparable joy in optimizing builds both conventional and experimental by pushing the limits of obtainable resources ad infinitum. The end game grind is long and at times challenging as you make the jump to Grandmaster 1+ difficulty in search of top-tier loot to perfect your build. This is what looter shooters are all about.

If you don’t like the sound of that, you’ll probably drop Anthem right after finishing its campaign. But if you do like the sound of that, you might find yourself playing this game for years.

TL;DR: This game is serious fun, but is also in need of some serious Game & UI Design 101. 

I wrote a lot more about individual aspects of the game beneath the read more, if you’re interested. I’ve decided not to give the game a score, I’m just here to discuss it after playing through the campaign and spending a few days grinding elder game activities. There are no spoilers here.

Gameplay

The Javelins are delightful. I’ve played all four of them extensively and despite identifying as a Colossus main I cannot definitively attach myself to one class of Javelin because they’re all so uniquely fun to play and master. Best of all, they’re miraculously balanced. I’ve been able to hold my own with every Javelin in Grandmaster 1+. Of course, some Javelins are harder to get the hang of than others. Storms don’t face the steep learning curve Interceptors do, but placed in the hands of someone who knows what they’re doing, both are equally as destructive on the battlefield. 

I love the combo system. It is viscerally satisfying to trigger a combo, hearing that sound effect ring, and seeing your enemy’s health bar melt. Gunplay finally gets fun and interesting when you start obtaining Masterworks, and from there, it’s like playing a whole new game. 

Mission objectives are fairly bland and repetitive, but the gameplay is so fun I don’t even mind. Collect this, find that, go here, whatever. I get to fly around and blow up enemies while doing it, and that’s what matters. Objectives could be better, certainly. Interesting objectives are vital in game design because they disguise the core repetitive gameplay loop as something fresh, but the loop on its own stays fresh long enough to break even, I feel.

The best part is build flexibility. Want to be a sniper build cutting boss health bars in half with one shot? I’ve seen it. Want to be a near-immortal Colossus wrecking ball who heals every time you mow down an enemy? You can. There are so many possibilities here. Every day I come across a new crazy idea someone’s come up with. This is an excellent game for build crafters. 

But... why in the world are there so few cosmetic choices? A single armor set for each Javelin outside the Vanity store? A core component of looter shooters has always been endgame fashion, and on this front, BioWare barely delivers and only evades the worst criticism by providing quality Javelin customization in the way of coloring, materials, and keeping power level and aesthetics divorced. We’re being drip-fed through the Vanity store, and while I like the Vanity store’s model, there should have been more things permanently available for purchase through the Forge. Everyone looks the same out there! Where’s the variety? 

Story, Characters, World

Anyone expecting a looter shooter like Anthem to feature a Mass Effect or Dragon Age -sized epic is out of their mind, but that doesn’t mean we have to judge the storytelling in a vacuum. This is BioWare after all. Even a campaign that flows more like a short story - as is the case with Anthem - should aspire to the quality of previous games from the studio. Unfortunately, it does not, but it comes close by merit of narrative ambience: the characters, the world’s lore, and their execution. 

(For a long time I’ve had a theory that world building is what made the original Mass Effect great, not its critical storyline, which was basically a Star Trek movie at best. Fans fell in love because there were interesting people to talk to, complicated politics to grasp, and moral decisions to make along the way.)

While the main storyline of Anthem is lackluster and makes one roll their eyes at certain moments or bad lines, the world is immediately intriguing. Within Fort Tarsis, sophisticated technology is readily available while society simultaneously feels antiquated, echoing a temporal purgatory consistent with the Anthem’s ability to alter space-time. Outside the fort, massive pieces of ancient machinery are embedded within dense jungles in a way that suggests the mechanical predates nature itself. The theme of sound is everywhere. Silencing relics, cyphers hearing the Anthem, delivering echoes to giant subwoofers… It’s a fun world, it really is. 

As for the characters… they might be some of the best from BioWare. They feel like real people. Rarely are they caricatures of one defining trait, but people with complex motives and emotions. Some conversations were boring, but the vast majority of the time I found myself racing off to talk to NPCs as soon as I saw yellow speech bubbles on the map after a mission. And don’t even get me started on the performances. They are golden.

The biggest issue with the story is that it’s not well integrated with missions. At times it feels like you’re playing two separate games: Fort Tarsis Walking/Talking Simulator and Anthem Looter Shooter. And the sole threads keeping these halves stitched together during missions - radio chatter - takes a back seat if you’re playing with randoms who rush ahead and cause dialogue to skip, or with friends who won’t shut the hell up so you can listen or read subtitles without distraction. I found it ironic that I soloed most of the critical story missions in a game that heavily encourages team play.

Technical Aspects: UI & Design 

This is where Anthem has some major problems. God, this category alone is probably what gained the ire of most reviewers. The UI is terrible and confusing. There are extra menu tabs where they aren’t needed. The placement of Settings is for some inane reason not located under the Options button (PS4). Excuse me? It’s so difficult to navigate and find what you’re looking for. It’s ridiculously unintuitive.  

Weapon inscriptions (stat bonuses) are vague and I’ve even seen double negatives once or twice. They come off as though no one bothered to proofread or edit anything for clarity. Just a bad job here all around. And to make matters worse, there is no character stat sheet to help us demystify any of the bizarre stat descriptions. We are currently using goddamn spreadsheets like animals. Just awful. 

The list goes on. No waypoints in Freeplay. Countless crashes, rubber banding, audio cutouts, player characters being invisible in vital cutscenes, tethering warnings completely obscuring the flight overheat meter… Fucking yikes. Wading through this swamp of bugs and poor design has been grueling to say the least. 

And now for the loot issues. Dead inscriptions on gear; and by dead I mean dead, as in “this pistol does +25% shotgun damage” dead (this has been recently patched but I still cannot believe this sort of thing made it to release). The entire concept of the Luck stat (chance to drop higher quality loot) resulting in Luck builds who drop like flies in combat and become a burden for the rest of the team. Diminishing returns in Grandmaster 2 and 3; it takes so long to clear missions on these difficulties without significant loot improvement, making GM2 and GM3 pointless when you could be grinding GM1 missions twice as fast. 

At level 30, any loot quality below Epic is literal trash. Delete Commons, Uncommons, and most Rares as soon as you get them because they’re virtually useless. I have hundreds of Common and Uncommon embers and nothing to do with them. Why can’t we convert 5 embers into 1 of the next higher tier? Other looters have already done things like this to make progression omnipresent. You don’t have to reinvent the wheel here, BioWare. It’s already been done for you. 

When you get a good roll on loot, the satisfaction is immense. But when you don’t, and you won’t 95% of the time, you’ll feel like you’ve wasted hours with nothing to show for it. We shouldn’t be spending so much time hunting for useful things, we should be trying to perfect what’s already useful.

It’s just baffling to think that Anthem had the luxury of watching the messy release of several other looter shooters during Anthem’s development, yet proceed to make the same mistakes, and some even worse. 

Nothing needs to be said about visuals. They are stunning, even from my perspective on a base PS4.

Sound design is the only other redeeming subcategory here. Sound design is amazing, like the OST. Traditional instrumentals meet alien synth seamlessly. Sarah Schachner is a seriously talented composer. 

I’m just relieved to see the development team hauling ass to make adjustments. They’ve really been on top of it - the speed and transparency of fixes has been top-notch. They’re even working on free DLC already! A new region, more performances from the actors... I’m excited and hopeful for the future. 

[furrmeals-blog]

Health Benefits of Home Cooked Meals For Your Dog

Health Benefits of Home Cooked Meals For Your Dog

Home cooked Food for Pets in Delhi

"Good Nutrition Great health "  Home cooked Food for Pets in Delhi

Home cooked Food for Pets in Delhi

A recent study done by The Journal of Animal Physiology found out that various dog food brands contained beef, soy, and poultry in detectable amounts. This outlook into pet foods has been triggered by the various pet food recalls in recent times. This has left many pet owners wondering whether they are feeding their pets the right food. Since the 2006 recall, serious pet owners resulted in feeding their pets with home cooked meals. Home cooked Food for Pets in Delhi

Home cooked Food for Pets in Delhi

While In India, there are a couple of good puppy nourishment brands accessible, numerous brands don't regularize the quality and wellspring of the meat items and different fixings that go into this canine sustenance. Specialists and raisers prescribe numerous brands yet to be straightforward, there isn't much mindfulness about how a quality canine nourishment ought to be, aside from many puppy proprietors not monitoring what ought to be correct or wrong for their mutts. Home cooked Food for Pets in Delhi

While few brands have been globally perceived for their uncommon eating routine, nature of eating routine and proportion of dynamic meat content, we know that those brands are just constrained in India as of now. Home cooked Food for Pets in Delhi

Home cooked Food for Pets in Delhi

One can't simply rely upon business pooch sustenance for the canine's general wellbeing and considering home cooked puppy nourishment as a choice on a rotational premise. Before we investigate why home-cooked canine sustenance could be an incredible alternative for your pooch, there are a couple of focuses that should be considered. The best favorable position of a quality puppy sustenance is that it is an adjusted feast extraordinarily intended for your mutts. The kibbles have a blend of the considerable number of fixings blended in the correct extent alongside supplements for the general strength of your canine. On account of home-cooked pooch sustenance, there is dependably a slight shot of overloading your puppy. Many canine proprietors don't know about the fixings that are wrong for their pooches and furthermore feed them human nourishment. Be that as it may, if this center ground can be secured, in the event that one knows the amount to sustain his or her canine and precisely which fixings are incredible for your pooch, at that point home cooked sustenance is the best blessing one can provide for his puppy. Home cooked Food for Pets in Delhi

In the event that you inquire about on the best way to make a very much adjusted canine sustenance at home, you will have the capacity to encounter all the integrity of the home cooked new pooch nourishment.  Home cooked Food for Pets in Delhi

                              "Good Nutrition Great health "

Home cooked Food for Pets in Delhi

A decent, very much adjusted low grain puppy eating regimen will empower you to have an entire power over the fixings and since it is made of new deliver, you will dispense with all additives, added substances, and other terrible fixings. Home cooked Food for Pets in Delhi

Home cooked Food for Pets in Delhi

Since you additionally know your canine's wellbeing conditions superior to anything any Dog nourishment mark, you will have the capacity to alter the pooch sustenance in light of what is expected of your puppy. A few mutts are adversely affected by grain so you can supplant grain items with another wellspring of sugars like sweet potatoes and beans. Home cooked Food for Pets in Delhi

Home cooked Food for Pets in Delhi

breuer-premium-2Dogs are essentially rapacious in the wild and are utilized to the genuine meat rather than prepared meat side-effects. In your home-cooked canine nourishment, you will have finish command over how much lean meat, offal, and fat goes into his dinner. You additionally get the chance to pick the sort of supplements, vitamins, and oils to the puppy sustenance in light of which part of your pooch's wellbeing you need to make strides. Home cooked Food for Pets in Delhi

One of the key advantages of cooking natively constructed pooch sustenance is that you can take out modest fillers and substandard meat side-effects. Home cooked Food for Pets in Delhi

Unimportant, mutts likewise process home cooked sustenance better. Bolstering great quality fixings sensationally enhances your puppy's absorption, in this way lessening the volume of crap and tooting. Home cooked Food for Pets in Delhi

Home cooked Food for Pets in Delhi

Puppies feel good and feel more vigorous while their jackets sparkle significantly more.

The greatest elusive advantage of cooking nourishment for your pooch is the holding you wind up making with your Happy pets turning, moving and woofing while you make their sustenance and acknowledging what you cooked for them is something no cash can purchase in this world. Home cooked Food for Pets in Delhi

Home cooked Food for Pets in Delhi

Preparing home-cooked meals has many benefits. Besides, home cooked meals give your dog something to be happy about. Generally, a dog that feeds on home-cooked meals is more healthy and happy than a dog that feeds on packed foods. Here are the awesome health benefits of home-cooked meals for your dog.     Home cooked Food for Pets in Delhi

"Good Nutrition Great health "

1. Better Gut Health

Home cooked Food for Pets in Delhi

Commercial dog foods mostly contain fillers and preservatives that affect the gut balance of your dog. Furthermore, the lack of moisture makes the dog suffer from various gut-related diseases. If your dog starts experiencing chronic vomiting, diarrhea, fatigue or obesity, they are all likely signs of unhealthy dog food.

Cooking your dog fresh homemade foods helps restore the gut system to a natural balance. The dog gets more moisturized food, and you get to eliminate fillers and preservatives. The nutrient levels of a home cooked meal are also higher than that of commercial foods.

2. Healthy Skins

Home cooked Food for Pets in Delhi

Is your dog’s skin worn off? If your dog’s skin is too dry or looks worn off, chances are that you need to start feeding it homemade food. The skin of your dog, just like yours, thrills under various nutrients and moisture. Dogs foods are mostly dry and do not help in supplying the dog with moisture. A dog, unlike human beings, loses much of its moisture on a sunny day by cooling its body through mouth evaporation. Any dog that does not get a sufficient supply of moisture, both from food and water, is bound to have a dry skin. When the skin gets dry, it is likely to develop further complications.

3. Stronger Teeth

Home cooked Food for Pets in Delhi

Every dog needs to have strong teeth. Its teeth are the only weapon it can rely upon. Unfortunately, commercial dog foods do not aid in strengthening the teeth. As a natural predator, the teeth of a dog are made to tear into flesh and chew. The idea of your dog feeding on beef supplements, that have already been processed, just serves to make the teeth weak. As a result, the dog becomes less aggressive. If you rely on your dog for security at any level, then feeding it an all-natural homemade meal will help strengthen its powers. Home cooked Food for Pets in Delhi

"Good Nutrition Great health "   Home cooked Food for Pets in Delhi

4. Improved Kidney Health  

Home cooked Food for Pets in Delhi

A dog that suffers from kidney disease needs food that is less toxic with plenty of water. A dog that feeds on natural homemade food tends to spray more often than a dog that feeds on commercial foods. If your dog is having kidney problems, feeding it homemade foods will help in reducing the symptoms. If well managed, you could increase the life of your dog by several years when you feed them with well-prepared homemade foods. If your dog is experiencing spraying issues, you should have them checked for kidney disease and start feeding them homemade foods.

5. Mental Health.

Home cooked Food for Pets in Delhi

One of the key factors that cause a dog to be frustrated or irritated is feeding it food it does not like. If you feed your dog with well-cooked homemade foods, the dog will be generally jovial and playful. A happy and playful dog engages in more physical activities. When the dog is active, the brain releases chemicals that are responsible for changing its mood and releasing it of anxiety. A dog that feeds on homemade food is generally stress-free and more interactive. It is also not easily agitated and is always friendly to you.

Bottom Line  

Home cooked Food for Pets in Delhi

Just like human beings, dogs greatly benefit from feeding on natural foods. When you prepare good and tasty meals that are well balanced for your dog, you give it a chance to live long and happily. Every dog that feeds on natural homemade foods has healthier skin, less digestive problems and is generally happy. Therefore, it is only reasonable for you to prepare well-cooked food for your dog if you value it. You can try any of the best known homemade dog food recipes and find out what your dog loves.

"Good Nutrition Great health "

[brian-cdates]

5 Long-term Side Effects of Bulimia & Anorexia

Eating disorders take a toll on your body and the side effects of bulimia and anorexia are vast, including side effects like:

 COMMON SIDE EFFECTS OF BULIMIA

Unwanted shifts in weight

Eroded enamel on teeth and tooth decay

Ruptured or damaged esophagus

Irregular heart beat and heart failure

Dehydration

Weakened kidney and heart muscle

Electrolyte imbalances

GI irregularity and constipation

Russel’s Sign (scratches on fingers and hands from self-induced purging)

Swollen salivary glands

Acid reflux

Sore throat and hoarse voice

Facial swelling

Blood in vomit

Feeling faint

Low libido

Red eyes

Mood swings

Depression and anxiety

COMMON SIDE EFFECTS OF ANOREXIA

Weight loss and thin appearance

Loss of appetite

Brittle hair and nails

Flakey, dry skin

“Peach fuzz” hair that grows on body (lanugo)

Constipation & bloating

Cold body temperature

Anemia

Abnormal blood counts

Fatigue

Dizziness and fasting

Bone Fractures, Stress Fractures & Osteoporosis

Amenorrhea (Losing your period) & Infertility

Irregular heart beat and heart failure

Dehydration

Kidney damage and failure

Elevated liver enzymes and Liver damage

Seizures

Low blood pressure

Depression and anxiety

  Despite our awareness of the side-effects of active eating disorders however, something rarely discussed with individuals in eating disorder recovery are the long-term side effects of bulimia and side effects of anorexia—even once you’ve chosen to pursue a new healthy lifestyle.

I call this “Post-Recovery Recovery”—the side effects of bulimia and anorexia that happen to your body AFTER recovering from an eating disorder (especially a long-term eating disorder)—and I’ve been there, got the t-shirt.

In my personal eating disorder recovery from a 15 year battle with anorexia, the words “You could die from this” often fell on deaf ears.

While I experienced my fair share of “unhealthy side effects” (such as peach fuzz hair on my body, anemia, a heart arrythmia, osteoporosis, elevated liver enzymes, fainting and dehydration) once I decided to pursue recovery MANY of these anorexia side effects improved tremendously.

However, after I chose a new recovered lifestyle, I soon discovered, my health was not all “rainbows and butterflies.”

After 15 long years spent trying dozens of diets,; following hundreds of food rules; going in and out of multiple hospitals, treatment centers, and tube feeding interventions; and fighting for my life, my body is FAR from perfect, and while I am 100% recovered in my mind, my body has taken its sweet time to catch up.

Here are 5 Long-Term Side Effects of Bulimia & Anorexia No One Talks About in Eating Disorder Recovery (and what to do about them):

 5 Long-Term Side Effects of Bulimia & Anorexia No One Talks About in Eating Disorder Recovery

SIDE EFFECT #1: YOU HAVE “GUT ISSUES” (BLOATING, CONSTIPATION, IBS)

Individuals in eating disorder recovery often complain about “gut issues” with gut side effects in Bulimia, Anorexia and Eating Disorder Recovery including:

Feeling bloated or excessively full after meal

Chronic constipation

GERD/Heartburn

Poor appetite, or insatiable appetite (like they have malabsorption)

IBS

Loose stools and diarrhea

Abdominal cramping

Nauseas

To a great degree, it makes sense that after a period of time spent NOT listening to your body’s hunger-fullness signals, eating processed diet foods (Diet Coke, sugar free candy/gum, frozen dinners), abusing laxatives, nutrient deficiencies and significant stress, your gut health would NOT feel well in recovery.

Enter: “Leaky gut” or intestine permeability—gut distress wherein your digestive system and gut lining get weak, “leaky” and/or imbalanced in gut bacteria, triggering both the ongoing struggle with anorexia and bulimia, as well as leaving your gut not feeling well in eating disorder recovery.

The Real Causes of Gut Side Effects in Eating Disorders

Other much less buzz terms and presentations of impaired gut health that I see daily in my own functional medicine, nutrition and therapy practice include:

Bacterial and fungal infection

Bacterial overgrowth or “SIBO”

Parasites

Healthy-unhealthy gut bacteria imbalance (“Dysbiosis”)

IBS

Food intolerances

Constipation

And a host of ALL the other side effects discussed in this article

Understanding the Gut-Eating Disorder Connection

Your gut is the gateway to your health and IF and WHEN our healthy gut bacteria and healthy process of digestion is thwarted and stressed, then “gut issues” and other associated health issues experienced in eating disorders and recovery ALSO occur (i.e. anxiety and depression, autoimmune disease,  thyroid dysfunction, blood sugar  and hormone imbalances, etc ).

Think of the gut like a domino.

If it falls, then the OTHER “dominoes” of your health will also fall—often in the form of the diseases and imbalances you are MOST genetically susceptible to (Krautkramer et al, 2016)

My Experience

Unfortunately, in my own experience, this was (and is) the case, but most of my medical care providers and treatment programs at the time just discounted my “gut feelings” as:

“Just part of recovery”

An excuse to get out of drinking milkshakes and takeout pizza

The need for Miralax, Colace, prune juice and other stool softeners

“All in my head”

An excuse to restrict my food and not eat gluten or dairy

For weeks and months at a time, I’d suck up eating disorder treatment, eating Pop-Tarts, Twinkies, Snickers Bars, Ben & Jerry’s, fast food challenges, Nestle chocolate tube feeding formulas, Boost shakes, Honey Nut Cheerios, Goldfish and pretzels, and the occasional green vegetable, going through the motions, but rarely feeling great inside (BOTH in my head and in my gut).

While eating disorders DO often cause an adverse reactions to otherwise considered “normal” Standard American Diet foods, this is not to discount the impact that processed foods and lack of gut health support can have on perpetuating poor gut health and the ongoing link between eating disorders and gut bacteria imbalances.

Looking back on the accumulated 3-4 years I personally spent in hospitals and treatment centers with these conventional re-feeding treatments and neglected gut health care, I am more than anything thankful!

Without them, I would have not discovered the amazing connection between gut health and brain health and eating disorders (the brain-gut connection) (Borgo et al, 2017), NOR would I be able to look back on the countless “food challenges” and exposures that helped me develop “thick skin” to NOT freak out (in my eating disorder brain) if I was to eat a bite of a (gasp) cupcake or Twinkie .

Side Effect #2: Your Metabolism SLOWS DOWN or SPEEDS UP

“Why do I keep gaining weight?!” OR “Why do I have a hard time holding on to my weight?!”

Metabolic dysfunction impacts individuals in recovery on both sides of the spectrum—some people with histories of eating disorders struggle to maintain a healthy weight as it seems their body puts on 5 to 10 to 20 more pounds by simply looking at food, and others in recovery from eating disorders (particularly long-time anorexia) struggle to “hold on” or maintain a healthy weight.

What gives?!

One word: Stress.

Eating disorders do a number on your stress levels—often also referred to as “adrenal fatigue.”

In the stress response, cortisol levels (your stress hormones) are elevated or suppressed in the struggle to “keep up” (i.e. the eating disorder), and eventually over time, this stress wreaks havoc on your metabolism.

What is your Metabolism?

Your metabolism is a representation of how efficiently your body is at using your energy (food and energy stores in your cells, muscle and organs) for ALL your cellular processes and body functions.

If you have a “fast metabolism” it typically means your body burns your energy like a furnace. However, it can ALSO mean you have impaired digestive pathways (and your body is actually STRESSED and/or unable to absorb or use your energy to the best of its abilities), often due to a leaky gut or blood sugar imbalances caused by a period of chronic dieting and under-eating.

If you have a “slow metabolism” it typically means your body’s digestive process, blood sugar balance and/or stress hormone pathways are stressed and sort of like walking through the mud after a hard rain in stiletto heels, your metabolic processes (digestive, stress response, blood sugar balance mechanisms) “walk” less smoothly and efficiently. They get stuck clomping through the muck.

Why is My Metabolism Off in Eating Disorder Recovery?!

Whichever side of the spectrum your metabolic presentation falls on (“fast” or “slow”) in eating disorder recovery, the bigger question is WHY is it STILL “off”—even though you are “taking care of yourself” and no longer neglecting your body now?

Here are 4 reasons your metabolism is off in eating disorder recovery:

Chronic Dieting & Under-eating Backfires

One of the most poignant studies of this phenomenon is the “Biggest Loser” study (Fothergill et al, 2016), wherein researchers followed and tracked the metabolic efficiency of former “Biggest Loser” TV show contestants 8 years after being on the show and experiencing amazing weight loss results from their 12-week stint spent dieting. The findings? Every single contestant had gained their weight back, despite eating “healthier,” and their metabolisms were 1 to 2 times LESS efficient than they had been previously (i.e. they required about 500 calories less for weight maintenance than previously).

Thyroid Dysfunction Happens

Other research has shown that individuals with both bulimia and anorexia experience the consequences of thyroid dysfunction (Altemus et al, 1996) (Warren, 2011)—the organ responsible for making sure your metabolic processes are working in tip top process. Hashimoto’s (thyroid autoimmune disease) is also highly correlated with eating disorder recovery, often characterized by unwanted weight gain or weight loss, food intolerances, fatigue and impaired metabolism. If your thyroid levels are “off,” (i.e. a TSH value above 2, or T3

Blood Sugar Levels Are Unstable

Blood sugar is what gives you energy and balanced blood sugar levels are a sign that your body is using energy properly.

In an ideal world, when you eat, blood sugar levels go “up” (slightly) as insulin rushes in to your cells, giving them energy, then gradually come down with time back to a balanced flatline state of natural, normal energy—no caffeine or sugar needed.

However, in eating disorders, after a period of binging/purging or active restriction, your natural process of blood sugar balance gets off!

Blood sugar levels either get extremely high (hyper-glycemia) or super low (hypo-glycemia) (Mirsa & Klibanski, 2011) as your body becomes less and less able to tap into normal digestive enzymes and blood sugar balance processes since your eating patterns tend to be more extreme.

Over time, the eating disorder conditions your blood sugar levels to function the majority of the time in these extreme states (i.e. under-eating, restricting proteins or fats or carbs, binging and purging, fasting). Couple this with the high chance of “leaky gut” and other gut imbalances in eating disorders, and malabsorption of nutrients in the first place ALSO prevents your body from getting the “proper nutrients” and absorbing the just-right-amount of energy and nutrients to keep your metabolism revving in tip top speed.

Reactive hypo-glycemia (eating but blood sugar dropping) (and insulin resistant hyperglycemia (as seen in diabetes) (Prioletta et al, 2011 )may also occur.

You Get a New “Set Point”

On the opposite end, in research of individuals in recovery from anorexia, researchers have found that those who fought the battle for a longer amount of time, suffered from metabolic “damage” or side effects that entailed needing at least 1.5 times the amount of caloric load as other “normal controls” of their same size and stature (Kaye et al, 1988), and that their bodies were in hyper-calorie burning (Zipel et al, 2013) and hyper fat-burning mode (FASEB, 2008) (Dellava et al, 2009) . Researchers speculate this to be due to the catabolism (break down) of body tissues and organs, as well as long-term malnourished state and a body that “soaks up” nutrition to repair body damage once recovery ensues. Leaky gut and unhealthy gut bacteria from malnutrition also impair healthy metabolic pathways making malabsorption a common phenomenon others experience in recovery as well (Kane et al, 2015)

In short: Chronic dieting, under-eating, over-exercise and/or body neglect tend to backfire.

SIDE EFFECT #3: Adrenal Fatigue

Tired despite sleeping for 7-9 hours?

Need coffee to function?

Crave sugar or artificial sweeteners?

Wired and tired at night or difficulty sleeping?

Hangry before meals?

Afternoon sleepiness or need naps often?

Frequent headaches?

Easily anxious, wound up or depressed?

Horrible PMS?

Adrenal fatigue or “HPA Axis” Dysfunction  is a common phenomenon experienced in individuals in the aftermath of an eating disorder, due to the side effects of chronic long term stress on the body.

Although stress is a NORMAL part of life, and we all experience stress on a daily basis, TOO MUCH STRESS WITHOUT PROPER RECOVERY can throw off our cortisol response.

Cortisol is your stress hormone responsible for helping you “fight or flee” in the fight or flight response. However, if cortisol is constantly called upon and unable to help you fight or flee with the mounting stress, HPA Axis Dysfunction and hormone imbalances are a given.

Even in recovery, as you’re taking care of yourself, your body may still be healing for the time it spent living on edge constantly.

It’s vital to recognize that stress goes FAR BEYOND just mental and emotional stress as well. It can also be physical. Other common stressors include:

Common Stressors in Eating Disorder Recovery

Lifestyle Stressors

Burning a candle at both ends

Bluelight screen exposure (long times on screens)

Social Media comparison/endless scrolling

Trying to be all things to all people/people pleasing

FOMO (lack of downtime for yourself)

Less than 7 hours of sleep most nights

Overtraining

Imbalanced exercise (i.e. doing HIIT/cardio all the time without mixing it up)

Not talking about your stress (bottling it up)

Not doing things you love

Exposure to chemicals in beauty, cleaning and hygiene products

Plastic tupperware/container use

Lack of outdoor/nature and fresh air

Lack of play and fun

Endlessly Google searching answers to your health questions

NSAID use (headaches, etc.)

Birthcontrol and long term medication use

Disconnection from community/meaningful relationships

Food Stressors

Frequent coffee/caffeine consumption

Artificial sweeteners (most commercial stevia included)

Eating packaged, refined or processed foods

Low water intake (less than half your bodyweight in ounces)

Tap water (not filtered)

Frequent eating out (more than preparing/handling your food)

High focus on calories, diet plans and food rules

Lack of Vitamin P (pleasure in foods)

Low carb intake and/or Low fat intake

Lack of quality protein (amino acids for your brain)

Dairy (conventional) consumption

Grains and “gluten free” processed products (with gluten-cross contaminants)

Binging/Purging and erratic eating habits

NOT listening to your gut

Consider how you could dial back on ONE of these things….just ONE to start.

 SIDE EFFECT #4: Getting Your Period Then…Losing Your Period

You got your period in recovery…then you lost your period.

Hello?! Where did your period go?!

A woman’s period is her monthly health “report card”—a sign that her hormones are working as they should (especially if PMS is minimal)—and a sign for the woman in recovery from an eating disorder that her body is in a more “stable place.”

However, some people find they get their period back for one or two cycles, only to find that their period goes missing AGAIN—even though they are taking care of themselves.

Healing from an eating disorder is not always “rainbows and butterflies” or “Happily Ever Afters” for your body and the loss of your period can be due to multiple factors that are only corrected with time, consistency, patience, and self grace and love.

As mentioned previously, stress is the #1 driver AGAINST your period happening—and in the case of disordered eating, this is the #1 reason why amenorrhea is common.

Adrenal fatigue or impaired cortisol function equally (negatively) influences estrogen and progesterone presentation (hormones needed to make your period happen). If cortisol is either too high or too low, estrogen levels are “thrown off” and the last thing your body wants to do is be fertile or have a baby.

Blood sugar levels and insulin growth factor production (normal insulin levels) ALSO are key players in healthy hormones. If your blood sugar balance is off (due to poor digestion and/or stress), then research supports that the period may still be “missing” in recovery (Cominato et al, 2014)

In addition, since your hormones are produced by fats you eat and fat oxidation—including cholesterol—if your digestive pathways are still healing, you have leaky gut OR enhanced fat “oxidation” (you burn fat really easily) from metabolic dysfunction—then hormone production (namely estrogen and progesterone are going to be an uphill climb).

Some women can STILL experience ovulation, despite no shedding of their uterus lining (i.e. bleeding), but more often than not, the period won’t happen until stress levels (inside and out) continue to be addressed. This is not ideal however, as iron overload and osteoporosis are also common in women who do not have regular periods.

SIDE EFFECT #5: Autoimmune Disease

Autoimmune disease affects 1 in 4 women, and 1 in 6 men—and, research shows if you’ve had an eating disorder, the prevalence and incidence of autoimmune disease goes up nearly two fold.

There are more than 30 Autoimmune diseases that range from Crohn’s Disease, to Celiac Disease, Ulcerative Colitis, Lupus, Hashimoto’s, arthritis and osteoporosis.

No matter what condition or symptoms an individual has, the universal theme of an Autoimmune Disease is the same—the immune system is suppressed and the body attacks itself.

Enter: Inflammation, increased cortisol (stress hormone), food intolerances and leaky gut or intestinal permeability.

One study (Raevuori et al, 2014) of 2342 patients who received treatment for an eating disorder found nearly a 2:1 greater ratio risk of having an autoimmune disease (regardless of genetic history), compared to healthy controls (particularly hormone and gut-related diseases). The researchers also speculated that the relationship between Autoimmune Disease and eating disorders may be bi-directional, asserting that Autoimmune Disease can further drive psychological symptoms [such as OCD (obsessive compulsive disorder and tendencies), depression and anxiety seen in eating disorders] since Autoimmune Disease is characterized by inflammatory anti-bodies that attack the person’s own body cells—including brain cells and neurotransmitters.

Another study of 930,977 volunteers, confirmed this hypothesis as participants with autoimmune conditions were up to 75% more likely to develop/have histories of anorexia, bulimia and EDNOS (eating disorders not otherwise specified).

Causes of Autoimmune Disease

How does the immune system get “suppressed” and autoimmune disease happen in the first place?!

Considering that 80-percent of your immune system is produced in your gut, the bigger question is: “How is your gut health?” If your gut health is poor (i.e. eating disorder behaviors) or you have a “leaky gut” (intestinal permeability), then you are more AT RISK for developing an autoimmune disease (Mu et al, 2017 ).

Since “leaky gut” is both a common side effect of eating disorders AND a trigger to eating disorders (Lam etal, 2017), autoimmune disease likelihood makes total sense.

Currently research is being conducted on the prevalence of “leaky gut” and autoimmune antibodies in individuals before and after re-feeding, with the authors believing that the increased presentation  of leaky gut arises from current conventional eating disorder treatment protocols (i.e. Ensure shakes, processed foods, etc.), enhanced stress levels and lack of education of proper gut health support during treatment. (Grigioni, 2016)

What to Do About It?!

Regardless of what Side effects you experience in eating disorder recovery, there is always room to feel better and improve your health in your post-recovery recovery!

While it can be extremely frustrating for your mindset to be in one place, but your body still feel like it’s lagging behind or trying to catch up, there is more for you in your continued healing.

Work with a functional medicine practitioner or nutritionist to address underlying stressors and conditions impeding your gut health, hormone health, blood sugar balance and all-around wellbeing together.

Some lab testing may be warranted depending on your own side effects and symptoms, including:

Comprehensive Functional Blood Work

Stool Testing

SIBO/Bacterial Overgrowth Breath Testing

Urine Organic Acids Testing (gut test)

Hormone DUTCH Urine & Saliva Testing

Based on results, dietary guidance, supplements and lifestyle “therapy” and medicine (i.e. de-stressing your body) help markers improve.

Above all: Know patience and consistency will pay off AND…you are worth it.

The post 5 Long-term Side Effects of Bulimia & Anorexia appeared first on Meet Dr. Lauryn.

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Is There Something Neurologically Wrong With Donald Trump?

President Donald Trump’s decision to brag in a tweet about the size of his “nuclear button” compared with North Korea’s was widely condemned as bellicose and reckless. The comments are also part of a larger pattern of odd and often alarming behavior for a person in the nation’s highest office.

Trump’s grandiosity and impulsivity has made him a constant subject of speculation among those concerned with his mental health. But after more than a year of talking to doctors and researchers about whether and how the cognitive sciences could offer a lens to explain Trump’s behavior, I’ve come to believe there should be a role for professional evaluation beyond speculating from afar.

I’m not alone. Viewers of Trump’s recent speeches have begun noticing minor abnormalities in his movements. In November, he used his free hand to steady a small Fiji bottle as he brought it to his mouth. Onlookers described the movement as “awkward” and made jokes about hand size. Some called out Trump for doing the exact thing he had mocked Senator Marco Rubio for during the presidential primary—conspicuously drinking water during a speech.

(Joshua Roberts / Reuters) (Mark Wilson / Getty)

By comparison, Rubio’s movement was smooth, effortless. The Senator noticed that Trump had stared at the Fiji bottle as he slowly brought it to his lips, jokingly chiding that Trump “needs work on his form. Has to be done in one single motion, and eyes should never leave the camera.”

Then in December, speaking about his national-security plan in Washington, D.C., Trump reached under his podium and grabbed a glass with both hands. This time he kept them on the glass the entire time he drank, and as he put the glass down. This drew even more attention. The gesture was like that of an extremely cold person cradling a mug of cocoa. Some viewers likened him to a child just learning to handle a cup.

Then there was an incident of slurred speech. Announcing the relocation of the American embassy in Israel from Tel Aviv to Jerusalem—a dramatic foreign-policy move—Trump became difficult to understand at a phonetic level, which did little to reassure many observers of the soundness of his decision.

Experts compelled to offer opinions on the nature of the episode were vague: The neurosurgeon Sanjay Gupta described it as “clearly some abnormalities of his speech.” This sort of slurring could result from anything from a dry mouth to a displaced denture to an acute stroke.

Though these moments could be inconsequential, they call attention to the alarming absence of a system to evaluate elected officials’ fitness for office—to reassure concerned citizens that the “leader of the free world” is not cognitively impaired, and on a path of continuous decline.

Proposals for such a system have been made in the past, but never implemented. The job of the presidency is not what it used to be. For most of America’s history, it was not possible for the commander in chief to unilaterally destroy a continent, or the entire planet, with one quick decision. Today, even the country’s missileers—whose job is to sit in bunkers and await a signal—are tested three times per month on their ability to execute protocols. They are required to score at least 90 percent. Their commander in chief is not required to be able to execute a protocol, much less to execute the sort of high-level decision that would set this process in motion.

The lack of a system to evaluate presidential fitness only stands to become more consequential as the average age of leaders increases. The Constitution sets finite lower limits on age but gives no hint of an upper limit. At the time of its writing, septuagenarians were relatively rare, and having survived so long was a sign of heartiness and cautiousness. Now it is the norm. In 2016 the top three presidential candidates were ages 69, 70, and 75. By the time of the 2021 inauguration, a President Joe Biden would be 78.

After age 40, the brain decreases in volume by about 5 percent every decade. The most noticeable loss is in the frontal lobes. These control motor functioning of the sort that would direct a hand to a cup and a cup to the mouth in one fluid motion—in most cases without even looking at the cup.

These lobes also control much more important processes, from language to judgment to impulsivity. Everyone experiences at least some degree of cognitive and motor decline over time, and some 8.8 percent of Americans over 65 now have dementia. An annual presidential physical exam at Walter Reed National Military Medical Center is customary, and Trump’s is set for January 12. But the utility of a standard physical exam—knowing a president’s blood pressure and weight and the like—is meager compared with the value of comprehensive neurologic, psychological, and psychiatric evaluation. These are not part of a standard physical.

Even if they were voluntarily undertaken, there would be no requirement to disclose the results. A president could be actively hallucinating, threatening to launch a nuclear attack based on intelligence he had just obtained from David Bowie, and the medical community could be relegated to speculation from afar.

Even if the country’s psychiatrists were to make a unanimous statement regarding the president’s mental health, their words may be written off as partisan in today’s political environment. With declining support for fact-based discourse and trust in expert assessments, would there be any way of convincing Americans that these doctors weren’t simply lying, treasonous “liberals”—globalist snowflakes who got triggered?

* * *

The downplaying of a president’s compromised neurologic status would not be without precedent. Franklin Delano Roosevelt famously disguised his paralysis from polio to avoid appearing “weak or helpless.” He staged public appearances to give the impression that he could walk, leaning on aids and concealing a crutch. Instead of a traditional wheelchair, he used an inconspicuous dining chair with wheels attached. According to the FDR Presidential Library, “The Secret Service was assigned to purposely interfere with anyone who tried to snap a photo of FDR in a ‘disabled or weak’ state.”

Documenting the reality of Roosevelt’s health status fell to journalists, who had been reporting on his polio before his first term. A 1931 analysis in Liberty magazine asked “Is Franklin D. Roosevelt Physically Fit to Be President?” and reported on his paralysis: “It is an amazing possibility that the next president of the United States may be a cripple.” Once he was elected, Time described the preparation of the White House: “Because of the president-elect’s lameness, short ramps will replace steps at the side door of the executive offices leading to the White House.”

Today much more can be known about a person’s neurological status, though little of it is as observable as hemiplegia. Unfortunately, the public medical record available to assuage global concerns about the current president’s neurologic status is the attestation of Harold Bornstein, America’s most famous Upper Manhattan gastroenterologist, whose initial doctor’s note described the 71-year-old Trump as “the healthiest individual ever elected to the presidency.”

The phrasing was so peculiar for a medical record that some suggested that Trump had written or dictated the letter himself. Indeed, as a key indicator of neurologic status, Trump’s distinctive diction has not gone without scrutiny. Trump was once a more articulate person who sometimes told stories that had beginnings, middles, and ends, whereas he now leaps from thought to thought. He has come to rely on a small stable of adjectives, often involving superlatives. An improbably high proportion of what he describes is either the greatest or the worst he’s ever seen; absolutely terrible or the best; tiny or huge.

The frontal lobes also control speech, and over the years, Donald Trump’s fluency has regressed and his vocabulary contracted. In May of last year, the journalist Sharon Begley at Stat analyzed changes in his speech patterns during interviews over the years. She noted that in the 1980s and 1990s, Trump used phrases like “a certain innate intelligence” and “These are the only casinos in the United States that are so rated.” I would add, “I think Jesse Jackson has done himself very proud.”

He also more frequently finished sentences and thoughts. Here he is with Larry King on CNN in 1987:

King: Should the mayor of the city be someone who knows business?

Trump: Well, what we need is competence. We don’t have that. We have a one-line artist. That’s all he is ...

Or on Oprah in 1988:

Winfrey: What do you think of this year’s presidential race, the way it’s shaping up?

Trump: Well, I think it’s going to be very interesting. I think that probably George Bush has an advantage, in terms of the election. I think that probably people would say he’s got, like, that little edge in terms of the incumbency, et cetera, etcetera. But I think Jesse Jackson has done himself very proud. I think Michael Dukakis has done a hell of a job. And George Bush has done a hell of a job. They all went in there sort of as semi-underdogs—including George Bush—and they’ve all come out. I think people that are around all three of those candidates can be very proud of the jobs they’ve done.

Compare that with the meandering, staccato bursts of today. From an interview with the Associated Press:

People want the border wall. My base definitely wants the border wall, my base really wants it—you’ve been to many of the rallies. Okay, the thing they want more than anything is the wall. My base, which is a big base; I think my base is 45 percent. You know, it’s funny. The Democrats, they have a big advantage in the Electoral College. Big, big, big advantage ... The Electoral College is very difficult for a Republican to win, and I will tell you, the people want to see it. They want to see the wall.

Ben Michaelis, a psychologist who analyzes speech as part of cognitive assessments in court cases, told Begley that although some decline in cognitive functioning would be expected, Trump has exhibited a “clear reduction in linguistic sophistication over time” with “simpler word choices and sentence structure.”

This is evident even off camera, as in last week’s post-golf sit-down with The New York Times at his resort in Florida:

... The tax cut will be, the tax bill, prediction, will be far bigger than anyone imagines. Expensing will be perhaps the greatest of all provisions. Where you can do something, you can buy something ... Piece of equipment ... You can do lots of different things, and you can write it off and expense it in one year. That will be one of the great stimuli in history. You watch. That’ll be one of the big ... People don’t even talk about expensing, what’s the word “expensing.” [Inaudible.] One year expensing. Watch the money coming back into the country, it’ll be more money than people anticipate. But Michael, I know the details of taxes better than anybody. Better than the greatest CPA. I know the details of health care better than most, better than most. And if I didn’t, I couldn’t have talked all these people into doing ultimately only to be rejected. Now here’s the good news. We’ve created associations, millions of people are joining associations. Millions. That were formerly in Obamacare or didn’t have insurance. Or didn’t have health care. Millions of people. That’s gonna be a big bill, you watch. It could be as high as 50 percent of the people. You watch. So that’s a big thing ...

The paper said that the transcript was “lightly edited for content and clarity.”

If Trump’s limited and hyperbolic speech were simply a calculated political move—he repeated the phrase “no collusion” sixteen times in the Times interview, which some pundits deemed an advertising technique—then we would also expect an occasional glimpse behind the curtain. In addition to repeating simplistic phrases to inundate the collective subconscious with narratives like “no collusion,” Trump would give at least a few interviews in which he strung together complex sentences, for example to make a case for why Americans should rest assured that there was no collusion.

Though it is not possible to diagnose a person with dementia based on speech patterns alone, these are the sorts of change that appear in early stages of Alzheimer’s. Trump has likened himself to Ronald Reagan, and the changes in Trump’s speech evoke those seen in the late president. Reagan announced his Alzheimer’s diagnosis in 1994, but there was evidence of linguistic change over the course of his presidency that experts have argued was indicative of early decline. His grammar worsened, and his sentences were more often incomplete. He came to rely ever more on vague and simple words: indefinite nouns and “low imageability” verbs like have, go, and get.

After Reagan’s diagnosis, former President Jimmy Carter sounded an alarm over the lack of a system to detect this sort of cognitive impairment earlier on. “Many people have called to my attention the continuing danger to our nation from the possibility of a U.S. president becoming disabled, particularly by a neurologic illness,” Carter wrote in 1994 in the Journal of the American Medical Association. “The great weakness of the Twenty-Fifth Amendment is its provision for determining disability in the event that the president is unable or unwilling to certify to impairment or disability.”

Indeed, the 1967 amendment laid out a process for transferring power to the vice president in the event that the president is unable to carry out the duties of the office due to illness. But it generally assumed that the president would be willing to undergo diagnostic testing and be forthcoming about any limitations.

This may not happen with a person who has come to be known for denying any hint of weakness or inability. Nor would it happen if a president had a psychiatric disorder that impaired judgment—especially if it was one defined by grandiosity, obsession with status, and intense aversion to being perceived as weak.

Nor would it happen if the only person to examine the president was someone like Harold Bornstein—whose sense of objective reality is one in which Donald Trump is healthier than the 42-year-old Theodore Roosevelt (who took office after commanding a volunteer cavalry division called the Rough Riders, and who invited people to the White House for sparring sessions, and who after his presidency would sometimes spend months traversing the Brazilian wilderness).

It was for these reasons that in 1994, Carter called for a system that could independently evaluate a president’s health and capacity to serve. At many companies, even where no missiles are involved, entry-level jobs require a physical exam. A president, it would follow, should be more rigorously cleared. Carter called on “the medical community” to take leadership in creating an objective, minimally biased process—to “awaken the public and political leaders of our nation to the importance of this problem.”

More than two decades later, that has not happened. But questions and concern around Trump’s psychiatric status have spurred proposals anew. In December, also in the Journal of the American Medical Association, mental-health professionals proposed a seven-member expert panel “to evaluate presidential fitness.” Last April, representative Jamie Raskin introduced a bill that would create an 11-member “presidential capacity” commission.

The real-world application of one of these systems is complicated by the fact that the frontal lobes also control things like judgment, problem solving, and impulse control. These metrics, which fall under the purview of psychiatrists and clinical psychologists, can be dismissed as opinion. In a hospital or doctor’s office, a neurologist may describe a patient with Parkinson’s disease as having “impaired impulse control.” The National Institute on Aging lists among the symptoms of Alzheimer’s “poor judgment leading to bad decisions.”

These are phrases that can and do appear in a person’s medical record. In the public sphere, however, they’re easily dismissed as value judgments motivated by politics. The Harvard law professor Noah Feldman recently accused mental-health professionals who attempt to comment on Trump’s cognition of “leveraging their professional knowledge and status to ‘assess’ his mental health for purposes of political criticism.”

Indeed thousands of mental-health professionals have mobilized and signed petitions attesting to Trump’s unfitness to hold office. Some believe Trump should carry a label of narcissistic personality disorder, antisocial personality disorder, or both. The largest such petition has more than 68,000 signatures—though there is no vetting of the signatories’ credentials. Its author, psychologist John Gartner, told me earlier this year that in his 35 years of practicing and teaching, “This is absolutely the worst case of malignant narcissism I’ve ever seen.”

Many other mental-health professionals are insistent that Trump not be diagnosed from afar by anyone, ever—that the goal of mental health is to help people who are suffering themselves from disabling and debilitating illnesses. A personality disorder is “only a disorder when it causes extreme distress, suffering, and impairment,” argues Allen Frances, the Duke psychiatrist who led the writing of the third edition of the Diagnostic and Statistical Manual, which was the first to include personality disorders.

This is consistent with the long-standing, widely misunderstood rule in the profession that no one should ever be diagnosed outside of the confines of a one-on-one patient-doctor relationship. The mandate is based on a legal dispute that gave rise to the American Psychiatric Association’s (APA) “Goldwater Rule,” which was implemented after the politician Barry Goldwater sued Fact magazine for libel because a group of mental-health professionals speculated about Goldwater's thought processes in its pages.

The rule has protected psychiatrists both from lawsuits and from claims of subjectivity that threaten trust in the entire enterprise.

After more than a year of considering Trump’s behavior through the lens of the cognitive sciences, I don’t think that labeling him with a mental illness from afar is wise. A diagnosis like narcissistic personality disorder is too easily played off as a value judgment by an administration that is pushing the narrative that scientists are enemies of the state. Labeling is also counterproductive to the field in that it presents risks to all the people who deal with the stigma of psychiatric diagnoses. To attribute Trump’s behavior to mental illness risks devaluing mental illness.

Judiciousness in public statements is only more necessary as the Trump administration plays up the idea of partisan bias in its campaign against “the media.” The consistent message is that if someone is saying something about the president that depicts or reflects upon him unfavorably, the statement must be motivated by an allegiance to a party. It must be, in a word, “fake”—coming from a place of spite, or vengeance, or allegiance to some team, creed, or party. Expertise is simply a guise to further a hidden political cause. Senator Lindsey Graham recently told CNN that the media’s portrayal of President Donald Trump is “an endless, endless attempt to label the guy as some kind of kook not fit to be president.”

(Of course, Graham himself has called Trump a “kook” who is “not fit to be president.” That was in 2016, though, during the Republican presidential primary, when the two were not yet allies).

That sort of breathless indictment—followed by a reversal and condemnation of others for making the same statement—may not be rare among politicians, but it is a leap to assume that doctors and scientists would similarly lie and abandon their professional ethics out of allegiance to a political party. When judgment is compromised with bias, it tends to be more subtle, often unconscious. Bias will color any assessment to some degree, but it needn’t render science useless in assessing presidential capacity.

The idea that the president should not be diagnosed from afar only underscores the point that the president needs to be evaluated up close.

A presidential fitness committee—of the sort that Carter and others propose, consisting of non-partisan medical and psychological experts—could exist in a capacity similar to the Congressional Budget Office. It could regularly assess the president’s neurologic status and give a battery of cognitive tests to assess judgment, recall, decision-making, attention—the sorts of tests that might help a school system assess whether a child is suited to a particular grade level or classroom—and make the results available.

Such a panel need not have the power to unseat a president, to undo a democratic election, no matter the severity of illness. Even if every member deemed a president so impaired as to be unfit to execute the duties of the office, the role of the committee would end with the issuing of that statement. Acting on that information—or ignoring or disparaging it—would be up to the people and their elected officials.

Of course, the calculations of the Congressional Budget Office can be politicized and ignored—and they recently have been. Almost every Republican voted for health-care bills this year that would have increased the number of uninsured Americans by 20-some million, and they passed a tax bill that will add $1.4 trillion to the federal deficit. A majority of Americans did not support the bill—in part because a non-partisan source of information like the CBO exists to conduct such analyses.

That math and polling can be ignored or disputed, or the CBO can be attacked as a secretly subversive entity, but at least some attempt at a transparent analysis is made. The same cannot be said of the president’s cognitive processes. We are left only with the shouts of experts from the sidelines, demeaning the profession and the presidency.

Article source here:The Atlantic