Low cost vaccine clinic harrisburg pa

My partner has gastroparesis that is caused by MALS. As well as a string of other mental illnesses including depression. Our journey to find a diagnosis has been both physically and mentally exhausting. She almost died from malnutrition because the doctors wanted more tests done before admitting her. When they finally did admit her, they fitted her with a feeding tube. What's great about these feeding tubes is that they're only supposed to last for 3 weeks. She's been using it for 3 months (we had to get it replaced a month after she got it).
During this time her Gallbladder failed giving her extreme abdominal pain. To the point where they had to surgically remove it.
Whenever we try to set up an appointment with specialists. They either tell her to speak with her PCP instead or schedule an appointment 4 months out. WE NEED TO SEE A DOCTOR NOW. Through some sort of luck she was able to set up an appointment with a specialist at the Mayo Clinic in Florida. We flew out and were able to get a whole bunch of tests done. One of the tests showed MALS which gave us hope that she will be cured through MALS surgery.
Not so fast though, doctor's want a simple MRA to confirm that she has MALS. Far enough, we'll schedule as soon as we can so we can get this behind us. MY GOD WE HAVE TO WAIT EVEN MORE BECAUSE THE HEALTH CARE SYSTEM IS SO BACKED UP WITH APPOINTMENTS. As someone who is generally healthy, I never realized how awful the state of our health care system is.
Due to this condition my partner experiences nausea, stomach pain, depression, very low blood pressure (to the point of almost passing out), a stomach that longer works, digestive issues, and malnutrition.
To say that this is putting a strain on our relationship is an understatement. Watching her suffer like this is extremely frustrating and seeing how she gets treated or passed around by doctors is infuriating. Not to mention the cost of all these tests and procedures. If wasn't for her still being on her parent's insurance she'd be dead by now.
My partner is a lovely person who was gone through so much trauma in her life. She attempted to unalive herself 4 times before we met. And now that she finally wants to live her body betrays her. She can't work or do any of things she enjoys anymore.
I don't know how much longer we can do this.
TLDR: Partner is sick with Gastroparesis caused by MALS. The healthcare system is so backed she has to wait months to get testing done and EVEN more months get any procedures done. It's become so debilitating she can't work and is in a bout of depression. I've become depressed and cynical watching her go through this.

I just wrapped up my first week in my first clinical/RD job since passing the exam! My hospital is acute care, with a focus on behavioral health in a large metropolitan area. Majority of our patients are homeless, low-income, or inmates. Most are also admitted with behavioral health issues, from untreated mental illnesses to substance abuse, etc.
I want to make sure I'm up to date on different recommendations and implications for the population I serve. My department does not have access to the NCM through work (and I know its a little out-dated sometimes too). What are some places I can look for guidelines, preferably free or lower cost?

When I found out I was pregnant by a fling, I went to a local clinic and they would be I was already about 25 weeks. I am from South Carolina and abortion is nonexistent here so I mentally shut down as I was only 21 years old, halfway through school and not mentally or financially prepared at all to take care of a child on my own.
I did extensive research and learned of the Dupont Clinic in Washington DC. I called and they helped me get in contact with the Public Abortion Fund. They were so accommodating and it was a surprisingly easy process. They paid for my flight there, hotel, procedure, flight back. Even offered to pay for an uber to the airport and overall food costs for my trip if necessary.
When I arrived in DC I rode the train to the Clinic and checked in. The clinic itself is very secluded and there is security at the front to escort you to the elevator up to the clinic. When you arrive you meet your doula, who is essentially your support person and there with you through every part of the process. Mine was one of the nicest, must understanding people I have met and she really eased a lot of my anxiety. You are assigned a room and wow. There is a TV with all streaming platforms, rain machine, diffuser, snacks and drinks,blankets, just really anything you could thing of to make someone comfortable. While there they make it so you never come across another patient at all for everyones privacy. They introduced me to my nurse who was also so kind and willing to answer any questions under the sun at all. She gave me some medicine (note that every time she went over what each was) and some Xanax as well as I told her I was extremely anxious. I met with my doctor who completed an ultrasound. He was also so accommodating. He asked if I would like to know any information like sex or of a picture of the ultrasound (but with no pressure if I didn't either) and then I was done for day one. My doula walked me to the hotel right next door and helped me check in. The hotel was very nice.
The second day I went in and they did a pelvic exam and went through the process of opening my cervix. They have a TV set up above your head and you can watch anything you want, we watched a relaxing video during the process. I won't lie this was not the most pain free experience but I also have a very low pain tolerance. And it's not that bad, but there is honestly some discomfort but it went very quickly. They sent me back with medications all labeled at when to take. I experienced some cramping starting later in the afternoon into the night but was still able to rest.
The third day I went in and was feeling super anxious about the iv sedation as I had never gone through anything like that before. My doula and nurse were so patient and didn't start the sedation until I really felt I was ready. The rest of the procedure I genuinely have no recollection of, and when I came back to I was in my patient room with a blanket, snacks and I remember feeling an overwhelming feeling of relaxation and relief and no pain at all. They checked in with me often, and eventually I was ready to walk back to the hotel for the night.
I wanted to write this because I wanted to help any other person as confused or anxious as I was feel settled. The people working at the clinic and the fund I could genuinely never thank enough for how easy this process was. And I want to say that everyones experience with abortion is obviously different, and they will support you though any process. All this being said I was to say mentally this was the hardest decision I've ever had to make. Time has gone on and I finally felt ready to write this and I hope it helps. All gets better with time. - <3
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A DEFECT IN NEUROLOGY, NOT A DEFECT OF HUMANITY ADHD: A National Crisis
2023
To Larrakia Country I write to you from the lands and home of Larrakia, in the Northern Territory, which I am grateful to call my home too. Their elders, leaders and children are the owners and protectors of this land and its stories and songs. I am grateful for their hospitality and grace, considering the intolerance and violence that they continue to endure. I dedicate my work and myself to support their stewardship, in whatever role I am asked.
To my sons You are incredible people already. This is one of the biggest things I think I will ever do to make the world you are growing up in a better place than the one I was born into. We have already endured so much together, yet you go from strength to strength. The Blue Witch’s days are numbered.
To E, A, J, M, Ki, N, P, B, Ke, and all the Spirited Children Some might think I paint a bleak picture in this document. You all know this isn’t even the half of it. You deserve the life you want to lead, anything less is a failure, and should be unacceptable to all.
To Dad, Star, Cat, Moh. It is a comfort to know you are somewhere better, when we are left here.
A DEFECT IN NEUROLOGY, NOT A DEFECT IN HUMANITY ADHD: A National Crisis
Abstract ADHD is the biggest and easiest dealt with human challenge of our time. It is a debilitating impairment, that is lifelong and brings no inherent benefits or superpowers. It has likely been a part of hominid neurology for 300,000 years, and in that time it has been systematically rejected by genetic evolution as an enormous set of risks to the survival of the human race. It brings earlier death, more disease, isolation, hopelessness. Making the people who live with it even more remarkable. I have seen neglect, abuse, cruelty and ignorance that would make Dickens blanch. ADHD is routinely rejected, shunned and left in-addressed by Psychiatrists, Paediatricians, Nurses, Teachers, Judges, Police, leaving families in ruins, good and vibrant people be turned to husks, and children as young as 7 turn to suicide.
Not understanding it, not treating it costs our economy $20.5baud a year, if not more.
The need for a national effort to tackle the challenges is paramount to the future success of all Australians.
Self and Evidenced Truths.

1. People with ADHD deserve recognition as living beings with rights, dignity, and aspirations despite our impairments.
   
2. Fundamental to those rights, dignity and aspirations being observed we deserve guaranteed access to our medications, support, workplace arrangements and other accommodations across our lifespan.
   
3. ADHD is a current and emerging Australian national crisis that demands immediate response in kind.
   
4. ADHD is a chronic neurodevelopmental and psychiatric disorder that impairs many aspects of living, at all points of the lifespan (Faraone et al., 2015).
   
5. People diagnosed with ADHD face higher risks of other neurodevelopmental disorders, of suffering child abuse, experience school exclusions and engagement, discrimination, financial predation, other mental health problems, physical disorders, substance use, accidental injuries, chronic health problems and premature death, including suicide attempts and completions. Children are twice as likely to die by age 10, adults are 5 times more likely to be dead by age 25 (Barkley et al., 2022).
   
6. Stimulant medications should be used as soon as possible and practicable following a diagnosis. Several Stimulant medications are safe and effective for treating ADHD and for preventing many adverse outcomes. Non-Stimulant and Non-medication treatments are less effective. (Storebø et al., 2015).
   
7. ADHD costs Australia $20.4 billion per year in lost productivity, wellbeing, and public services (Deloitte Access Economics, 2019).
   
8. There is a need for more awareness, education, and training explaining what ADHD is, as many people with ADHD remain undiagnosed and untreated due to ignorance, bias, or incompetence (Faraone et al., 2019).
   
9. Australia’s attitude towards ADHD costly, uncoordinated, and unfair. This harms people with ADHD in multiple ways, such as limiting their ability to manage their symptoms, increasing their financial burden, and reducing their social support (Australian Clinical Practice Guidelines for ADHD Working Group, 2022).
   

As a Matter of Urgency

1. The Commonwealth Government must fund a co-designed national awareness campaign for ADHD, highlighting its medical nature, the importance of early and persistent intervention and its impacts across the lifespan, and all aspects of modern life as a matter of priority. a. With particular focus on key peak bodies; Australian Health Practitioners Registration Agency and its members, the Australian Council of Unions and its Members, Australian Curriculum Assessment and Reporting Authority Curriculum, Australian Chamber of Commerce and Industry, Australian Finance Industry Association, Law Council of Australia, Police Federation of Australia, Universities Australia, and Australian Council for Private Education and Training.
2. The Commonwealth Government must expand the professions that can screen, assess and diagnose ADHD to include Teachers, General Practitioners, Mental Health Nurse Practitioners, Midwives and Remote Area Nurses, as well as expand telehealth options for remote areas.
3. The Commonwealth Government must establish a national framework for ADHD assessment and support that clarifies roles and responsibilities of different agencies and ensures seamless transitions across life stages and reduce costs for government.
4. The Commonwealth Government should mandate that bachelors, postgraduate degrees, and Community Service certificates and diplomas in health sciences, enrolled and registered nursing, education, community health, criminal and industrial law and allied health fields include compulsory modules in ADHD, co-designed with people with ADHD.
5. The Commonwealth Government must delist methylphenidate, amphetamines, and their various formulations as Schedule 8 drugs and relist them as Schedule 4, they must also expand Medicare and PBS coverage for ADHD medication to include all people with a diagnosis of ADHD. This would reduce the stigma and discrimination associated with ADHD medication use as well as simplify the prescription and dispensing process for people with ADHD and their prescribers.
6. The Commonwealth Government must fund presentation sensitive research on ADHD and its comorbidities, as well as presentation responsive training for anyone who cares for, educates, works with, or employs people with ADHD.
7. The Commonwealth Government must direct new training and mentoring programs for practitioners, staff and community and health service delivery areas, focusing on Peri-Natal Services, Daycare and Primary School staff. Rationales Personal Experience My personal experience is as a father of a child with ADHD and as a sufferer of undiagnosed ADHD myself. My professional experience with government, hospitals, mental health, drug and alcohol case management, and the elderly, has led me to being an Advocate.

I suffered countless unnecessary medical, emotional, economic hardships and injustices throughout my life because of my undiagnosed ADHD. As a child I experienced routine ridicule, shame, and punishments. I was regularly abused and excluded by teachers, both immediate and extended family, peers, and random members of the public, verbally and physically. For symptoms, colloquially and incorrectly referred to as behaviours, of my Combined Presentation of ADHD. Combined Presentation of ADHD means that I have both inattentive and hyperactive-impulsive symptoms. Symptoms are the observable signs of ADHD, such as difficulty paying attention, being easily distracted, fidgeting, talking excessively, not saying much, daydreaming, working memory issues, etc. Symptoms that informed my personality and identity, that I was targeted for, abused for.
As I grew up, contrary to popular belief that ADHD symptoms get better as people age, the effects of my undiagnosed ADHD quickly got worse. The lack of access to university due to needing to work to support myself and look after my ailing father put me in unskilled retail positions, which became administrative positions before accidentally falling into Community Services. Through those careers, the constant workplace bullying and harassment prior to my diagnosis, needing to leave positions that were constantly either short contract or put up for recruitment where my skills, knowledge and wisdom meant nothing has left me with a colourful and varied career. The experience is nice but puts me at a significant disadvantage as I get older. My undiagnosed ADHD made it possible for me to perform well in different jobs. But as I juggled time management, organisation, communication, and self-regulation I would be burnt out as I self-medicated with work, and I would become expendable. Less time in positions, less experience, less expertise, less money, less able to provide for my family, less able to take part in society.
Despite my experience with health systems and supporting disabilities, my son who is 5, is facing similar barriers already and he is aware of himself. Being unable to access practical support for his disability, medication has been rationed as though we should be grateful to be receiving any assistance at all. We are 6 months post the last review, and the practitioner we saw last, hopefully mistakenly, provided us with incorrect information. Both his school and education department in the Northern Territory refused to allow therapists into the school to do observations without onerous and impractical limitations, not least of which was opposing observations in classes which effectively means no inclusive practices. It has come to the point where, to conserve his and my own mental well-being we will have to close his plan out. This shows how the education system continues to fail to accommodate the needs of children with ADHD and violates their right to inclusive education, and not much has changed in 30 years.
The emotional and physical toll of everyday life with ADHD and past traumas makes life an ongoing struggle. My Combined Presentation ADHD, physically, is managed, but even that is tenuous. My health is up in the air, as getting regular reviews with a psychiatrist is impossible, despite the medication I am on being perfectly safe and the prognosis of my condition is unremarkable while on medication. Regular reviews with a psychiatrist are essential for monitoring my medication dosage, side effects, and effectiveness, as well as for addressing any other mental health issues that I endure. You’ll need to start another Inquiry before I talk about those though.
ADHD has meant more serious consequences, and harder to rectify situations: homelessness joblessness, discrimination, isolation. I am still standing but am never safe from them. These are some of the ways that ADHD, diagnosed and undiagnosed, has impacted my life. Due to the lack of recognition, respect, dignity that I deserve as a person, disability or not. I received my Diagnosis less than 3 years ago and already I have experienced the best stability and success I have ever had. In this 3 years I have been homeless, unemployed, suffering severe trauma and depression. All dealt with alone.
My NDIS application is now 18 months into its appeal. I wonder if it will survive longer than the AAT?
ADHD assessments and diagnosis: Children and adults with ADHD often face various gaps and barriers in accessing appropriate assessment, diagnosis, and treatment services for their condition. These include lack of awareness and recognition of ADHD among health professionals and the public; stigma and discrimination associated with ADHD; variability in diagnostic practices and criteria; limited availability and accessibility of specialist services; high out-of-pocket costs for diagnosis and treatment; lack of coordination and integration of care across different sectors; insufficient monitoring and evaluation of treatment outcomes; and lack of evidence-based guidelines and quality standards for ADHD care. These gaps and barriers contribute to the underdiagnoses and under treatment of ADHD in Australia and limit the potential benefits of early intervention and quality care.
ADHD management: Qualified and experienced practitioners who can assess and diagnose ADHD in children and adults are in short supply, especially in rural and remote areas. This leads to long waiting times, inflated costs, and inconsistent quality of assessments, and cascading health outcomes. People with the Inattentive presentation of ADHD, which is predominantly girls and women, face significant gender bias in ADHD assessments, support services and research. This leads to under recognition, misdiagnosis and inadequate treatment and supports of both inattentive presentation ADHD and female-specific issues related to ADHD. Different sectors and levels of government fail to coordinate and integrate their support services for people with ADHD. This creates gaps, overlaps and confusion in accessing education, health, disability, and social services. The National Disability Insurance Scheme (NDIS) staff, and feeder service staff incorrectly prevent and discourage people with ADHD as a primary disability from making access requests. This flows to review mechanisms, including the Australian Administrative Tribunal. This excludes and isolates many people with ADHD from accessing not just NDIS support, but any support at all. Many people with ADHD cannot afford or access ADHD medication, especially those who are not eligible for Medicare or PBS subsidies. This limits their treatment options and affects their quality of life.
The impact of ADHD on individuals, families, and society: Children and adults with ADHD have a significantly reduced life expectancy and are more likely to die prematurely from various causes, such as accidents, suicide, cardiovascular disease, cancer, and substance abuse. The reduction in life expectancy ranges from 9 to 13 years for people with ADHD compared to those without ADHD. The risk of premature death is higher for those with more severe ADHD symptoms, comorbid disorders, and untreated ADHD. In Australia, this means that (statistically) about 1,900 deaths per year would be attributable to ADHD, but further study would be necessary to investigate. Children and adults with ADHD are more likely to suffer from various chronic physical and mental health conditions, such as obesity, diabetes, hypertension, asthma, allergies, sleep disorders, anxiety, depression, bipolar disorder, personality disorders, substance use disorders, and antisocial behavior. These conditions can impair the quality of life and functioning of people with ADHD and increase their health care costs and utilization. In Australia, the annual health system cost of ADHD is estimated to be $546 million. Children and adults with ADHD face various economic challenges and disadvantages, such as lower educational attainment, lower income, higher unemployment, higher poverty, lower productivity, higher criminality, higher health care expenses, and higher social service costs. The annual cost of ADHD to the Australian society is estimated to be $20.4 billion, which comprises $12.8 billion in financial costs and $7.6 billion in wellbeing costs.
Awareness of ADHD: ADHD is not a result of poor parenting, low intelligence, or moral weakness. ADHD is a lifelong condition that can persist from childhood to adulthood and affect various aspects of life. The importance of recognising ADHD as a genetic, neurological medical condition, requiring medication as a first line of successful management, and not a behavioural issue, cannot be overstated. Health professionals, educators, employers and the public lack awareness and understanding of ADHD, which causes stigma, discrimination and underdiagnoses of ADHD. Research funding for ADHD in Australia is inadequate, which hampers the development of evidence-based practice guidelines, interventions, and policies for people with ADHD. This also limits the opportunities for innovation and collaboration in addressing the challenges posed by ADHD. Children with ADHD typically receive a disproportionate percentage of school based harassment, both from peers, and education staff. Routinely EAPs are formulated in opposition to recommendations made by specialist practitioners, and children are severely punished for not meeting the often odious or impossible goals. Detentions, responsibilities, suspensions, supervision and expulsions are common place. In the classroom, ignorant and unqualified teachers harass students and parents to stop behaviours they, from no basis, deem developmentally inappropriate. Time off to be with the excluded children is often supported by employers, higher education facilities, until they decide that enough is enough. ADHD is a neurodevelopmental disorder that has a strong genetic basis. ADHD is associated with structural and functional differences in the brain, especially in the regions involved in attention, executive function, emotion regulation and reward processing. ADHD is also influenced by environmental factors that can affect gene expression and brain development. The name ADHD (Attention-Deficit/Hyperactivity Disorder) is inadequate and misleading for several reasons. First, it implies that the core symptoms of the disorder are only attention deficit and hyperactivity, while ignoring the causal and key features such as impulsivity, emotional dysregulation, and executive dysfunction. Second, it suggests that attention deficit and hyperactivity are always present and equally severe in all cases of ADHD, while ignoring the heterogeneity and variability of the disorder across individuals, subtypes, and contexts. Third, it conveys a negative and stigmatising view of the disorder as a deficit or a problem, while ignoring the strengths and potential of people with ADHD.
Conclusion The writing is on the wall, whether you read it or not is irrelevant to its truth; improve the outcomes for people with ADHD and the entire nation will benefit, go on ignoring its magnitude and we will continue the cycle again, until the next generation finally addresses it. Addressing it represents net savings for the Commonwealth Government, and the states and territories. I think we could find other ways to spend $7 billion dollars than on badly managing ADHD in Australia.
I am happy to answer more questions or speak to any of the points raised herein.
References: Barkley, R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). Guilford Press. Biederman, J., Faraone, S. V., Monuteaux, M. C., Bober, M., & Cadogen, E. (2006). Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biological Psychiatry, 59(12), 1123-1131. https://doi.org/10.1016/j.biopsych.2005.12.036 Doshi, J. A., Hodgkins, P., Kahle, J., Sikirica, V., Cangelosi, M. J., Setyawan, J., Erder, M. H., & Neumann, P. J. (2012). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child & Adolescent Psychiatry, 51(10), 990-1002.e2. https://doi.org/10.1016/j.jaac.2012.07.008 DuPaul, G. J., Weyandt, L. L., O’Dell, S. M., & Varejao, M. (2009). College students with ADHD: Current status and future directions. Journal of Attention Disorders, 13(3), 234-250. https://doi.org/10. 1177/1087054709340650 Efron, D., Sciberras, E., Hassell, P. (2015). Are Australian children with ADHD being adequately treated? Archives of Disease in Childhood, 100(10), 914-916. https://doi.org/10. 1136/archdischild-2014-307467 Faraone, S. V., Asherson, P., Banaschewski, T. et al. (2015). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 1, 15020. https://doi.org/10. 1038/nrdp. 2015. 20 Faraone, S. V., Banaschewski, T., Coghill, D. et al. (2020). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 108, 1-18. https://doi.org/10. 1016/j.neubiorev. 2019. 11. 022 Garg, S., Lillystone, D., Dossetor, D. (2018). Attention deficit hyperactivity disorder: an update for paediatricians. Journal of Paediatrics and Child Health, 54(2), 120-125. https://doi.org/10. 1111/jpc. 13717 Kooij, J. J., Bijlenga, D., Salerno, L., Jaeschke, R., Bitter, I., Balázs, J., … & Stes, S. (2019). Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56, 14-34. https://doi.org/10. 1016/j.eurpsy. 2018. 11.001 Le, H. H., Hodgkins, P., Postma, M. J., Kahle, J., Sikirica, V., Setyawan, J., Erder, M. H., & Doshi, J. A. (2014). Economic impact of childhood/adolescent ADHD in a European setting: the Netherlands as a reference case. European Child & Adolescent Psychiatry, 23(7), 587-598. https://doi.org/10.1007/s00787-013-0495-0 Nigg, J. T., Greven, C. U., & Wilmot, B. (2015). Neurodevelopmental problems: an overview. In A. Thapar, D. S. Pine, J. F. Leckman et al. (Eds.), Rutter’s child and adolescent psychiatry (6th ed., pp. 1-14). Wiley Blackwell. Russell, A. E., Ford, T., Williams, R., & Russell, G. (2019). The association between socioeconomic disadvantage and attention deficit/hyperactivity disorder (ADHD): a systematic review. Child Psychiatry & Human Development, 50(3), 487-503. https://doi.org/10.1007/s10578-018-0842-6 Sayal, K., Prasad, V., Daley, D., Ford, T., & Coghill, D. (2018). ADHD in children and young people: prevalence, care pathways and service provision. The Lancet Psychiatry, 5(2), 175-186. https://doi.org/10.1016/S2215-0366(17)30167-0 Sciberras, E., Mulraney, M., Silva, D., & Coghill, D. (2014). Prenatal risk factors and the etiology of ADHD—review of existing evidence. Current Psychiatry Reports, 16(1), 431. https://doi.org/10.1007/s11920-013-0431-3 Taylor, E., Döpfner, M., Sergeant, J. et al. (2004). European clinical guidelines for hyperkinetic disorder—first upgrade. European Child & Adolescent Psychiatry, 13(Suppl 1), I7–I30. https://doi.org/10.1007/s00787-004-1002-x Coghill, D. R., Banaschewski, T., Zuddas, A. et al. (2011). European guidelines on managing adverse effects of medication for ADHD. European Child & Adolescent Psychiatry, 20(1), 17–37. https://doi.org/10.1007/s00787-010-0140-6 Deloitte Access Economics. (2019). The social and economic costs of ADHD in Australia. https://www2.deloitte.com/content/dam/Deloitte/au/Documents/Economics/deloitte-au-economics-social-costs-adhd-australia-270819.pdf Australian ADHD Professionals Association. (2019). The social and economic costs of ADHD in Australia. https://aadpa.com.au/the-social-and-economic-costs-of-adhd-in-australia/ Doshi, J. A., Hodgkins, P., Kahle-Wrobleski, K., Erder, M. H., & Gericke, C. A. (2020). Social and economic costs of attention-deficit/hyperactivity disorder across the lifespan: a systematic review and meta-analysis. PharmacoEconomics, 38(11), 1205-1222. https://doi.org/10.1007/s40273-020-00958-8

41f here. I was diagnosed with Graves' Disease when I was 14, had thyroid ablation when I was 15, and have been hypothyroid ever since. I switched from Synthroid to Armour Thyroid over 7 years ago.
My blood test results are usually normal-ish and have had minor adjustments over the years. I'm currently on 120 ug of Armour 6 days a week. Previously I was taking 90 ug and 15 ug pills daily, but I was essentially paying double for the 2 pills, and it was getting costly. Taking 120 ug 6 days a week, averages out to the same.
My TSH has normally been on the low side of the 'normal' range, and Free T4 has been on the mid-low side too.
Recently, I decided to stop taking hormonal birth control. Not because I'm trying to become pregnant, but I was tired of the side effects. So my endocrinologist suggested I get my bloodwork redone, just in case.
In December 2022, these were my results:
TSH: 0.69 (Range: 0.340 - 5.600 uIU/mL)
Free T4: 0.9 (Range: 0.60 - 1.60 ng/dL)
I had blood drawn today, and these are my results:
TSH: 0.760
Free T4: 0.52
So not a huge change in the TSH, but definitely a change in the Free T4. Looking through my historical Free T4 results, they have always been typically 0.8 - 0.9, so this does seem like a big drop.
Does this mean I'm now clinically hypothyroid?
I've been trying to lose some pandemic weight gain for the past few months, and despite calorie restriction and exercise, it's not really coming off. I've also notice a bit more water retention / edema.
My endo hasn't gotten back to me yet about my new blood test results. Should I ask her about the low Free T4 result? Any suggestions on what I should ask her about?
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Someone sent me a chat request asking about affordable ketamine providers. I wrote this up and thought to publish it on several of the ketamine subReddits.
I have a list of psychotherapy providers, most of whom are affordable. But these are T's NOT ketamine providers. So, I don't have a great response for your specific request. Best I can offer is this.
There are two sources of ketamine: Legitimate; and, black-market. That's life.
In the US, in the legitimate market, it is clear that Joyous.team is the price leader. They offer very-low doses to low doses at-home for $129/month, prescription and drug included. Their customer service is uneven. Yet, they have many satisfied customers. Definitely worth trying if they are licensed in your state (or a state you can get to easily) and if they accept you, and if their dosing works for you.
From this point, the legitimate market answer gets complicated.
There are a few other tele-ketamine providers who are affordable but harder to identify. See the directories at KetamineTherapyForMentalHealth.com There is a page with a few providers and their pricing that will give you a better (albeit not complete) picture of the pricing in the market. And, a few providers who are at the lower end of the spectrum. If -ultimately- these directories were substantially complete, they would provide the answer from the legitimate market. But we are a long way from seeing them complete.
Dr Smith, before he lost his DEA license, had a pricing schedule of $250/month for his services for the first 12 months. Plus $50 for drugs if you used, e.g., Precision. That's $300/month service+drugs for 12 months. But, after 12 months, Dr. Smith required only quarterly consultations, so his cost was $250/QUARTER. That's $250/3=$83/month. $83+$50=$133/month after the first year. That was almost the Joyous price.
Dr Pruett also offers less frequent consultations after a patient stabilizes on a dose. He is - so far as I understand - less rigid regarding the time to stabilize. Not fixed at 12 months; might be a little sooner or a little later. And might not be quarterly; might be bi-monthly. So, Dr Pruett isn't as expensive as he seems, with his initial consultation at $450 and monthly follow-ups at $250.
I suggest asking other tele-ketamine providers if they have a pricing schedule for AFTER the first year; or, whenever the patient stabilizes. Maybe some do, but it's not prominent on their websites. Some may attract business by offering a reduced consultation frequency after the first year or so.
Initially, in my learning about ketamine, I thought that the IV/IM clinics were priced high relative to the tele-ketamine providers. I'm less convinced today. It seems that the durability of IV/IM ketamine is longer than that for sublingual/rectal. IF this is true, then the cost of boosters is much lower per time period than seems apparent from the pricing for the initial course of treatment (usually 6 or 4 or 8 sessions.)
First, I'm going to suppose a patient who can get transportation to/from a clinic. Second, that the clinic offers a relatively attractive rate for infusions/injections. And third, the patient can schedule appointments at times convenient for his work/home responsibilities. If ALL these presuppositions apply, then the in-clinic ROAs are applicable.
If IV/IM really is durable for a patient, then the cost of - let's say - a $900 infusion with a durability of 3 months is competitive with a $300/month service+drug price from a tele-ketamine provider. Still, the proposition is complicated. The in-clinic experience is going to be expensive in the first 1 - 3 - 6 months and get less expensive only after that. The at-home experience is much less expensive in the first month, less expensive in the 2n'd month, and gets competitive with the in-clinic pricing only in subsequent months. If the at-home provider requires only quarterly consultations after a year, that provider is competitive with the in-clinic pricing for quarterly boosters.
I think accessibility to a reasonably-priced clinic is critical. If you have that accessibility, then seriously consider that in-clinic provider. If you don't have that accessibility, you have to find the best-priced provider among tele-ketamine prescribers licensed in your state. Finding ketamine clinics is relatively easy by googling "ketamine clinics near me" or finding directories online. Finding tele-ketamine prescribers licensed in your state is hard. I wish the directories at KetamineTherapyForMentalHealth.com were complete today; but they are not yet complete.
I can NOT advocate black-market ketamine. It is not feasible to assess the potency and purity of black-market-sourced ketamine. It might be fine, good enough, or something really dangerous. Your dealer won't be able to provide reliable guidance regarding dosing. But what can I say to the prospective patient who lives in a jurisdiction where legal ketamine is NOT AVAILABLE?
If you can travel to the US or some other country where ketamine IS legal and accessible, that represents an alternative. I mostly live in Mexico and source my legitimate ketamine in the US. Legitimate ketamine is no longer available in Mexico. So, travel to the US works for me; it will work for many people outside the US. Some other countries might be more accessible to a given patient. For example, Central American countries are somewhat more accessible to prospective patients living in southern Mexico than the US. Look at your map.
If you live in the US but in a state with few clinics and fewer licensed tele-ketamine providers, then find a nearby provider you can reach. It could be a state a few miles from your home. Or, in a state hundreds of miles from your home where you have a friend/relative living. You might have to acquire a state ID showing that friend/relative's address, a so-called "non-driver's license."
Compare the pricing from your best legitimate source to what you might find in the black market. Suppose your black market price is $50/gram. Suppose your "sweet spot" dose (if you could find a prescriber) was 4 grams per month. (That's 400 mg every 3 days.) Your black-market cost for 4 grams per month would be $200. How much more would a legitimate provider cost you? If it's $300 (service+drugs) in the first year, that's only $100/month more; $1,200 for the first year. In the second year, your legitimate cost might be as low as $83+$50=$133/month; i.e, $67 LESS than your black-market cost for the drugs with no dosing guidance.
It is worth your while wrestling with the constrained legitimate market in the US rather than resorting to the black-market. All-in costs for a few years are comparable. Pharmacutical-grade ketamine is a much safer bet than black-market ketamine. The guidance from a prescriber is apt to help you find your sweet spot dose maximizing the therapy with minimum risk to your urinary tract.

Someone sent me a chat request asking about affordable ketamine providers. I wrote this up and thought to publish it on several of the ketamine subReddits. I have a list of psychotherapy providers, most of whom are affordable. But these are T's NOT ketamine providers. So, I don't have a great response for your specific request. Best I can offer is this. There are two sources of ketamine: Legitimate; and, black-market. That's life. In the US, in the legitimate market, it is clear that Joyous.team is the price leader. They offer very-low doses to low doses at-home for $129/month, prescription and drug included. Their customer service is uneven. Yet, they have many satisfied customers. Definitely worth trying if they are licensed in your state (or a state you can get to easily) and if they accept you, and if their dosing works for you. From this point, the legitimate market answer gets complicated. There are a few other tele-ketamine providers who are affordable but harder to identify. See the directories at KetamineTherapyForMentalHealth.com There is a page with a few providers and their pricing that will give you a better (albeit not complete) picture of the pricing in the market. And, a few providers who are at the lower end of the spectrum. If -ultimately- these directories were substantially complete, they would provide the answer from the legitimate market. But we are a long way from seeing them complete. Dr Smith, before he lost his DEA license, had a pricing schedule of $250/month for his services for the first 12 months. Plus $50 for drugs if you used, e.g., Precision. That's $300/month service+drugs for 12 months. But, after 12 months, Dr. Smith required only quarterly consultations, so his cost was $250/QUARTER. That's $250/3=$83/month. $83+$50=$133/month after the first year. That was almost the Joyous price. Dr Pruett also offers less frequent consultations after a patient stabilizes on a dose. He is - so far as I understand - less rigid regarding the time to stabilize. Not fixed at 12 months; might be a little sooner or a little later. And might not be quarterly; might be bi-monthly. So, Dr Pruett isn't as expensive as he seems, with his initial consultation at $450 and monthly follow-ups at $250. I suggest asking other tele-ketamine providers if they have a pricing schedule for AFTER the first year; or, whenever the patient stabilizes. Maybe some do, but it's not prominent on their websites. Some may attract business by offering a reduced consultation frequency after the first year or so. Initially, in my learning about ketamine, I thought that the IV/IM clinics were priced high relative to the tele-ketamine providers. I'm less convinced today. It seems that the durability of IV/IM ketamine is longer than that for sublingual/rectal. IF this is true, then the cost of boosters is much lower per time period than seems apparent from the pricing for the initial course of treatment (usually 6 or 4 or 8 sessions.) First, I'm going to suppose a patient who can get transportation to/from a clinic. Second, that the clinic offers a relatively attractive rate for infusions/injections. And third, the patient can schedule appointments at times convenient for his work/home responsibilities. If ALL these presuppositions apply, then the in-clinic ROAs are applicable. If IV/IM really is durable for a patient, then the cost of - let's say - a $900 infusion with a durability of 3 months is competitive with a $300/month service+drug price from a tele-ketamine provider. Still, the proposition is complicated. The in-clinic experience is going to be expensive in the first 1 - 3 - 6 months and get less expensive only after that. The at-home experience is much less expensive in the first month, less expensive in the 2n'd month, and gets competitive with the in-clinic pricing only in subsequent months. If the at-home provider requires only quarterly consultations after a year, that provider is competitive with the in-clinic pricing for quarterly boosters. I think accessibility to a reasonably-priced clinic is critical. If you have that accessibility, then seriously consider that in-clinic provider. If you don't have that accessibility, you have to find the best-priced provider among tele-ketamine prescribers licensed in your state. Finding ketamine clinics is relatively easy by googling "ketamine clinics near me" or finding directories online. Finding tele-ketamine prescribers licensed in your state is hard. I wish the directories at KetamineTherapyForMentalHealth.com were complete today; but they are not yet complete. I can NOT advocate black-market ketamine. It is not feasible to assess the potency and purity of black-market-sourced ketamine. It might be fine, good enough, or something really dangerous. Your dealer won't be able to provide reliable guidance regarding dosing. But what can I say to the prospective patient who lives in a jurisdiction where legal ketamine is NOT AVAILABLE? If you can travel to the US or some other country where ketamine IS legal and accessible, that represents an alternative. I mostly live in Mexico and source my legitimate ketamine in the US. Legitimate ketamine is no longer available in Mexico. So, travel to the US works for me; it will work for many people outside the US. Some other countries might be more accessible to a given patient. For example, Central American countries are somewhat more accessible to prospective patients living in southern Mexico than the US. Look at your map. If you live in the US but in a state with few clinics and fewer licensed tele-ketamine providers, then find a nearby provider you can reach. It could be a state a few miles from your home. Or, in a state hundreds of miles from your home where you have a friend/relative living. You might have to acquire a state ID showing that friend/relative's address, a so-called "non-driver's license." Compare the pricing from your best legitimate source to what you might find in the black market. Suppose your black market price is $50/gram. Suppose your "sweet spot" dose (if you could find a prescriber) was 4 grams per month. (That's 400 mg every 3 days.) Your black-market cost for 4 grams per month would be $200. How much more would a legitimate provider cost you? If it's $300 (service+drugs) in the first year, that's only $100/month more; $1,200 for the first year. In the second year, your legitimate cost might be as low as $83+$50=$133/month; i.e, $67 LESS than your black-market cost for the drugs with no dosing guidance. It is worth your while wrestling with the constrained legitimate market in the US rather than resorting to the black-market. All-in costs for a few years are comparable. Pharmacutical-grade ketamine is a much safer bet than black-market ketamine. The guidance from a prescriber is apt to help you find your sweet spot dose maximizing the therapy with minimum risk to your urinary tract.

If you're considering cosmetic surgery, you want to choose a surgeon who is experienced and has a good reputation. You also want to find a surgeon who is affiliated with a reputable hospital.
Delhi's Leading Cosmetic Surgery Clinic is one of the most experienced and reputable cosmetic surgery clinics in Delhi. We've been helping people transform their appearance for over 20 years.
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If you're considering cosmetic surgery, you want to choose a surgeon who is experienced and has a good track record. You also want to find a surgeon who is qualified to perform the specific procedure you're interested in.
At our practice, you'll find experienced surgeons who are qualified to perform a wide range of cosmetic surgery procedures. We're dedicated to providing our patients with the best possible care, and we're committed to achieving beautiful, natural-looking results.
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If you're considering cosmetic surgery, we encourage you to contact us to learn more about our practice and to schedule a consultation. We'll be happy to answer your questions and help you make an informed decision about whether cosmetic surgery is right for you.

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As with any surgery, there are some risks associated with cosmetic surgery. These risks can include infection, bleeding, and scarring.

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Recovery time from cosmetic surgery varies depending on the procedure. Generally, simpler procedures have shorter recovery times while more complex procedures may take longer.

Hi guys so in my neighborhood there’s a stray cat that’s hurt cause there’s blood on the cats neck and I’m wondering if anyone knows a low cost clinic I could take the cat too once I can (safely )catch it .

Rescued two twins in March and May respectively and started a gofundme (https://instagram.com/place_of_gathering?igshid=MzNlNGNkZWQ4Mg==) to cover fixing. So far we've covered the cost for one of their fixing appointments, which was about 200$.
However, the fixing appointment for the other twin cost in May cost just under 300$ because we made sure to be more thorough with vaccines and flea medicine. and ubers to the clinic cost 70$ total. Vet costs, fecal samples(77$each) and vaccines have all added up to around 900$, and one of the cats still hasn't had an FIV vaccine.
I'm just asking because are some of the things I'm doing are unnecessary? F.e. does he need an fiv vaccine when the other is vaccinated and he isn't going outdoors? I'm trying to be responsible but they've never had any visible health issues as far as I could tell. Maybe this is why rescuing should be left to organizations?

Hi all!
I am 1 month into my urgent care job as a new grad. I originally wanted family medicine, but the hospital system in my area refused to hire me for that because I was a new grad. It was a pretty crappy process with poor communication and empty promises from preceptors in FM. My UC gig is pretty good. Clinically I am way more interested in FM and really miss chronic disease management. I also miss building relationships with patients. Conversely, I can already see how the in basket and constant flood of pt messages may be exhausting. I intended to stay in UC for 6-12 months before considering anything else. I have good training and support from colleagues and my SP (not on site, but very responsive to text/call questions on shift). However, I was made aware of a FM opening for a site I rotated at. I didn't work with this specific doc, but I knew who he was. I love the location and clinic manager. This would be a pretty significant paycut and I don't want to burn bridges with the department I am currently in. My gut says not to do it because I need to give this job time... I don't hate it but don't love it.
UC Contract: 150 shifts/year (3 shifts/week -- 8a-8p), $123k ($68.75/hour, any additional shifts are base pay + 15%), up to 15% annual bonus, unlimited ATO (not PTO) as long as contractual hours are met. 36 weekend hours/month + 1 major holiday per year (rotating).
FM structure (from what I have heard from colleagues): 36 pt facing hours/week (typically in office 4 days/week) + 4h admin time/week. Pay ~$108k with up to 15% bonus. Can switch from salary to production-based model after 2 years. 6 weeks of ATO. Would be inheriting a very full pt panel from a NP who is leaving to pursue a behavioral health gig. She was wonderful but was frequently double and triple booked.
For reference, I am in a very low cost of living area in the midwest. I am unsure if I could even get hired for FM if I applied since I am still so new... I think my rotation there is the only reason I would be considered. I also found the previous hiring process to be heartbreaking since I had my heart so set on FM so I'm not sure if I am ready to potentially go through that again while I am trying to be content where I have been placed.
Sorry for the novel...
TL;DR Can't decide if I should stay with a decent gig or apply for a lower-paying gig that I feel would be more fulfilling.

Hey friends,
My wife is missing two shots and we are looking into getting those as well as the labs to go ahead and complete medical. We have a certified translated copy of the rest of required vaccines to give to doctor.
What did you guys pay for doctor, shots and test? We are looking of course for low cost options, this process can bankrupt anyone. Any information, fees and contacts you can share in the Northeast or Central Florida is greatly appreciated!!

পার্ক সার্কাস অথবা তার আসে পাশের এরিয়াতে কম টাকাই কী কোনো পশু চিকিৎসালয়/সেল্টার আছে? গতকাল একটা বিড়ালের বাচ্চাকে স্ট্রিট থেকে অসুস্থ অবস্থায় উদ্ধার করলাম। নর্মাল ঠান্ডা আর নাক বন্ধ মনে হচ্ছে, কাল থেকে জল ছাড়া কিছু খায়নি। আমার সেন্ট্রাল কোলকাতার এলাকাটা অত ভালো চেনা নেই, আর আমি একজন স্টুডেন্ট তাই বেশি খরচা করে বড়ো প্রাইভেট ক্লিনিকে দেখানোর বর্তমানে সামর্থ্য নেই। কেউ কম খরচে লোকাল/প্রাইভেট ট্রিটমেন্ট সেন্টার অথবা কোনও স্ট্রে এনিমেল রেস্কিউ সেল্টার সাজেস্ট করতে পারবেন।
Is there any affordable animal clinic/shelter in the park circus or nearby area? The day before, I rescued a sick kitten from the street. Seems like normal cold and congested nose, haven't eaten anything except water since yesterday. I'm not familiar with places in central Kolkata, and since I am a student, I can't currently afford to see the kitten in a private clinic that costs more. Can anyone suggest a low-cost local/private treatment center or a stray animal rescue shelter?

I live in Downtown Bothell and would prefer to stick close to there.
My priorities are: Quality of Care, and low wait times for an appointment.
As far as cost goes: I'm not looking for a low income clinic, but my dog will need to get spayed so if you've had a pet fixed recently, I'd love to know how much you paid including any pre-op bloodwork and follow-up care.

...with an absolute reduction of 4·1%, compared with placebo. Metformin has clinical benefits when used as outpatient treatment for COVID-19 and is globally available, low-cost, and safe."
This is good news because Metformin, typically used by prediabetics, diabetics and those struggling with insulin resistance (ex. PCOS), is relatively cheap and widely available.
Source
Bramante, C. T., Buse, J. B., Liebovitz, D. M., Nicklas, J. M., Puskarich, M. A., Cohen, K., Belani, H. K., Anderson, B. J., Huling, J. D., Tignanelli, C. J., Thompson, J. L., Pullen, M., Wirtz, E. L., Siegel, L. K., Proper, J. L., Odde, D. J., Klatt, N. R., Sherwood, N. E., Lindberg, S. M., … Boulware, D. R. (2023 Jun 8). Outpatient treatment of COVID-19 and incidence of post-covid-19 condition over 10 months (covid-out): A multicentre, randomised, quadruple-blind, parallel-group, phase 3 trial. The Lancet Infectious Diseases. https://doi.org/10.1016/s1473-3099(23)00299-200299-2)

- Recipes for Disaster: An Anarchist Cookbook
Helping Women and Society Escape Violent Relationships
Women exist in a "domesticated" combat zone. On any given day in the United States, an average of 480 women will be raped, 5,760 women will be assaulted, and 4 will be murdered by a [cis] male partner. Domestic violence [against women] is an assault on women's bodies and minds by those who claim to love them and love to claim them. The success of this violence depends on the complicity of community. If we intend to bring about true liberation, we must foster explicitly antiauthoritarian behavior in both personal and political life. No hierarchy is acceptable and no domination is justifiable—not even "behind closed doors." Because one in four women will be assaulted (likely including someone you love), we must wage war on domestic violence. We serve to empower our communities best by fighting the violence and hierarchy closest to home… or in the home.
Ingredients

• Outreach materials
• Shelter
• Childcare
• Basic safety materials—pepper spray, whistles, deadbolts, phone
• Knowledge of local resources
• A network of safe communities/spaces for women
• Personal dedication to the complete annihilation of authority
• Instructions

Stage One: Helping Her
Educate yourself. Domestic violence (DV) is rarely a single instance of battery, but instead a pattern of power and control. It may involve sexual or physical violence, or it may be a complex web of threats, property destruction, isolation, and emotional, financial, and mental abuse. Understanding this will help you recognize abuse if it comes without physical bruises.
If you are truly ready to have your mother, friend, or daughter tell you what is happening in her private life, invite her to come to you. If you are speaking against violence and rape, she will know you are ready. Wheatpaste neighborhoods with posters about domestic violence, hold street fairs against violence in residential neighborhoods, plaster infoshops and collective homes with signs that invite women into a safe space. If she, her children, or her animals are in immediate danger, however, you may need to approach her. Never approach the abuser: most abusers are paranoid and will quickly assume their victims have exposed them, and may retaliate against them.
Follow her lead. The most important thing you will do is be there for her, even if you feel useless. Trying to be a hero can only undermine her autonomy. Let her make her own decisions, even bad ones, and never tell her what to do. Give her back control: refuse to dominate her and recreate the abuse.
Give her a phone number or a way to contact you or someone in the community. Best is a cell phone that will always be on, or a collective house's number where someone is usually awake.
Let her talk. Don't wince or gasp: tales of [rape] and strangulation are not easy to listen to, but they are harder to tell. Survivors are often terrified of either tainting someone else's world with their trauma or not being believed. Tell her you believe her. You will be changed by what you hear; thank her for that. Confirm what may seem obvious.
An abuser spends a lot of time telling her she is crazy, and that no one would believe her. Tell her that you are listening, and offer eye contact and physical closeness if she is comfortable with it. Assure her that the way she feels is okay. There is no "normal" way to respond to abnormal acts of violence. Understand that the shield of invulnerability has been shattered (41% of rape victims and 89% of domestic violence victims expect to be assaulted again). She may be hyper-vigilant; the best way to help is to make her feel safe and legitimize/recognize her fears.
Focus on practical and immediate concerns. Where can one buy mace? What organizations work with DV issues? Ask her what she needs in order to leave: shelter? transportation? a job? childcare? money? Help her find these resources. Then ask what she needs to stay out of the relationship. For most women, it takes seven to fourteen attempts to leave their abusers. If she doesn't have the resources to stay gone, she may return because he can support her. Many abusers manipulate these needs. This is what makes DV such a pernicious crime: the perpetrator is the person who knows her best.
Address her immediate safety. If she is living with the abuser, make sure she has a plan to get out during a violent episode (contact your local coalition against DV for safety plans). Offer to keep personal papers and a packed suitcase for her and some extra money. Make sure she has a phone. An old cell phone without service can still dial 911 if charged. Consider establishing code words for her to use if she needs help, or other signals—a porch light off, for example, could let the neighbors know they should contact the police. If she doesn't live with her abuser, offer to find someone to stay with her or nearby. Do a safety check: make sure phone lines can't be cut, doors have deadbolts, and windows are nailed shut. If she wants to stay in hiding, help her cover her tracks by getting all mail sent to another address or post office box; offer to put your name on utilities. If she rides a bus or bike, find a car for her to borrow. Find community members who can do errands with her, pick her up from work, watch the children, etc. 90% of stalking cases are former intimate partners, not strangers.
The anti-DV movement started as an underground railroad of homes. Consider where she stays carefully. If the abuser knows where she is staying, she can feel like a sitting duck, especially if she stays with a [cis man]—an abuser's insecurity and suspicions can easily turn to rage. The majority of extreme violence and murder occur when the woman tries to leave, because the abuser feels he is losing control of her. Taking a survivor into your home is a serious commitment; unless you are prepared to internalize her constant vigilance and your home is very secure, she may be safer with someone else.
If she wants, help her use the legal system to file charges, obtain a protective order, file for custody, or get a divorce. Discuss the pros and cons of this in relation to safety, not politics. Until we develop an alternative, we cannot criticize a woman for using "the system." It is imperative, however, that she doesn't invest her safety or emotional wellbeing in the criminal justice system, as it often fails.
The community might want to deal with or "out" the abuser. Some communities have ostracized abusers, boycotted their businesses, refused to speak to them. You could make posters of his face, or spray paint his house. You can run abusers out of town, though understand this has the potential of resulting in his abusing someone somewhere else. You can threaten him with violence. No matter what is done, it must be acceptable to the survivor, because her well-being is at stake.
Stage Two: Helping Us
There are many steps we must take as communities and collectives to be welcoming and radicalizing spaces for survivors. At the same time, we must each take personal responsibility for shifting the public conscience toward abhorrence for violence. In a patriarchal state, violence toward and the rape of women prop up sexist oppression and exploitation. We cannot transform "rape culture" without committing ourselves to resisting and eradicating all patriarchy.
We must redefine sex and relationships away from terms of violence, power, domination and status. In our relationships we can try to create a new vocabulary that [prioritizes] consent and equality.
[Cis] men in particular need to organize. [Most] DV is a [cis] man's problem—women just suffer the consequences. A radical [cis] heterosexual male must give up the privileges of his gender—only then can he be approachable, only then will he be capable of offering meaningful help to a survivor. You cannot aid a survivor while allowing for other forms of sexism to prevail. [... Cis m]en can unlearn their gender construction and undermine patriarchy; imagine if every boy grew up around men who were struggling against patriarchy and violence.
Account
Taheera called the police after Mark had threatened to take their five-month-old baby, Juan. There were bruises on her neck from a previous incident, and Mark was arrested. It had been Mark's idea to move to the city when Taheera was 3 months pregnant. Taheera started to go to a low-cost clinic for prenatal care, but stopped going when Mark accused her of sleeping with the doctor. The first time Mark hit her was after she made a list of baby names. He was jealous of the attention the baby was getting.
I am a social worker, and an agency referred her to me. When we first talked, Taheera kept looking behind her. I suggested she push her chair against the wall, and promised her that I would keep checking down the hallway for Mark (even though Mark was in jail and wasn't going to be coming).
She was scared of Mark and of what he might do to her and the baby, especially now that he had been arrested. Mark's job was their only source of income, and he might be fired if he didn't get out of jail soon. She had a lot of questions about the legal system and was curious to know if I had talked to other women who felt like she did. We talked about local groups and shelters that could help, but mostly I just listened. I gave her my number and a 24-hour crisis number. Taheera chose to bail Mark out, using all their savings, but not to speak with him. The state had Mark sign a "no contact order" telling him he couldn't contact her or move back home, so he got an apartment upstairs from Taheera and made a point of bringing lots of "bitches" home so Taheera would see. Taheera didn't show up to court and the case was dropped.
Two weeks later, Taheera called and said that Mark was upstairs, Juan was asking for him, and that she was trying to resist going up to him. She missed him. I simply listened, and told her, as best I could, that her feelings were normal. She kept asking, "What's wrong with me?" I tried to refocus on Mark's problems. Taheera finally agreed to walk downtown and sign up for a support group that had childcare. But she never did, and instead went upstairs to Mark.
Eight months later, Taheera called from a payphone. Mark had held a gun to her head because he was angry that they now lived together in the upstairs apartment but he still had to pay for the downstairs apartment. He cut the phone cord so she couldn't call out. Things had been okay for a while: Mark had let her get a job and was being a "good daddy." Taheera told me that she had left several times, but each time he had found her or threatened her family Taheera felt too tired to leave, and just wanted things to "stay sane."
Taheera decided to save up money. We met for lunch one afternoon and made a list of what to do, which I kept so Mark wouldn't see it. I also gave her an old cell phone to call 911, which she hid in a cabinet. She got a separate bank account and started funneling part of her paycheck into it. She told a neighbor what was happening and gave the neighbor a packed suitcase to keep for her. I researched Section 8 housing in her hometown, and had the papers sent to my office. Taheera asked me to look up domestic violence resources in her hometown on my computer, because Mark made a point of checking out which websites she had visited when he got home from work. Mark grew suspicious, probably because Taheera seemed to be happier. Mark started calling her work and hanging up, and kept this up until she was fired. He bought her a cell phone so he could call her repeatedly any time she was out. He started not letting her leave the house with Juan, so that she would have to come back. He took her car keys. Eight months before, Taheera might have given up, because Mark seemed to be catching on.
I don't know all the details, but one night Taheera got someone from her church to park outside the apartments and start shouting. Mark, easily annoyed, went out to shut them up, and she and Juan got their suitcases from the neighbors and left through a back door, where the church friend picked them up.
I don't know if Taheera's story is a success story, but it is a real story. Since then, Mark has found out where she lives and has gained visitation rights to Juan through a court. Mark has also assaulted her twice since she left, once running her and Juan off the road. Taheera, however, has broken her connection to Mark and broken the cycle of abuse. Sometimes I think about her friend from church and the neighbor, and wonder what would have happened without them.
Recently, she read an article about my being arrested for protesting and asked what I was doing. I told her that I fight violence and hierarchy on all levels and she muttered, "Oh." But yesterday she left a message saying she was reading a lot and did I have any favorite authors? I'm thinking Emma Goldman or a little Naomi Wolfe.

I am looking for advice on how I can best help my family navigate their situation.
My mom and dad are in their early 60's and live at home with my brother and sister who are in their mid-20's. Mental health issues are abound: Dad, sister, and brother all deal with clinical depression. My mom was the sole breadwinner, but stopped working in 2019 to help the other 3 get on their feet. Currently, no one in the house works and they have no source of income.
A few months ago, my mom let me know they were getting to the last of her 401k savings and I gave them a small loan. They were planning to sell their house and use the equity to move to a low cost of living area, but as of today no effort has been made to work with a real estate agent, get an estimate, pack belongings, etc. I'm sure they also have lots of credit card debt.
Today I learned that my mom asked another family member for a loan. I am concerned as I see no progress or plan for the future. They are very isolated and don't leave the home often.
What can I do to help them?