Water aerobics and yoga are usually the best options. I would try to find a yoga instructor skilled in physical therapy / disability modifications to the poses. Water aerobics is typically specifically designed for physical rehab so you’re more likely to find most of those classes are geared towards that. If affordability is a problem you may find that your health insurance, even or possibly even especially if it’s public health insurance. In the gym though you want anything that’s low impact and low intensity like maybe an elliptical on the very lowest resistance setting.

I went into nursing instead of astrophysics. Decided I wanted a job that would outlast the apocalypse.

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People act like me not getting off the raised republican train until my early 20s is really slow but that’s when as a female child they allowed me to leave the house regularly for things other than school or church.

Eeeeh. I kinda get why it fell out of favor. For context, the weird thing about the nursing perspective vs the MD perspective is that you don’t get as much of the benefit of large studies, but you also aren’t as sensitive to big pharma marketing studies either which… good AND bad. Like for school I had to take a class on evaluating the validity of drug trials and one of the studies mentioned was taking advantage of the fact that there’s basically no equivalent doses between different antipsychotics but you can also look at the doses from an experienced clinician perspective and be like huh they’re saying this drug has less side effects compared to 20mg of Haldol daily, but literally ANYTHING has less side effects than 20mg of Haldol daily; that dose is insane. The nursing perspective also tends to be more sensitive to variations in the needs of local populations, you’ve lived in an area and worked within that specific demographic and environmental setting for a few decades vs the doctors main body of knowledge often even includes studies from across the world. Just giving some background as to the upsides and downsides of my perspective.

So back to my point, I can tell you I associate lithium with being a last resort med for really sick patients who nothing else cuts it for. I associate it with horrible side effects including crazy weight gain and thyroid problems as well as fluid and electrolyte balances, and depakote and tegretol aren’t gonna cause that last one at all and also do have that advantage of blood level monitoring. I don’t see tegretol prescribed as much but depakote is probably what I see as the most prescribed med even before lamictal. Now lamictal I completely understand why I’m not seeing in the inpatient setting; you can’t rapidly titrate without risking the death rash (SJS/TENS), and the objective of inpatient care is always rapid stabilization with tweaking to occur in the community. And also maybe I’m associating lithium with all these horrible side effects because I’m seeing it used for patients suffering from both the direct effects of severe mania, especially those with the cumulative effect of multiple manic episodes over time, as well as all the other horrible things those episodes put them at risk of such as homelessness, substance abuse, and general increased risk of injury and illness due to decreased capacity for self care.

I guess the TLDR is, it wouldn’t shock me if the inability to patent salt was the reason lithium isn’t preferred, but I also associate it with being a pretty old-school heavy hitter like thorazine is for psychosis, and while my perspective has the advantage of being more experiential, that comes at the disadvantage of being less empirical (but its also often difficult to tell how empirical some studies are due to the influence of capitalism on the development of pharmaceuticals).

As a professional I’d basically be required to say the above, but I’m also watching from the inside as my country’s health system decays starting with populations that were underserved to begin with like the mentally ill. In other news I have a hospice interview tomorrow. If nothing else I’ll just get to focus on making people comfortable. That sounds so relaxing. I’m getting tired of having to tell people no all the time.

Yeah the line between adhd and bipolar is thinner than ppl wanna admit. Lemme find The Infographic.

Yeah like tbh the original comment thread wasn’t worth banning them. Kinda silly but whatever. Literally everything after that was worth a ban though. They picked a molehill and just… fought to the last breath on it.

Yeah when I got that report and responded all I could think was “this thread is basically incomprehensible. Why are these people arguing poetry vs theoretical physics? It’s like arguing whether or not TMNT is enjoyable based on it not being an accurate depiction of turtle biology???” There is a time and a place to get this heated about the fundamental concepts that define the universe we inhabit but a lemmy post about a Tumblr post that’s written like an overly dramatic fanfiction just ain’t it. The last time I got into an argument that dumb (somewhat coincidentally also on tumblr) was literally over half my life ago!

Well said. This is the only person I’ve ever personally banned and it’s because they went out of their way to start multiple fights over silly shit.

I recently listened to “A Wizards Guide to Defensive Baking” recently and I was NOT expecting YA fantasy fiction to go that hard on the subject of “heroism” being a term used to excuse the phenomenon of pushing people into dangerous jobs way too young to cover for the systemic failures and often outright corruption of existing power structures. I had a good few years experience in Healthcare beforehand but I graduated nursing school mid-covid and that book really spoke to me.

Somewhat coincidentally iirc it was actually released mid COVID as well, and I imagine had been worked on for years beforehand. So it’s interesting to me that the author picked up on the already existing manifestations of this phenomenon in a way that would speak so well to the epic clusterfuck that ultimately occurred.

I’m surprised that particular aspect of the side effect profile comes into play with acute usage.

Well obvs. It’s basically,“idk which receptor is making them _____ (punch people, refuse to eat or drink, or whatever other immediate harm to themselves / others), but we need it to stop 3 days ago and can figure out the details or a potential cross-taper to something better later.”

Ah, yes, this happens a lot. No, I don’t work in the medical field at all. I just know things, for reasons.

Color me fascinated, lol. My guesses are personal experience / reading up on your own treatment or that of a loved one, tangential relation to the field such as clinical research, or just plain personal fascination. Given you linked to a drug that appears to be in trials my first guess is actually the second one. Hadn’t heard of it, and I’m hopeful, but after seeing abilify get approved for acute agitation I’m… skeptical.

i.e. the psychosis has done so much cumulative damage at this point that you need to fall back to the typicals. That explains why the third-gens are useless.

Yeah a lot of people don’t realize the damage is additive, both people w/ these disorders and unrelated laypeople who think “talented artist stops taking their meds and continues to be talented but starts creating art with weirder subject matter as their brain boils” is a cool story.

I’m mostly replying to add though that risperdal also has the distinction of being avaliable as a long-acting injectable, and if you’re trialing oral meds before committing to an LAI, your options are somewhat narrowed. Zyprexa does have an LAI available, but I’ve actually never seen it used and while I can’t tell you why for certain, I do have a guess.

If you have a patient sick enough that you’re considering an LAI, you don’t want to take benzos off the table for an entire month, especially if it turns out to be inadequate after discharge and they wind up in an ED agitated and unable to report their own med hx and get B52ed and stop breathing. I’ve had a pharmacist tell me considering that interaction is going out of style but a history of that kind of adverse event is difficult for a med to shake. Accutane still has suicidal ideation in adolescents listed as a side effect but I have a strong suspicion that it’s less causation and more correlation with the impact of pizza face on the self and social esteem of a teenager.

Dude sometimes we still give thorazine. And tbh ime the 3rd gens don’t do shit for my typical patient. For context also though, I’m essentially providing ICU level care, so when you say the word “symptom control” it’s often referring to like, fists.

We had a Lady maxxed on Haldol BID one time and she managed to cheek for a week and eventually she just hauled off and rapid fire punched a nurse in the head three times. She legit thought a man was entering through her window every night on a beam of light to forcibly impregnate her and deliver the baby. She kept demanding to see the 50 babies she had up on L&D from the past few months. I’ve actually seen quite a few pregnancy delusions and they’re almost always completely wild psychosis. Another was such an angry manic but high insight enough that when she couldn’t take it anymore she would just come scream at me for the thorazine.

I’m unsure if you don’t work inpatient psychiatry or you just work somewhere significantly classier than I do. I do work in an inner city area that’s flush with people stuck in a cycle of drugs / homelessness so I’m also not going to tell you that any of this is the best solution, just that it’s the only one avaliable to any of us right now due to shitty government policies.

To the extent that men can lactate! It’s one of the possible side effects of risperdal, which I have to be aware of because I give it fairly regularly. It’s all the same structures it’s just a matter of the hormone signals they’re getting.

an oldie but goodie

Yeah even if it is weird as shit where I am now is already weird as shit.

Soap is decreasing friction. The dental floss done correctly should apply compression to the tissue and force fluid out of the area. This is especially helpful if a lot of tugging has resulted in swelling.

If you’d like to edit the thing I wrote for free at 2am to include your edits for clarity and more localized bureaucratic knowledge, I’m happy to link right to you at the beginning. Other than that, you’re welcome.