care guidelines

Things to make your pet happy! 🐾

🐾 Pick them up and let them cling to you.
🐾 Lots and lots of cuddles.
🐾 Use nick names when talking to them.
🐾 Saying good boy/girl/pet and always giving praise.
🐾 Good morning messages.
🐾 Let them curl up on you and nuzzle into you.
🐾 Tell them you love them.
🐾 Encourage their ideas.
🐾 Head petting.
🐾 Collars/ears/tail

i hate when people unfollow me when i say the bode meme wasn’t funny like

are you really out here trying to defend the Comedy of animal abuse and getting mad about it… i know it seems like it’s not that deep but so much animal abuse happens because of internet popularity

please think of macgyver the lizard, the endless memes and ‘cute’ videos of fat animals being unable to function, of people terrorizing and scaring and stressing out their animals for views. you need to stop anthropomorphizing and stop acting like real life fat animals are fine and okay to consume content of as jokes without criticism because there are going to be people, there already are people out there, making a market out of abusing their pets because people find it cute and it makes them money and they see things like that and they get more incentive to keep it going

fat positivity has no place in a non-human space and you can’t act like your animals are little people you have to spoil and overfeed and throw out the basic care guidelines you should know as a responsible pet owner, you can’t act like it’s a positive thing that you have control over every aspect of these animals lives and you’re using it to generate internet fame instead of caring for them properly 

Watch on symmetralove.tumblr.com

Sharing is Caring (some guidelines for sharing these goodies!) with Anjali Bhimani (VA of Symmetra)

“Learned a new lesson about sharing this week, and wanted to make sure to keep all you beauties safe as you share content from this channel on your own (although always feel free to share the links from here anywhere!)…”

testanxiety  asked:

Any advice for an m3 starting family medicine clerkship?

Here’s a brief little post I wrote about what to read and what to study for the shelf. 

But wait, there’s more!

Family medicine is a hard rotation, especially to have at the beginning of the year, because it covers SO much material.

  • Hi Yield stuff to know
  • Think systematically. Use mnemonics to help you expand your differential diagnosis. Keep patient demographics and co-morbid conditions in mind as you make your differential.
  • Even if you have no interest in family medicine, you will learn something relevant to your specialty of choice on your family med rotation. Depending on your attendings, you may be able to tailor your rotation a bit toward what you are interested in (more kids! Pregnant ladies! women’s health! sports medicine for you ortho folks! office procedures for the surgeonly types! more psych for you little Freuds!).
  • Embrace the variety. Don’t let it overwhelm you. You will see something new every day. Write it down and read about it when you go home. Write down the medications or diagnoses that are unfamiliar to you and read on them too.
  • The AAFP is your friend. They have tips for doing well on your rotation too. You can make a student account and access lots of practice questions for your shelf exam. Use the online board exam prep questions.
  • If you have the opportunity to do your family medicine rotation in a community or rural practice rather than an academic medical center, take it. Family medicine was designed to be a community based practice, not academic, so you will find the specialty looks very different in those two settings.
Self Care

We must know how to care for ourselves regardless of our situation. Although I am currently 5 days deep into a meth relapse I am sticking to the self care guidelines I have put together through extensive research.


Info collected from drug-forum.com

This is a Reference Guide and is quite long, but the information provided will help you remain healthier and your body will thank you for it.

Some people want meds to take the unpleasantness away after using methamphetamines. Others want to take “something” to keep from getting the same reactions before using meth. The wiser will be the second group. For those of you who know little or nothing about the upkeep of your body and what meth is doing to it: There is NO magic pill.

Obviously, we can’t cover every condition or medical problem associated with using meth, but we can give you an essential guide to using the basics of vitamins, minerals and even herbal supplements that can be used preventatively, during and after use.

We won’t discuss any chemicals that may be found in other sections of Drugs-Forum dealing with bringing down the high, forcing sleep or in any way induces the body to react in a manner you might like it to. We are not polyusers and don’t subscribe to it. Combining uppers with uppers, or uppers with downers can become quite dangerous—and that is not Harm Reduction.

The use of meth causes a rapid chemical change in the mind and body, and the body reacts to it as a toxin, which it is. Our idea is to reduce the damage caused.

Preparation for a meth session is extremely important. If the body is not ready for this onslaught, the damage comes on faster and with more force. Two things we might not find in the medicine cabinet, but more likely the refrigerator, are the essentials you need, in liquid and solid form.

Keeping the body hydrated is the #1 rule. What does this mean? Simply making sure we have consumed enough water and metabolites, and continue to do so, while meth does its thing. Water is the base liquid, but the addition of metabolites such as potassium and sodium, are critical to maintain your body’s fluid, regulate blood pressure and heart function. Sports drinks are recommended by many.

Once meth enters the body, it’s a fight for survival and blood is routed to the organs that cleanse the body. The blood has to be moving fast—free-flowing—and that means it’s not sticky and dehydrated. Those organs need to remain healthy to do the job at hand and survive while doing it.

Eating. A nutritious diet of fresh fruits and vegetables, as well as high protein foods such as red meats will give your body the majority of vitamins and minerals you need to keep you healthy. Fatty foods such as French fries and deep-fried cheese sticks do not contain them.

Hydrating and Eating are your 2 top priorities, bar none.

Now, let’s go see what’s in the medicine cabinet. On the top shelf—the most important one–the first item is Multivitamins (and minerals). Do you really need them? Do you eat 3 nutritiously balanced meals a day along with drinking 3, 8-oz. glasses of homogenized milk, including a good workout regimen in the sun? Most people don’t, and that’s why you need a multivitamin.

Many meth users have asked what kind of a multivitamin they should take. If you research them on the internet, it seems the ratings on each chart are somewhat dependent on who is sponsoring the charts of the best. I’ve looked around, read reviews, and come up with two that actually rate somewhere better than the middle of the charts and aren’t that expensive. Just remember: take one per day, and only one.

For Men: Centrum Silver Men 50+. The experts say you should ignore the “men 50+,” because the combination is correct for any male. These multis don’t contain any iron and you already get enough from your food. Go to the Centrum Silver website and get a $3.00 off coupon for them!

For Women: One-A-Day Women’s contain the amount of iron needed for premenopausal women, in addition to the other essentials you should find in a multi. Go to the One-A-Day Women’s website and get a $1.00 off coupon!

While included in the multis, there is one other vitamin that needs to be increased in the meth users’ diet, as well as those who also smoke cigarettes. It is Vitamin D3. You need vitamin D3 to properly absorb calcium. Meth leaches the body of calcium and it’s vital you maintain blood calcium levels. You also need D3 to help your body continue to build strong and healthy bones all throughout your life. It also can reduce inflammation and hold your immune system in check. The most natural way the body gets Vitamin D3 is from the sun. Milk is also fortified with Vitamin D3. But since you didn’t drink your milk and didn’t go outside to exercise in the sun, you really need these. I take one 5,000I.U. soft gel every day.

The next bottle on the top shelf is Calcium, Magnesium & Zinc. Even though they are already included in your multi (but only at 25%-30% of daily recommended value for Calcium and Magnesium), the way meth uses these minerals up, you really need more. Calcium, of course, builds strong bones, but it also makes muscles move and contract, allows nerves to carry messages, keeps blood vessels throughout the body healthy, and helpsneurotransmitter release! If you know and love dopamine, then you know how really important this is. Unless you are on a heavy fig and rutabaga diet, then you need this supplement.

Magnesium is important for the functioning of your heart, muscles, kidneys, and balancing other nutrients such as calcium and potassium. It also improves blood pressure. Once you know what the deficiencies of magnesium cause, you will ask no more questions. They are: anxiety, weak bones, low energy, weakness, inability to sleep, PMS and hormonal imbalances, irritability, nervousness, headaches, abnormal heart rhythm, muscle tension, spasms, cramps, and fatigue. Now get this—one of the biggest complaints we have—TEETH CLENCHING, or Bruxism, is also a Magnesium deficiency. And it seems the magnesium does a better job resolving it when it has a fresh supply of calcium helping it.

Zinc helps you maintain a healthy immune system and fights infections. (Take note, IV users.) Zinc is necessary for the functioning of more than 300 different enzymes and plays a vital role in an enormous number of biological processes.

What a one-two-three knockout punch these guys have. And only two tablets a day will take care of all these things for just pennies.

Potassium Gluconate. I think I was taking these tablets before meth was invented. Potassium is an electrolyte (along with sodium), which is why I encourage people to use sports drinks, as they are included. The potassium helps regulate (lower) blood pressure and heart function. As you know, when using meth, your blood pressure skyrockets, so why not help curb the possibility of a stroke? As a matter of fact, there was a Harvard study that showed taking potassium supplements along with a diuretic (yeah, give me a couple of those potassiums with a cup of coffee), reduced the incidence of a stroke by 60%. Potassium is what makes our cardiovascular and nervous systems function. I’ve found it also works with magnesium to prevent cramping, and it aids during the recuperation part of your meth escapades.

The tablets contain 595mg of potassium, which is slightly more than the potassium found in a medium-sized banana. Take your pick. Have one of each. But be sure to double that number over the period of a day. Potassium doesn’t stay in the system for a long time. Oh, and one more very important thing: potassium is one of the prime movers, along with zinc, in elimination of wastes. That’s where all of those toxins the body is trying to get rid of are hanging out. And if they hang out inside of you too long, you become a recipient of toxic buildup—not a good thing.

Those, believe it or not, are your “prepping for meth use” essentials. Food, drink, and 4 bottles of vitamins and minerals. And when you look at it, and how complete it really is, it reminds me of prepping for the flu. You know the invader is coming, and you are prepared.

Before we have a look at the 2nd shelf, let me tell you that the supplements industry brings in over $60 billion a year. Once some people start taking them, it becomes almost an…addiction. “Horny Goat Weed sounds good. I think I’ll try that along with the Horsetail Shavegrass.” About $1,000 later and a cabinet full of supplements, these people realize all they are doing is taking supplements. They can’t even remember the last time they cooked a meal. So, let’s not get too carried away and fill the shelf too full.

Another point of view involves human nature. If we make a list of things to take every day that is too long, because of the hassle and time involved, a lot of people will fall out of the program. However, if we have simply the essentials that will do the job, the tablets or capsules can be assembled and swallowed in less than a minute.

My first two personal picks not only are helpful when using meth, but also fulfill a couple of other needs I have. The first is L-arginine. It’s a dietary supplement that produces Nitric Oxide (NO). Nitric Oxide should not be confused with Nitrous Oxide, the laughing gas. But it’s still a gas and what is does is enter the bloodstream and drop off these little bubbles on the insides of the vein walls, stretching them out, making them wider. My primary use is because I have a slight high blood pressure condition, and it allows the blood to flow smoother. But, if you’re a meth user, too, you might have figured out it works against vasoconstriction, or tightening of the veins. Many men cope with vasoconstriction when high. The more meth they use, the tighter the blood vessels, until no more blood can get through to make an erection. Relief is possible with just a couple of capsules a day, two times a day. Also, for IV users who have a difficult time finding veins, I have discovered that as the veins plump a little, they also become more visible in some areas.

The next supplement is HGH Dopa 400, also known as mucuna pruriens. I don’t bother with the HGH (human growth hormone) efficacy as it is small, even if true, but the plant material ground up and put in these capsules is full of L-dopa, a precursor to making dopamine. Now why would anyone want their brains to produce more dopamine? Besides the fact I’m getting a bit old and maybe the dopamine production isn’t as good as it used to be (normal), maybe I just don’t want to run out of dopamine when I’m high and want to stay that way.

The next couple of bottles contain supplements that are popular, and effective.

Omega-3 fatty acids. Omega-3s are not produced by the body and naturally are derived from eating fish. Research shows that omega-3 fatty acids reduce inflammation and may help lower risk of chronic diseases such as heart disease, cancer, and arthritis. Omega-3 fatty acids are highly concentrated in the brain and appear to be important for cognitive (brain memory and performance) and behavioral function. It may also assist in controlling high blood pressure and, in people with Bipolar disorder, reduce mood swings. Symptoms of omega-3 fatty acid deficiency include fatigue, poor memory, dry skin, heart problems, mood swings or depression, and poor circulation. Daily dosing should be based on the amount of EPA (180mg) and DHA (120mg) acids, not total amount of fish oil.

Coenzyme Q10, or CoQ10 vitamin supplement, is naturally made in the body, but sometimes (especially with aging) the necessary levels of this enzyme-protein that speeds up the rate at which chemical reactions take place in the body, drop to below what is considered normal. Its main function, however, is as an antioxidant. While many trials have been run, peer reviews have not been overwhelmingly positive, due to the lack of further studies. The antioxidant function of CoQ10 appears strongest in reducing neurological damage or decline, including that of dopamine neurotransmitters. My next door neighbor, who is 80, says this is the closest thing to a miracle drug. Do you want to live that long? My answer is that I take this stuff. Since it is fat-soluble, I take it at the same time as my Omega-3. Daily dosage is 200mg-600mg.

At this point in time, I am satisfied with the above list. The dietary regimen that we started off with, along with these vitamins, minerals and supplements, are really the glue that binds in keeping our bodies whole, especially for the meth user. They are also the most protective and restorative additions we can make without breaking the bank.

There are other supplements that seem to be common with meth users. Perhaps the most often mentioned is melatonin. This is a hormone that is found in all biological organisms, and as such, we know we produce it ourselves, in the pineal gland from the raw material Tryptophan. Melatonin regulates our internal clock and maintains the Circadian Rhythm of our body. But we know what happens when we start using meth. All of a sudden our internal clock is shattered and we are officially on “Meth Time.” Depending on usage patterns and amounts, we find one Meth Day can extend itself past 24, 36, 48 hours and even beyond. At some point, the user may decide to end this prolonged day and get some sleep. But the meth is still active and sleep is hard to arrive.

Melatonin turns off the meth clock and helps reset the body to the biological clock function. It also promotes sleep and affords the body a long restful period, where deep sleep begins and allows the body to start healing itself. Taking the recommended tablets returns the body to normal levels of Melatonin where sleep becomes automatic.

Melatonin is also used by some people along with benzodiazepines; however there is a possibility of creating a benzo dependency with long term use. (As mentioned earlier, I can’t talk about or recommend using uppers with uppers or uppers with downers as there sometimes are consequences that cannot be predicted.) There are also several other chemical interactions with a supplemental dose of melatonin which can reduce the efficacy of other medications you may be taking. It was for that reason, I decided not to use melatonin.

If we were to look at the lower level of the Meth Medicine Cabinet, we also might find other things that might be used. For instance, that bottle ofisopropyl alcohol, which is mostly used to sterilize any areas of the skin that might be met by an IV needle, a broken piece of a glass pipe or other minor cuts and scratches. A tube of Hydrocortisone 1% Cream used to treat itching and small burns, and a tube of Triple Antibiotic Ointment (Neosporin) to be applied on a damaged area to prevent infection are a couple of great first aid musts. Not to mention only accidents that happen when doing your drug, think of all of those times you’ve experienced spun out people pulling things apart, moving things around, falling on their butts and creating minor mayhem.

What’s this bottle? Viagra! For those men who have really serious consequences trying to get their manhood going while under siege from vasoconstriction, a half-tab of this stuff may do the trick. The caution is that it’s trying to relax those veins while the norepinephrine release is doing just the opposite. There’s a tug-o-war going on here that can stress the body, especially the heart.

Yohimbe 2000 is over there in the corner. It’s a natural stimulant, what I call “Poor Man’s Meth.” One of the better features of this herbal product is that it actually acts as a vasodilator, while still stimulating the body. Yohimbe has been known as an aphrodisiac for centuries, which most likely has been based on how it stimulates. Let’s say you are all out of your man-made stimulant but still feel ready to go that extra mile. Using one or two of these capsules may just let you make it to the finish line. But be careful, as there is a very thin line between being good and being bad. Too much of this stuff, and the nausea and other bad vibe reactions kick in, simply spoiling the moment.

Sitting up behind the Yohimbe bottle are a couple of sanitary wrapped prophylactics. They are there as a reminder that meth users, as a group, become a pretty high percentage of people who spread STDs, HIV/AIDS, and other infectious diseases along with assorted cooties, which are not the same as meth bugs.

Below the Meth Medicine Cabinet, there’s a basket full of goodies. Let’s investigate. I see a couple of toothbrushes, some toothpaste and dental floss. I think we’re onto something! Taking care of your teeth and mouth are extremely important, whether a meth user or not. But when meth gets ahold of your mouth, the damage can increase at the speed of light. Next to those items is a big bottle of ACT Restoring Mouthwash, great for restoring enamel and it helps mineral recrystallization on the teeth. Next to the ACT is a bottle of Biotene, a mouthwash specifically made for dry mouth. Meth dries out the mouth and gives you the common “Meth Mouth.” A dry mouth means bacteria can form, causing ulcerations—mouth sores. Biotene also comes in gel form, which is designed to keep your mouth from going dry for 6-8 hours. There’s also a salt shaker and an empty glass. Falling short of the commercial methods, you can always gargle with warm salt water to kill off the bacteria. Just do it more often.

Recommendations—Good and Bad

Here are a couple of items I have seen people recommend, but they come with some advisories. There are many of our multivitamins that are also sold individually as Super Paks or under other marketing names. Let’s take the Vitamin B Complex group as one such item. And I am sure they have some benefits that your multis don’t have. But the fact remains that they are already in your multis at 100% Recommended Values. Before proceeding to take the both, and therefore at least doubling recommended amounts, I would want to research them to see at what level they become toxic.

Here’s another that I see recommended from time-to-time, and for the life of me I can’t understand why, except whoever started this trend did not do their homework. L-tyrosine is abundant in our foods and we get more than enough of it without supplementation. But, it’s also known to convert to L-dopa. And that’s where the research must have ended. They didn’t read how it also produces a lot of norepinephrine, that Dark Knight of Vasoconstriction–that bugaboo of irony created when using meth. But there’s more. It just might be that adding the supplement puts you over the top and actually shuts down your production of dopamine. That’s what L-tyrosine can do in larger amounts.

Some people simply cannot eat when high, due to other conditions they may suffer, or their own body chemistry. There is an alternative in liquid form that you can use to replace the solid food. Many meth users prefer to use protein shakes, such as Ensure.

Before we end this, let’s talk about dosages. More people than I want to imagine must believe that if one tablet is good, two must be better. That is not the case. Even vitamins and minerals have toxic levels. Always read recommended dosages and warning labels on any vitamins, minerals, supplements, and medicines you may also be taking. As I had to remind a friend one time: taking too many vitamins is not going to get you high, but it might get you sick.

EXO reaction to finding their girlfriend passed out outside in the rain/snow

I don’t know how this is going to turn but just a little warning if you don’t like sad/serious reactions. Xo, Admin A~

/I don’t own any of the gifs used, unless stated otherwise/


Chanyeol:

*Runs to you when he sees you* “Jagi! Wake up!! You can’t be here… I’ll take you back inside… it’s warm there” *His internal flame starts to warm you a little while he takes you back*

Kris:

*Your angel arrives fast* “Don’t worry baobei… I’ll take you home in no time. You won’t be cold ever again…” *Flies back home with you in his arms*

Sehun:

*Looks for you nonstop* “Jaaaaagi!! Answer me! A storm is coming… where.. jagi!!!” *Feels like having a heart attack until he finds you*

Tao:

“Good thing I grabbed this coat… you said it wouldn’t be useful” *Covers you with it and does everything he can to keep you safe*

Kai:

*Quickly transports you to a warm place* “Come on jagi.. wake up, you need to.. What were you doing sleeping out there? Snow isn’t.. a blanket.. come on jagi!” *desperate* 

Xiumin:

*Tries not to panic and keep you warm and awake* “We are almost there… don’t give up jagi, we are almost there”

Baekhyun:

*Doesn’t leave your side for a second* “I already changer her clothes… tug her in bed… Why isn’t she waking up?” 

Luhan:

“I thought I was going to lose you baobei… Please don’t go alone next time, I don’t want it to happen again” *Almost in tears while holding you tightly*

Chen:

*Waiting for you to come back* “I wonder where… Is she safe… maybe I should check on her… *Arrives just in time*

Kyungsoo:

*No matter how strong the storm is he will always find you* “Jagi… please be safe… we have to move before… I’ll keep you warm.. please wake up” *kisses you before carrying you and taking you home*

Lay:

“Hey babe… you woke up, are you okay? I bought you home as soon as I found you. I was scared something could happen to you” *Feels better now that you are awake and safe in his arms*

Suho:

*Gives you his dry clothes to keep you warm while he takes you back home and to take care of you*

[Masterlist] [Guideline]

anonymous asked:

I can't even begin to state how you have turned my perception of Petco around. I work for an independent pet store, and the Petco branch we have in town is terrible. They don't care for half their snakes if they aren't eating, give incorrect advice, and when I got a bearded dragon from them they gave me NO information on how to care for him. I am so happy to know that it's only the one in my town and not the company as a whole, keep up the good work!

Yeah– even though I work for them I STILL say that EVERY PET STORE IS DIFFERENT.  I had a super great Petland near my apt in Brooklyn that took great care of their animals and fish and housed everyone appropriately.


Head up the road about 20-ish blocks and the Petland there had everyone on sand, their fish all had fin rot and were kept with incompatible tankmates, the bird cages were dirty (it was mid day so if cleaning was being done it would have been done by then) etc.


PETCO’s animal care policies (the company standard and care guide) are actually REALLY GREAT, but the employees at each store (including managers) have to CARE.  We get monthly inspections but I know that some stores just buckle down for inspection day and don’t give two hoots any other time because they are putting more focus on other parts of the store.


That’s why I like being the animal care manager at my location– I get to make the calls in terms of what we get in (to an extent), I enforce cleaning standards and I educate everyone I work with on the proper care/setups for all of our animals.  I also dictate when animals should go to the vet and I’m on great terms with out exotic vet in the area.

I think I’m the only PETCO in our area that keeps ALL their beardies/leopard geckos on carpet (the care guide says that carpet or sand can be used, but I educate employees as to why we shouldn’t use sand).  :\



I think what’s hardest is that even with a company that cares about animals is that they still sometimes use outdated information (bettas being in bowls, the impaction debate on reptile sand, etc) and it can be hard to work around the company’s opinion while still staying within the care guidelines/policies I HAVE to follow.


I do my darndest though!  I make sure that I do a TON of research before ordering anything new to the store so that I can coach everyone on it!

anonymous asked:

Hello! What apps would you recommend to get more up to date with medical literature/news that's happening? Thank you!

I use:

  • UpToDate (which is not free… quite pricey but if your hospital provides it you can get app access)
  • Medscape
  • ePocrates (you can get the full version free sometimes as a student)
  • Pap guide (easy flow chart to tell you what to do with abnormal paps)
  • GoodRx
  • AHRQ ePSS - not a catchy name, but you put in a patient’s age, sex, and a little more info, and it will tell you all sorts of preventive care guidelines that apply to that person, and what the quality of the recommendation is
  • Prescriber’s Letter - also not free, but it’s not terribly expensive for a 1 year e-subscription, and lots of med schools get it for students anyway. It’s basically like 5 pages a month with little blurbs about all sorts of different drugs and what the evidence on them boils down to - whether you should use them or not, big side effects to remember, drug interactions, etc
  • FP Notebook - not always completely up to date, but if you like outlines, it will give you good basic history/physical/diagnosis/treatment info on commonly seen issues in family practice
  • AFP Journal - Not free - Has great articles that are practical, useful, and not as boring as JAMA and NEJM.
  •  Youtube - I use it more for patient education than my education, but there are some great videos demonstrating home exercises or explaining complex medical conditions. I will occasionally use them to review my musculoskeletal exam skills because I hate ortho and have a hard time remembering which test means what sometimes.
  • Don’t forget podcasts! The only medical ones I listen to are the American Family Physician podcast (even more condensed “high yield” info from the journal, only about 20 minutes) and Sawbones, which is more funny than educational, but it focuses on history of medicine and crazy things that we’ve used as medicine in the past.

anonymous asked:

ooo i have a fic idea! Malia makes fun of Lydia or says something offensive to Lfydia for something serious (be it money problems, the fact that she doesn't know how to use her banshee powers or the fact that Meredith just died) and Stiles hears it and is all defensive and then they break up and stydia is canon

Aww poor Lydia :( 

Anti-Malia/Stalia up ahead, so keep scrolling if that’s not your thing! 

Here’s your fic, hope you like it.

Keep reading

Routine Antenatal Care

According to Antenatal Care Guidelines developed by the National Institute for Health and care Excellence, here are the minimum set of tests for routine antenatal care:

First contact with health professional

  • Give specific information on folic acid supplements, food hygiene, healthy lifestyle, and all antenatal screening
  • offer information about screening for sickle cell diseases and thalassaemias.
  • Give information about the anomaly scan and let them know that this gives them a chance to terminate pregnancy, prepare for treatment or care of disability, manage the birth in a specialist center, and have intrauterine therapy. Inform them of the limitations of ultrasound screening and that the detection rates vary by the type of anomaly, pregnant person’s BMI, and the position of the fetus at the time of the scan.

At booking

  • Explain the development of pregnancy, nutrition and diet (including vitamin D supplements), exercising (including pelvic floor exercises)
  • start planning the place of birth
  • information about breastfeeding and workshops in the area
  • information on participant-led classes
  • information on maternity benefits.
  • Identify people who may need additional care and plan pattern of care for the pregnancy.
  • Measure blood pressure and test urine for proteinuria (pre-eclampsia)
  • Inform those under 25 of the high prevalence of chlamydia in their age group and give details about STI screening.
  • Offer early ultrasound scan for gestational age assessment and structural anomalies.
  • Ask about mental health, ask about mood to identify possible depression.
  • Ask about occupation to identify potential risks.
  • Haemoglobinopathies screen
  • Blood group and rhesus D status
  • Hepatitis B virus screen
  • HIV screen
  • Rubella susceptibility
  • Syphilis screen
  • MSU for asymptomatic bacteriuria
  • risk of venous thromboembolism evaluated (previous VTE, thrombophilia, medical comorbidities, surgical procedures such as appendicectomy, age about 35, BMI above 30kg/m, 3 or more children, smoker, varicose veins, systemic infection, immobility, pre-eclampsia, dehydration, etc.)
  • test for gestational diabetes if there is an identified risk (height, weight, family history, ethnic group, previous pregnancies, etc)
  • measure Height, weight, and body mass index and give health advice.

After 10 weeks 0 days

  • Before 13 weeks 6 days: ultrasound scan to determine gestational age
  • Before 14 weeks 1 day: Combined test for Down Syndrome

16 weeks

  • Review, discuss, and record the results of any screenings.
  • Measure blood pressure and test urine for proteinuria (pre-eclampsia)
  • investigate if haemoglobin level is below 11g/100ml and consider iron supplements.
  • Give information on the routine anomaly scan to take place at 18 weeks.
  • offer those with significantly atypical red-cell alloantibodies a referral to a specialist.

After 14 weeks 2 days

  • Before 20 weeks 0 days: Serum quadruple test for Down Syndrome

All appointments

  • blood pressure
  • urine test for proteinuria

At booking and 28 weeks

  • Haemoglobin
  • Red-cell alloantibodies

18 weeks

Before 20 weeks 6 days: ultrasound screen for structural anomalies including

  • fetal echocardiography of fetal heart
  • detection of neural tube defects

25 weeks

only needed if you’ve never been pregnant before to measure blood pressure/test urine and measure and plot symphysis-fundal height

28 weeks

  • measure blood pressure/test urine
  • offer a second screening for anaemia and atypical red-cell alloantibodies.
  • investigate a haemoglobin level below 10.5g/100ml and consider iron supplements
  • offer anti-D prophylaxis to people who are rhesus D-negative
  • measure and plot symphysis-fundal height.

31 weeks

Only needed if you’ve never been pregnant; review, discuss, and record the results of screening taken at 28 weeks, measure blood pressure/test urine, measure and plot symphysis-fundal height

34 weeks

  • Review, discuss, and record results of screening taken at 28 weeks
  • measure blood pressure/test urine
  • offer second dose of anti-D prophylaxis to those who are D-negative
  • measure and plot symphysis-fundal height
  • give specific information on preparation for labor and birth including the birth plan, recognizing labor, and coping with pain.
  • Give information about cesarean section including indications of a need for c-section, what the procedure involves, risks and benefits, and implications for future pregnancies after c-section.

36 weeks

Fetus is approximately full term.

38 weeks

  • measure blood pressure/test urine
  • measure and plot symphysis-fundal height
  • give options for management of prolonged pregnancy.

40 weeks

only necessary if this is your first pregnancy; measure blood pressure/test urine, measure and plot symphysis-fundal height, and further discussion of management of prolonged pregnancy.

41 weeks

  • offer membrane sweep
  • offer induction of labor
  • measure blood pressure/test urine
  • measure and plot symphysis-fundal height

42 weeks

  • from this point on offer those who decline induction of labor increased monitoring (at least twice-weekly)

People should be able to make an informed choice about whether to accept or decline each tests, and notes should include a record of any tests offered and declined as well as the results of tests accepted

Dear Tumblr staff,

I am having an actual problem with harrassment and stalking and your Abuse@Tumblr email is “teaching me how to block and ignore users” as if I’m five years old and don’t know how. I have a problem with another user, who I have told to stop contacting me, who I have blocked both their account and their Anon IP, and who I have already turned off my Anon feature to avoid, who has now made another account to circumvent my attempts in order to continue contacting me. 

This is a blatant attempt at breaking your rules, and you’re telling me to “block her and ignore her because you left Anon on so it’s basically your fault.”

Yes, that’s why I turned Anon off when this problem occurred. I thought it was solved, but apparently not. I now have a second account to block and ignore twice, and I can forsee it happening again and again if something is not done.

I don’t know what I want you to do about this, but what I don’t want is for someone to act condescending in teaching me how to use your basic functions when someone is trying to guilt trip me into talking to them again by threatening suicide. I take suicide very seriously and I don’t appreciate that it’s being used as a guilt tactic to keep me around.

hey uh. if y'all neopagans could stop dismissing orthodoxy/religious guidelines/careful intent as being useless or unimportant that would be gr8. not everyone’s religion is solely about connecting with the spirit of the universe. not everyone feels that their deities will be chill even if they mess stuff up or disregard all tradition. for some of us, orthodoxy and ritual are comforting, reassuring, and important to feel that we’re doing the right thing by our Gods. sometimes it’s important to worship in certain ways because the Gods demand the best we can give Them, and that doesn’t always mean something nebulous with a lot of crystals.

David and Killian driving a car. Blame those spoiler pictures.


David gives Killian a look across the car as the ladies join the newcomer in the back. “Guess you’ll be riding shotgun.”

Killian gives him a suspicious look. “That sounds like an atrocious idea, mate.”

“No, not a literal—it means sit in the front, beside the driver.”

The pirate shakes his head, halfway between embarrassed and exasperated. “Why can’t you just say that?”

David grins. “You’re one to talk about using flowery language.”

They drive for all of five minutes before things begin to go wrong.

“Shouldn’t you have checked your starboard mirror before making that turn?”

“What? It’s the right mirror. You use right and left in cars.”

“How impractical.”

“Anyway, no, I knew no one was coming up behind us, it was fine.”

“How can you know that when you didn’t look?”

“I knew, okay?”

Another two minutes of silence. Then:

“There’s a car coming up on the port side.”

“I know, I saw it. I’m waiting, see?”

“Fair enough.”

“And it’s the left side.”

Killian sighs.

They make the turn onto another road, and David guns the engine.

“What’s the speed limit around here, mate?”

“It’s fifty.”

Killian cranes his neck.

“I’m doing forty-eight right now, Hook,” David grinds out.

“Aye, so I see.”

They pass another car, an ancient thing being driven by an equally ancient man by the looks of it.

“I thought it was standard practice to use the turn signal when you—”

“Damn it, Hook! You want to drive?”

“I’m not versed in controlling this ridiculous contraption.”

“Then shut up and let me do it!”

“I’m simply pointing out—”

“You’re distracting me, is what you’re doing!”

“The safety guidelines for driving clearly state—”

“I don’t care what the guidelines state!”

“You’re the bloody sheriff, you should be setting an example!”

“I—You—shut up or you can walk home!”

And from the back come twin groans of frustration as Snow and Zelena, former enemies and nothing alike, finally find themselves in complete agreement.

anonymous asked:

What forms of asset protection are there to protect your personal assets in the case of a malpractice lawsuit? What ways are there to prevent a malpractice lawsuit? How do you deal with the stress of knowing that there is a high likelihood of facing a malpractice suit, even if no malpractice was committed?

Asset protection is something you should discuss with a malpractice insurance carrier or a financial advisor or accountant, not me, because I have no assets and I know nothing of such things. 

Ways for preventing malpractice lawsuits:

  • Don’t be a doctor. Seriously. 75% of physicians in low risk specialties will be sued at least once in their careers, and it goes up to 99% for those in high risk specialties. If you don’t want to ever be sued, don’t practice medicine. 
  • Be nice. Patients are less likely to sue doctors that they like, even if something goes wrong.
  • Be a good doctor. Stay up to date on standards of care and current guidelines. 
  • Be a good communicator. Many perceived wrongs or errors could be avoided with good communication between doctor and staff or doctor and patient. Make sure your patients understand your instructions, their conditions, their procedures, and their drugs. 
  • Document, document, document. All documentation should be thorough. It may save your butt or a patient’s life one day. If you talked about risks and benefits of XYZ, document it. If a patient refuses a screening test or medication, talk to them about the consequences and document it. Your documentation will remember things that you won’t be able to remember a year from now.
  • Don’t drop the ball. Don’t forget to follow up on that abnormal lab or get the report on that stat chest x-ray. In a busy practice, it’s easy to forget. Make sure your practice has a system in place for making sure things don’t slip through the cracks. 
  • Know your patient. Review their med lists and charts to make sure you’re not causing their problems with the meds you prescribe. Know their allergies before starting something new. Know major interactions and side effects they’ve had. Know their conditions and how they will interact with each other. 
  • Be compassionate. Show your patient that you care about what happens to them. Often they will forgive adverse outcomes if they know you had their best interests in mind.
  • Acknowledge your mistakes and don’t repeat them. Most states have laws that allow doctors to apologize for adverse outcomes and not let their statements be held against them in malpractice suits. But in many cases, all a patient wants to hear is “I’m sorry. I made a mistake. We didn’t mean for XYZ to happen.”

How to deal with worrying about being sued:

I never worried about being sued until I got sued. Then I worried about it all the time for a while. Now I’m back to not worrying about it much, but it has definitely changed the way I practice.

Avoid the temptation to practice defensive medicine. Doctors get sued whether they did the useless CT scan or not. So don’t waste resources doing unnecessary tests.

Work on documenting well. I can’t stress this enough. My documentation and that of the nurses who worked with me is what proved that we followed standard of care and national guidelines to a T in my case. It gave me peace of mind because I was able to look back and know that I did exactly what I was supposed to do in the situation and that there was nothing I could have done to anticipate or prevent the outcome that happened.

Constantly push yourself to be a better doctor. Read more. Learn from past mistakes and don’t repeat them. Strive to deliver high quality care to your patients. 

Accept it when it comes. This is why we have malpractice insurance. I’m not going to lie: being sued SUCKS. Big time. It’s miserable. It makes you feel like total garbage, even if you did absolutely nothing wrong. You kick yourself for not being able to prevent a bad outcome, or you feel guilty for actually screwing something up if you did mess up. But there’s really no avoiding it sometimes. You hope for the best and move on when it’s over.