Nissen fundoplication

There's r/ketoscience which focuses on discussion about scientific publications regarding keto.

Sorry, I hadn't logged in, so only much later am I seeing this:

Out of curiosity, why is a non-diabetic using CGM?

My wife and I both use them precisely to understand how we react to different foods (and we both react differently), so that we can maintain healthy blood glucos/insulin levels.

I got mine first through a company called Levels, that enrolls non-diabetics in their research, and prescribes them on that basis. Of course, there's no insurance coverage, so it costs about $200 for 30 days worth of CGMs, and then another $200/year subscription to their service, so it's not exactly cheap. There a variety of other companies that also offer a similar service.

My wife got hers prescribed by her doctor. She was concerned by some weight gain, and while her fasting glucose was still below 100, it had been creeping up over the years (as also shown by an A1C that was creeping up), so she was worried about insulin resistance, and becoming pre-pre-diabetic. Insurance does cover a good portion of her prescription, and it costs her about $85/month.

We've gained a ton of insight into how we react to different foods, and just how different those reactions can be, so I count it as very valuable.

If I were you, I would keep the appointment with the surgeon - no because you want surgery, but so that you get the opinion of a real expert. No surgeon is going to do surgery without your consent, so there's no danger in speaking with them. Let them see that your GP made a bad referral and wasted everyone's time. Also, a bariatric expert will be able to reaffirm that you've made good progress without surgical intervention and are therefore, you're a poor candidate for surgery. Having that opinion from an expert will make it easier to have that conversation with other healthcare providers in the future, should it come up.

I'm a non-diabetic who has been using a CGM (continuous glucose monitor). I've had absolutely zero changes in blood sugar from drinking artificially sweetened zero calorie drinks while fasted. That suggests, at least for me, that any insulin response is extremely negligible, unless one posits another mechanism like absolutely perfectly timed gluconeogenesis to maintain constant blood sugar levels in the face of those supposed spikes in insulin.

It's called "positive anymore," meaning "these days."

Yes, it's anthropocentric. Why is that an issue?

I think it's interesting that most replies refute the proposition but I think a better question is "why does it matter?" I think it's a weird premise. Would it make it any less helpful or true? I'm not a raccoon at the moment. I'm a human. Emphasizing the benefits and detriments of the human condition and encouraging humans makes sense.

Buddhism does not place humans as having more inherent worth than any other being. If the six realms are taken literally, being human is a temporary condition. There are no "humans" in the universal sense - just certain beings experiencing humanity at any given moment.

Humans just happen to be in a place and time that affords more privileged than other incarnations/emanations. Recognizing privilege and using that privilege to better conditions for oneself and others is admirable.

I'm writing from Thailand, and it's a bit more complicated, but here's a recent article that supports the gist of your characterization. It's expected that most men will ordain, at least temporarily, at some point, and entering and leaving the Sangja is really easy (and Sangha in the Thai context exclusively means the monastic community and excludes the lay community). They're not above the law, but held in very high regard while ordained, and also tightly controlled by a constellation of laws that more often dictate their role in society (for example they are legislatively beyond politics, meaning unlawful for them to participate in politics, including voting - this has to do with a history of religious activism). Women are traditionally excluded from ordination/being recognized as bhikkhunis (though there is some pressure to change that).

Tattoos are extremely common in Thailand, but tattoos of Buddha are generally considered disrespectful and inappropriate, and there are signs in many temples explaining that to spiritual tourists. That doesn't stop tattoo artists here from tattooing them, though.

Every neurologist I've ever spoken to has strongly advised against seeing a chiropractor for any reason whatsoever. They're not real doctors, having very little training in clinically proven methods, and they can and do cause serious injury, which land people in neurologists' offices. Physical therapists, on the other hand, have training in clinically validated practices that are actually science based. Think of chiropractors as "nutrition coaches" and PTs as RDs.

That's great news!!

In my experience, the people at the 1-800-number were always super helpful and responsive. That makes sense, in that it's a huge money maker for Allergan, even with the discount they give by covering out-of-pocket expenses for patients. If you stop using Botox because you can't or don't want to pay the non-covered portion, they lose the revenue from your insurance company. That means they're on your team most of the time, as that's what's most profitable.

Occipital never blocks worked for about a year. Botox worked relatively well for about 4 years, but eventually decreased in effectiveness. Nurtec, out of everything I've tried, has worked the best.

I feel like propranolol was a huge mistake for me. It was the first preventative I was put on. The issue is that I already had a relatively low heart rate (~55bmp) and low blood pressure (90/65). I was athletic, ate a really clean diet, and aside from chronic migraine, I was in great health. The propranolol made me lethargic, and because I was lethargic, I was always hungry, as if my body craved any source of energy it could get. I started eating everything in sight, and my weight ballooned massively. I developed horrible eating habits. Even though my neurologist weaned me off after a few months, 6 years later, I'm still trying to fix the damage I did to my body while on propranolol. Also, I have no history of depression, but the reason my neurologist pulled me off it was because I developed signs of clinical depression. She said it was a not uncommon side effect. Once I was pulled off, I was fine again, in that regard. As far as migraines, it did definitely reduce the frequency and intensity.

I did topamax for a few months, too, and understand completely why you'd get away from that as well. Both propranolol and topamax are the two worst treatments I ever tried.

He needs to talk with a doctor. Postcoital/orgasm/sexual activity headaches aren't uncommon, and aren't necessarily dangerous, but only a doctor running proper diagnostic tests will be able to figure out what's going on, and hopefully also point to treatment options.

Of course - I just don't like to sound like a pharmacy rep!

So, what's worked for me is Nurtec. I was incredibly skeptical, as I've tried so many therapies over the years, but it feels like it's given me a new life - it's amazing how much more energy I have when I'm not constantly managing the constant discomfort of migraine - discomfort I hadn't noticed the extent of until it went away.

I've also been getting Botox for a few years, which allowed me to get my migraines mostly under control, except for the pro- and predrome symptoms and occasional crippling breakthroughs. My neurologist first prescribed the Nurtec for those breakthroughs (triptans weren't cutting it). I realized that not only did the Nurtec stop the active migraine, the pre- and postdrome symptoms were also treated, and there are no side-effects. I'm in the process of switching from Botox as my preventative to Nurtec, it's that effective.

I still worry the Nurtec will stop working. I look back on my days on Topamax/topiramate, and I'm grateful for the advances and medical technology.

I recognize myself in this. I found it was an issue with certain treatments that treated the pain, but which still left me with pro- and postdrome symptoms. For me, dysphasia is my biggest symptom, and it's hit me at difficult times. That's a source of a lot of anxiety. It's also exhausting, especially since my migraines are chronic.

My neurologist and I have found a treatment that has knocked out the pro- and predrome phases most of the time, and I feel like a new person.

That's fine and all, but non-attachment is decidedly not indifference to injustice and suffering nor is it an excuse for non-action when we're in a position to help alleviate the suffering of others.

And I just noticed, with your comment, your nails, and I think that's brilliant!

Good luck!

Those straps only measure ketones present in urine, and not whether you're actually in ketosis. As you're body becomes more efficient at using ketones for energy, you'll lose much less in urine. You'll get a negative reading, and wonder why you're not in ketosis. Don't let that discourage you.

That's an ELI5 version. Ketone metabolism in complex. I just would hate for anyone to get discouraged because they didn't understand what exactly they were measuring.

There are blood ketone monitors (I own one), which are a bit more accurate, but they have their own issues, as well. The validation from external, objective measures can be helpful, but usually only until they give us bad news. Then it can become a liability.

I live in one of a number of US states where there is a strong presumption of coercion, meaning a presumption of inability to consent, when the person making the advances is a member of the clergy or religious authority.

Looking at Minnesota law, for example, (where I don't practice) the criminal code defines criminal sexual assault in the third degree as any sexual penetration that occurs "during a period of time in which the complainant was meeting on an ongoing basis with the actor to seek or receive religious or spiritual advice, aid, or comfort in private." The statute goes on to say that consent of the victim is not a defense for the perpetrator. That law has "penetration" as an element of the crime, but it gives you a sense of how clergy are held to a higher standard under the criminal codes in a number of jurisdictions. Mine happens to be one of those, and mine also doesn't require "penetration" for sexual assault to occur.

PS. I didn't down vote you and don't think others should either. You were unaware of laws which penalize clergy (and psychotherapists and other professionals who work with the mentally, emotionally, or spiritually vulnerable) who make sexual advances, and I got a chance to share information about that topic. The sharing of information and learning should be celebrated.

That's not illegal, but it is deeply unethical.

You're making a lot of assumptions about the laws of OP's jurisdiction. I'm a lawyer myself, most likely in a different jurisdiction, and wouldn't presume to give this sort of counsel to anyone outside of my jurisdiction (and it's wrong advice in the jurisdiction where I practice).

OP likely has multiple avenues for reporting to various authorities, and shouldn't be discouraged from looking into any of those avenues, and seeking guidance from people more qualified than either you or I about the outcomes of that reporting.