Hello, Noctor community!

I'm an occupational therapist working in pediatrics these days, although I've also worked in neuro rehab primarily with patients recovering from CVAs. I've found my career immensely rewarding, and I have tremendous respect for the physicians I've worked alongside.

Many people in my family are physicians, so I've also had considerable exposure to the medical profession outside my own experience. I've seen firsthand how valuable physician advocacy can be, particularly when insurance companies deny or restrict access to rehabilitation services. I've collaborated with physicians to challenge those decisions and help patients obtain necessary care.

I'm curious how this community views OTs and our role within the healthcare system? I have an OTD because I received a scholarship that covered it, however I don't think this should be a required entry level degree for our field. A masters level education for PT and OT is plenty imho. No PT or OT I have ever known has masqueraded themselves as "doctor". I think we would all laugh at anyone who did this as soon as they turn their back.

I've also been thinking about the expanding independent NP practice. If I were an NP, I would personally prefer to work under direct physician supervision, particularly given the differences in clinical training. I'm not entirely sure why an NP would want to practice independently without that oversight. There is no way an NP can make up for the lack of residency and training that doctors have. Why would any NP even want independent practice?

Their training should include substantially more rigorous clinical preparation, ideally something approaching the structure and intensity of physician residency training. I also believe NP licensure should require physician supervision rather than permit independent practice.

I'm interested in hearing your perspectives, both on occupational therapy and on the broader question of appropriate clinical supervision and scope of practice. Thank you!

I’m a 48-year-old male, 5’10”, about 170 lb, down from roughly 205 lb, so I’ve lost about 35 lb or 17% of my body weight. I wish I could say I did it all on my own, but I am on trizepitide.

I have a CAC score of 1 which I guess is higher than 75% of people my age. That's what got me on statins with my terrible family history.

My lipid history has changed pretty dramatically:

Date	Total Chol	LDL-C	HDL	Triglycerides
Sep 2020 ATE FATTY FOOD PRIOR TO LABS	227	105	66	281
Jun 2023	241	157	64	111
Sep 2024 QUIT ALL ALCOHOL	194	117	53	118
Oct 2025	183	119	47	87
Jun 2026 STARTED CRESTOR 10 MG	149	80	54	74
Aug 2026 INCREASED CRESTOR TO 20 MG	126	59	54	65

The June LDL of 80 was after starting rosuvastatin 10 mg. I then increased to 20 mg, and the next LDL was 59.

My latest labs:

LDL-C: 59
ApoB: 49
Non-HDL: 72
Triglycerides: 65
HDL: 54
Total cholesterol: 126
Lp(a): 44 nmol/L
hs-CRP: 1.28 mg/L
Fasting glucose: 96 mg/dL (every grandparent, my dad and almost every aunt and uncle are diabetics)
A1c: 4.8%

My hs-CRP was previously 4.05 mg/L and is now 1.28, roughly a 68% reduction.

There have also been major lifestyle changes over this period. I quit drinking alcohol entirely, lost about 35 lb, and substantially cleaned up my diet.

At this point, the only meat I really eat is chicken breast and salmon. I never eat butter or cheese. Olive oil and whole foods like eggs are essentially my only added fat. I never eat fast food and don’t eat out often, so I’m not sure there is a huge amount left to accomplish by simply cutting saturated fat.

I could still improve the quality of the diet further by emphasizing more whole foods, vegetables and leafy greens, but I do love salad and try to eat it regularly. My weak spot is sugar. I don'yt buy it, but if I am around cookies or brownies, that's a problem. I’m drawn to sweets, dried fruit and other calorie-dense foods, but I am fending it away.

What I’m most curious about is the inflammation piece. Going from hs-CRP 4.05 to 1.28 looks encouraging, especially alongside major weight loss, quitting alcohol, triglycerides falling to 65, fasting glucose of 96 and A1c of 4.8%, and ApoB reaching 49.

But does that hs-CRP reduction actually indicate that the underlying inflammatory state and cardiovascular risk have improved, or could the statin simply be lowering an inflammatory marker without addressing whatever caused the elevated hs-CRP?

Given CAC 1, LDL 59, ApoB 49, Lp(a) 44, triglycerides 65, hs-CRP 1.28, fasting glucose 96, A1c 4.8%, 35-lb weight loss, no alcohol, and a very low-saturated-fat diet, how would you view my residual cardiovascular risk?

At this point, is there anything meaningful left to optimize besides continuing the statin, maintaining the weight loss, exercising, and shifting even more of my diet toward whole plant foods? I am concerned that these numbers are "artificial" that hs-CRP is pushed down due to a pill and that the root causes of inflammation are still there.

I’m a 48-year-old male, 5’10”, about 170 lb, down from roughly 205 lb, so I’ve lost about 35 lb or 17% of my body weight.

I have a CAC score of 1, so there is technically detectable coronary calcium, although the burden is extremely low.

My lipid history has changed pretty dramatically:

Date	Total Chol	LDL-C	HDL	Triglycerides
Sep 2020	227	105	66	281
Jun 2023	241	157	64	111
Sep 2024	194	117	53	118
Oct 2025	183	119	47	87
Jun 2026	149	80	54	74
Aug 2026	126	59	54	65

The June LDL of 80 was after starting rosuvastatin 10 mg. I then increased to 20 mg, and the next LDL was 59.

My latest labs:

LDL-C: 59
ApoB: 49
Non-HDL: 72
Triglycerides: 65
HDL: 54
Total cholesterol: 126
Lp(a): 44 nmol/L
hs-CRP: 1.28 mg/L
Fasting glucose: 96 mg/dL
A1c: 4.8%

My hs-CRP was previously 4.05 mg/L and is now 1.28, roughly a 68% reduction.

There have also been major lifestyle changes over this period. I quit drinking alcohol entirely, lost about 35 lb, and substantially cleaned up my diet. The older numbers are useful context because at one point my total cholesterol was 241, LDL was 157, and historically my triglycerides even reached 281.

At this point, the only meat I really eat is chicken breast and salmon. I never eat butter or cheese. Olive oil is essentially my only added fat. I rarely eat fast food and don’t eat out very often, so I’m not sure there is a huge amount left to accomplish by simply cutting saturated fat.

I could definitely improve the quality of the diet further by emphasizing more whole foods, vegetables and leafy greens. My weak spot is sugar. I’m drawn to sweets, dried fruit and other calorie-dense foods, so there is certainly room to replace more of those with minimally processed foods.

What I’m most curious about is the inflammation piece. Going from hs-CRP 4.05 to 1.28 looks encouraging, especially alongside major weight loss, quitting alcohol, triglycerides falling to 65, fasting glucose of 96 and A1c of 4.8%, and ApoB reaching 49.

But does that hs-CRP reduction actually indicate that the underlying inflammatory state and cardiovascular risk have improved, or could the statin simply be lowering an inflammatory marker without addressing whatever caused the elevated hs-CRP?

Given CAC 1, LDL 59, ApoB 49, Lp(a) 44, triglycerides 65, hs-CRP 1.28, fasting glucose 96, A1c 4.8%, 35-lb weight loss, no alcohol, and a very low-saturated-fat diet, how would you view my residual cardiovascular risk?

At this point, is there anything meaningful left to optimize besides continuing the statin, maintaining the weight loss, exercising, and shifting more of my diet toward whole plant foods?

I acquired Portuguese citizenship after the birth of my minor children. I want to apply for their citizenship and register my marriage. I do not live anywhere near the Portuguese consulate. Does anyone have experience with filing this through the mail to a CRC office? Does the signature need to be authenticated and apostilled? I am confused on this. Thank you!

Hey everyone,

My partner (US citizen) and I (Portuguese citizen living in the US) are planning to get married in Porto during the first week of January 2027.

Because we live abroad and I don’t have the Portuguese digital authentication keys to start the registration process online, we have to submit everything manually. I reached out to the CRC in Porto, and the Conservadora confirmed that the marriage process must be initiated either in person or through a Procurador (a proxy with a special Power of Attorney).

Since we will only be in Portugal for a single week in January, we cannot wait until we arrive to start the process. We need to hire a local professional in Porto to act as our proxy, submit our physical documents, and secure our ceremony date before we land.

We have all of our required documents prepared, including:

- Apostilled US birth certificates
- The required Certificate of No Impediment for my partner. The state we live in offers these.

We are looking for recommendations for:

• A reliable Solicitador or family lawyer in Porto who has experience handling civil registry bureaucracy.
• An English-friendly agency or despachante that specializes in handling marriage documentation for expat/bi-national couples.

If you have personally worked with someone trustworthy who handles these kinds of administrative proxy filings in Porto, please let me know!

Obrigado!

I'm a Portuguese citizen, through descent, but I was born and raised in the US, have never lived in Portugal and I don't speak Portuguese. I've read the posts here about obtaining a marriage license in Portugal, and it sounds like absolute hell. I am trying to decide whether to get married in Denmark (Copenhagen) or Gibraltar and sending in the marriage for registration in Portugal would be simpler. If it were easy to do, getting married in Portugal would be the best thing since it would automatically be transcribed into the registry.

My understanding is that Denmark, as an EU member state, can issue a marriage certificate with the EU multilingual standard form, and that under EU regulations an apostille shouldn't be required for EU public documents presented in another EU country.

However, I've also heard that some Portuguese conservatorias or consulates still ask for an apostille when transcribing a foreign marriage. I've had such a hellish time with my name change with Portugal and their bureaucracy.

Has anyone here registered a marriage from Denmark or Gibraltar in Portugal?

• Did Portugal require an apostille on your Danish or other EU marriage certificate?
• Did you obtain the EU multilingual standard form, and was it accepted? I really want to avoid needing to get a certified translation.
• If you married in Gibraltar, did Portugal require an apostille? I'm gonna guess yes, since it's non EU.

I'm looking for recent firsthand experiences rather than assumptions. Thanks!

Maronite Catholic checking in. I just wanted to send prayers, love, and solidarity to all of our Catholic brothers and sisters around the world and ask you not to forget about us. We Maronites are **fiercly loyal** to the Holy Father and the Vatican is our beacon in this crazy world. I am proud that the Maronite College in the Vatican is robust with vocations.

I have many Melkites in my family too, and we are collectively scared for the region. The places in scripture are not just historical sites. They are home to living Christian communities that have endured war, displacement, persecution, and hardship for generations while faithfully preserving the Christian faith. It's from all sides, the Islamist regime in Syria, the Islamists in Iran, the radical "messianic" fascist settler regime in Israel which is attacking Christian parts of Lebanon, no one speaks for us, our safety and our interests but the Holy Father. I am disgusted by the "Christian zionism" I've witnessed online, and I am truly perplexed how anyone can support what Israel's government does. We need peace. We need to listen to the Holy Father and his prophetic message for the world.

Please keep the Catholics and other Christians of the Middle East in your prayers, along with all innocent people suffering from violence and conflict. We need your voices nw more than ever.

First, I want to apologize if this seems like a trivial request given everything Lebanon is currently enduring. I know many people are facing far more urgent concerns as the country continues to suffer from conflict and instability. My heart, solidarity, and best wishes are with the Lebanese people. Vive le Liban Libre!

I'm posting on behalf of a friend's family who are trying to complete a Portuguese civil registration process. They have Syrian marriage and birth certificates that were recently obtained and authenticated in Syria. Despite documentation from the Patriarchate that they are married Portugal has demanded the documents be issued within the last year. They have been informed that the next step requires taking the documents (that I have) to the Syrian Embassy in Beirut and then to the Lebanese Ministry of Foreign Affairs for legalization before the documents can be sent to the Portuguese Consulate in Cyprus.

I am trying to determine whether anyone in Beirut provides document-running, legalization, or administrative assistance services and would be willing to help with this process for compensation. We would, pay fees for the work and any associated costs. Just message me.

If anyone has experience with this procedure, knows a lawyer, document service, or trusted individual who handles these matters, I would be very grateful for any guidance.

Thank you, and wishing safety and peace to everyone in Lebanon, Vive un Liban libre, souverain et en paix!!!

My father is a Syrian-American and my mother is American of Portuguese origin. Both are American citizens who have resided in the US as a married couple since the early 70s. My parents married in Beirut in the early 1970s before there were wars there and it was a great stable place, Switzerlanad of the Middle East, yada yada. Kinda sad compared to now. We are trying to complete Portuguese marriage registration for my parents so my dad can eventually become a Portuguese citizen too.

We already have the original Catholic church marriage certificate and original birth records. Lebanon does not even have civil marriage, yet Portugal is demanding a “recent” secular marriage certificate issued within the last year. Not only that, they want these newly issued Lebanese records physically sent back to Cyprus for processing. There isn't even a Syrian consulate in the US to request a new birth certificate from. We have my dad's baptismal certificate in French, and that wasn't enough. I explained that Syria did not even exist as a country when my dad was born, he was born under the French Mandate, and his family are devout Catholics. There was no civil registration. The Portuguese consulate literally suggested I go to the Syrian consulate in Brazil, Paris, or Cuba. HAH! They want my older dad, who has a very French name to go to Syria at a time when Christians are not treated so well. They were unswayed. Could not care less.

We have no relatives in Lebanon and certainly not in Syria anymore. My parents are old and they want them to go all the way to a war zone to get my moms birth cert and their marriage cert. The region is unstable and there is literally a war affecting the broader area. Getting documents out of Lebanon is already difficult enough, but now we are being told the records must be recently issued despite already possessing the originals from the church and Lebanese authorities.

The Portuguese consulate in DC has been incredibly unhelpful and rigid throughout this process. Every interaction seems to produce a new requirement or contradiction. I am astounded by the absurdity of it, I am going to reach out to the CRC directly.

I'm probably going to hire a lawyer, but I just wanted to let people know my own awful experience with this. My parents have been married for more than 50 years and the consulate is being really awful.