u/DumpsterPuff

I've trying to figure out why my symptoms have been horrendous for the past month. Like it's to the point where I'm fighting for my life trying to stay awake at work and counting down the minutes to when I can clock out and take a nap. Even on my days off, I start to get drowsy doing things that I actually enjoy and usually keep me engaged and alert.

The only thing that's really changed is that I started exercising more often, and started tracking my calories again and am currently in a deficit with the help of my personal trainer and a dietician. I do weight lifting with the trainer 2x a week and go to the gym by myself 1-2x a week on top of that. Nothing super strenuous lifting-wise and my cardio tends to be on the lighter side.

I know that deficits can make anyone feel tired if the calories are too low, but mine seems very reasonable and not extreme at all. I'm 32 years old, male, 5'7" 212lbs and they have me on about 1850-1900 calories a day. I'm not feeling starving all the time and started taking a multivitamin last week. When I was tracking my calories before the deficit, I was eating about 2100-2200 a day, so it's not a massive reduction.

Could being in a calorie deficit, even if it's not extreme, be causing my symptoms to flare up this badly? I'm wondering if others have experienced the same thing. The symptoms are to the point where my doctor is trying me out on a stimulant again (and I hate how stimulants make me feel) because the Xywav isn't enough to keep my daytime sleepiness under control anymore.

I've been a medical coder for nearly 4 years, and I have an extensive medical background + bachelors in public health, so I didn't have a whole lot of issues with the diagnoses/medical terminology.

My wife is sick of her job and wants to do something where she can work from home, have flexible hours, and have weekends off - so basically my current job. She's seriously thinking about getting a coding certification, which is great, except she doesn't really have any medical background at all. She's been a retail manager for about 15 years and has a bachelors in history.

For anyone who got their coding certification WITHOUT a prior medical background, was it incredibly difficult to understand the material? I know AAPC does offer medical terminology/anatomy courses, which I didn't take because of my background, but I'm wondering if she should try those first.

I loooooove the Fairlife protein shakes - I have the 42g one every morning and they basically taste like melted strawberry/chocolate ice cream. Only problem though is that they're so freaking expensive and take up a ton of space in my fridge. I want to see if I can switch to a protein powder instead to drink it + use it to put in overnight oats, smoothies, etc. I've tried a few in the past, both whey and plant-based, and they all tasted awful and just congealed into clumps even when I used a mixer bottle. There's so many to choose from so I'm a little overwhelmed.

I'm specifically looking for a whey one because my stomach seems to not like plant-based. Bonus points if it comes in strawberry or some other fruit flavor (I have GERD so chocolate gives me reflux and I'm not the biggest fan of vanilla, but I'll still use it if it's the only option).

This is probably a tall order but I'm looking for an auto wet feeder with some specific features that may or may not all exist at once, so I'm looking to see whether such a thing exists, or if something with most of the features I want is a thing.

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From most to least important:

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-Has more than 3 wells

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-Responds to our cats' microchips to open and does NOT require them to wear a collar to open it

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-Can keep food fresh for >24 hours without constant ice pack changes

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-Can automatically warm the food prior to eating

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Our current autofeeder has 6 wells (which is great because they eat wet food 2x a day), but there's issues with food stealing because either cat can get to them. We also have to change the ice packs twice a day in the summer because they melt pretty fast, so we run the risk of the food spoiling or it ends up being too cold for their enjoyment.

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So yeah, if anyone has any suggestions for something that meets these specifications or pretty close, that would help a lot!

I swear that every single place I go wants you to go on google and give them a rating. Restaurants, okay fair enough, I get it. But I've had multiple doctors offices this past month send me emails being like "rate us on google!" One even told me to my face that I should do one for his office. It's really the constant badgering from all of the businesses that irks me. Maybe I'm the only one bothered by it, but it's just annoying to get texts/emails/etc constantly asking for a rating.

Got an eye exam last month and got an updated prescription (I have astigmatism), picked up my glasses a week later. At first they seemed good but lately I've been noticing that my vision still seems a little blurry. When I wear them, if I close my right eye, everything in my left eye is clear and crisp. If I close my left eye, my right eye vision is kinda blurry. I can still see but it's definitely fuzzier than the left. I'm wondering my new prescription is slightly off. My insurance only pays for one eye exam a year, so am I gonna be stuck like this until next year? Or should I just pay out of pocket for a repeat exam?

I read that supposedly orexin increases when you exercise and is supposed to help you stay awake, and I'm trying anything to motivate me to exercise again. I remember feeling more sleepy a few hours after exercising, but I'm wondering if maybe I'm just not going at the right time? But yeah, just curious what it does to everyone else.

Wondering if this is a common symptom of GAD or not. I feel like when things are going well, or if a significant real stressor has been resolved, I get temporarily relieved but then my brain immediately tries to find *something* to worry about, even if it's trivial. It's not really a "I feel worried about things in general" kind of feeling, it's more of a "I NEED to find something to worry about", almost like I can't exist without anxiety in my life. I'm afraid that if everything in my life suddenly becomes peaceful, I'll drive myself crazy by trying to find such non-trivial things to be anxious about. It's exhausting.

I'm in a weird limbo where we don't actually know what my true diagnosis is. The MSLT showed no SOREM but I was on antidepressants during the test. We wouldn't be able to do a repeat without meds because I tried coming off of them and had a mental health crisis as a result. My doctor *thinks* I might actually have N1 because there's some evidence that I might have mild cataplexy, but it's hard to tell. Since we don't 100% know, for insurance purposes though he just made my diagnosis on paper as N1 so I could have access to medications, and it's been this way for almost a decade.

I'm super interested in trying an orexin agonist when they come out, but I don't know if they would *only* work for N1. I figured since they found out that Xywav works for IH, maybe these will work for it too? Definitely a long shot but at least wanted to ask if anyone has heard of either condition also being tested.

I live near the train tracks and they've been doing something on it all week. Right now there's this never ending WHIRRRRRRRRR that's driving me absolutely insane. I can even hear it through my noise canceling headphones with music playing. Just curious to know what they're doing.

So we have a major problem with our primary care providers where a lot of them avoid putting a diagnosis of overweight or obesity in the documentation. They'll put in just a BMI code or just say things like "desires weight loss" followed by BMI code, or "weight management" followed by BMI code. It's driving me absolutely nuts because it's literally not codable.

I typically send them a query saying that a BMI is a secondary diagnosis and that the primary condition being treated that the BMI measurement is related to needs to be indicated. Sometimes they get it, but I will also get messages back saying "BMI is the diagnosis" or "they're being seen because they want to lose weight." They don't seem to understand that there needs to be some sort of weight-related diagnosis to report BMI, or even that they can actually just code obesity.

When I look in the ICD-10 guidelines, it specifically states "BMI can only be coded if there is a separate, reportable diagnosis (such as obesity or anorexia) documented by the provider." If I send them this exact quote taken from the guidelines, including the part where it says "such as obesity or anorexia", does that come off as a leading query? I don't want to get in trouble but I just want to be clear as humanly possible to them so I can stop sending 8 billion messages about this every day.

I'm housesitting for my parents right now and they live in a very quiet neighborbood - unlike me where my apartment is next to a highway and a train comes through every hour or so. So I took advantage of the quiet and went to take a nap on the couch because I was exhausted.

Every 5 minutes, I kept hearing TAP... TAP TAP against the window that's right next to the couch. I tried to ignore it but every time as I was just about to fall asleep, TAP, TAP, TAP. After the 4th time I was getting pissed and looked out the window. There was this giant wasp that kept smashing itself against the windowpane. I was cranky and exhausted so I grabbed the first spray bottle I could find and ended up Windexing it to death.

I think committing war crimes against an insect has hit my number 1 pettiest things I've done because I just wanted to sleep.

Or more specifically, I hate AI charting when the providers won't review their notes and just click random buttons on the problem list that populates into an Epic charge session and the diagnosis is nowhere in the documentation. Or there's a bunch of AI-generated diagnoses that WERE captured in the note but weren't on the charge session. It's basically to a point where when I see on the top of the note "patient refuses recording" I breathe a sigh of relief. Our poor educators have been trying to inform the providers for months that they NEED to make sure everything is matching up but of course they won't listen. It's making HCC coding especially a massive nightmare.

Anyone else feeling my pain?

Are you guys also majorly affected by the days getting longer? For the past week it's taken me FOREVER to fall asleep and I wasn't sure why, until I realized that the sun has been out until almost 8:30pm. My bedtime is typically at 9. I'm dreading summer because I live in the pacific northwest and the sun doesn't set until almost 10pm here between June-August. Anyone else in the same shitty boat?

Hoping someone might be able to clarify this for me since the pharmacy is closed. So I've had to use the Xywav bridge program a couple of times in the past due to insurance issues. I just had to use it again last week and pretty sure I will have to use it again next week because my doctor's office PA team has been really dropping the ball this past month as far as communication and submitting the PA how the insurance wants it to be submitted as.

Anyways, so I saw there's a 120 day limit for the bridge program, but is that a lifetime 120 day limit? Or does it reset after a certain time frame (like a year or something)?