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PaperclipPerfector  2d ago (text post)   1207 thread views

Wellness Wednesday for January 15, 2025

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

  • Requests for advice and / or encouragement. On basically any topic and for any scale of problem.

  • Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.

  • Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.

  • Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).

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How safe is HGH? What's the highest possible safe dose? Is there a highest possible safe dose? Will a high dose do anything (thicken bones like your feet, hands, wrists, ankles, vertebrae) that a low dose won't? I'm actually trying to thicken my ankles and wrists to see if thicker bones allow for a larger tendon CSA which allows me to do more in the gym without overuse pain, because my growth was stunted. It seems like acromegaly patients do get significant thickening of the bones I care about, however, do you need a mega-dose to achieve that thickening or not?

If you're looking to have it:

thicken bones like your feet, hands, wrists, ankles, vertebrae

You're basically into acromegaly territory, and I don't think that's a very good idea, unless your lover is into the Neanderthal look.

I doubt there's much concrete evidence out there, but I found this:

https://pmc.ncbi.nlm.nih.gov/articles/PMC2657499/#:~:text=It%20can%20be%20argued%20that,%2C%20menstrual%20irregularities%2C%20and%20impotence.

There are few controlled studies on the effectiveness of GH on the performance of top level athletes. In general these studies have been performed with supraphysiological dosages but not with the large amounts claimed to be effective, for instance, by bodybuilders. The results of most of these controlled studies are generally less impressive than the claims of those who misuse the substance. A study of volunteers under heavy resistance training found decrease of free fatty mass but no difference in the muscle strength.23 With weight lifters, it has been shown that short term GH treatment does not increase muscle protein synthesis more than placebo24 or other factors such as maximal voluntary strength (biceps or quadriceps).25

The long term risks of hGH use are not well known since epidemiological data regarding this type of treatment in healthy sportsmen are unavailable. Acromegaly, which results from a pathological increase in endogenous production of GH, is often cited as one of the major risks associated with excessive use of hGH. The major symptoms are swelling of the hands and feet, coarsened facial appearance, dentition problems, arthralgias, fluid retention, and excessive sweating. Acromegalic patients have an increased risk for diabetes mellitus and hypertension that can lead to premature mortality from cardiovascular diseases.26 It can be argued that long term hGH doping with high dosages will probably result in misusers experiencing symptoms of fluid retention and increased risk of development of diabetes mellitus and hypertension. There is also a risk of cardiomyopathy, osteoporosis, menstrual irregularities, and impotence. Some of these side effects are reversible after withdrawal of the drug.

You're in the peculiar position of wanting thicker bones as opposed to more muscle. I don't know how you can get that just in your peripherals without fucking up your face. If you want an actually well-informed answer, you probably want the kind of sports-physician who has a cult following in the powerlifting community and isn't overly afraid of losing their license.

Hey man thanks a lot, this is very informative. Looks like there are some serious risks of long-term use...so most likely would only do this for a year and see what happens while eating a surplus. Yeah, the neanderthal look would be an unwelcome side effect. Figured there could be a dose somewhere in between that would do what I want without fucking up my face completely, but perhaps this magical goldilocks dose doesn't exist. I will look around and see if I can find one of those powerlifting physicians you speak of.

I decided to look around some more and the more I read, the worse an idea this seems.

https://pubmed.ncbi.nlm.nih.gov/31100715/

When GH and IGF-I are secreted in excess, bone remodeling is enhanced leading to deterioration of bone microstructure and impairment of bone strength. Indeed, acromegaly causes skeletal fragility, and vertebral fractures are reported in a remarkable number of subjects exposed to GH and IGF-I excess.

In other words, you'll have thicker bones. But they'll be unhealthy bones, that'll be more prone to fracture under stress. That seems entirely counterproductive for your goals.

By all means see that doctor if you're keen to have a definitive answer, but from where I'm standing, this probably won't have any positive results even if you have a strong risk appetite. I see no evidence of threshold effects, where there's an amount of HGH post-puberty that-

  1. Noticeably thickens bones
  2. Makes those thick bones actually stronger
  3. Doesn't cause acromegaly.

Be very careful with the stuff.

Oof. Point taken...I already have osteoporosis so it would suck to deteriorate bone quality. I figured up to now that because my growth was stunted I'd be particularly suited for HGH, but with low bone density I think it might be that I'm particularly not suited for HGH.

They are finally confirmed to be getting denser now that I'm maintaining a middle-range-normal BMI instead of a borderline normal BMI, and if I manage to naturally get to a density Z-score of 0 maybe there will be some natural thickening that occurs, who knows. I'm not hugely optimistic about the prospect of noticeable natural thickening at my age but I don't think anyone has studied whether bones only recover density versus recovering both density and some thickness in recovery from malnutrition as an adult.

At least my search turned up no results on recovery of bone thickness. "Catch up" growth obviously doesn't work for height after growth plate closure, but nobody out there seems to be even asking the question about catch-up growth of bone thickness. I hope the phenomenon exists and doesn't depend as much on growth plate status, but haven't had any measurable thickening in myself yet. I guess I'll be a case study if my ankles and wrists circumference somehow grow to what they should be genetically (around 20-25th percentile most likely, currently sitting somewhere off the chart below the 1st percentile).

Anybody here know if mostly-but-not-completely torn ACLs can recover on their own well enough for someone to play pro soccer again? I have a relative that mostly tore his a few months ago, it has now healed over with scar tissue but is still lacking the proper thickness and orientation of fibers. He has no pain now (after months of rehab) and jogs everyday now, does some weight vest workouts and is squatting more weight than he did before he got injured.

He injured some other stuff that has healed somewhat too. Surgeons want him to get surgery and said ACLs can't heal on their own, yet my relative literally has imaging evidence that it has healed to some extent already in just a few months, but the surgeons chalked it up to just being scar tissue and not falling under their definition of healing. There are studies that say athletes do just as well conservative management as surgery for that injury. Anybody here have experience with this stuff? Thanks.

When a close friend had ACL surgery, the doctor mentioned that even full tears healing naturally isn't unheard of, but in that case (full tear) the surgery was still recommended. I was surprised that "just live with no ACL" was considered a viable option for anything short of playing sports like soccer.

In that case, I think an outpatient surgery was perhaps a bit optimistic, but the overall recovery prognosis wasn't otherwise inaccurate.

Damn that's crazy.

https://www.strongfirst.com/community/threads/acl-reconstruction-acl-rehab-without-surgery.21455/#post-399283

Strongfirst is a goon show but Prevost is the real deal. It sure doesn't sound like your boy needs surgery.

Wow this is very helpful thanks!

It has come to this: Halfway through life, I must don glasses.

Please give me your best, least obvious or highest benefit-cost-ratio tips and advice for the newly bespectacled.

Edit: Context: Apparently I'm nearsighted and have Astigmatism. I already got a first pair of glasses; plastic lenses in a very simple frame. Not the sturdiest (I wanted it to be fairly light), but not exactly wireframe either. Cost me around 250€. My parents regularly shell out 1000€-2500€ for glasses, so this seemed an acceptable price. No extra features though.

Learn how sensitive you are to chromatic aberration. The last time I updated my prescription, they upsold me to high-index lenses, which are thinner and lighter than regular CR-39 and don't gain any yellow tint from UV exposure, but I simply couldn't wear them at all due to their low Abbe number. Everything not dead ahead of me had colored outlines. I went back and demanded CR-39 lenses and a partial refund.

To add to @SubstantialFrivolity's answer, consider photochromic sunglasses. I own a pair of regular prescription sunglasses because I hate the look of photochromic lenses, but it's quite annoying when you have to venture indoors:

  • either you look weird wearing sunglasses indoors
  • or you take them off and have to do this weird squint with your mouth agape to read the prices
  • or you take your regular pair of glasses with you as well and look like a total dad with one pair hanging off your shirt collar and the other on your face

Oh, and get an extra pair to keep in your glovebox.

Heh, I've come to consider "I can see the spectrum of light sources" as an amusing-but-useless superpower. It's pretty easy to discern between natural light and color LEDs, for example. But yeah, it could see it being disorienting pretty easily.

One note on the photochromic lens suggestion: do not try to use these as your only pair of glasses (like I did). If you're in a situation where you need to be in photos outside, they will darken (which may or may not be an issue for the specific photo, I suppose). Blue light filter will also show up in photos (your glasses will have a blue tint to them). I wound up getting a new pair of plain clear lenses for my wedding just so that I would look normal in the wedding photos.

They also don't work in the car, which is one of my big use cases for sunglasses. It's a bummer.

I recommend (if you can afford it) getting a pair of prescription sunglasses to go with your regular ones. Sunglasses don't go over glasses very well, so it's nice to have prescription ones when you are driving and the sun is in your eyes. Also, if your regular glasses break (as just happened to me recently) you can use the sunglasses as an emergency backup.

If you struggle with glasses sliding off your face, you can buy for ~negligible sums rubber grips/hooks that curl around your ear and keep them in place. In conjunction with fogging, and the awkwardness of getting someone else to adjust your glasses without disturbing the sterile field, I couldn't have made it through a surgical rotation without them.

https://amzn.eu/d/50D7mX8

(Also those prices you've mentioned strike my Indian sensibilities as fucking insane, not sure how much the cost of labor factors in)

Frankly, they strike me as just as insane. But everything here is expensive. Labor, energy, goods, rent. Life. Earn 3k€/M, feed a family of three, have 0€ left over at the end of the month.

My glasses don't fall off easily, but of course they're new. I hope it stays that way, though. I'm mostly annoyed by how they jump around on my nose when I make any sort of quick movement; but around the ears they seem solid enough.

Reading glasses? If yes, then the prescriptions are easy enough to find cheaply and in bulk. My parents typically order like a 5 pack of them and just sprinkle them around the house.

If lasik is at all an option do it. I only wish there were more thousand dollar procedures out there that could enhance my body.

Call around to find an optometrist who is willing to give you the pupillary distance as well as the prescription, then buy the glasses online through Zenni. Alternatively, if you only have the prescription, you can use a reversed or expired credit card to measure your pupillary distance at their website by taking a picture of your face with the card on your forehead. If you order during Black Friday, it is very cheap.

Get the maximum blue light protection possible. It will help you sleep and reduce eye strain and headaches. Get some clip-on sunglasses, too.

Two is one and one is none. Get three pairs. Nothing sucks more than not being able to find your glasses when you absolutely need to go out the door.

Get sturdy plastic glasses with as few moving parts as possible. Thin wire-frame glasses break way too often. They should look like this, not like this.

Frames vary widely in price for no apparent reason. I have seen virtually identical frames priced more than $100 apart. Get the cheap ones.

Two is one and one is none. Get three pairs. Nothing sucks more than not being able to find your glasses when you absolutely need to go out the door.

I can't agree with this. Having a tinted pair is often worth it (see my other post), but three pairs is way too much. Also, it's not hard to keep track of your glasses so you shouldn't ever be in the situation where you can't find them.

Maybe you just have better executive function than I do? All I can tell you is that three pairs have really saved my ass when one pair was long-term lost (later found between the bed and the wall), the second pair I was using was short-term lost (left in the bathroom) and I really had to go out the door to get to work.

Besides, each pair was only $30 (again, Zenni + Black Friday), so why not.

It sounds like maybe the problem is not having a place you consistently put them? If my glasses aren't on my face (or in my hands), they are in one of exactly two places: the nightstand next to my bed (while I sleep), or the bathroom vanity (while I shower). Consequently, losing my glasses just isn't a thing that happens in my life.

I have seen virtually identical frames priced more than $100 apart.

That’s not that bad. In France, they have a system where it’s obligatory for the employer to provide glasses insurance(1) . Then once a year the giddy employee can choose glasses with frames worth 600 dollars(2) “for free”.

(1) This costs him frequently around 100 dollars/month or more. There's some other random nonsense included in the insurance. A full set of glasses costs only like 50 dollars.

(2) They look exactly the same as frames worth 25 dollars. There’s a lot of ads for glasses in France.

My mom got a free amount of money towards glasses through Medicare, and it was use it or lose it, so she ended up getting glasses worth several hundred dollars for no reason right as the money was about to expire. She was pretty happy about it, too.

From "Against Tulip Subsidies" by Scott Alexander:

Americans take eight years to become doctors. Irishmen can do it in four, and achieve the same result. Each year of higher education at a good school – let’s say an Ivy, doctors don’t study at Podunk Community College – costs about $50,000. So American medical students are paying an extra $200,000 for…what?

Remember, a modest amount of the current health care crisis is caused by doctors’ crippling level of debt. Socially responsible doctors often consider less lucrative careers helping the needy, right up until the bill comes due from their education and they realize they have to make a lot of money right now. We took one look at that problem and said “You know, let’s make doctors pay an extra $200,000 for no reason.”

And to paraphrase Dirkson, $200,000 here, $200,000 there, and pretty soon it adds up to real money. 20,000 doctors graduate in the United States each year; that means the total yearly cost of requiring doctors to have undergraduate degrees is $4 billion. That’s most of the amount of money you’d need to house every homeless person in the country ($10,000 to house one homeless x 600,000 homeless).

I want to be able to say people have noticed the Irish/American discrepancy and are thinking hard about it. I can say that. Just not in the way I would like. Many of the elder doctors I talked to in Ireland wanted to switch to the American system. Not because they thought it would give them better doctors. Just because they said it was more fun working with medical students like myself who were older and a little wiser. The Irish medical students were just out of high school and hard to relate to – us foreigners were four years older than that and had one or another undergraduate subject under our belts. One of my attendings said that it was nice having me around because I’d studied Philosophy in college and that gave our team a touch of class. A touch of class!

This is why, despite my reservations about libertarianism, it’s not-libertarianism that really scares me. Whenever some people without skin in the game are allowed to make decisions for other people, you end up with a bunch of elderly doctors getting together, think “Yeah, things do seem a little classier around here if we make people who are not us pay $200,000, make it so,” and then there goes the money that should have housed all the homeless people in the country.

I'm putting off a first visit to an optometrist. I know what's coming.

According to mine, even if you have vision problems, it's only a necessity to deal with it either if it seriously hinders you in your daily life, or if you're still fairly young (younger than about 20, IIRC) so that your brain doesn't grow up wrong. If you already made it to middle age and you can live with your eyes as they are, then you can pass on glasses.

I for one was mostly just annoyed by the blurriness at a distance. I recalled seeing sharper when I was younger. But it wasn't a hindrance in any way.

Do you have to test your vision when renewing your driving license in Germany? Here the optometrists will put a "vision correction mandatory" on your certificate if your eye chart performance doesn't impress them.

You don't have to renew it. Unless you lose it somehow. But if you do need to get a new license, then yes, you also need to do the vision test again, and my optometrist did tell me that I probably wouldn't pass muster without glasses (which also means that I would get such a note on my driver's license). Whether that's true, who knows, maybe she just really wanted to make another sale that day, but it's technically possible.

Thanks. For me it's a relatively new inability to read at very close distances (eg phone with small text in bed). I've got a pair of off the shelf reading glasses from the department store which covers this so I'm going to hold out as long as I can.

I can't google anything useful about my issue and Claude is largely unhelpful, the doctors try to diagnose me with depression (I have a very well managed SAD, so I technically might qualify but this is not the main root cause), sports medicine physicians just don't exist where I am, so I want to dump the list of the symptoms I have and see whether you guys can help me come up with a direction to dig.

The main issue: when I do sports, whether it's cardio or weightlifting, I find it really hard to sleep. Fundamentally, my sleep is more fragile. I fall asleep easily all of the time, but when I work out it's easier for me to wake up during the night (for any reason, e.g. noise, wanting to go pee, being too hot, being too cold) and harder to fall back asleep after I wake up.

  • I've had those problems regardless of whether I'm depressed or not. But in general, I'm not depressed. I get depressed when I don't get enough sleep consistently.
  • Given the allotted time slot of 7 hours 40 minutes, when working out, I sleep 5-6 hours, when I'm not I sleep around 7+ hours.
  • I've worked out consistently for over a year and during all of that time my sleep quality was in the dumpster. As soon as I stopped, it improved drastically. I stopped waking up in the middle of the night as much and I have no trouble falling back asleep almost entirely. I thought that if I power through sleep issues, they are going to go away, but they didn't.
  • I tried to start working out again and bad sleep quality was back after the first session.
  • If I engage in a physically demanding activity (for example a hike) bad quality returns the same day.
  • I have a restless leg syndrome and drink magnesium for it. Magnesium removes the feeling in my shins almost entirely, but it seems like it flares up more when I work out. Rolling out the shins doesn't help.
  • When I work out, I am constantly thirsty, regardless of how much I drink. Due to that, I wake up to go pee 2 or 3 times a night. I tried to stop drinking 1-2 hours before going to bed, but it just feels really uncomfortable.
  • I was working out both when I restricted calories and when I was supporting my current weight. When restricting calories, I woke up due to being hungry sometimes (I attribute that to the sleep being fragile).
  • Working from the assumption that this might be related to the restless legs syndrome, I tried to refrain from targeting legs in my workouts, but it doesn't really matter which muscle group I target.
  • I maintain strict sleep hygiene, so we can rule out external factors.
  • Room where I sleep is cool, dark and (reasonably) quiet.
  • I tried working out in the morning and it doesn't matter when I do it.
  • I thoroughly stretched after the work out (when I did work out) and I also stretch before going to bed.
  • I tried adding more electrolytes (i.e. Gatorade), but I don't know what the hell I'm doing or what I'm measuring. In any case, I eat a lot of salt as is and I didn't notice any difference when adding additional electrolytes in my diet.

I desperately want to see a doctor, but they are trying to diagnose me with a mental health problem rather than a chemical imbalance. Feel free to ignore my complaints about doctors and suggest me to see a doctor, but I'd be grateful if you could spell out what I should say to him.

The simplest explanation is that exercise is depleting nutrients that you are currently borderline low in.

Have you tested your Iron and Ferritin levels recently? RLS is caused by not enough dopamine being processed by certain receptors. One of the co-factors for this process is iron. So low iron will by definition cause RLS. It could be something else causing low dopamine but since magnesium helps you temporarily, it seems worth trying.

Do not trust the doctors if they try to pin your problems on something psychological. They just default to that when they don't have a clue. I would also wager that your depression is a symptom of a underlying physical problem.

Solving nutrition / chronic illness problems is very complicated and very few people know what they are doing. Experimentation and sceptical but open-minded reading is sadly the best approach that I have found.

If I were you I'd try a basic multi-vitamin before and/or after exercise (just one with reasonalbe RDA, like 50-100%) and a high-quality (but low potency, iron poisoning is a thing and is very bad) iron supplement. Try it for maybe a week (or until you feel something), then re-evaluate. If something gets better try to figure out what. Since just spamming supplements without understanding them is bad long-term, but fine short-term, usually. So ordering some blood tests and researching the results is also recommended. Doctors will only react when the values are profoundly bad, especially if you are young.

When I got diagnosed with RLS, doctor did a blood test but did not find any kind of deficiency. I think it’s worth trying it again. Testing supplements myself is a good idea, I’ll try it after ruling out electrolyte imbalance. Thank you!

I would also wager that your depression is a symptom of an underlying physical problem.

I don’t think I’m currently depressed, but let’s see whether any of the advice I got here changes my mind on this!

Look up the blood test values yourself if possible. Doctors often skip pointing out values on the verge of terrible, because unless they have studied nutrition on their own, they will basically know nothing about it. Except "Value X below Y is very terrible because of Z. But value X = Y + epsilon is fineeeeee". Very few have a coherent model about the body.

I don’t think I’m currently depressed, but let’s see whether any of the advice I got here changes my mind on this!

I'm sorry. I misread your post. Your reaction seems perfectly normal in that regard then!

Tell me about it.

Me: I think I have anemia. My score is just above the threshold and I’m tired all the time.

Doctor: But it’s not below the threshold, so you don’t.

Me: but it’s literally as low as you can go without passing the threshold, right at the bottom of the ‘healthy’ range. Presumably almost having anemia is pretty nearly as bad as actually having anemia. Can’t we bump up my iron levels a bit?

Doctor: yeah, that’d be normal procedure. If you had anemia.

I can only imagine how annoying that is as a patient but problems like that are unfortunately not what our system is optimized for.

If you recommend something that makes sense but isn't quite justified (because the labs are normal for instance) then you introduce a huge amount of liability if something goes wrong, and good luck getting it paid for if the patient doesn't meet whatever criteria.

Additionally, medical care is in general about preventing someone from dying, "minor inconveniences" (that nonetheless may be subjectively quite inconvenient) are generally not something we are equipped to manage (this being for a huge variety of reasons).

An extra level is the need to avoid fighting with patients unnecessarily.

In this specific case there are other significantly more likely causes of tiredness. Lifestyle habits (including diet, exercises, stress, substances, caffeine, sleep habits, etc etc), psychiatric issues, and boring things like aging are way more likely to be responsible.

I have no idea about you personally, but many patients are extremely resistant to having one of these pointed to.

Lastly there's a bunch of complicated stuff about reference ranges, additional studies, lab uncertainty, diagnostic nonsense... overworked primary care doctor is not going to bother.

Thanks for the reply! It’s always interesting to get a medical perspective on these kinds of interactions.

One wrinkle is that this actually took place in Japan, where medical care is extremely cheap (heavily subsidised) and efficient but as a consequence it’s very process-oriented. Most discussions with a doctor cost $5 but take about 5 min; that transcript was pretty nearly the whole conversation, although to be fair that was partly because I had a more urgent problem.

I take your point about other lifestyle factors; I wanted to treat my ‘anemia’ so I could rule it out and apparently taking strong iron tablets is dangerous without medical supervision.

I assume that you're a doctor. Have you heard of the work of Derrick Lonsdale? Some articles. He also wrote some very interesting books.

https://hormonesmatter.com/the-wrong-fork-understanding-the-current-medical-model/

https://hormonesmatter.com/western-medicine-house-built-sand/

https://hormonesmatter.com/dysautonomia-hypoxia/

Nutritional deficiency was more or less also my instinct when I read the description. The mechanism I had envisioned is:

  1. Sweating + some diuresis triggers a thirst response
  2. OP reacts by consuming a bunch of sodium and water, thus the night time need to pee
  3. The increased urination flushes other critical minerals (including Iron which I failed to mention)
  4. Deficiency in blood mineral concentration increases thirst, return to 2.

I also agree that blood-work could be helpful here, but it would still be hard to interpret. Finding a physician who can properly interpret the results usually requires a specialist, and even that is hit-or-miss.

Even with a multi-vitamin, do you you think separate supplementation for each under covered nutrient with individual or a multi-mineral would also be advisable? My recollection is most common multi-vitamins still do not come close to even 50% RDA on several important minerals (including iron and potassium). Blanketing the spectrum does seem a lot easier than accurate tracking, but also makes it really hard to isolate variables.

Assuming, you do need supplements in addition to the multi, how important is nutrient timing in your opinion? For example if OP is supplementing vitamin D, calcium, and iron. How strong is the synergistic effect of D+calcium and how strong is the antagonistic effect of calcium+iron?

I was also thinking last night that perhaps the need to supplement magnesium in the first place is already mostly explanatory. OP didn't mention which type of magnesium supplement they was using. Of the zillion options which do you think is best for bio-availability, the ability to cross the blood-brain barrier, and sleep, Magnesium L-Threonate? Is it possible the version OP is using is just barely available enough to affect RLS, but not available enough at the brain? On timing, most recommendations are to take magnesium at night for sleep. In my personal experience if I take magnesium right before bed I end up with crazy dreams. With my last big meal of the day, or even at breakfast, tends to work better for me.

The idea of blanket testing is to do a broad nutrition check. "Do I feel better with this?" If so investigate why. Isolating variables is reasonably simple as long as it's a straight deficiency. For potassium, just buy a powder and see how it feels to eat. One can also look up foods very high in certain nutrients and eat them. The body has the not so suprising ability to 'taste' nutrients it needs. So if you buy seeds high in iron, eat those, wait until next day, eat them again. If at this point they suddenly taste fantastic, I'd wager there's something in those seeds your body wants. However anything connected to the B-vitamins, methylation and similar can get very tricky, since it depends on your specific genes and the ratios of the B-vitamins.

Assuming, you do need supplements in addition to the multi, how important is nutrient timing in your opinion? For example if OP is supplementing vitamin D, calcium, and iron. How strong is the synergistic effect of D+calcium and how strong is the antagonistic effect of calcium+iron?

From my experience one reacts to nutrients a lot quicker than what one would assume. But vitamin-D and iron is still in the 'you'll feel it tomorrow' stage, unless you get a iron shot which can be pretty instant if very deficient. Calcium is a lot quicker, a common symptom of low calcium is losing electrolytes like crazy. Sub-communities on reddit are very good for quickly finding out stuff like this, if you have a good filter for people with anxiety disorders. I don't know how antagonistic iron is but I try to take it without any other minerals if I take it. Calcium should be taken with D3 and K2 to prevent health problems.

I was also thinking last night that perhaps the need to supplement magnesium in the first place is already mostly explanatory. OP didn't mention which type of magnesium supplement they was using. Of the zillion options which do you think is best for bio-availability, the ability to cross the blood-brain barrier, and sleep, Magnesium L-Threonate? Is it possible the version OP is using is just barely available enough to affect RLS, but not available enough at the brain? On timing, most recommendations are to take magnesium at night for sleep. In my personal experience if I take magnesium right before bed I end up with crazy dreams. With my last big meal of the day, or even at breakfast, tends to work better for me.

That is true. It is possible he's using oxide or something similar which is horrible. I usually take magnesium malate for energy. And a 3x magnesium in an attempt to get it everywhere in the body. I wish I could take glycinate to calm down but the glycine makes makes me depressed (and so calm I'd describe it as catatonic).

I take 400mg Magnesium Bisglycinate 1-1.5 hours before sleep. No weird dreams, no feeling in the legs either

Check the start of this video. https://youtube.com/watch?v=h5Hyhmxli54

I have not watched it completely so I'm not sure if he mentions gut inflammation later on, but I doubt it. But as said in the video, the main cause of RLS is iron deficiency inside the brain. Getting stuff into the brain is complicated, minerals especially. Gut inflammation can screw with this process. If you have gut problems you should probably try to fix it, since it tends to get worse over time otherwise.

Others have covered this, but from my experience it sounds like overtraining which can be mitigated somewhat by allowing your nervous system more time to recover over hours before sleeping. I don't lift heavy weights or go running after 7pm for this reason. Morning through afternoon workouts are fine. If its a regular issue I would have my workouts in the morning and scale back intensity until I found the sweet spot of exertion that allowed me to sleep.

Do yourself a favour and try other non-exercise related sleep remedies such as reducing caffeine. I found a shocked nervous system (via overtraining) could be further irritated by electronic stimulation so try to cut out screens before bed. Books and audiobooks are encouraged in the hour before sleep. Magnesium as a muscle relaxant before bed is also good for getting to sleep (but not necessarily staying asleep).

tried adding more electrolytes (i.e. Gatorade), but I don't know what the hell I'm doing or what I'm measuring. In any case, I eat a lot of salt as is and I didn't notice any difference when adding additional electrolytes in my diet.

Literally Gatorade? Despite the advertising, the "electrolytes" in Gatorade are mostly sodium. One potato has ~8x the potassium of a 20 oz Gatorade, IIRC. Some of your symptoms are consistent with your electrolytes being completely wack. Slightly supported by the mentioned magnesium supplementation combined with high sodium, but no mention of potassium, phosphorus, or calcium.

Maybe try tracking micro-nutrients in cronometer, and seeing if you are hitting adequate intake for everything? It's hard to get enough potassium, especially at higher sodium intakes since the ratio of potassium and sodium also matters.

I also agree with @jeroboam time of day for physical activity does tend to matter, though more for some people than others. It's also likely that you need to allocate more time to adequately recover if intensity or volume is high. I used to live with a very high level athlete, it wasn't uncommon for him to allocate like 10+ hours for bed. You can get away with a lot less if you are not training hard, other stressors are low, or if it's a short stint but some people just naturally need more sleep time.

Literally Gatorade? Despite the advertising, the "electrolytes" in Gatorade are mostly sodium. One potato has ~8x the potassium of a 20 oz Gatorade, IIRC. Some of your symptoms are consistent with your electrolytes being completely wack. Slightly supported by the mentioned magnesium supplementation combined with high sodium, but no mention of potassium, phosphorus, or calcium.

I actually don't know anything about micronutrients and that's on me, I'll do the research. I haven't seen anyone mentioning that this can have a connection to sleep quality.

Not just Gatorade, of course. I salt my food a lot which I assume counts as more sodium, but I haven't supplemented anything else. I just checked and Macrofactor also has a micronutrient tracker, I'll start using that today.

Maybe try tracking micro-nutrients in cronometer, and seeing if you are hitting adequate intake for everything? It's hard to get enough potassium, especially at higher sodium intakes since the ratio of potassium and sodium also matters.

I think potassium is a really likely culprit. When I worked out my didn't have a lot of vegetables and the fruits I ate didn't contain a lot of it too. I was likely very short of the required ratio.

I used to live with a very high level athlete, it wasn't uncommon for him to allocate like 10+ hours for bed. You can get away with a lot less if you are not training hard, other stressors are low, or if it's a short stint but some people just naturally need more sleep time.

I find I feel great with 7:40 hours when I'm not working out and it's hard for me to reshuffle my routine during work days due to family obligations, but I'll see whether I can do it and feel good in case I can't solve it while working out.

Electrolyte pills will have more quantity and types of electrolytes than a gatorade, without the sugar. I have taken this brand.

I sometimes do very strenuous workouts at night because that's when my sportsball practices are. When that happens, I also have trouble sleeping. In particular I have to get up to pee a lot.

Even though you say it doesn't matter when you do the workouts, it has to matter somewhat, right? For example, if you did a workout 2 days ago you would sleep better than if you did one today.

In any case, if you figure it out let me know! Claude's answers seem to make sense though:

Exercise-induced diuresis: Physical activity can increase blood flow to your kidneys, which leads to increased urine production.

Muscle recovery: During recovery, your body breaks down muscle tissue, producing waste products that need to be filtered out through urination.

Not sure there's anything to be done, honestly. From a practical level, try to give yourself more than 7hr 40m to sleep. Obviously its better to sleep through the night, but it's okay to wake up if you get overall enough.

Thank you taking your time to respond!

Even though you say it doesn't matter when you do the workouts, it has to matter somewhat, right? For example, if you did a workout 2 days ago you would sleep better than if you did one today.

I experience severe side-effects from insomnia so on day 2 I usually just sleep easier just from the sheer lack of sleep on the previous day. But after intense workouts the symptoms usually persist for 2-3 days.

From a practical level, try to give yourself more than 7hr 40m to sleep. Obviously its better to sleep through the night, but it's okay to wake up if you get overall enough.

That's what I have been doing, more or less. If I don't get enough sleep during the night, I just wake up later, but I find it inconvenient enough from the work-life balance standpoint to actually try to resolve the underlying issue.

Overtraining? You could try doing the minimal possible workout and see if the problem persists.

Seems like it, in all honesty. I'll try just doing Zone 2 cardio for a while and increase it in 5 minute intervals weekly.

Can you help me find new direction in 2025? I’m feeling a little lost in my career currently – US based. My core issue at bottom is that I never really developed a passion for anything. Broadly, I’ve been in “administrative” roles for 20+ years. As you can imagine, it hasn’t been super lucrative. I’ve never had much drive or ambition, but I do need to start thinking long term and how I can earn sufficient income to pay all my bills. (Full disclosure: bills include a somewhat pricey private school for my kid. I understand that choice has financial consequences. I’m not open to changing my mind about it. I’m doing a side gig as supplemental income but I can only manage about 10 hours/week.)

I was at a nonprofit a couple of years right out of college and then moved into a commercial real estate firm where I stayed for 15 years. The interesting thing about “administrative” roles is that you get to wear all the hats. At the real estate company I dipped into marketing and took a few graphic design courses. I liked that okay except I really am not that creative. I can execute others’ ideas but I’m lousy at coming up with my own.

I could have parlayed my real estate experience into a better opportunity. But when COVID hit I was unemployed for almost two years before taking an administrative role at another nonprofit because I was happy to get anything. Part of my “marketing” role at the real estate firm included helping set up trade shows, so I got a bit into operations and logistics, and I played up those skills to get the nonprofit gig. Here I do about half operational (supply ordering, workstation setup, equipment inventory), half HR-adjacent functions, and a sprinkling of IT support. (I got halfway to a COMPTIA A+ cert before I gave up.)

Where I’m at now is working for me in a lot of ways, including the flexibility which is a godsend as a single parent. But that’s not going to be quite so important in another year or two. As you can imagine the role doesn’t pay very well and not much chance for advancement. So let’s consider my options from least to most likely:

Web/graphic design: I don’t see myself pursuing it as I’ve let the skills get quite stale and my web design knowledge is 10 years old or more, and anyway isn’t AI going to take all those jobs?

Real estate: eh, I was never passionate about it at all, just something I fell into. Unless I wanted to become licensed or throw myself into Autocad maybe, I just don’t see it. And I’d have to explain the now 5-year break from it I’ve had.

IT: I actually do enjoy the helpdesk stuff I’ve been able to do, but I think I’m in the absolute perfect setup for it right now. The company environment means I’m not getting yelled at by end users and having to chase people down for payment, but there’s also no expectation of certain metrics/reporting or CSR scripts. And my knowledge would have to get a lot deeper if I wanted to find somewhere else.

And here is really where I’m torn:

Operations/logistics: from what I can tell I’m quite good at it. I have a head for details and patience for working through bureaucracy to get permits signed, make sure insurance is in line, all the tricky things that “idea people” don’t understand what it takes to actually execute on something. But where’s the advancement? Either I guess I supervise other people (which I’ve never done) or I help manage a larger site (10x the headaches). Only major drawback I can think of is if I get called in the middle of the night because a water main broke, or I have to be up at 5am to supervise an arriving shipment or something.

Human Resources: my current role is about 50% HR-Adjacent and it feels like it could be a good move. My HR experience is zero but I can take some independent courses at very discounted prices to bolster the educational side. But is this role susceptible to AI, or ideological capture? The ideological capture thing doesn’t concern me too much. One, I’d be more on the process side probably, and two, you can feel out organizations and get a sense for how much they buy in on the DEI-verse. One significant drawback is that it’s unclear if I’d be able to make the move internally (for funding reasons, not doubts about my ability). But an outside organization would be underwhelmed with my HR experience without having the title and education to show for it.

Either role probably gets pinned down by metrics and rigid processes more than I’d like. I like having the flexibility and autonomy to make decisions and propose common sense solutions as I see fit.

I mentioned education a bit ago. I find myself strangely excited to take HR courses. It’s an ideal subject for independent learning. I can’t imagine any operations-related courses that wouldn’t instantly make me zone out. Purchasing 101? Greening your building?

At one point I would have been interested in going further in IT. I’ve found it an incredibly difficult subject to learn independently because (1) you have to be motivated to do the hands-on work, and (2) having teachers/mentors/peers to ask questions to is incredibly valuable. Plus you need constant continuing education because it all changes so fast. To do it right costs money and time investment that I just don’t have right now.

And by the way, I do understand how HR is viewed in some circles. I’m not really interested in hearing about it. Fundamentally, I think a person of integrity in the right HR role performs a valuable and ethical function – i.e. one which businesses are willing to pay for.

Sounds like you are most excited by the possibility of switching to HR. You can:

  • (1) Get the SHRM-CP (Society for Human Resource Management Certified Professional) certification. You can do it on your own time and at your own pace.

  • (2) Ask your employer to either transfer into their HR full-time, or to take on more HR tasks. If the latter, ask that your title reflect this new responsibility.

  • (3) Document all the HR-adjacent tasks you have already done, and keep documenting it. Use the documentation to negotiate (2).

  • (4) If for some reason you look into (1) and decide against it, "Professional in Human Resources" certificate from Human Resource Standards Institute is also good.

  • (5) If you are working through (1) or (4): learn how to use an AI to help you learn. I recommend Claude. Don't let it do your thinking for you, but do use it as a broadly knowledgeable tutor who sometimes goes off the rocker (so validate any concrete piece of info you absolutely need to rely on).

Good luck!

I've been attending BJJ for about a month now, with a gap around the holidays for of in-laws followed by a gap for illness. I attend between three and four classes a week. I'd like to push closer to five, but work obligations get in the way, along with injury avoidance. When I do back to back days especially a night class followed by a morning class from Friday to Saturday, I tend to back off on rolling after a couple of rounds. My buddy who I started with has already had to skip two or three separate weeks with different injuries he picked up, though I think it's worse for him because he did enough martial arts back in high school to have some idea what he's doing, so his mind is telling his body to do things his body isn't ready for.

Fitness wise, it's been a tremendously good decision for me. The workout I get out of rolling is so completely different than what I was doing before, that I really see the value. Some of that is probably just a matter of new movement patterns and angles, but it's also cardio in a way I've historically been bad at forcing myself to do. Hopefully, it will also provide the motivation to do more cardio at home, because I clearly need to improve my conditioning to survive rolling longer, especially as I'm relying on strength to escape, pretty constantly. The coordination and proprioception aspects are also weaknesses of mine, and I hope to see improvement over time.

The relationship of strength to technique in BJJ has been interesting. The lore of BJJ has always been that strength doesn't matter, size doesn't matter, with enough technique experience and intelligence will always win out. This is often true, I've been choked out by guys I outweighed by a lot. But, the value of strength is also immediately apparent to me. While obviously I do suck, I would suck a lot worse if I were weak on top of everything else, I watch other newbies suffer even getting through the warmups, I'm grateful to my past self for spending so much time lifting/climbing/rowing. My belief has been reinforced that strength is the master category, and will improve your experience in any activity.

My biggest concerns to progress at this point beyond conditioning and injury avoidance are related to metrics and tracking. I miss the feedback of the weightroom, numbers go up good. I've always tended towards something like the Bulgarian Lite system, and it has kept me motivated over the years. In BJJ at this point, it's hard to figure out what a good day looks like for me, because I'm getting my ass handed to me over and over. My coaches, who are great guys but perhaps not the most introspective, would with certainty reply to this question with something like "Just keep coming you'll get better." Which is probably true, and the fact that this is a mental problem for me at all is probably the reason I never made it as an athlete, I know I'm the one who is wrong here. At one point a couple weeks back, when I was getting a little down about just getting worked in every roll, I wrote in my notebook the goal of landing one submission by the end of January, and that I would wait until then to reassess. Funnily enough, the next day I went to class and managed to surprise a guy by hitting a throw, taking his back, and sinking the RNC. With that hurdle overcome (my k/d isn't zero!), looking forward I need to figure out what's next. After yesterday's class, I wrote down in my lifting notebook a quick count of submissions I hit cleanly, clean sweeps, and successful guard passes. The fact that I could write that down more or less from memory after ten rounds should tell you a lot about how I was doing, I was mostly in survival mode trying to get to half guard from side control or mount. I'll see if this is a practical way to track progress, or if it at least salves my feelings of inadequacy long enough to get to a point where I'm making real progress.

I feel like you're the healthiest most badass motherfucker on here.

I think it's funny that you say that, because based on your stories about your life I tend to imagine you as a sort of Errol Flynn figure. Just going around to different exotic places and seducing beautiful women there, lol.

I've always felt like our George was the kind of guy who genuinely looks good in a hat.

I bask in your praise, but I'm probably just the guy who uses this place as an accountability journal. I'm not sure anyone reads my workout posts, making them helps me stay on track for goals I've claimed I'm going to meet.

I read 'em even if I don't really have anything to say about them. They're good! You're not just yelling into the void.

I would suck a lot worse if I were weak on top of everything else, I watch other newbies suffer even getting through the warmups, I'm grateful to my past self for spending so much time lifting/climbing/rowing. My belief has been reinforced that strength is the master category, and will improve your experience in any activity.

Just make sure that you wear long rashguards, shower after each session and get a wrestling headgear to avoid long-term issues. You may not even need extra cardio work, in time you would be able to get through your rounds without being winded. I had to sit down in my car and wait for 5 minutes before I could drive back home my first wrestling practice. Modern BJJ is submission wrestling where the takedown is a big part, rash guards and MMA have made the sport far more fun.

As long as you avoid injuries, staph and always try to be on top, you are golden. BJJ is notoriously slow in terms of belt progression but it is the only martial art you can do till you drop dead. I cannot rejoin MMA for now due to my shoulder and time constraints.

I'll see if this is a practical way to track progress

Not sure, but if you care enough to track then you will be Demian Maia among those with the same mat time. Most are just floating in a state of trance, caring this much alone makes a big difference. Many people just butt-scoot and play guard. Getting a takedown to a fully locked choke is good.

I know I'm the one who is wrong here. At one point a couple weeks back, when I was getting a little down about just getting worked in every roll, I wrote in my notebook the goal of landing one submission by the end of January, and that I would wait until then to reassess

It can be demoralising, as you get better, you will start rolling with pros which is even more demoralising but we all get better. Do not get down about this though, many in your area who join are people who have wrestled before, some have judo bases so they know some ground game. Great update regardless man, I hope to hear how this month goes.

I did work more last week so had 3-4 decent days of work despite travel. I am now in the top 4 percent of mathacademy users in terms of work done on a weekly volume, they have categories and I just hit emerald, the highest tier. The site's most productive user ever did 200 xp sustainably daily and I can get near that if I just start work on time and sleep well. As of now I average out about 600-700 xp a week and my aim is to do 180xp per day for 6 days which is 1080, 600 already puts me in top 20 going by the blogpost. This is not a big achievement, but I still think I did ok as opposed to my regular which is inactivity, I hope I can hit 1100 XP a week soon.

Beyond that I also started doing pullovers again and will do them every time I workout, with light weights since I want to keep my form clean, I got injured doing them last may and want to not be afraid of stuff again. Anyhow I am running late again, have a fun week.

You often mention grinding leetcode or mathacademy. Do you find it is helping you in your job/job search? My opinion of those bite-sized code/math problem websites has drifted towards "it's just tutorial hell and fucking around to feel like you're getting better at the real thing, just solve real problems", but maybe that's just laziness speaking.

I have a two-pronged approach where I want to get better at harder tech which is math followed by then machine learning and softer tech which would be backend and frontend. I try to devote more time to my soft stuff. It's just that the things I do on mathacademy are easier to track and quantify with built-in dashboards whereas I have to keep manual track of my web dev stuff. I want to be employable asap, I try to get 4 hours off programming besides my math work in daily.

Do you find it is helping you in your job/job search?

I would guess in the long term it should help, I eventually want to work on machine learning, in case it becomes a deterrent, I would change course and reduce my workload, for now I should be able to do the pre-requisite math for Machine Learning stuff by march end and I should be through with a lot of my boot.dev and the current front end book plus another that is javascript-based.

I do enjoy it which is something I would have never said about doing math or puzzles, it is quite different from leetcode, worth checking out.

This website seems to be frequented by a lot of mentally ill people. Let's discuss the torture that is life!

In late 2022, I started to feel a confusing lack of happiness and willpower. There was no apparent reason for me to feel bad. I was making zillions of dollars at work, was acclaimed as the most diligent and most innovative employee in my office, and was on track to retire at age 33. But the enjoyment that I was able to extract from my hobbies (primarily, playing video games and converting PDF and print books to HTML) and my tolerance of work gradually dwindled. I tried going to bed an hour earlier than usual, drinking more water (even though it tasted disgusting) rather than my usual drink of grape juice mixed with seltzer water, and taking relaxing walks of three to seven miles (five to eleven kilometers) on weekends. But those efforts had no effect. By late 2023, I was experiencing intermittent testicle aches and literally 24/7 headaches (both of varying intensity, from mild to severe), and semi-frequently couldn't even force myself to work after sitting down in my cubicle. After searching for possible headache causes online and getting a testicle ultrasound that revealed nothing suspicious, I was forced to conclude that I must be suffering from depression.

My doctor prescribed 5 mg/d of escitalopram to me. After a month, no effect was apparent, so the dosage was increased to 10 mg/d. And the clouds parted! My headaches and testicle aches receded to the background, and sometimes even disappeared entirely. I regained the ability to feel happy and to tolerate the taste of plain water. The only side effect was perhaps a month of intermittent severe stomachaches before those too receded. I genuinely felt like the Zoloft blob.

My willpower still is trash. I would say it has recovered from one-third of normal to two-thirds of normal. (I just upgraded today to the maximum escitalopram dosage of 20 mg/d, since the headaches have been returning a bit. I didn't do so previously because I was leery of having the severe stomachaches return.) But I just have to hold out for two more years so that I can retire, embark on fifty years of undiluted relaxation in my custom-built house, and finally recover enough willpower to convert the entirety of For Want of a Nail (including all the footnotes and bibliography entries) to HTML!

Two thoughts:

  1. Your presentation seems pretty biochemical - rapid response to an therapeutic dose (5 is too low), somatic symptoms, a significant amount of side effects (the stomach is common and usually self limited and associated with specifically the initiation of medication and changes of doses). You should keep that in mind and inform your doctor if you need to make changes or you get a new one.

  2. This advice will may mean less to you if your presentation is in fact pretty biochemical, but therapy and medication is superior to either alone. Our best guess for how SSRIs work (and you may not actually be one of these it sounds) is that they make your cognitive structure more flexible and allow good decisions and therapy to stick better. If you feel like you could do more to be better, get a reputable therapist.

Additional thoughts - also sounds like you have a decent chance of being the kind of person whose brain isn't good at listening to their brain or body, so you get random ass symptoms as your brain flails around in confusion. In those situations it may be wise to reach outside yourself to try and figure out if you are doing okay/how well you are doing. Of note it's not uncommon for successful people to be like this because they establish patterns of just puttering along and getting it done and burn themselves in the process.

If you feel like you could do more to be better, get a reputable therapist.

I am highly skeptical of therapy after an annoying experience as a teenager (several sessions of mandatory therapy as part of a settlement of a frivolous prosecution for terroristic threats).

Also, Big Man Siskind says:

I work in a clinic with about ten therapists. Some are better than others, but all of them are competent. I send my patients to them. In a few hundred patients I’ve worked with, zero have had the sudden, extraordinary, long-lasting change that the therapy books promise. Many have benefited a little. A few would say that, over the course of years, their lives have been turned around. But sudden complete transformations? Not that much.

Why go for therapy when medication has already brought about "sudden, extraordinary, long-lasting change"?

He also says:

Medications and psychotherapy are about equally effective in treating depression, but psychotherapy costs a lot more, takes more time, and is harder to get your insurance to cover.

it's not uncommon for successful people to be like this because they establish patterns of just puttering along and getting it done and burn themselves in the process.

You may rest assured that I have been confiding in my favorite coworkers that my days of masochistically taking on extra work without being told to by my boss are over.

As usual blah blah I don't agree with Scott on most aspects of doctoring.

Therapy works, and it works great, and has a great evidence base. The problem is that unlike medication management and general medical care, it's very hard to tell if you are getting good therapy, or the therapy that is good for you - not only is proficiency level variable, but the match between the therapist and patient is important and that can be hard to manage (classically: a good chunk of men are not going to respond well to the more ooey-gooey therapists)*.

Quality therapy also intends to end, it's not open ended or indefinite.

That said it sounds like you are skeptical, had a bad experience, and aren't necessarily the best type of patient for it (plus the expense).

But it is something to consider in the future if you are not satisfied with where you at or slide a bit.

Alternatively you can use the classic man-therapy type approaches. Sportsball! Teams! Friends! Woodworking! Blah blah.

*Yeah I really don't know what Scott is going on about here. There are absolutely the type of patients who therapy isn't likely to work for but DBT for BPD is well validated, and every therapist I've ever dated (pro-tip: don't date therapists) will endorse patients with radical improvement or development, even if it's just catching a college student who needed to grow up. If Scott isn't ever seeing it work something about his catchment is fucked or he is exaggerating in an unhelpful way.

pro-tip: don't date therapists

Fuckin' A, man. Fuckin' A.

Jesus H Christ. Headaches yeah, fine, we all get them, but blue balls without the aching hour of unrealized foreplay, that seems like the curse of an angry god. Sorry to hear it.

If it takes the edge off what is already a blunt non-edge, I'm way past 33, not nearly retirement ready, feel like probably my whole life I've been depressed-ish but just lived it (no jibes meant against the truly nonfunctional depressives out there) and I just pre-ordered a tuxedo for a shit ton of money from my Sikh tailor. But my wife and I laughed at the dinner table tonight (lemon chicken pepperonccino pasta my recipe) my oldest son cut up a big pomelo fruit and ate it on tissue paper, and my youngest sang the melody to an old George Benson song (turn your love around) without prompting. What I'm saying is life, in the words of Anne Sexton, is a trick. Life is a kitten in a sack.

Edit: past, not passed

I'm deeply jealous that antidepressants actually worked for you, and the very first one you've tried!

For someone who prescribes or oversees the use of plenty, I've had shit luck with them. Fluoxetine, buproprion and vortioexetine for about 5 years in the past 10 with no noticeable (positive) effect.

I did, however, start mirtazapine last week. I can attest to the sedating effect, which paradoxically is the maximum at the lowest dose. Let's see if that makes a difference, but I did feel much better when I fled Scotland after 5 months to spend a couple weeks at home. I've been back to work for a week or two, and things have been mildly looking up.

(What I'd give to retire by 33. Ain't happening with UK doctor wages I'll tell Ya)

This website seems to be frequented by a lot of mentally ill people

Here to mark my attendance. But seriously, this sounds horrible, I have no concrete suggestions but I can relate somewhat to your issues. Please take care, the conversion of books to HTML sounds like a very cool project.

the conversion of books to HTML sounds like a very cool project

Example file (must be downloaded to be viewed, since Catbox blocks HTML-file viewing in order to prevent phishing)

Quite nifty!

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