𝑨𝒓𝒊_𝒄𝒉𝒂𝒏 👹 | INDEFINITE HIATUS

Welcome Sinner! I'm Ari, your Oni living in The Forest of Sins. I'm leading this world with amazing people. I'm not a pure soul and sometimes you'll meet my sin side 😈. I expect to start streaming soon + if you have questions, feel free to ask here 🤭. #Vtuber #VTuberUprising

Well dame darling, aren't you just one of the sweetest meals I've tasted in a while. 🎨 Frutilla97 (vgen)

@donniedumbbell We're so blessed 🥹

Veins

Moonlight 🌕 #valko

💗 FINALLY! IT'S LOGO RAFFLE 💗 🥇will get a static vtuber logo+simple background 🥈will get a static vtuber logo how to join: ⋆. 𐙚 ˚ follow + RT ⋆. 𐙚 ˚ drop your OC #artraffle #vtuber

@TurboRyuX It's because I love everything about it 💟

@ari_chanVT sure hun ^^

im curious, what do ya'll like about my design ?

@renjiro_okami Ears+hair

Alright, ive been seeing this everywhere so I wanna know now

“The god Osiris created a creature with a thousand forms…” Nice to meet you. Some of you already know me, and for those who don’t, let me introduce myself. I draw both digitally and traditionally. My art has a slightly creepy vibe. I like history 🥀 Hashtag: #vakkhistory

@donniedumbbell The love of my life!!! 🥹🩷 I thought it weighs much more!!

Day 35: Lift That Pokémon - Clefairy

gothic love 🖤🦇

@bunmire_ 🥹🩷🙏🏻

FREE ART RAFFLE! i've been wanting to draw OCs for desk background, so let's do a raffle! how to join: - follow me - retweet this post - drop your OC in the replies winner will get a fully rendered desk background illustration in my style! winner announced on June 25th, good luck!🩷 #artraffle #artgiveaway

I bet there will be nothing.

@renjiro_okami It's too late... I will keep it for me.

Oh this should be good

@Elegance_VT Can you be my pleasure?

This is absolute nonsense! I'm going to appeal this decision 🤭!poomang.com/en/t/guiltyper…

@SouthernDevil93 Can you be my first? 😅🫠👉🏻👈🏻

Finish it, I dare you! What is this dream collector to you??

@saikenMD @JF__MD I'm so glad you're talking about this! I have arthritis in my lower back since a car accident and I saw a doctor who I've specified that anti-inflammatories did nothing and he told me to go home and continue them 🫩. Now, I'm on immune suppressant meds. Chronic pain is no joke 😭

Elia is a close friend, so I was happy to talk through her experience! Anyone can understand how frustrating it would be to seek help, only to hear "it's arthritis, use NSAIDs and a splint." Just a quick exam and sent home with no other explanation? It's a disservice to patients. It costs nothing to show kindness and respect to patients who seek care. As much as patient advocacy is encouraged, doctors shouldn't be so unilaterally dismissive of symptoms (or even suggestions from their own staff!) when a patient has a concern. And when there is a reason a certain diagnosis isn't being worked up or test isn't ordered, then the clinician should be the one responsible to educate and inform the patient why! It is a pet peeve of mine working with residents who infodump gigantic care plans on patients, and then quickly ask "so do you have any questions?" while halfway out the door. A few moments can make all the difference between a patient understanding the diagnostic process, or going home with more questions than answers. Of course, "a few moments" can really add up throughout the day, as doctors (especially in the outpatient setting) are increasingly pressured to fit more and more patients within the hour. Maybe not in all countries to the extent that it is in the US, but it is a worrying trend overall. The art of medicine was never intended to be performed in 15-minute chunks, and yet entire specialties are now boiled down to productivity and billing. But amidst this workflow shitshow, remember you always have the right to speak up about your care. Advocate for yourself, do not let a doctor brush you off in the name of clinic efficiency. After all, if you don't voice a concern, then who else in the room will? If I were her doctor, here are some basic education points I would have told her before sending her home: - There are multiple (like 6-7!!) types of "arthritis," though the most commonly encountered ones are rheumatoid vs. osteoarthritis, along with psoriatic arthritis, gouty arthritis, septic arthritis, etc. - Rheumatoid arthritis (RA) is an autoimmune disease that attacks synovial joints, and more commonly diagnosed in middle-aged women. It has a very specific diagnostic criteria defined by the 2020 ACR/EULAR classification requiring a number of joint involvement, serology testing, inflammatory marker testing, and duration of symptoms. - Osteoarthritis (OA) is a "wear and tear" process causing degradation of the articular cartilage, usually in older adults, characterized by joint space narrowing on X-ray. - Compared to RA, OA has different physical exam findings, joints affected, pattern of symmetry, etc. - RA is treated with DMARD therapy (Disease-Modifying Antirheumatic Drugs) like methotrexate and steroids. - OA is treated conservatively with anti-inflammatory medications and physical therapy. - It's also entirely possible that this is a Repetitive Strain Injury (RSI), which would also improve with the conservative therapy prescribed for OA. Elia is in Japan right now, so I actually have no idea what their clinical processes are for the diagnosis and management of these conditions. But based on the American guidelines, it can be appropriate to diagnose OA clinically without lab tests or imaging (as was done here). However, when another diagnosis is suspected, further testing such as labs and imaging should be done in order to rule out alternatives and confirm the proper diagnosis/treatment. Elia's presentation and symptoms did not entirely line up with the typical OA picture, to the point where I would feel comfortable diagnosing it clinically. In this case, her doctor handed her the diagnosis of "arthritis" and sent her home with conservative management. Now that you've read all of this, can you see how your perception of this decision changed? Just based off of a few bullet points providing basic education, expected treatment, and a differential diagnosis, this becomes a more robust plan of care that can be conveyed to the patient. It's really just a pity that it didn't happen in this case.