#and most of the inadequate support is on the medical end

[naamahdarling]

.

#life isn't great right now #im angry all the time #im lonely #im bored #im tired #and i don't feel adequately supported which is not my bfs fault or anything it's just that with a full time job he isn't here to help #and most of the inadequate support is on the medical end #my gp is great but i am starting to suspect that the nurse that does most of his correspondence is an asshole who doesn't check my file eve #and just gives me canned answers that often don't make sense

[sizzlingsandwichperfection-blog]

You may wonder what this whole Awesome Coffee Club thing is all about. Today I was reminded what it’s all about:

In 2019, the unpaid intern who runs this tumblr account visited Sierra Leone’s Kono District. Kono is the among the most impoverished communities in the world due to a long history of enslavement, colonialism, and civil war. A decade ago, Kono’s healthcare system was in a state of collapse--clinics had no running water or electricity or paid staff, and inconsistent supplies of medications and other necessities.

As a result, Kono was the epicenter of the global maternal mortality crisis: One out of every seventeen women could expect to die in childbirth. Over 10% of children died before the age of five. 

Beginning in 2014, Partners in Health began working with Sierra Leone’s Ministry of Health to bring change. This started with the basics at the region’s hospital, Koidu Government Hospital: running water, 24-hour electricity, and hiring nurses, community healthworkers, cooks, facilities management staff, and so much more. 

At the time, KGH’s maternity ward had a dirt floor. Many people were dying for want of an emergency C-section or a blood transfusion. By 2019, this was getting better--two functioning operating rooms were able to perform C-sections, and a blood bank could address postpartum hemorrhaging. But it was still inadequate, and maternal and child mortality were horrifyingly routine.

To address the crisis, PIH Sierra Leone directors Jon Lascher and Dr. Baillor Barrie wanted to build a world-class maternal and child health center that could save thousands of lives yearly while also serving as a teaching hospital to train the next generation of Sierra Leonean healthcare workers. They told us they needed $25,000,000 to break ground, and would probably eventually need another $25,000,000 to support the hospital’s operation over its first few years.

I am, as unpaid interns go, doing quite well, but not THAT well. So our family committed what we could and asked others to join us, and within two years, we passed that $25,000,000 goal. Together, we’ve now raised close to $40,000,000. 

Today, I visited the site of the Maternal Center of Excellence, the first wards of which will hopefully open next year. Nearly all of the construction team are from Kono, and 65% of them are women--they work as welders, engineers, planners, laborers, and so much more. You see three of them above. I had the privilege of talking with them about this project. The young woman to the right, Success, told me that her dream is to work for the hospital her whole life, helping to maintain and support it. One of the other women told me, “We are passionate about this work because it is the future of our country. And we know that we and our friends will someday give birth here.” I am so proud that our projects support their training and livelihood, and so grateful to have them as colleagues in this work.

The hospital--which will include over 100 maternal beds, a NICU, and enough operating suites to perform over 10 emergency C-sections per day, will also require ongoing funding for staff, stuff, systems, maintenance, and more. Our hope is that open-ended projects like the Awesome Coffee Club and Awesome Socks Club can help provide that funding, although the most efficient way to support this project is to donate directly! 

So that’s why this tumblr, and the awesome coffee club, exists. World-class maternal and infant healthcare is coming to Kono, a wonderful and  too long impoverished by colonialism and extractive capitalism. It is only a first step. There is so long to go. But what a first step.

#also i guess for memes #awesome coffee club #partners in health #sierra leone #drink good coffee #coffee #pih

[andhumanslovedstories]

hello this is kind of heavy and no pressure at all to answer. and apologies because im sure you must have answered this before. but do you go through like a pain management flow chart for your patients and if so what are some of the steps? my dad is having some medical issues and i want to be able to help him manage his pain as much as i can. thank you and enjoy wasteland!

I work in a hospital setting so my pain management care plan is part of an interdisciplinary team in that setting. It's relatively easy for me to get, say, IV pain meds for a patient with extreme breakthrough pain. I don't know how well my approach would translate outside of that setting, I'm not palliative care trained, and I don't personally deal with chronic or acute pain (which is why I'm answering this publicly so other people can chime in), but in broad strokes:

First: Define pain. What type of pain is it? Muscle pain? Indigestion? Neuropathy? Surgical site? Stiffness from lack of movement? Is part of the pain also the fear of the pain? Sometimes when pain has been bad for a long time, or even has been bad in a short-term but very notable way, the idea of hurting that bad again is traumatizing. That fear of pain can, unfortunately, make you focus more on the pain you're feeling because now it's not just the physical sensation of pain, it's also the psychological impact of it.

Then, how does the pain affect you? Is it stopping you from sleeping? Is it stopping you from eating? Is it making you short-tempered or depressed? Does it make it difficult to focus on things? Does it make you nauseated? Anxious? Isolated? Do you feel like you need to hide it from those who care about you?

Everything pain is and affects is a place where you can intervene. Some of these interventions will be very small and would, if they were the only intervention, feel completely inadequate. Pain relief is rarely "you do one thing and you're done." You're addressing pain on multiple fronts, and sometimes that doesn't mean your focus isn't just the reduction of pain but the restoration of what pain has taken away. It's possible the worst part of pain for you isn't the pain itself but, for example, the immobility it causes. Are there different ways you can learn to move? Can you get a grabber? Can you get a shower chair? Can you find physical therapy exercises that help you regain strength or stop you from deconditioning to the degree you're able? What mobility aids might restore movement to you?

And if returning mobility is not possible at this time or ever, how can you modify your environment to support you? Can you figure out what bothers you the most about that immobility and mitigate that? If it's annoying that not being able to leave bed makes you bored, what can be within arm's reach? If it's frustrating that being too painful to move means you feel isolated from other people, can you make wherever you are more central? If pain makes having your bed on the second floor unfeasible, can you move your bed to the first floor? How can you adapt the environment around you?

I'd encourage movement too, to the degree it is possible. Being in the same position HURTS. If it feels good to stretch but you can't do it by yourself, can someone help you with range of motion? (You can look up "passive range of motion" to get an idea of how to do that.) This doesn't need to be exercising, just exploring the joy of moving your body. Related to movement is physical touch. I love lotions and medicated creams for pain patients because you can turn them into massages. Just be careful with pressure and be open about what hurts and what feels good. At the most gentle end of the spectrum is something called the M Technique which isn't even massage, it's like guided gentle touch. Give the body something else to feel.

Different medications work better with different types of pain. This part is hard to talk about in general because of the specificity of some pain med regiments. Tylenol is great, but be cautious with how much you are taking (acetaminophen overdoses are no joke) and remember that there's a point where more tylenol doesn't mean more pain relief. Opioids are great, but they can be very dangerous and aren't well-indicated for a lot of types of chronic pain. Even if opioids work best, I'd encourage you to be working on pain reduction on multiple fronts, as opioids are so controlled, it is easy to lose access to them. If opioids give you enough pain relief to do physical therapy, then make sure to do that physical therapy. Medications are amazing and I love them and I give out PRNs like crazy, but similarly to how I can't just take my depression meds and stop being depressed, pain medication works best in conjunction with other strategies. Those other strategies though can literally be something like "tramadol takes away the pain enough I can focus on something, and what I want to do with that focus is to watch a movie I've been meaning to rewatch for a while now but haven't had the spoons for." Sometimes all you will want to do when you get pain meds is sleep because you can't when you're hurting. Sleep is wonderful; how can you arrange your sleeping place and habits to make sleeping even more of a delight?

And if you find a medication that works, use it consistently. It is always easy to keep pain level than it is to address a pain spike. Don't wait until symptoms are at their worst to address them. Figure out what it feels like when your symptoms are ramping up, and intervene early.

Sometimes medications that aren't explicitly for pain can still help. If anxiety makes pain worse, consider an anxiety medication. If coughing hurts, can you get a numbing spray from your throat to make it less sensitive so you cough less?

I don't know how useful this is to you and your family. Hopefully it's at least something to think about. Think about palliative care (which is about the management of symptoms of illnesses rather than the treatment of illnesses) as not just taking away bad sensations but restoring good ones. You can't always get someone to a place with no pain. But what can you do to enhance life in the presence of that pain? There is a psychological aspect to pain, it's a parasite that drains you and makes you feel like you are nothing but a body that hurts and won't stop hurting. I want to make clear, I'm not saying pain is only in your mind. Bone mets and nerve pain exist whether you're cheerful about it or not. But pain doesn't have to mean suffering, it doesn't have to take away the things that make you you. Address pain through medication and therapies, but also remember that protecting, promoting, and prioritizing the parts of yourself that you most value and give you the most joy will help give your life so much substance that pain can't rob it all. You aren't doing one big thing. You are doing a thousand small things that make life easier, better, more suited to yourself and your abilities, and more aligned with the parts of life that you that give your life meaning.

(And a note in particular for being the family member of someone in pain--ultimately, they are going through this alone. It is their body. What can you make smoother for them? How can you protect their dignity and their privacy without making them feel abandoned or alone? How can you make it so your reaction to their pain is not part of their burden? Like for the six hundred other hypothetical questions in this endless post, the answers will be highly personal and will take time to figure out. Be patient and calm.)

#nursing tag #oops! sorry! it’s an essay with I think no definite answers for you #and also an extrapolation of my in hospital work and my home health work #long post

[theculturedmarxist]

One of the advantages of being a pessimist is that being wrong is a positive event. Like Norman Finkelstein, I had worried that there was still enough fear of crossing the US that the International Court of Justice jurists would use shortcomings in how South Africa had teed up its case procedurally to demur, at least until South Africa tried again. The other end of the spectrum that yours truly had anticipated was that the Court would rule significantly for South Africa by supporting its provisional measures calling for humanitarian relief, provision of medical services, and similar requirements, as well as less controversial but important steps like the preservation of evidence but not constrain the Israeli army, as South Africa had also sought via asking for a ceasefire.

I am basing this post on notes taken from the live presentation, where President Joan Donaghue read most of the ruling verbatim. We have embedded the video below and [in a 9 AM EST update] have added the text of the order.

Of critical importance, and a huge smackdown to Israel, is the Court came as close as it reasonably could to calling for a ceasefire in ruling for the provisional measure (which it devised itself) for Israel to cease military action against Palestinians as members of a protected group under the Genocide Convention.1 I had opined that the Court could not call for a ceasefire since it could not bind Hamas to comply. It would not be sound or shrewd to give Israel an easy pretext for defying the court by saying that a one-sided ceasefire would leave it defenseless. But impressively, the court went as far as it could, and way way further than I expected, in constraining Israel military operations against the Palestinian population.

Experts will soon opine but I assume this would still allow Israel to pursue Hamas members if it could do so without violating the Genocide Convention. This was 15 to 2, with the only dissents Uganda and the ad hoc judge from Israel.

The Court also implemented a measure which sounded like, and may have indeed been, the third requested by South Africa<,3 which I thought the Court would likely not implement as pretty much amounting to a reiteration of Israel’s existing obligations under the Genocide Convention. Including them came off as an additional rebuke as well as serving for further grounds for ruling against Israel in the upcoming trial if they continued to act wantonly against Palestinians.

It was not all that far into President Donaghue’s reading of the ruling that it was clear the Court had not even slightly bought what Israel was selling. I was surprised to see the Court rely on an Israel FAQ from its Foreign Ministry as the basis for Israel having responded to South Africa. As we pointed out earlier, these sort of media communications are normally not considered to be formal responses. But perhaps in this era of intense narrative management, those boundaries may have shifted somewhat. But the noteworthy part was not the Court’s conclusion here but that it didn’t deign to dignify Israel’s attempt to dispute the dispute by mentioning its arguments,

Instead, the Court spent a great deal of time on facts and Israel’s unabashed conduct. It was very far into the recitation that the ruling stooped to address one of Israel’s lame defenses, that they had provided humanitarian aid and the Attorney General, very late in the game, fingerwagged officially about not trash talking Palestinians. The text barely politely brushed that aside, saying that was inadequate.

I would need to read the ruling against earlier material (and remember each side did submit further backup) but the Court clearly went beyond what both sides provided. For instance, the ruling referencing findings from UN officials and agencies after January 12, when Israel made its oral argument. The Court appeared to give very heavy weight to the many dehumanizing statements made by Israel official (and again, my impression was the judges went beyond the ones provided by South Africa) and the findings of UN officials and agencies on the horrific conditions in Gaza.

In addition to requiring Israel to provide aid and services, stop dehumanizing Palestinians, and quit destroying infrastructure, the provisional measures included the preservation of evidence and requiring Israel to make a written report to the Court in a month on what it was doing to comply with the provisional measures, with South Africa then having the opportunity to comment on the report.

We’ll post the actual order shortly after it is up on the Court’s website. I may also add some hot takes from the Twitterverse. It will be interesting to see how the MSM organs like The Economist, which had vigorously defended Israel, and even more so Tony Blinken and Biden, try to ‘splain this outcome. It will be even more reveling to see how Israeli politicians and its press try to rationalize this ruling when the vote on every count were so lopsided, and even the US jurist and expected stalwarts like Australia did not side with Israel on any of the provisional measures.

Update 9;00 AM EST: Here it is, over an hour since the ICJ presentation, and I have yet to see a newsflash in my e-mail inbox from The Hill, the New York Times. or other usual suspects. It appears porcine maquillage is in short supply.

____

1 From the South Africa’s December 29 application:

(1) The State of Israel shall immediately suspend its military operations in and against Gaza.

(2) The State of Israel shall ensure that any military or irregular armed units which may be directed, supported or influenced by it, as well as any organisations and persons which may be subject to its control, direction or influence, take no steps in furtherance of the military operations referred to point (1) above.

2 From South Africa’s December 29 application:

3) The Republic of South Africa and the State of Israel shall each, in accordance with their obligations under the Convention on the Prevention and Punishment of the Crime of Genocide, in relation to the Palestinian people, take all reasonable measures within their power to prevent genocide

#naked capitalism #international court of justice #israel #gaza #palestine #israel palestine conflict

[haggishlyhagging]

For many years, Mary Putnam Jacobi was "theoretically opposed" to woman suffrage. She had stood quietly against it for several years, not publicly denouncing it, but not endorsing it either. Women's education and work in the professions were bigger priorities because they could provide the true means for gender equality, she believed. With the woman suffrage movement split and struggling in the 1870s and early 1880s and the failure of Reconstruction to secure black male suffrage and citizenship, Jacobi did not see the vote as a pressing need for women. Her scientific faith determined her priorities, so that early on, conducting medical experiments was more important than casting votes. But by the last stage of her career, science and suffrage had become related, if not inseparable, causes.

In 1885, she publicly vowed her support for women's political enfranchisement. In a short article in The Woman's Journal, the suffrage newspaper of Lucy Stone and Henry Blackwell, she announced, “Please count me henceforth among those who believe in woman suffrage.” In the years that followed, Jacobi became deeply involved in the resurgent suffrage movement, so that by 1894 she was the leading voice for the New York City campaign. Explaining her commitment to the cause, she told Agatha Schurz, daughter of Carl Schurz, “My great reason for desiring Equal Suffrage, is as a formal recognition of the equality of the sexes, — and because such recognition as a matter of theory is essential to securing equality as a matter of fact.” Late in her life, she came to see suffrage as the most important right of citizenship and, consequently, that it represented the actualization of gender equality.

Jacobi initially opposed woman suffrage as a matter of strategy and priorities but also because she opposed universal suffrage, in general. She believed it granted the vote to the uneducated and, in her eyes, the undeserving. Showing both her scientific sensibility and class position, Jacobi held that voters should be intellectually agile and properly trained to comprehend complex questions and analyze data. She explained her position: “Persons habituated to technical pursuits are ... always inclined to distrust the action of masses in relation to subjects about which they must be inadequately informed.” For years Jacobi questioned the ability of the male "masses" to vote with integrity; she also questioned whether women were intellectually prepared and ready for the vote. Frustrated with the spotty educational opportunities for women early in her career, she at first was reluctant to support woman suffrage. But by the mid-1880s, she believed that women had evolved and were ready and capable of enfranchisement. They were no longer a political liability but an asset in the promotion of social justice and the struggle to end corruption. Jacobi now echoed fellow women advocates who celebrated women's "progress" as a justification for female enfranchisement.

Philosophically, Jacobi also changed her mind because she had come to see woman suffrage as compatible with her positivist views on women's health and the social organism. She believed that "the real basis of democracy, republicanism and justice is the physiological equality or equivalence of human beings." Society could be a healthy body when all of its elements contributed to the larger whole, and this meant the full inclusion of women in political activity. When women were denied the vote and full political participation, they were prohibited from being complete living organisms, and the social organism failed to function to its most healthful capacity. She believed this denial explained a "large share of . .. the physical ill health of women, not to speak of [their] moral unhappiness." Again, Jacobi used her identity as a woman physician to blame female illnesses, as well as social ills, on women's second-class status.

-Carla Bittel, Mary Putnam Jacobi & The Politics of Medicine in Nineteenth-Century America.

#carla bittel #Mary putnam Jacobi #women in science #womens suffrage #female oppression #class consciousness

[ukrfeminism]

15 minute read

An overhaul of medical care for transgender minors is exacerbating bottlenecks in England, Reuters found, leaving thousands of patients in limbo and adding to years-long treatment delays. The crisis comes amid a broader debate on appropriate care for rising numbers of teens seeking help in Europe and the United States.

DOVER, England - On an October morning in the living room of a modest family home in this coastal town, Miles Pitcher, 17, received a message that would change his life.

It came from GenderGP, a private online health service that treats people suffering from gender dysphoria – the distress of identifying as a gender different from the one assigned at birth. The doctors had reviewed his case, the message said, and would prescribe the testosterone that would help Miles develop the facial hair, deeper voice, broader physique and other characteristics aligned with his gender identity. It would put an end to the menstrual periods he dreaded.

Miles gestured at his phone, speechless. He shook his head, and, beaming, showed the message to his mother as their pet dog Moose bounded around the room.

"Finally," he said. "Something being done."

Miles, assigned female at birth, has identified as male since he was 14. Yet until he got that message, he was stuck in limbo for three years, one of at least 8,000 young people in England and Wales waiting to receive gender care from the state-funded National Health Service (NHS) as of October, a Reuters review of NHS documents shows.

The UK government has promised to overhaul the youth gender care system, after it was deemed inadequate by England's regulator of health and social care. Some clinicians had complained that England's only state-run youth gender clinic was too quick to offer medical treatments to young people. And many families protested over the distressingly long wait for a first appointment – an average of nearly three years, a Reuters analysis of the clinic's records found.

In July, the NHS said it would close the sole clinic, known as the Tavistock, next year and replace it by spring 2023 with regional centers to better accommodate a fast-growing patient population. Its plan calls for the centers to operate under new treatment guidelines, informed by the best available medical evidence for treating transgender adolescents and the most in-depth review of care conducted by any country.

But the reality is already falling short of those ambitions, creating new delays and uncertainties, according to Reuters interviews with transgender teens and their families as well as physicians and government officials involved. They described a deeply flawed system that is now hobbled by a toxic political climate around gender care.

Young people like Miles say their only option is to turn to private providers such as GenderGP, which is registered in Singapore and thus operates beyond the supervision of the NHS. The company says under-18-year-olds make up a growing portion of its UK patient population, with about 800 youth currently on its books.

"I wish we didn't have to exist," said Dr Helen Webberley, who founded GenderGP with her husband. Both once worked for the NHS. "But we are years away from the NHS pulling themselves together on this."

The NHS's proposed new treatment guidelines were altered after they were reviewed earlier this year by a Conservative government wary of medical interventions for transgender adolescents, Reuters found. Gender clinicians say the proposals now depart from international treatment protocols, which support gender-affirming care. Pioneered more than 20 years ago in the Netherlands, such care can include everything from supporting a social transition – using a person's preferred pronouns and name – to counseling and medical interventions, including drugs that pause puberty.

The Tavistock, based in London, continues to see existing patients. But first appointments for people who have been on its waiting list since 2019 have slowed to a trickle as staffing and morale drop ahead of the closure, according to NHS data and four people involved in the reorganization. More than 1,500 young people recently referred with gender dysphoria are being kept on a separate list for the future regional centers, with no clarity on when or how they will be treated, three NHS sources told Reuters.

Once assigned to a waiting list, young people have been effectively locked out of state-provided mental health counseling and other specialist support related to their gender dysphoria, because those services were offered only through the gender care system they are waiting to join. Delaying medical treatment also means young people mature in bodies that don't align with their gender identity – changing that in later life is more difficult.

The NHS said in a statement to Reuters it is expanding healthcare services for young people with gender dysphoria in line with recommendations from the review, and working on better supporting those on the waiting list. It has previously said it "strongly discouraged" families from turning to private or unregulated providers.

"These have been an exceptionally challenging couple of years for our patients and their families, with a lot of toxicity in discussions around their care and chronic uncertainty about its future," Dr Polly Carmichael, director of the youth gender clinic at the Tavistock, said in a statement to Reuters.

The Department of Health and the Prime Minister's office declined to comment for this story.

Both sides in the polarized debate are turning to the courts: patients who say they've waited too long, and others who say the NHS moved too fast. At the end of November, transgender rights advocates challenged NHS England in the High Court over long wait times for both youths and adults seeking treatment. In 2020, a young woman who had detransitioned from being a transgender man challenged the Tavistock's use of puberty blockers in the same court.

Long wait lists are common within the NHS, but its statistics show the three-year wait for transgender youth is extreme. Most young people with a "non-urgent" eating disorder get specialist help within three months of being referred, the figures show. On average, young people seeking mental health support wait just over a month for a first appointment, according to a government analysis of NHS England data.

One mother shared with Reuters a letter she received from the NHS in February after she followed up on her daughter's October 2021 referral to determine when she might receive attention. The letter said a decision would be made at some point from early 2022 on whether the child "is likely to meet the access criteria" for gender care. She has heard nothing since and suspects her child isn't even being considered for NHS help.

"We are on a waiting list for a waiting list," said the mother, Rose, who asked to be identified by her first name only to protect her daughter's privacy.

"She basically feels suicidal every single day." The NHS declined to comment on the case.

"STOP HURTING YOURSELF"

Miles plans to study archaeology at university and is a keen rugby player. He has felt like a boy for as long as he can remember, but recalls a moment of delight at the start of a new school year when he was around 9.

The teachers were handing out colored notebooks and lanyards based on gender: blue with wizards and astronauts for boys, pink for girls. He was given blue books – "and wizards and astronauts over everything," he said.

"It was not like 'I'm trans,' but just this amazing sense of joy within myself, 'This feels amazing, and I don't know why.'"

By age 11, as puberty began, Miles entered an all-girls' secondary school. He was bullied by classmates for not wearing a bra or conforming to female norms. To fit in, he tried to be ultra-feminine, wearing skirts and make-up, having his eyebrows threaded, wearing false nails.

"My mood really dropped," he said. After about a year, "I realized, I can't do this anymore. I hate this." Miles was barely leaving his room. He began cutting himself, over a period of four or five months. "In my mind, it was just easier to deal with physical pain than mental pain."

His mother, Connie Pitcher, noticed the regular, precise lines on his arms. When she asked why he was distressed, Miles said he was struggling to understand his sexuality.

"I said, 'I don't care if you're gay, straight, or whatever – I just want you to stop hurting yourself,'" Connie said. The family considered seeking mental health help, but worried about long waiting lists.

"We saw him really, really dip," she said. "We were struggling with what to do. Because there is really no support."

The World Health Organization, which informs health policy worldwide, does not have detailed guidelines for this area of healthcare for youth. It says it works closely with the World Professional Association for Transgender Health (WPATH), a U.S.-based non-profit that has drawn up the most widely adopted standards of care.

These say a young person's exploration of gender should be respected and supported, and that medical interventions for young people at or after puberty should be one option, after a comprehensive assessment.

Research from the Netherlands paved the way for that medical treatment, establishing a model requiring adolescents who sought care to be assessed for about six to 18 months. If they had persistently expressed gender dysphoria since early childhood, lived in supportive homes, and had no other complicating mental health diagnoses, they could be offered puberty suppression, followed by hormones, and later, in some cases, surgery.

Since then, the number of young people seeking gender care has surged in parts of Europe and the United States, supported by greater awareness and the availability of professional treatment. They continue to face threats of violence and discrimination, as well as political efforts in some countries to block that care.

At the same time, some gender-care professionals have questioned the lack of definitive evidence on the long-term impact of puberty blockers or hormones on minors. Puberty blockers are not licensed in the United Kingdom or United States for treating gender dysphoria and the NHS says it is not known how they may affect brain development or long-term bone health in young people. Hormones, only available for older adolescents, cause potentially irreversible changes such as a deeper voice, and can cause infertility. Other changes, including breast development, are reversible only with surgery.

Those professionals are also concerned that as the number of pediatric patients has surged, so has the number of youth whose main source of distress may not be persistent gender dysphoria. Some may have mental health problems that complicate their cases.

"THE WRONG TREATMENT"

While not all English youths with diverse gender identities seek medical help, for those who do, a doctor or professionals including social workers or teachers are the first port of call. Any one of them can refer a youth for gender care, which so far has only come through the Tavistock – formally known as the Gender Identity Development Service, or GIDS – run by the Tavistock and Portman NHS Foundation Trust.

The clinic became a focal point for opponents of youth gender care in the UK in 2018 when an internal report compiled by Dr David Bell, a former senior psychiatrist and staff representative at the Tavistock, was leaked to national media. Bell, who did not treat young people, cited accounts from 10 unidentified colleagues who were working with transgender youth and came to him with concerns, including that some patients were "rushed through" to medical treatment without proper evaluation when they finally got an appointment.

"It was not just the wait," Bell told Reuters. "It was also a wait for the wrong treatment."

Bell now advocates against starting a gender transition before adulthood. He is at the fore of a group of mental health professionals who argue that accepting a child's new gender identity without exploring other underlying issues is clinically irresponsible, and puts them on a track to potentially irreversible changes that they may later regret.

The Tavistock has consistently defended its methods of treatment. Subsequent inquiries by outside investigators into care at the clinic did not raise concerns about patients being referred too quickly to medical interventions. However, they did criticize a lack of standardized assessments, adding that "it was not possible to clearly understand from the records" why care decisions had been made, according to a 2021 report from the regulator of health and social care, the Care Quality Commission.

The report rated the clinic as "inadequate" on these grounds, on the long waiting lists, and on concerns that teams treating patients did not always include the full range of experts required.

Another major challenge came in the 2020 lawsuit. Keira Bell, a young woman who detransitioned after what she said was improper care at the Tavistock, asked the court to rule on whether youths should receive puberty blockers. She alleged that the information provided by the Tavistock was not adequate, and said youths under 18 were not able to give informed consent to treatment. The High Court effectively banned their use for under-16-year-olds, a ban that was overturned last year on appeal. Bell did not respond to a request for comment.

The Tavistock told Reuters its current protocol requires meeting patients at least three to six times over some months before any recommendation for medical treatment. The timeline would be longer in complex cases. If the clinician, parents and the young person agree, puberty blockers may be prescribed from the onset of puberty, usually after the age of 10 or 11. The clinic only introduces hormone treatments after 16. Surgery is not an option before age 18 under NHS rules.

The clinic estimates that its staff referred only between 10% and 20% of young people for medical interventions, indicating what team members have described as its cautious approach. This year to August, 125 adolescents received referrals for either puberty blockers or hormones, the clinic told Reuters.

An ongoing review commissioned by the NHS highlighted another problem. Led by Dr Hilary Cass, a prominent pediatrician, the review found that practitioners across the country might be referring patients with gender concerns to the Tavistock without first addressing mental health issues such as depression, according to an interim report released in February. Such practices may have contributed to the clinic's fast-growing waiting list, the report said.

Annual referrals to the clinic have surged from 210 a decade ago to 5,234 in the financial year that ended in March 2022.

According to NHS documents seen by Reuters, there were 7,696 minors on the waiting list for a first appointment as of July. Just over 1,000 young people were referred to the Tavistock from April to October and are awaiting attention, the clinic says.

"I'M STILL YOUR CHILD"

In 2019, a 13-year-old Miles began exploring his relationship with his changing body, wearing baggy clothes. He cut his hair short and began sampling videos from transgender teens on YouTube.

At first, "it was denial – those guys are cool, but I'm not like them," he said. "Then slowly, I thought, 'what they're talking about is exactly what I feel. So maybe I need to actually look at this.'"

He came out to his close friends, who were supportive. In February 2020, Miles left a letter on his bed for his parents, just before heading to school.

"Dear Mum and Dad," it read. "I am transgender. I identify as male. I'm still your child."

His mother was taken aback. "I was a little bit fearful, because I didn't understand it," Connie said. She texted Miles at school. "We'll talk about this in a few days," she wrote. "We love you."

That November, an NHS doctor referred Miles's case to the Tavistock. Miles was excited, hoping to receive puberty blockers but realizing that, given the long waiting list, he was likely to be too mature for them by the time he was seen.

As he waited to hear from the clinic, he began his social transition, dressing like a boy and using male pronouns. He started to wear a binder to conceal his breasts and, on occasion, padding known as a packer inside his underwear to give the look of male genitalia. He took a contraceptive pill to limit the frequency of his periods.

Last year, he legally changed his name – his parents paid, as a gift for his 16th birthday. Miles now studies at school in a co-educational class. He is attracted to boys.

By July this year, Miles was uneasy, having heard nothing from the Tavistock clinic. He contacted them to ask about his referral. They had no record of it.

"That was a crash and burn," Miles said. "I've had two years of my life thinking it was happening, for nothing. It sounds extreme, but it feels like the NHS has failed me as a trans person. Because I'm just left in limbo. No-one really knows what to do."

Miles's doctor referred him a second time. But a few weeks later, when he checked with the clinic again, it still had no record of him. Neither his doctor nor the Tavistock would comment on his case.

"INCREDIBLY DISTRESSING"

Other young people and their parents across England are also at a loss. Waiting "isn't an option when you've got a child in distress," said Rose, whose daughter has been on a waiting list since October 2021.

Her daughter's case shows how hard life for young trans people can be - even when they do get care.

Assigned male at birth, Rose's daughter told her parents how unhappy she was in her changing body at age 12, two years ago. A few months later, knowing about the NHS waiting list, Rose sought help from family members to pay for private care from Dr Aidan Kelly, a clinical psychologist now in private practice who worked with youth at the Tavistock for five years.

Kelly diagnosed their daughter with gender dysphoria in August 2021, and she socially transitioned a month later. Now 14, she is taking puberty blockers prescribed overseas by a registered pediatric endocrinologist whom Kelly declined to identify. Kelly remains involved in her care.

In June this year, Rose's daughter tried to take her own life, cutting herself and attempting to drink bleach. She had previously been referred for NHS mental health care, but did not receive attention until she tried to kill herself, Rose said. The NHS then prescribed antidepressants.

A different private practitioner has also recently diagnosed the teen as autistic. Rose declined to make her daughter available to Reuters for comment due to the teen's distress.

"I'm just trying to do things to keep my child here," said Rose. The treatments are helping, she said, but her daughter is still struggling.

Another mother, Liz, said her teenager has been on the Tavistock waiting list for three years after being referred by their family doctor. Assigned female at birth, the child came out as a transgender boy at school, but Liz and her husband do not use his chosen pronouns. Instead, they use a gender-neutral nickname, saying that they want to keep their child's options open.

Liz said the child has autistic traits, depression and childhood trauma, and has experienced years of severe homophobic bullying. Liz declined to make the child available for comment.

She worries that the teen, now 16, could receive gender medication without taking into account these other issues. The family has received no NHS gender care or mental health support since the referral, she said. The family is also frightened to entrust the teen to a system that is set to be replaced because it has been judged to be failing young people.

Most of all, Liz is afraid of her child making a mistake.

"If I knew this was the route" for the child to grow "into a healthy well-adjusted adult, that would be a different question," she said. "But I don't have that kind of information."

In a statement to Reuters, the NHS's Healthcare Safety Investigation Branch said the "incredibly distressing" wait for gender care "created a significant patient safety risk for young people."

In April, the investigation branch released a report into the death of a young transgender man before his 19th birthday, outlining how he had complained of the long wait for care before committing suicide. He was first referred to the Tavistock at 16. The clinic itself referred the incident to the investigators, saying it was "vital" that services worked together to better protect vulnerable young people.

There is evidence that transgender youth face a higher risk of suicide, but whether that risk has increased for adolescents in England who are waiting for care is not well understood. The Cass report said in February that many young people's mental health deteriorated while in a holding pattern.

"DROWNING IN THE MIDDLE"

For young people already in the system, the NHS has said care at the Tavistock clinic would continue unchanged ahead of its closure. NHS documents reviewed by Reuters show only a few dozen appointments are available for new patients each month, down from between 75 and 120 for most of last year, despite the growing waiting list.

Staffing has also dipped as several psychologists have left or, like Kelly, entered private practice. The Tavistock said in board documents that staff morale is low and told Reuters it does not have the capacity to meet demand.

The deadline for shuttering the clinic has also slipped, to late June 2023 at the earliest, two people familiar with the plans said, although the NHS is still aiming to open two new sites in spring next year, with up to seven more to follow. People who have been waiting the longest will be prioritized.

The NHS is also working on a system to cope with the backlog and improve support for those on the new list, a spokesman said.

But clinicians say polarized views around gender care will make finding staff challenging.

"The people who have gender-critical views call you child abusers and monsters, and then there are a lot of angry families accusing you of gatekeeping. And you're just drowning in the middle of it all," said Dr Laura Charlton, a clinical psychologist who left the Tavistock in 2020 after six years and now only treats adults.

The gender-care revamp became further entangled in political upheaval after Prime Minister Boris Johnson resigned in September. Both his successors, Liz Truss and Rishi Sunak, voiced their opposition to the use of what they described as "irreversible" measures for transgender young people earlier this year.

Neither Truss nor Sunak's office responded to a request for comment for this story. Sunak has said under-18s should be protected from "life-altering treatments."

A few weeks into Truss's tenure, in September, the NHS briefly posted a draft of its proposed new treatment guidelines on its website, then removed them. The guidelines were re-released on Oct. 20, the night Truss resigned.

A Reuters review of the original draft shows key passages were changed by the time they were re-released.

Both versions of the guidelines say only medical professionals may refer young people for gender care, and call for a meeting between clinicians before a child is added to the waiting list. New clinics will be led by medical doctors rather than psychologists, they say.

The guidelines also say young people who, like Miles, obtain medicines from providers that are not regulated in the UK should be referred to local authorities – such as police and social services – once the NHS takes on their case.

The NHS has said separately it would only prescribe puberty-blocking drugs for transgender teens "in the context of a formal research protocol." It has not specified how gender-affirming hormones would be prescribed, although it also suggests enrolling young people into a clinical trial in the future.

However, the revised guidelines say adolescent patients would require a gender dysphoria diagnosis from a specialist clinician before their social transition would be supported by the NHS, rather than, as at present, relying on the statements of an adolescent.

The changes around social transition appeared after the draft was sent through government approval processes within the Department of Health and the Prime Minister's Office, rather than the NHS or gender experts, two people involved in the process said.

For government employees to not recognize a young person's preferred gender identity without a medical diagnosis would run counter to the way gender-affirming care has been practiced both in England and globally. The proposed requirement was not endorsed by the doctors involved in the Cass review, said people briefed on the matter. There was no such requirement around social transitioning in the original draft.

The draft plan has been criticized by medical groups specializing in transgender health around the world.

"This represents an unconscionable degree of ... intrusion into ... everyday matters such as clothing, name, pronouns, and school arrangements," WPATH, along with a number of allied regional and national groups, said in a statement in late November.

"We've spent 20 years trying to reduce barriers to care. And now we're seeing barriers put up," Dr Marci Bowers, president of WPATH and a gender surgeon in the United States, told Reuters in response to the NHS guidelines.

Spokespeople from the Health department and the Prime Minister's office declined to comment. The government is considering public feedback on the proposals and expects to publish final guidelines early next year.

"EVOLVING EVIDENCE BASE"

England is not the only country in Europe that is changing its approach.

In Finland and Sweden, healthcare officials are limiting access to puberty blockers and hormone treatments, citing concerns that the risks may outweigh any benefit for adolescents, particularly those struggling with mental health problems.

Until 2020, adolescents expressing gender dysphoria in Finland could generally access puberty blockers and hormones, but that year its national healthcare council released guidelines for transgender care. These recommended supporting "identity exploration" and mental health treatment as the first steps to ensure that any psychological issues are addressed. The council said medical intervention for transgender minors "is still an experimental practice."

Health officials in Sweden changed course after finding many adolescents seeking treatment had diagnoses beyond gender dysphoria.

In February, Sweden's National Board of Health and Welfare revised its recommendations on puberty blockers and hormone treatment for adolescents. It recommended the treatments be given within a clinical trial. Until a trial is in place, it said, the drugs should only be given to people who fit the original Dutch model of persistent gender dysphoria with no mental health issues.

"It's not an easy decision," Thomas Linden, a director at the board, told Reuters. "Some people are in great need of medical attention. Others are at risk of being harmed if they are given the same treatment. We really need better precision in the diagnosis."

Kelly, the former Tavistock clinician, said even as knowledge changes and governments review policies, clinicians must not deny young people care.

"We need to practice within an evolving evidence base – and that doesn't mean do nothing," he said.

"A NORMAL TEENAGER"

It took just one week after Miles's first full online appointment for GenderGP to agree to prescribe testosterone. The company, which operates in more than 40 countries, says its practices are consistent with WPATH and other international care guidelines.

GenderGP has no age limits to care, or minimum time periods before recommending prescriptions, including puberty blockers, to young people, co-founder Helen Webberley told Reuters. Its usual time-frame is within four to six weeks, she said, although complex cases take more assessment. Parental consent is not always required.

Miles said he hesitated about turning to GenderGP. The Webberleys have both been sanctioned by official medical tribunals for gender care they have provided since setting up their online clinic in 2015. The General Medical Council (GMC), the national watchdog that sets standards for doctors and maintains a register of those deemed fit to practice, referred both cases to the tribunals after concerns were raised by other doctors involved in caring for the same patients as the Webberleys.

Founder Dr Michael Webberley was struck off the British medical register this year after the tribunal found he had failed several patients by not conducting proper tests or assessing them robustly enough, both before and after recommending hormones or puberty blockers. The tribunal concluded that he was working outside his specialty as a gastroenterologist.

His wife, Helen, is currently suspended from practice after a separate hearing found she did not adequately explain the potential fertility impacts of medical treatment to a patient seeking help with gender-related distress.

Both deny that they failed their patients and appealed, although Michael Webberley's appeal was dismissed by the High Court in early December. They told Reuters that they currently do no clinical work for GenderGP.

There is little NHS or independent data available on how many young people seek care privately. GenderGP says the share of under-18-year-olds among its more than 8,000 UK patients is rising, which it attributes to the lack of care offered through the NHS.

The Webberleys transferred their ownership of GenderGP to a Hong Kong-based company, Harland International, in 2019 to avoid the controversy associated with them, they said. The company is now registered in Singapore as GenderGP PTE Ltd, with Dr Helen Webberley as a director. Harland could not be reached.

The clinic's prescribing doctors are all based overseas and regulated within their home countries – from the United States to European Union countries. EU-based doctors can prescribe to UK patients under rules drawn up after Brexit. Some GenderGP therapeutic counselors are UK-based.

Miles's parents say they are happy with GenderGP, but worry that the lack of NHS care will lead young people to unscrupulous online providers or even to self-medicate.

The NHS doesn't cover the cost of Miles's private treatment Read full story. He is paying for his care with his wages from working at a local restaurant, and can recite the company's charges by heart. He says he had reservations about using testosterone but decided to go ahead.

"I know it can affect fertility," he said. "And it sounds weird, but baldness, because it runs in my family."

He applies a testosterone gel to his arms every morning, normally before heading to school. The gel dries and then cracks, like a face mask, when first applied, he said, then sinks in.

Miles has not told his co-workers that he is transgender. To them, along with his friends at an archaeology group that he digs with in Dover, he is just a young man. Yet he still plays for a girls' rugby team, until the effects of the testosterone kick in.

"I'm going to be able to start living my life as I want to," he said. "I want people to see that just because I'm trans, that doesn't affect who I am. I'm still a normal teenager."

The Tavistock, based in London, continues to see existing patients. But first appointments for people who have been on its waiting list since 2019 have slowed to a trickle as staffing and morale drop ahead of the closure, according to NHS data and four people involved in the reorganization. More than 1,500 young people recently referred with gender dysphoria are being kept on a separate list for the future regional centers, with no clarity on when or how they will be treated, three NHS sources told Reuters.

O nce assigned to a waiting list, young people have been effectively locked out of state-provided mental health counseling and other specialist support related to their gender dysphoria, because those services were offered only through the gender care system they are waiting to join. Delaying medical treatment also means young people mature in bodies that don't align with their gender identity – changing that in later life is more difficult.

The NHS said in a statement to Reuters it is expanding healthcare services for young people with gender dysphoria in line with recommendations from the review, and working on better supporting those on the waiting list. It has previously said it "strongly discouraged" families from turning to private or unregulated providers.

" These have been an exceptionally challenging couple of years for our patients and their families, with a lot of toxicity in discussions around their care and chronic uncertainty about its future," Dr Polly Carmichael, director of the youth gender clinic at the Tavistock, said in a statement to Reuters.

The Department of Health and the Prime Minister's office declined to comment for this story.

Both sides in the polarized debate are turning to the courts: patients who say they've waited too long, and others who say the NHS moved too fast. At the end of November, transgender rights advocates challenged NHS England in the High Court over long wait times for both youths and adults seeking treatment. In 2020, a young woman who had detransitioned from being a transgender man challenged the Tavistock's use of puberty blockers in the same court.

Long wait lists are common within the NHS, but its statistics show the three-year wait for transgender youth is extreme. Most young people with a "non-urgent" eating disorder get specialist help within three months of being referred, the figures show. On average, young people seeking mental health support wait just over a month for a first appointment, according to a government analysis of NHS England data.

One mother shared with Reuters a letter she received from the NHS in February after she followed up on her daughter's October 2021 referral to determine when she might receive attention. The letter said a decision would be made at some point from early 2022 on whether the child "is likely to meet the access criteria" for gender care. She has heard nothing since and suspects her child isn't even being considered for NHS help.

"We are on a waiting list for a waiting list," said the mother, Rose, who asked to be identified by her first name only to protect her daughter's privacy.

"She basically feels suicidal every single day." The NHS declined to comment on the case.

"STOP HURTING YOURSELF"

M iles plans to study archaeology at university and is a keen rugby player. He has felt like a boy for as long as he can remember, but recalls a moment of delight at the start of a new school year when he was around 9.

The teachers were handing out colored notebooks and lanyards based on gender: blue with wizards and astronauts for boys, pink for girls. He was given blue books – "and wizards and astronauts over everything," he said.

"It was not like 'I'm trans,' but just this amazing sense of joy within myself, 'This feels amazing, and I don't know why.'"

By age 11, as puberty began, Miles entered an all-girls' secondary school. He was bullied by classmates for not wearing a bra or conforming to female norms. To fit in, he tried to be ultra-feminine, wearing skirts and make-up, having his eyebrows threaded, wearing false nails.

"My mood really dropped," he said. After about a year, "I realized, I can't do this anymore. I hate this." Miles was barely leaving his room. He began cutting himself, over a period of four or five months. "In my mind, it was just easier to deal with physical pain than mental pain."

His mother, Connie Pitcher, noticed the regular, precise lines on his arms. When she asked why he was distressed, Miles said he was struggling to understand his sexuality.

"I said, 'I don't care if you're gay, straight, or whatever – I just want you to stop hurting yourself,'" Connie said. The family considered seeking mental health help, but worried about long waiting lists.

"We saw him really, really dip," she said. "We were struggling with what to do. Because there is really no support."

The World Health Organization, which informs health policy worldwide, does not have detailed guidelines for this area of healthcare for youth. It says it works closely with the World Professional Association for Transgender Health (WPATH), a U.S.-based non-profit that has drawn up the most widely adopted standards of care.

These say a young person's exploration of gender should be respected and supported, and that medical interventions for young people at or after puberty should be one option, after a comprehensive assessment.

Research from the Netherlands paved the way for that medical treatment, establishing a model requiring adolescents who sought care to be assessed for about six to 18 months. If they had persistently expressed gender dysphoria since early childhood, lived in supportive homes, and had no other complicating mental health diagnoses, they could be offered puberty suppression, followed by hormones, and later, in some cases, surgery.

Since then, the number of young people seeking gender care has surged in parts of Europe and the United States, supported by greater awareness and the availability of professional treatment. They continue to face threats of violence and discrimination, as well as political efforts in some countries to block that care.

At the same time, some gender-care professionals have questioned the lack of definitive evidence on the long-term impact of puberty blockers or hormones on minors. Puberty blockers are not licensed in the United Kingdom or United States for treating gender dysphoria and the NHS says it is not known how they may affect brain development or long-term bone health in young people. Hormones, only available for older adolescents, cause potentially irreversible changes such as a deeper voice, and can cause infertility. Other changes, including breast development, are reversible only with surgery.

Those professionals are also concerned that as the number of pediatric patients has surged, so has the number of youth whose main source of distress may not be persistent gender dysphoria. Some may have mental health problems that complicate their cases.

"THE WRONG TREATMENT"

While not all English youths with diverse gender identities seek medical help, for those who do, a doctor or professionals including social workers or teachers are the first port of call. Any one of them can refer a youth for gender care, which so far has only come through the Tavistock – formally known as the Gender Identity Development Service, or GIDS – run by the Tavistock and Portman NHS Foundation Trust.

The clinic became a focal point for opponents of youth gender care in the UK in 2018 when an internal report compiled by Dr David Bell, a former senior psychiatrist and staff representative at the Tavistock, was leaked to national media. Bell, who did not treat young people, cited accounts from 10 unidentified colleagues who were working with transgender youth and came to him with concerns, including that some patients were "rushed through" to medical treatment without proper evaluation when they finally got an appointment.

"It was not just the wait," Bell told Reuters. "It was also a wait for the wrong treatment."

Bell now advocates against starting a gender transition before adulthood. He is at the fore of a group of mental health professionals who argue that accepting a child's new gender identity without exploring other underlying issues is clinically irresponsible, and puts them on a track to potentially irreversible changes that they may later regret.

The Tavistock has consistently defended its methods of treatment. Subsequent inquiries by outside investigators into care at the clinic did not raise concerns about patients being referred too quickly to medical interventions. However, they did criticize a lack of standardized assessments, adding that "it was not possible to clearly understand from the records" why care decisions had been made, according to a 2021 report from the regulator of health and social care, the Care Quality Commission.

The report rated the clinic as "inadequate" on these grounds, on the long waiting lists, and on concerns that teams treating patients did not always include the full range of experts required.

Another major challenge came in the 2020 lawsuit. Keira Bell, a young woman who detransitioned after what she said was improper care at the Tavistock, asked the court to rule on whether youths should receive puberty blockers. She alleged that the information provided by the Tavistock was not adequate, and said youths under 18 were not able to give informed consent to treatment. The High Court effectively banned their use for under-16-year-olds, a ban that was overturned last year on appeal. Bell did not respond to a request for comment.

The Tavistock told Reuters its current protocol requires meeting patients at least three to six times over some months before any recommendation for medical treatment. The timeline would be longer in complex cases. If the clinician, parents and the young person agree, puberty blockers may be prescribed from the onset of puberty, usually after the age of 10 or 11. The clinic only introduces hormone treatments after 16. Surgery is not an option before age 18 under NHS rules.

The clinic estimates that its staff referred only between 10% and 20% of young people for medical interventions, indicating what team members have described as its cautious approach. This year to August, 125 adolescents received referrals for either puberty blockers or hormones, the clinic told Reuters.

By July this year, Miles was uneasy, having heard nothing from the Tavistock clinic. He contacted them to ask about his referral. They had no record of it.

" That was a crash and burn," Miles said. "I've had two years of my life thinking it was happening, for nothing. It sounds extreme, but it feels like the NHS has failed me as a trans person. Because I'm just left in limbo. No-one really knows what to do."

Miles's doctor referred him a second time. But a few weeks later, when he checked with the clinic again, it still had no record of him. Neither his doctor nor the Tavistock would comment on his case.

"INCREDIBLY DISTRESSING"

Other young people and their parents across England are also at a loss. Waiting "isn't an option when you've got a child in distress," said Rose, whose daughter has been on a waiting list since October 2021.

Her daughter's case shows how hard life for young trans people can be - even when they do get care.

Assigned male at birth, Rose's daughter told her parents how unhappy she was in her changing body at age 12, two years ago. A few months later, knowing about the NHS waiting list, Rose sought help from family members to pay for private care from Dr Aidan Kelly, a clinical psychologist now in private practice who worked with youth at the Tavistock for five years.

Kelly diagnosed their daughter with gender dysphoria in August 2021, and she socially transitioned a month later. Now 14, she is taking puberty blockers prescribed overseas by a registered pediatric endocrinologist whom Kelly declined to identify. Kelly remains involved in her care.

In June this year, Rose's daughter tried to take her own life, cutting herself and attempting to drink bleach. She had previously been referred for NHS mental health care, but did not receive attention until she tried to kill herself, Rose said. The NHS then prescribed antidepressants.

A different private practitioner has also recently diagnosed the teen as autistic. Rose declined to make her daughter available to Reuters for comment due to the teen's distress.

"I'm just trying to do things to keep my child here," said Rose. The treatments are helping, she said, but her daughter is still struggling.

She worries that the teen, now 16, could receive gender medication without taking into account these other issues. The family has received no NHS gender care or mental health support since the referral, she said. The family is also frightened to entrust the teen to a system that is set to be replaced because it has been judged to be failing young people.

M ost of all, Liz is afraid of her child making a mistake.

"If I knew this was the route" for the child to grow "into a healthy well-adjusted adult, that would be a different question," she said. "But I don't have that kind of information."

In a statement to Reuters, the NHS's Healthcare Safety Investigation Branch said the "incredibly distressing" wait for gender care "created a significant patient safety risk for young people."

In April, the investigation branch released a report into the death of a young transgender man before his 19th birthday, outlining how he had complained of the long wait for care before committing suicide. He was first referred to the Tavistock at 16. The clinic itself referred the incident to the investigators, saying it was "vital" that services worked together to better protect vulnerable young people.

There is evidence that transgender youth face a higher risk of suicide, but whether that risk has increased for adolescents in England who are waiting for care is not well understood. The Cass report said in February that many young people's mental health deteriorated while in a holding pattern.

"DROWNING IN THE MIDDLE"

F or young people already in the system, the NHS has said care at the Tavistock clinic would continue unchanged ahead of its closure. NHS documents reviewed by Reuters show only a few dozen appointments are available for new patients each month, down from between 75 and 120 for most of last year, despite the growing waiting list.

Staffing has also dipped as several psychologists have left or, like Kelly, entered private practice. The Tavistock said in board documents that staff morale is low and told Reuters it does not have the capacity to meet demand.

The deadline for shuttering the clinic has also slipped, to late June 2023 at the earliest, two people familiar with the plans said, although the NHS is still aiming to open two new sites in spring next year, with up to seven more to follow. People who have been waiting the longest will be prioritized.

The NHS is also working on a system to cope with the backlog and improve support for those on the new list, a spokesman said.

But clinicians say polarized views around gender care will make finding staff challenging.

"The people who have gender-critical views call you child abusers and monsters, and then there are a lot of angry families accusing you of gatekeeping. And you're just drowning in the middle of it all," said Dr Laura Charlton, a clinical psychologist who left the Tavistock in 2020 after six years and now only treats adults.

For government employees to not recognize a young person's preferred gender identity without a medical diagnosis would run counter to the way gender-affirming care has been practiced both in England and globally. The proposed requirement was not endorsed by the doctors involved in the Cass review, said people briefed on the matter. There was no such requirement around social transitioning in the original draft.

T he draft plan has been criticized by medical groups specializing in transgender health around the world.

"This represents an unconscionable degree of ... intrusion into ... everyday matters such as clothing, name, pronouns, and school arrangements," WPATH, along with a number of allied regional and national groups, said in a statement in late November.

"We've spent 20 years trying to reduce barriers to care. And now we're seeing barriers put up," Dr Marci Bowers, president of WPATH and a gender surgeon in the United States, told Reuters in response to the NHS guidelines.

Spokespeople from the Health department and the Prime Minister's office declined to comment. The government is considering public feedback on the proposals and expects to publish final guidelines early next year.

"EVOLVING EVIDENCE BASE"

England is not the only country in Europe that is changing its approach.

In Finland and Sweden, healthcare officials are limiting access to puberty blockers and hormone treatments, citing concerns that the risks may outweigh any benefit for adolescents, particularly those struggling with mental health problems.

Until 2020, adolescents expressing gender dysphoria in Finland could generally access puberty blockers and hormones, but that year its national healthcare council released guidelines for transgender care. These recommended supporting "identity exploration" and mental health treatment as the first steps to ensure that any psychological issues are addressed. The council said medical intervention for transgender minors "is still an experimental practice."

Health officials in Sweden changed course after finding many adolescents seeking treatment had diagnoses beyond gender dysphoria.

In February, Sweden's National Board of Health and Welfare revised its recommendations on puberty blockers and hormone treatment for adolescents. It recommended the treatments be given within a clinical trial. Until a trial is in place, it said, the drugs should only be given to people who fit the original Dutch model of persistent gender dysphoria with no mental health issues.

"It's not an easy decision," Thomas Linden, a director at the board, told Reuters. "Some people are in great need of medical attention. Others are at risk of being harmed if they are given the same treatment. We really need better precision in the diagnosis."

Kelly, the former Tavistock clinician, said even as knowledge changes and governments review policies, clinicians must not deny young people care.

"We need to practice within an evolving evidence base – and that doesn't mean do nothing," he said.

"A NORMAL TEENAGER"

It took just one week after Miles's first full online appointment for GenderGP to agree to prescribe testosterone. The company, which operates in more than 40 countries, says its practices are consistent with WPATH and other international care guidelines.

GenderGP has no age limits to care, or minimum time periods before recommending prescriptions, including puberty blockers, to young people, co-founder Helen Webberley told Reuters. Its usual time-frame is within four to six weeks, she said, although complex cases take more assessment. Parental consent is not always required.

Miles said he hesitated about turning to GenderGP. The Webberleys have both been sanctioned by official medical tribunals for gender care they have provided since setting up their online clinic in 2015. The General Medical Council (GMC), the national watchdog that sets standards for doctors and maintains a register of those deemed fit to practice, referred both cases to the tribunals after concerns were raised by other doctors involved in caring for the same patients as the Webberleys.

Founder Dr Michael Webberley was struck off the British medical register this year after the tribunal found he had failed several patients by not conducting proper tests or assessing them robustly enough, both before and after recommending hormones or puberty blockers. The tribunal concluded that he was working outside his specialty as a gastroenterologist.

His wife, Helen, is currently suspended from practice after a separate hearing found she did not adequately explain the potential fertility impacts of medical treatment to a patient seeking help with gender-related distress.

Both deny that they failed their patients and appealed, although Michael Webberley's appeal was dismissed by the High Court in early December. They told Reuters that they currently do no clinical work for GenderGP.

There is little NHS or independent data available on how many young people seek care privately. GenderGP says the share of under-18-year-olds among its more than 8,000 UK patients is rising, which it attributes to the lack of care offered through the NHS.

The Webberleys transferred their ownership of GenderGP to a Hong Kong-based company, Harland International, in 2019 to avoid the controversy associated with them, they said. The company is now registered in Singapore as GenderGP PTE Ltd, with Dr Helen Webberley as a director. Harland could not be reached.

The clinic's prescribing doctors are all based overseas and regulated within their home countries – from the United States to European Union countries. EU-based doctors can prescribe to UK patients under rules drawn up after Brexit. Some GenderGP therapeutic counselors are UK-based.

The Tavistock, based in London, continues to see existing patients. But first appointments for people who have been on its waiting list since 2019 have slowed to a trickle as staffing and morale drop ahead of the closure, according to NHS data and four people involved in the reorganization. More than 1,500 young people recently referred with gender dysphoria are being kept on a separate list for the future regional centers, with no clarity on when or how they will be treated, three NHS sources told Reuters.

Once assigned to a waiting list, young people have been effectively locked out of state-provided mental health counseling and other specialist support related to their gender dysphoria, because those services were offered only through the gender care system they are waiting to join. Delaying medical treatment also means young people mature in bodies that don't align with their gender identity – changing that in later life is more difficult.

The NHS said in a statement to Reuters it is expanding healthcare services for young people with gender dysphoria in line with recommendations from the review, and working on better supporting those on the waiting list. It has previously said it "strongly discouraged" families from turning to private or unregulated providers.

"These have been an exceptionally challenging couple of years for our patients and their families, with a lot of toxicity in discussions around their care and chronic uncertainty about its future," Dr Polly Carmichael, director of the youth gender clinic at the Tavistock, said in a statement to Reuters.

The Department of Health and the Prime Minister's office declined to comment for this story.

Both sides in the polarized debate are turning to the courts: patients who say they've waited too long, and others who say the NHS moved too fast. At the end of November, transgender rights advocates challenged NHS England in the High Court over long wait times for both youths and adults seeking treatment. In 2020, a young woman who had detransitioned from being a transgender man challenged the Tavistock's use of puberty blockers in the same court.

Long wait lists are common within the NHS, but its statistics show the three-year wait for transgender youth is extreme. Most young people with a "non-urgent" eating disorder get specialist help within three months of being referred, the figures show. On average, young people seeking mental health support wait just over a month for a first appointment, according to a government analysis of NHS England data.

One mother shared with Reuters a letter she received from the NHS in February after she followed up on her daughter's October 2021 referral to determine when she might receive attention. The letter said a decision would be made at some point from early 2022 on whether the child "is likely to meet the access criteria" for gender care. She has heard nothing since and suspects her child isn't even being considered for NHS help.

"We are on a waiting list for a waiting list," said the mother, Rose, who asked to be identified by her first name only to protect her daughter's privacy.

"She basically feels suicidal every single day." The NHS declined to comment on the case.

"STOP HURTING YOURSELF"

Miles plans to study archaeology at university and is a keen rugby player. He has felt like a boy for as long as he can remember, but recalls a moment of delight at the start of a new school year when he was around 9.

The teachers were handing out colored notebooks and lanyards based on gender: blue with wizards and astronauts for boys, pink for girls. He was given blue books – "and wizards and astronauts over everything," he said.

"It was not like 'I'm trans,' but just this amazing sense of joy within myself, 'This feels amazing, and I don't know why.'"

By age 11, as puberty began, Miles entered an all-girls' secondary school. He was bullied by classmates for not wearing a bra or conforming to female norms. To fit in, he tried to be ultra-feminine, wearing skirts and make-up, having his eyebrows threaded, wearing false nails.

"My mood really dropped," he said. After about a year, "I realized, I can't do this anymore. I hate this." Miles was barely leaving his room. He began cutting himself, over a period of four or five months. "In my mind, it was just easier to deal with physical pain than mental pain."

His mother, Connie Pitcher, noticed the regular, precise lines on his arms. When she asked why he was distressed, Miles said he was struggling to understand his sexuality.

"I said, 'I don't care if you're gay, straight, or whatever – I just want you to stop hurting yourself,'" Connie said. The family considered seeking mental health help, but worried about long waiting lists.

"We saw him really, really dip," she said. "We were struggling with what to do. Because there is really no support."

The World Health Organization, which informs health policy worldwide, does not have detailed guidelines for this area of healthcare for youth. It says it works closely with the World Professional Association for Transgender Health (WPATH), a U.S.-based non-profit that has drawn up the most widely adopted standards of care.

These say a young person's exploration of gender should be respected and supported, and that medical interventions for young people at or after puberty should be one option, after a comprehensive assessment.

Research from the Netherlands paved the way for that medical treatment, establishing a model requiring adolescents who sought care to be assessed for about six to 18 months. If they had persistently expressed gender dysphoria since early childhood, lived in supportive homes, and had no other complicating mental health diagnoses, they could be offered puberty suppression, followed by hormones, and later, in some cases, surgery.

Since then, the number of young people seeking gender care has surged in parts of Europe and the United States, supported by greater awareness and the availability of professional treatment. They continue to face threats of violence and discrimination, as well as political efforts in some countries to block that care.

At the same time, some gender-care professionals have questioned the lack of definitive evidence on the long-term impact of puberty blockers or hormones on minors. Puberty blockers are not licensed in the United Kingdom or United States for treating gender dysphoria and the NHS says it is not known how they may affect brain development or long-term bone health in young people. Hormones, only available for older adolescents, cause potentially irreversible changes such as a deeper voice, and can cause infertility. Other changes, including breast development, are reversible only with surgery.

Those professionals are also concerned that as the number of pediatric patients has surged, so has the number of youth whose main source of distress may not be persistent gender dysphoria. Some may have mental health problems that complicate their cases.

"THE WRONG TREATMENT"

While not all English youths with diverse gender identities seek medical help, for those who do, a doctor or professionals including social workers or teachers are the first port of call. Any one of them can refer a youth for gender care, which so far has only come through the Tavistock – formally known as the Gender Identity Development Service, or GIDS – run by the Tavistock and Portman NHS Foundation Trust.

The clinic became a focal point for opponents of youth gender care in the UK in 2018 when an internal report compiled by Dr David Bell, a former senior psychiatrist and staff representative at the Tavistock, was leaked to national media. Bell, who did not treat young people, cited accounts from 10 unidentified colleagues who were working with transgender youth and came to him with concerns, including that some patients were "rushed through" to medical treatment without proper evaluation when they finally got an appointment.

"It was not just the wait," Bell told Reuters. "It was also a wait for the wrong treatment."

Bell now advocates against starting a gender transition before adulthood. He is at the fore of a group of mental health professionals who argue that accepting a child's new gender identity without exploring other underlying issues is clinically irresponsible, and puts them on a track to potentially irreversible changes that they may later regret.

The Tavistock has consistently defended its methods of treatment. Subsequent inquiries by outside investigators into care at the clinic did not raise concerns about patients being referred too quickly to medical interventions. However, they did criticize a lack of standardized assessments, adding that "it was not possible to clearly understand from the records" why care decisions had been made, according to a 2021 report from the regulator of health and social care, the Care Quality Commission.

The report rated the clinic as "inadequate" on these grounds, on the long waiting lists, and on concerns that teams treating patients did not always include the full range of experts required.

Another major challenge came in the 2020 lawsuit. Keira Bell, a young woman who detransitioned after what she said was improper care at the Tavistock, asked the court to rule on whether youths should receive puberty blockers. She alleged that the information provided by the Tavistock was not adequate, and said youths under 18 were not able to give informed consent to treatment. The High Court effectively banned their use for under-16-year-olds, a ban that was overturned last year on appeal. Bell did not respond to a request for comment.

The Tavistock told Reuters its current protocol requires meeting patients at least three to six times over some months before any recommendation for medical treatment. The timeline would be longer in complex cases. If the clinician, parents and the young person agree, puberty blockers may be prescribed from the onset of puberty, usually after the age of 10 or 11. The clinic only introduces hormone treatments after 16. Surgery is not an option before age 18 under NHS rules.

The clinic estimates that its staff referred only between 10% and 20% of young people for medical interventions, indicating what team members have described as its cautious approach. This year to August, 125 adolescents received referrals for either puberty blockers or hormones, the clinic told Reuters.

By July this year, Miles was uneasy, having heard nothing from the Tavistock clinic. He contacted them to ask about his referral. They had no record of it.

"That was a crash and burn," Miles said. "I've had two years of my life thinking it was happening, for nothing. It sounds extreme, but it feels like the NHS has failed me as a trans person. Because I'm just left in limbo. No-one really knows what to do."

Miles's doctor referred him a second time. But a few weeks later, when he checked with the clinic again, it still had no record of him. Neither his doctor nor the Tavistock would comment on his case.

"INCREDIBLY DISTRESSING"

Other young people and their parents across England are also at a loss. Waiting "isn't an option when you've got a child in distress," said Rose, whose daughter has been on a waiting list since October 2021.

Her daughter's case shows how hard life for young trans people can be - even when they do get care.

Assigned male at birth, Rose's daughter told her parents how unhappy she was in her changing body at age 12, two years ago. A few months later, knowing about the NHS waiting list, Rose sought help from family members to pay for private care from Dr Aidan Kelly, a clinical psychologist now in private practice who worked with youth at the Tavistock for five years.

Kelly diagnosed their daughter with gender dysphoria in August 2021, and she socially transitioned a month later. Now 14, she is taking puberty blockers prescribed overseas by a registered pediatric endocrinologist whom Kelly declined to identify. Kelly remains involved in her care.

In June this year, Rose's daughter tried to take her own life, cutting herself and attempting to drink bleach. She had previously been referred for NHS mental health care, but did not receive attention until she tried to kill herself, Rose said. The NHS then prescribed antidepressants.

A different private practitioner has also recently diagnosed the teen as autistic. Rose declined to make her daughter available to Reuters for comment due to the teen's distress.

"I'm just trying to do things to keep my child here," said Rose. The treatments are helping, she said, but her daughter is still struggling.

She worries that the teen, now 16, could receive gender medication without taking into account these other issues. The family has received no NHS gender care or mental health support since the referral, she said. The family is also frightened to entrust the teen to a system that is set to be replaced because it has been judged to be failing young people.

Most of all, Liz is afraid of her child making a mistake.

"If I knew this was the route" for the child to grow "into a healthy well-adjusted adult, that would be a different question," she said. "But I don't have that kind of information."

In a statement to Reuters, the NHS's Healthcare Safety Investigation Branch said the "incredibly distressing" wait for gender care "created a significant patient safety risk for young people."

In April, the investigation branch released a report into the death of a young transgender man before his 19th birthday, outlining how he had complained of the long wait for care before committing suicide. He was first referred to the Tavistock at 16. The clinic itself referred the incident to the investigators, saying it was "vital" that services worked together to better protect vulnerable young people.

There is evidence that transgender youth face a higher risk of suicide, but whether that risk has increased for adolescents in England who are waiting for care is not well understood. The Cass report said in February that many young people's mental health deteriorated while in a holding pattern.

"DROWNING IN THE MIDDLE"

For young people already in the system, the NHS has said care at the Tavistock clinic would continue unchanged ahead of its closure. NHS documents reviewed by Reuters show only a few dozen appointments are available for new patients each month, down from between 75 and 120 for most of last year, despite the growing waiting list.

Staffing has also dipped as several psychologists have left or, like Kelly, entered private practice. The Tavistock said in board documents that staff morale is low and told Reuters it does not have the capacity to meet demand.

The deadline for shuttering the clinic has also slipped, to late June 2023 at the earliest, two people familiar with the plans said, although the NHS is still aiming to open two new sites in spring next year, with up to seven more to follow. People who have been waiting the longest will be prioritized.

The NHS is also working on a system to cope with the backlog and improve support for those on the new list, a spokesman said.

But clinicians say polarized views around gender care will make finding staff challenging.

"The people who have gender-critical views call you child abusers and monsters, and then there are a lot of angry families accusing you of gatekeeping. And you're just drowning in the middle of it all," said Dr Laura Charlton, a clinical psychologist who left the Tavistock in 2020 after six years and now only treats adults.

Miles's parents say they are happy with GenderGP, but worry that the lack of NHS care will lead young people to unscrupulous online providers or even to self-medicate.

T he NHS doesn't cover the cost of Miles's private treatment. He is paying for his care with his wages from working at a local restaurant, and can recite the company's charges by heart. He says he had reservations about using testosterone but decided to go ahead.

"I know it can affect fertility," he said. "And it sounds weird, but baldness, because it runs in my family."

He applies a testosterone gel to his arms every morning, normally before heading to school. The gel dries and then cracks, like a face mask, when first applied, he said, then sinks in.

Miles has not told his co-workers that he is transgender. To them, along with his friends at an archaeology group that he digs with in Dover, he is just a young man. Yet he still plays for a girls' rugby team, until the effects of the testosterone kick in.

"I'm going to be able to start living my life as I want to," he said. "I want people to see that just because I'm trans, that doesn't affect who I am. I'm still a normal teenager."

[catamongthepages]

My unexpected first post.

Ofsted need to train their inspectors in empathy

I had the misfortune of being on the end of an Ofsted interview unexpectedly and it was a deeply infuriating and unpleasant experience.

I was a speech and language therapist employed by the NHS. I saw children in their nurseries or school placements to ease appointment stress on parents.

I was in a nursery one day and the Ofsted inspector came uninvited into my session and said she was going to interview me. I asked her to leave as she did not have parental permission to be in what was a medically confidential procedure - “you wouldn’t walk in on a physio, or GP appointment, so you don’t walk in on mine.” I said, no I would not be interviewed by Ofsted because I was not employed by education, she was impinging on my therapy sessions with the children and everything I did was confidential. She went on and on to the point that I phoned my boss. My boss said to let her interview me just to shut her up but refuse to answer any questions pertaining to confidentiality. My boss said she would write to the families losing a therapy session as a result and apologise, and put in a complaint to Ofsted.

This is what Ofsted inspectors do - they impinge on the job you are trying to do, with zero respect for boundaries, children’s needs, and your stress levels. They have boxes to tick and they are damn well going to tick them. I am all for school, all services in fact, being monitored, audited, etc - in fact the Speech and Language Therapy profession was the first Allied Health Profession to create a set of standards and audit procedures for its staff. However this has to be done in a way that remembers, at the heart of what you are assessing, are humans  - and in particular reference to public services - humans at the mercy of public money cuts, potentially odious management, and some quite revolting parents if truth be told. Teachers are up against it from day one. Add in the pandemic, and they are, most days, putting out fires everywhere.

Needless to say, this absolute robot paid no heed to my legal requirement to maintain confidentiality and kept asking inappropriate questions about the children. I answered nothing to do with this other than to say “that is confidential and I don’t have the parent’s permission to discuss it with you”. She finally gave way and asked some questions about the staff. I said truthfully that they were excellent at supporting me and the children and perhaps if she had asked that question at the beginning at a pre-arranged time she wouldn’t have wasted three clients therapy sessions. This is what Ofsted also do - they negatively impact on the job you should be doing which is supporting children. At the heart of what they destroy is children’s precious nurturing time.

The teaching profession has my full support in campaigning for Ofsted change. No human should die as a result of this cold, inadequate, draconian dictat.

#compassion #empathy #teachers #ofsted #change

[nashvad52]

What You May Have Overlooked About General Insurance!

Being both under-insured or over-insured can have their downfalls. Under-insured THE SURPRISING REASON WHY IS SUTAB NOT COVERED BY INSURANCE? face the risk of getting into an accident and not having enough to cover the vehicle damage, and personal injuries to themselves and others involved. Over-insured drivers are just plain paying too much out of their pocket, therefore, wasting unnecessary cash. If you want to avoid this trap, please read on. If you receive your homeowner's insurance from a company that also sells health or auto insurance, consider combining your policies. Many companies offer bundled discounts, so if you combine policies you could save a considerable amount. Don't try to inflate the value of your car or truck. All this accomplishes is raising your premium. In the event that your car is written off or stolen, the insurance company is only going to pay the market value of your car at the time of the incident. Lately, insurance companies have begun to check your credit score when calculating your insurance premium. If CAN I SUE MY INSURANCE COMPANY FOR EMOTIONAL DISTRESS? maintain a good, clean credit score, you don't have to worry about them tacking on unneeded fees and raising your premium. A good credit score seems to make you less of a liability to them. Small business owners who employ people must be certain that they have sufficient worker's compensation coverage to amply meet their needs. If an employee is injured or killed on the job, and they are not properly covered by the employer's worker's compensation policy, that owner puts themselves in an extremely precarious legal position. To get the right insurance, you have to understand what the company is offering you. Insurance can be confusing; therefore, do not be afraid to ask questions of your company. If you feel that a provider is not being up-front with you about something, you can always ask another person for help. If you are aging and worry about your income, you should purchase a disability income insurance. If you become unable to work, your insurance will give you enough money to support yourself and your family. This kind of insurance is relatively cheap and secures your financial future no matter what happens. To cover your home for earthquake damage in California, you must purchase separate earthquake insurance. Regular homeowner's insurance will not cover quake damage. Your insurance company or broker can help you understand the risk in your area and provide the coverage for you. Many homeowners choose not to get earthquake coverage, as it can be quite expensive. Find a pet insurance policy that includes coverage of multiple different issues. Broad coverage is most important for things like prescriptions, dental care, and allergy issues. If you do not have this type of policy, expect to pay a lot more than necessary, especially as your pet begins to age. Never allow a pet insurance company to charge you a cancellation fee. If DOES BLUE CROSS MEDICAL INSURANCE COVER DENTAL IMPLANTS? find out that your pet's insurance company is a shady one that you do not want to deal with, tell them you refuse to pay fees to cancel your service. They may try to force you, but don't back down, and they will remove it. Thoroughly read your insurance policy, and do so several times. Many people do not bother reading their policies at all before they sign them, and later find out that they are overpaying, or that their policy was actually inadequate concerning important coverage details. Paying special attention to detail when reading through, can help prevent this. Make sure that your renter's insurance covers theft as well as natural disasters. Renter's insurance tends me a network of exclusions. Antiques or high end items may be excluded from coverage or you may not be covered in case of theft or flooding. Make sure of exactly what your policy covers and doesn't cover. So, here are some tips you want to keep in mind when considering insurance: Be sure to consult with a professional and find out the right amount of coverage that fits your needs. Be sure to evaluate both the kind of vehicle you drive and the average price of vehicles of other drivers in your area. Also, consider whether you have personal health insurance to cover the cost of your own potential injuries should an accident occur.

#CAN I SUE MY INSURANCE COMPANY FOR EMOTIONAL DISTRESS?

[sweetlaws123]

Phoenix Car Accident Attorney: Experienced Representation for Your Personal Injury Case

Introduction:

Car accidents can have profound and lasting impacts on individuals' lives, leaving them with serious injuries, emotional trauma, and financial burdens. In Phoenix, Arizona, navigating the aftermath of a car accident can be overwhelming, especially when dealing with insurance companies and legal complexities. That's where a skilled Phoenix car accident attorney comes in, offering experienced representation to help individuals recover compensation for their injuries and damages. In this article, we'll explore the importance of hiring an experienced car accident attorney in Phoenix and the benefits they provide in personal injury cases.

The Role of a Phoenix Car Accident Attorney:

A Phoenix car accident attorney plays a crucial role in advocating for the rights of individuals who have been injured in car accidents. These legal professionals specialize in personal injury law and have extensive experience in handling various types of car accident cases, including rear-end collisions, intersection accidents, and drunk driving accidents. Their primary objective is to help clients recover compensation for medical expenses, lost wages, pain and suffering, and other damages incurred as a result of the accident. From investigating the accident scene to negotiating with insurance companies and, if necessary, representing clients in court, a Phoenix car accident attorney provides comprehensive legal support every step of the way.

Experience and Expertise: One of the most significant advantages of hiring a Phoenix car accident attorney is their experience and expertise in handling personal injury cases. These attorneys have a deep understanding of Arizona's personal injury laws, as well as the tactics used by insurance companies to minimize payouts. With their knowledge and skills, they can build strong cases on behalf of their clients and pursue maximum compensation for their injuries and losses. Whether it's gathering evidence, interviewing witnesses, or negotiating settlements, experienced car accident attorneys leverage their expertise to achieve favorable outcomes for their clients.

Legal Representation and Advocacy: In the aftermath of a car accident, individuals may find themselves facing complex legal processes and negotiations with insurance companies. Without proper legal representation, they risk being taken advantage of or receiving inadequate compensation for their injuries. A Phoenix car accident attorney serves as a dedicated advocate for their clients, fighting tirelessly to protect their rights and interests. They handle all aspects of the legal process, allowing clients to focus on their recovery while knowing that their case is in capable hands. Whether through settlement negotiations or courtroom litigation, car accident attorneys advocate zealously on behalf of their clients to secure the compensation they deserve.

Tailored Legal Strategies: Every car accident case is unique, with its own set of circumstances, injuries, and damages. A skilled Phoenix car accident attorney understands the importance of developing tailored legal strategies that address the specific needs and goals of each client. They conduct thorough investigations, analyze evidence, and consult with experts to build robust cases that stand up to scrutiny. Whether pursuing a settlement or taking the case to trial, car accident attorneys tailor their approach to achieve the best possible outcome for their clients. By providing personalized and strategic legal representation, they ensure that clients receive the compensation they need to rebuild their lives after a car accident.

Compassionate Support and Guidance: In addition to providing legal representation, Phoenix car accident attorneys offer compassionate support and guidance to clients during what can be a challenging and stressful time. They understand the physical, emotional, and financial toll that car accidents can take on individuals and their families. By offering empathetic listening, clear communication, and practical advice, car accident attorneys help alleviate some of the burdens associated with the recovery process. They serve as trusted allies and advocates, working tirelessly to ensure that clients receive the care, support, and compensation they need to move forward with their lives.

Conclusion:

A phoenix car accident attorney can turn your life upside down in an instant, but you don't have to face the aftermath alone. With the experienced representation of a Phoenix car accident attorney, you can have confidence knowing that your rights will be protected, your voice will be heard, and your best interests will be prioritized. From negotiating settlements to litigating in court, car accident attorneys are dedicated to helping you recover the compensation you deserve for your injuries and damages. If you've been injured in a car accident in Phoenix, don't hesitate to seek the experienced legal representation of a skilled car accident attorney who will fight tirelessly on your behalf.

#phoenix car accident attorney

[ubaid214]

Unveiling the Wonder: Fat Face's Journey to Getting the Best Face Fat Pill

In the search for achieving a attractive, contoured appearance, many people frequently end up experiencing stubborn face fat. Whether it's the annoying double face, chubby cheeks, or puffiness around the eyes, excess fat in the face can be quite a source of stress and self-consciousness. Fortuitously, the pharmaceutical business has experienced a discovery in that sphere with the emergence of Fat Experience – a revolutionary face fat pill that's quickly established it self while the go-to alternative for reaching a thinner, more described facial profile.

Removed are the days when unpleasant techniques or inadequate jokes were the only alternatives for approaching facial fat. Fat Experience has converted the landscape of skin aesthetics by supplying a safe, non-invasive, and very efficient solution that offers noticeable benefits without the need for surgery or downtime. But what sets Fat Experience aside from different products in the market, getting it the popular subject of the greatest face fat supplement in the pharmacy? بهترین قرص لاغری در داروخانه

First and foremost, Fat Face has a scientifically formulated blend of strong what specifically target fat cells in the skin region. This private mix harnesses the ability of organic substances known for their power to accelerate fat metabolism, promote lipolysis (the break down of fat), and inhibit fat storage. By targeting fat cells at the origin, Fat Face assures that customers achieve obvious cutbacks in face fat, leading to a more sculpted and explained appearance.

More over, Fat Face is guaranteed by extensive study and medical reports, providing users with the confidence of its safety and efficacy. Unlike different items which make lofty claims without any scientific evidence to guide them, Fat Face stands apart as a respected option that offers tangible results. Their track record of success and good testimonies from pleased people further solidify its reputation as the very best face fat tablet obtainable in the pharmacy.

Furthermore, Fat Face prioritizes quality and transparency, adhering to stringent manufacturing criteria and utilizing premium-grade ingredients procured from respected suppliers. Each group undergoes demanding screening to ensure love, efficiency, and reliability, thereby guaranteeing the utmost quality and effectiveness for consumers. With Fat Experience, users can rest assured that they're buying a solution that prioritizes their security and provides effects they could trust.

Another important element adding to Fat Face's superiority is its usefulness and convenience. Unlike unpleasant procedures that require considerable healing intervals or awkward products that necessitate complicated use instructions, Fat Face provides a hassle-free alternative that matches easily in to any lifestyle. Their easy-to-swallow capsules could be integrated in to everyday exercises with ease, allowing users to savor the advantages of face fat reduction without disruption for their busy schedules.

In summary, Fat Experience has emerged since the undisputed champion in the sphere of face fat burning, making their concept as the most effective experience fat pill in the pharmacy. Having its clinically supported formula, commitment to quality and protection, and unmatched ease, Fat Experience has collection a new common for reaching a thinner, more described skin profile. Bid farewell to excess facial fat and hi to newfound confidence with Fat Experience – the greatest answer for transforming your appearance and unlocking your correct beauty

[surekhakapoor]

Hugs are more effective than drugs – A lesson learnt in SOS village

https://www.soschildrensvillages.in/

During my mandatory 3-month rural posting as part of my internship, I was stationed at Chiraigaon, Varanasi. The hospital was dilapidated, situated amidst vast agricultural fields, with poor sanitation, inadequate healthcare infrastructure, substandard living quarters for medical personnel, sporadic electricity supply, rough roads, absence of tap water, an abundance of mosquitoes, and frequent encounters with snakes. Understandably, most interns left for college after a few days, unenthusiastic about the forced rural experience. This immersion in the realities of primary healthcare in India left me disheartened. After investing five years in the rigorous MBBS program, I struggled to reconcile my dreams of a prestigious career in a modern hospital with the harsh realities I faced.

Contemplating a career change, I considered following in the footsteps of some friends by taking the Civil Service examination. However, I chose to stay a few extra days in the rural setting. On the third day, I learned that the Primary Health Centre (PHC) needed a doctor for a school health program. Seeking a break from boredom and loneliness, I volunteered for the assignment at the SOS Village.

Arriving at the SOS Village, I encountered a group of sickly children accompanied by caregivers. Their warm reception and hopeful gazes were unexpected. Despite feeling unequipped to treat children and anxious about my lack of pediatric knowledge, I attempted to connect with them by taking their medical history. Simmy, a six-year-old girl with a high fever, shared her heartbreaking story of losing her parents in a car accident and being sent to the orphanage. Overwhelmed by her suffering, I struggled with my inadequacies as a physician.

Fortunately, a nurse with pediatric experience joined me, offering invaluable support and expertise. With her assistance, I administered treatment to several children suffering from measles, provided comfort, and transformed a playroom into a makeshift ward. Despite initial doubts, I gained confidence and organizational skills, earning the gratitude of the children and their caregivers.

The experience at the SOS Village taught me invaluable lessons about compassion, humility, and the transformative power of genuine care. It reaffirmed my passion for medicine and the profound impact a caring attitude can have on healing. Though my time at the village eventually came to an end, the memories and lessons learned continue to guide me in my medical journey, reminding me of the noble calling of serving humanity.

The bond forged during those intense days at the SOS Village remains etched in my heart. It was not just about medical treatment; it was about being present, listening, and offering empathy to those in need. As I reflect on that transformative experience, I realize that true healing goes beyond prescriptions and procedures; it encompasses understanding, kindness, and human connection.

Returning to my college after the rural posting, I carried with me a renewed sense of purpose and a deeper appreciation for the privilege of being a healthcare provider. The challenges and rewards of that time continue to shape my approach to patient care and remind me of the resilience and strength I witnessed in the faces of those children.

The SOS Village became a symbol of hope, resilience, and the power of collective support. It taught me that while medical knowledge and skills are crucial, it is our humanity, compassion, and dedication that make the real difference in people's lives.

#NGO For Children

[daretoknowthyself]

I haven't done a stream of consciousness wall of text for a while but for various I can't put this on twitter or Facebook or WhatsApp the person I'd usually bounce this shit off soooo hey.

I really struggle to compartmentalise stuff. Like. I can cope for so long and then somehow everything just mounts up and conspires to overwhelm me. And then I end up unloading it all on someone else, usually one person, and then I feel immense guilt, which naturally also fuels the whole cycle. So...mind dump time:

- I received my final warning from work just before Xmas for a gross misconduct offence and we agreed I'd have weekly check ins with one of the managers to help mitigate/avoid any repeats, and I was finding that helpful but then said manager had a holiday and then has a really bad injury so we've not had a check in for like 3 weeks

- My dad, who is partially paralysed and mostly non-verbal after a major stroke had major neurosurgery last week for a cranioplasty and got home this afternoon after a frustrating weekend of us not being able to get though to the hospital to find out how he was or when he'd be home

- I relapsed back into active alcohol addiction after 14 days of sobriety and am trying to claw my way back

- My mum has an ongoing medical condition which means she has to have blood transfusions every three weeks

- Because of everything that has been happening I seem to have stressed my way into having a period so I'm dealing with a whole boatload of unresolved gender dysphoria

- I'm in active discernment for ordination to the priesthood and every time I meet other potential ordinands or am supported by my existing clergy I feel so inadequate

- My grandmother has just gone to A&E because she continues to not be able to manage her diabetes, a few months after my grandfather has moved into full time residential care due to advanced alzheimers

Just. I'm tired. And scared. And in relapse. And guilty. And whilst for once I'm not actively wanting to hurt myself or anything else stupid. I would quite like a break.

And if you're wondering why I'm not telling my friend all of these things (though they do know most of them) they're currently receiving treatment for cancer, searching for a post curacy job, and separating from their partner with whom they have twin nine year olds

[westhilldentalgreenville]

Understanding the Feasibility of Bone Grafts for Dental Implants

Welcome to our blog post on the fascinating world of dental implants and the crucial role that bone grafts play in their success. If you're considering getting dental implants in Greenville or simply curious about this innovative solution for missing teeth, you've come to the right place! In this article, we'll dive deep into the world of bone grafts, exploring their types, importance, feasibility factors, success rates, risks associated with them and alternative options available. By the end of this read, you'll have all the knowledge you need to make an informed decision about incorporating bone grafts into your journey towards a dazzling smile. So let's get started!

Types of Bone Grafts Used in Dental Implants

When it comes to dental implants, bone grafts play a crucial role in ensuring the success and longevity of the procedure. But what exactly are bone grafts and how do they work? Let's explore the different types of bone grafts used in dental implant surgery.

1. Autografts: These are considered the gold standard for bone grafting. In this type, bone is taken from another area of your own body, such as your hip or chin, and transplanted into the jawbone where the implant will be placed. Autografts have excellent integration potential because they contain living cells that promote natural healing.

2. Allografts: This type involves using donated human bone tissue from a tissue bank instead of harvesting your own bone. Allograft materials undergo meticulous processing to ensure safety and compatibility with your body's tissues. They provide a framework for new bone growth by acting as scaffolding until your body replaces it with its own natural bone.

3. Xenografts: Derived from animal sources, typically bovine or porcine, xenografts offer an alternative option for patients who cannot use autograft or allograft materials due to medical conditions or personal preferences.

4. Synthetic Bone Graft Materials: These man-made materials include substances like hydroxyapatite (HA) and tricalcium phosphate (TCP). Synthetic options mimic natural mineral components found in bones and can successfully integrate with surrounding tissues over time.

Each type of bone graft has its advantages and considerations based on factors such as patient preference, availability, cost-effectiveness, and overall treatment goals.

Remember that these are just brief introductions to each type of graft material used in dental implants—your dentist will determine which option is most suitable for you after carefully evaluating your specific condition.

The Importance of Bone Grafts in Implant Surgery

When it comes to dental implant surgery, bone grafts play a crucial role in ensuring the success and longevity of the implants. But why are bone grafts so important in this procedure?

Bone grafts provide a stable foundation for the dental implants. When a tooth is lost or extracted, the jawbone may start to deteriorate over time due to lack of stimulation. This can lead to insufficient bone volume and density needed to support an implant. A bone graft helps rebuild and strengthen the jawbone, providing a solid base for the implant.

Bone grafts promote proper integration of the implant with surrounding tissues. The grafted material acts as a scaffold that encourages new bone growth around it. This process is known as osseointegration and is essential for ensuring that the implant becomes fully integrated into the jawbone, mimicking natural tooth roots.

Moreover, bone grafts help improve aesthetics by preserving facial structure and preventing further deterioration of the jawbone. Without sufficient supporting bone structure, there may be visible changes in facial appearance such as sunken cheeks or sagging lips.

Furthermore, using a bone graft allows dentists to place implants in areas where they might not have been possible otherwise due to inadequate natural bone quantity or quality. By augmenting the existing jawbone with a grafting material, patients can enjoy restored functionality and aesthetics through dental implants.

Understanding why bone grafts are important in dental implant surgery highlights their role in providing stability for implants, promoting osseointegration with surrounding tissues, preserving facial structure, and expanding treatment options for patients with compromised jawbones

Factors that Affect the Feasibility of Bone Grafts

When considering bone grafts for dental implants, there are several factors that can influence their feasibility. These factors include the patient's overall health, the location and size of the defect being treated, and the quality of existing bone.

One crucial factor is the patient's general health. Certain medical conditions such as diabetes or autoimmune disorders can affect how well a bone graft will integrate with existing tissue. Additionally, smoking or excessive alcohol consumption can hinder proper healing and increase the risk of complications.

The location and size of the defect also play a role in determining whether a bone graft is feasible. Larger defects may require more extensive grafting procedures or additional treatments to ensure successful implant placement. The proximity to vital structures like nerves or sinuses must also be considered during treatment planning.

Another critical factor is the quality and quantity of existing bone at the implant site. If there is inadequate natural bone available to support an implant securely, a bone graft may be necessary to enhance stability and promote osseointegration—the process by which new bone forms around an implanted device.

Furthermore, previous dental procedures or trauma can impact feasibility. For instance, if there has been significant loss or damage to surrounding tissues due to extractions or infections, it may affect whether a specific type of graft can be performed successfully.

Each patient's situation must be assessed on an individual basis by an experienced oral surgeon or periodontist who specializes in dental implants. They will consider these factors along with any other relevant details before determining if a bone graft is feasible for achieving optimal outcomes.

Understanding these various elements that affect feasibility allows patients to make informed decisions about their treatment options while working closely with their dental professional throughout every stage of care.

Success Rates and Risks Associated with Bone Grafts

When it comes to dental implants, bone grafts play a crucial role in ensuring their long-term success. But just like any medical procedure, there are both risks and rewards involved. Let's take a closer look at the success rates and potential risks associated with bone grafts for dental implants.

Let's discuss the success rates. Studies have shown that when performed by an experienced oral surgeon or periodontist, bone grafting procedures have high success rates. The success of a bone graft largely depends on various factors such as the patient's overall health, quality of the donor bone material used, surgical technique employed, and post-operative care.

However, it is essential to acknowledge that no medical procedure is without its risks. Some potential complications associated with bone grafts include infection at the surgical site, damage to surrounding structures such as nerves or blood vessels, allergic reactions to anesthesia or donor material (in rare cases), and failure of integration between the grafted bone and existing jawbone.

To minimize these risks, it is crucial for patients to undergo thorough pre-operative evaluations and follow post-operative instructions diligently. Additionally, choosing an experienced implant specialist who has a proven track record in performing successful bone graft procedures can significantly enhance the chances of achieving optimal outcomes.

Understanding both the successes and potential risks associated with bone grafts for dental implants allows patients to make informed decisions about their oral health treatment options. By consulting with a knowledgeable implant dentist who can assess individual circumstances accurately; one can ensure enhanced safety during surgery while maximizing overall implant longevity.

Alternative Options to Bone Grafts

There may be cases where a bone graft is not a feasible option for dental implant surgery. Fortunately, there are alternative options available that can still provide successful outcomes.

One alternative is the use of mini dental implants (MDIs). MDIs are smaller in diameter than traditional implants and can be placed directly into the jawbone without the need for extensive bone grafting. They are an excellent option for patients with limited bone volume or those who prefer a less invasive procedure.

Another alternative is All-on-4 dental implants. This innovative technique allows for a full arch of teeth to be supported by just four implants strategically placed in the jawbone. The posterior implants are angled to take advantage of existing bone structure, reducing the need for extensive grafting.

Furthermore, zygomatic implants offer another solution when traditional implant placement is not possible due to severe bone loss in the upper jaw. These longer implants anchor into the cheekbones (zygoma) and provide support for implant-supported dentures or bridges.

While these alternatives may not work in every case, they offer viable options for patients who would otherwise require extensive bone grafting procedures. It's essential to consult with your dentist or oral surgeon to determine which option is best suited for your specific needs.

Remember, each patient's situation is unique, and it's crucial to explore all available options before making a decision about dental implant surgery.

Making an Informed Decision About Bone Grafts for Dental Implants

When considering dental implants in Greenville, it is important to understand the feasibility of bone grafts. While bone grafting may be necessary in some cases to ensure the success and longevity of dental implant surgery, it is not always the only option available.

Before making a decision about bone grafts for dental implants, it is crucial to consult with a qualified and experienced dentist. They will assess your specific case and determine whether bone grafting is necessary or if alternative options can be explored.

Factors such as the quality and quantity of existing jawbone, overall oral health, and individual patient needs will all play a role in determining the feasibility of bone grafts. Your dentist will explain these factors to you in detail so that you can make an informed choice about your treatment plan.

Keep in mind that while bone grafting can significantly improve outcomes for dental implants, there are also risks involved. These risks include infection at the donor site or recipient site, nerve damage, rejection of the graft material, or delayed healing. However, with proper planning and execution by a skilled professional, these risks can be minimized.

It's worth noting that there are alternatives to traditional bone grafting techniques. For instance:

- Mini Dental Implants: These smaller-sized implants may eliminate the need for extensive bone augmentation since they require less space.

- All-on-4/All-on-6 Implants: This technique utilizes fewer implants strategically placed within the jawbone to provide stability without requiring extensive additional bone support.

- Zygomatic Implants: When patients have severe jawbone loss in their upper arches due to conditions like osteoporosis or long-term denture use, zygomatic implants anchor into the cheekbones instead of relying on insufficient natural jawbone structure.

Ultimately, the decision regarding whether or not to proceed with a bone graft should be based on thorough discussions with your dentist after considering all the available options.

#dentistinGreenville #westhilldentalgreenville #Greenvilldentist #dentistGreenville #dentist near me #dentist #dentalimplants

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What is a reason for a hip replacement?

Understanding Hipsterism reserves

At some point in life, numerous individualities may witness hip pain or reduced mobility due to colorful reasons, frequently performing in difficulty performing diurnal conditioning or enjoying an active life. Thankfully, medical advancements have handed results, and one similar transformative procedure is a hipsterism relief.

Understanding hipsterism relief

hipsterism relief, also known as hipsterism arthroplasty, is a surgical procedure aimed at replacing a damaged or diseased hipsterism joint with an artificial implant or prosthesis. The most common reasons for a hipsterism relief include

Osteoarthritis This degenerative common complaint is a primary cause of hipsterism pain. Over time, the defensive cartilage at the ends of bones wears down, leading to disunion between bones, inflammation, and pain.

Rheumatoid Arthritis An autoimmune condition causing inflammation of the joints, including the hipsterism, leading to pain, stiffness, and common damage.

Post-Traumatic Arthritis A former injury or trauma to the hipsterism joint might affect in arthritis times latterly, causing pain and confined movement.

Avascular Necrosis inadequate blood force to the hipsterism bone can beget the bone to collapse and deteriorate, leading to severe pain and dysfunction.

Other Conditions hipsterism reserves can also be recommended for individualities with certain hipsterism fractures, bone excrescences, or severe bone scars.

The Procedure

Before the surgery, thorough evaluations including imaging tests will be conducted to assess the extent of damage and determine the stylish course of action. During the procedure

Anesthesia Cases are given anesthesia, icing they're comfortable and pain-free during the surgery. The choice between general anesthesia and indigenous anesthesia will be bandied with the case.

Surgery The surgeon removes the damaged portions of the hipsterism joint and replaces them with artificial factors made of essence, ceramic, or plastic. These implants mimic the natural hipsterism joint, allowing for smooth movement and reduced pain.

RecoveryPost-surgery, a recuperation plan is acclimatized to each case, involving physical remedy and exercises to recapture strength, inflexibility, and mobility.

Benefits of hipsterism relief

hipsterism relief surgery offers multitudinous benefits

Pain Relief Most cases witness significant relief from habitual hipsterism pain, allowing them to renew diurnal conditioning without discomfort.

Advanced Mobility Restoring the hipsterism joint's functionality enhances mobility, enabling individualities to walk, climb stairs, and engage in conditioning they preliminarily set up grueling .

Enhanced Quality of Life With reduced pain and bettered mobility, cases frequently witness an overall improvement in their quality of life, enabling them to lead more active and fulfilling cultures.

Conclusion

A hipsterism relief can be a life- changing procedure for individualities suffering from hipsterism pain and confined movement due to colorful conditions. At Kalyani Hospital, our devoted platoon of orthopedic specialists, state- of- the- art installations, and substantiated care insure that cases admit the stylish possible treatment and support throughout their trip to restored mobility.

still, do not vacillate to reach out to our expert platoon at Kalyani Hospital for compassionate care and comprehensive results, If you or a loved one are passing hipsterism pain or considering a hipsterism relief.

Flash back, a pain-free and active life is within reach with the right medical guidance and treatment.

#hospital #wellness #health #doctor #surgery

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German Shepherd Rescue in Massachusetts: A Comprehensive Guide

German Shepherds have long been a favorite breed among dog enthusiasts, with their loyal, intelligent, and protective nature making them exceptional companions and working dogs. Brief Overview of the German Shepherd Breed and Their Popularity Importance of Rescue Centers in Massachusetts for German ShepherdsStatistics on Abandoned or Neglected German Shepherds in Massachusetts The Role of Rescue Centers in Providing a Second Chance Benefits of Adopting from Rescue Centers Researching German Shepherd Rescue CentersListing Prominent German Shepherd Rescue Centers in Massachusetts Providing a Brief Description of Each Center's Mission and Values Highlighting Their Commitment to the Well-Being of the Dogs Adoption Process Tips for Prospective AdoptersUnderstanding the Specific Needs of German Shepherds Preparing Your Home for a Rescued Dog Assessing Your Lifestyle and Commitment to a New Pet Conclusion However, not all German Shepherds are fortunate enough to find loving forever homes, and this comprehensive guide aims to shed light on the critical role of Massachusetts German Shepherd Rescue organizations, offering assistance to those who are considering adopting or supporting their efforts to rescue, rehabilitate, and find homes for these magnificent dogs. Key Takeaways - Understand the history and traits of the German Shepherd breed, and why they may end up in rescue centers. - Recognize the importance of rescue centers in addressing the issue of abandoned and neglected German Shepherds in Massachusetts. - Research reputable German Shepherd rescue organizations in Massachusetts and learn about their missions, values, and ethical practices. - Gain insight on the adoption process involved in German Shepherd rescue centers and the typical prerequisites and expectations. - Discover practical tips for prospective adopters, including understanding the specific needs of German Shepherds and preparing one's home and lifestyle for a rescued dog.

Brief Overview of the German Shepherd Breed and Their Popularity

Originating from Germany in the late 19th century, the German Shepherd breed has become one of the most beloved and recognizable dog breeds worldwide. Known for their intelligence, versatility, and loyalty, German Shepherds have excelled in various roles, including police work, search and rescue, and even as family pets. This section will provide a brief overview of the German Shepherd breed, highlighting their characteristics, and shedding light on their immense popularity. There are two main types of German Shepherds, working line and show line, each with its distinct traits and purposes. The working line German Shepherds are bred primarily for their working abilities, such as agility, strength, and obedience. In contrast, show line German Shepherds are bred primarily for their appearance, adhering to specific breed standards. "A well-trained German Shepherd is truly a breed apart - loyal, intelligent, and versatile." - Captain Max von Stephanitz, father of the German Shepherd breed Although German Shepherds are a popular breed, they may still end up in rescue centers for various reasons. Some common factors include behavioral issues stemming from inadequate training, changes in the owner's lifestyle, and medical conditions that require costly treatments. As a result, rescue centers often house a wide array of German Shepherds of different ages, sizes, and backgrounds. - Size: German Shepherds typically range from 22 to 26 inches in height at the shoulder and weigh between 50 to 90 pounds, with males being larger than females. - Coat: Their coat is double layered, with a dense and thick undercoat and a straight or slightly wavy outer layer. The most common colors are black and tan, but they can also come in black, sable, and bi-color varieties. - Temperament: German Shepherds are known for their intelligence, loyalty, and protective nature. They form strong bonds with their families and can be aloof or cautious around strangers. - Energy Level: This breed is highly energetic, requiring regular exercise and mental stimulation to remain happy and healthy. - Life Expectancy: The average lifespan for a German Shepherd is 9 to 13 years. The following table illustrates the key differences between working line and show line German Shepherds: CharacteristicWorking LineShow LineAppearanceAthletic and leaner buildHeavier build, often with a more sloping toplineDriveHigher working drive, suitable for demanding rolesLower working drive, bred for conformation purposesTrainabilityEager to learn and excel in various tasksStill trainable, but may be more laid-back and less focused on tasksTemperamentAlert and energetic, better suited for experienced handlersMore laid-back and adaptable to a variety of homes In conclusion, the German Shepherd breed is revered for its unique traits, making them highly popular among dog enthusiasts. Despite their popularity, German Shepherds can still end up in rescue centers, creating opportunities for potential adopters to provide loving homes to these deserving dogs. As we move on to the following sections, we will explore the importance of rescue centers in Massachusetts and how individuals can contribute to the welfare of German Shepherds in need.

Importance of Rescue Centers in Massachusetts for German Shepherds

The plight of abandoned and neglected German Shepherds in Massachusetts calls for the crucial intervention of rescue centers. These facilities dedicate their efforts to finding new, loving homes for these incredible dogs. In this section, we will explore the significance of rescue centers within the context of German Shepherd rescue, highlighting the state's current abandonment and neglect statistics, the second-chance opportunities provided by rescue centers, and the numerous advantages of adopting from such establishments. Statistics on Abandoned or Neglected German Shepherds in Massachusetts The abandonment and neglect of German Shepherds in Massachusetts are alarming. According to the Humane Society of the United States (HSUS), German Shepherds consistently rank within the top three dog breeds found in US shelters. Locally, Massachusetts has witnessed a steady increase in surrendered and stray German Shepherds over the past decade. This underscores the urgency to address these dogs' plight and the crucial role rescue centers play in providing them with a brighter future. The Role of Rescue Centers in Providing a Second Chance Rescue centers serve as a beacon of hope for German Shepherds in need. They commit to the rehabilitation, rehoming, and overall well-being of these abandoned and neglected dogs. The role of these centers consists of: - Fostering German Shepherds until suitable homes are found - Conducting thorough health checks and providing necessary veterinary care - Assessing and addressing behavioral issues - Educating potential adopters on the specific needs of German Shepherds - Matching dogs with compatible families and living situations The transformative work carried out by rescue centers offers second-chance adoptions for countless German Shepherds, allowing these deserving dogs to live happier, healthier lives. Also Read: White German shepherd from Puppy to Pal: The Complete Guide. Benefits of Adopting from Rescue Centers When considering dog adoption, the benefits of choosing a rescue center are plenty: - Pre-Adoption Health Checks: Rescue centers ensure the dogs have a clean bill of health and receive any needed medical treatments before adoption. - Behavioral Assessments: Dogs undergo behavioral evaluations by trained professionals, ensuring a good match and better understanding of the dog's personality and needs. - Support Systems: Both the dogs and adopters receive ongoing support and assistance, ensuring a seamless transition to their new lives together. - Saving Lives: Adopting from a rescue center provides much-needed space for other dogs in need, actively contributing to saving lives. In light of these benefits, prospective adopters should prioritize rescue centers as their go-to choice when adopting a German Shepherd. Providing loving homes for these dogs and supporting the essential work carried out by these centers can drive a positive impact, contributing to a brighter future for all German Shepherds in Massachusetts.

Researching German Shepherd Rescue Centers

Choosing a responsible and reputable rescue center is crucial when it comes to adopting a German Shepherd in Massachusetts. This section will guide you to research and select the right organization, presenting a list of prominent German Shepherd rescue centers in the state. We will provide brief descriptions of their mission statements and values, and highlight their commitment to the well-being of the dogs. Listing Prominent German Shepherd Rescue Centers in Massachusetts The following table features reputable German Shepherd rescue organizations located in Massachusetts, including their contact details for your convenience. OrganizationLocationContactGerman Shepherd Rescue of New England, Inc.Wayland, MA(978) 443-2202Northeast All-Volunteer German Shepherd RescueBoxford, MA(800) 914-3647BrightStar German Shepherd RescueRochester, MA(585) 293-0549Sedona Shepherd SanctuaryMillis, MA(508) 376-2817 Providing a Brief Description of Each Center's Mission and Values To help you understand what each organization stands for and their approach to rescue work, we have gathered brief descriptions of their missions and values. German Shepherd Rescue of New England, Inc. This organization is committed to rescuing, rehabilitating, and rehoming German Shepherds throughout New England. They provide each dog with medical care, training, and a safe environment. Northeast All-Volunteer German Shepherd Rescue A non-profit, all-volunteer group that rescues and finds suitable homes for German Shepherds in need, ensuring all dogs receive proper care, training, and socialization before being adopted. BrightStar German Shepherd Rescue BrightStar is dedicated to saving German Shepherds and offering them a second chance at a happy and healthy life. They provide comprehensive medical care and behavioral evaluations before placing dogs in loving homes. Sedona Shepherd Sanctuary Their mission is to rescue, rehabilitate, and find loving homes for adult and senior German Shepherds, focusing on ensuring each dog's well-being and providing them with medical care, socialization, and any specialized training necessary. Highlighting Their Commitment to the Well-Being of the Dogs Each of the listed rescue centers is dedicated to ensuring the well-being of the German Shepherds under their care. They ensure this through various means such as: - Providing comprehensive medical care, including spaying/neutering, vaccinations, and addressing any health issues - Carrying out thorough behavioral evaluations and implementing any necessary training to improve manners, social skills, and overall demeanor - Conducting screenings of prospective adopters to make sure they are a good fit for the German Shepherd and will provide a safe, loving, and stable home. - Providing ongoing support to adopters, including advice on training techniques and health maintenance of their new pet Researching German Shepherd rescue organizations in Massachusetts is essential in finding the right one to entrust the potential adoption process. By acquainting yourself with different rescue centers, their missions, values, and commitment to the dogs, you will be better prepared to make an informed decision and embark on a successful adoption journey.

Adoption Process

Adopting a German Shepherd from a rescue center in Massachusetts involves a series of steps designed to ensure that both the dog and the adopter are a suitable match. In this section, we outline the typical German Shepherd adoption process at various rescue centers, offering insight into the application process, prerequisites, and what to expect at each stage. - Research and choose a rescue center: Begin by researching German Shepherd rescue centers in Massachusetts. Consider factors such as their mission, values, and success stories. Once you've identified a rescue center that aligns with your values and expectations, start the German Shepherd adoption steps by visiting their website or contacting them for more information. - Submit an application: Most rescue centers provide an online or downloadable application form that you'll need to complete. This form typically includes questions about your living arrangements, experience with dogs, especially German Shepherds, and references. The center will use the information provided to determine if you're a suitable adopter. - Interview and home visit: If your application is accepted, the rescue center may arrange an interview with you, either in person or via phone. This is an opportunity for them to get to know you better and discuss your suitability as an adopter. In some cases, they may also conduct a home visit to ensure that your living environment is safe and appropriate for a German Shepherd. - Meeting the dog(s): If the rescue center feels that you're a good fit for adopting a German Shepherd, they will arrange for you to meet one or more of the dogs currently in their care. This allows you to interact with the dog and assess whether you're compatible with them. - Finalize the adoption: If you and the selected dog are a good match, you can proceed with the Rescue German Shepherd adoption procedure. The rescue center will discuss their adoption agreement, which typically includes a fee that covers veterinary and other care expenses. Once the agreement is signed, you can welcome your new family member home! Keep in mind that each rescue center may have slightly different steps in their adoption process. However, the majority will follow the general outline detailed above. As you embark on the adoption journey, be prepared for some common prerequisites and expectations during the procedure: - Proof of residence: Most rescue centers will require proof that you're a resident of Massachusetts or the surrounding area. - Veterinary references: If you have other pets, rescue centers may request references from your veterinarian to ensure they're up-to-date on vaccinations and receive proper care. - Landlord approval: If you're renting, you may need written approval from your landlord allowing you to have a German Shepherd on the property. - Age requirements: Some rescue centers may have age restrictions for adopters, such as being 21 years or older. - Family involvement: Involving your entire household in the adoption process is essential, as all family members should interact with the dog and be in agreement with the decision to adopt. Every rescue center may have its specific requirements and processes for adopting a German Shepherd; however, the goal remains the same - finding the perfect forever home for each dog.

Tips for Prospective Adopters

Adopting a rescued German Shepherd is a rewarding experience, but it also requires careful planning and considerations. In this section, you'll find valuable tips tailored specifically for future German Shepherd owners, covering essential aspects such as understanding their unique needs, preparing your home, and assessing your lifestyle and commitment. Understanding the Specific Needs of German Shepherds German Shepherds are an intelligent and active breed, with specific care requirements that differ from other dog breeds. Before bringing home a rescued German Shepherd, it is important to familiarize yourself with these unique needs, including: - Exercise: German Shepherds need regular and adequate physical activity to maintain good health and prevent behavioral issues. Plan for daily walks, runs, and playtime. - Mental stimulation: This breed is known for its intelligence and requires mental challenges to thrive. Provide puzzle toys, obedience training, and play sessions that engage their minds. - Diet: A well-balanced diet formulated specifically for large breeds like German Shepherds is crucial for maintaining their health. Consult your veterinarian for proper feeding guidelines. - Grooming: German Shepherds have a double coat and shed frequently. Regular brushing to remove loose hair and maintain their coat is essential. Preparing Your Home for a Rescued Dog

A rescued German Shepherd may have experienced trauma or neglect in their past, so it's essential to create a safe, welcoming environment for them to adjust to their new life. Here are some steps to prepare your home: - Designate a specific area for your dog's belongings, such as their bed, toys, and food and water bowls. - Ensure your home is dog-proof and free of potential hazards, such as toxic plants, loose wires, or dangerous household items. - Establish a routine for daily walks, feeding, and playtime to help your German Shepherd adjust and feel secure. - Be patient and give your rescued dog ample time to adjust to their new surroundings. Keep in mind that it may take several days or even weeks for them to become comfortable. Assessing Your Lifestyle and Commitment to a New Pet Before adopting a German Shepherd, it's essential to evaluate your lifestyle and long-term commitment to pet ownership. Read the full article

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Eat Sleep Burn PDF Download Dan Garner (eBook)

Many individuals worldwide have over the average weight, which is causing an alarm for people who just want to live out their lives without worrying about other things that can add up to their stress. Tackling obesity is no easy feat, as many people have already tried to counter this through different types of diet and exercise. The truth is that people who are overweight are risking their lives without knowing. Being overweight is a bane for most people, as it can only be solved by a specific solution within a particular individual. Most people take inadequate sleep as a very light issue that cannot affect their daily operations. What most people do not know is that the quality of sleep affects a person’s weight. However much they try to exercise and eat well, they always end up still gaining weight. 

The Eat Sleep Burn program is a revolutionary weight loss program that focuses on the connection between sleep and metabolism. The Eat Sleep Burn program offers a unique and science-based approach to weight loss by harnessing the power of sleep. With its comprehensive guidance, nutritional support, and exercise recommendations, it provides a holistic solution for long-term success. While commitment and consistency are required, the potential benefits of improved sleep, enhanced metabolism, and sustainable weight loss make this program highly recommended for individuals seeking a transformative journey to better health. Developed by Dan Garner and Todd Lamb, this program provides a comprehensive approach to improving sleep quality and burning fat while you sleep. Dan is the founder of Team Garner (is own company) and he is a professional coacher who specializes in athletic performance and physique transformation. Some of the people who dan coached are world titles and world records. Dan Garner says that more than 75% of the people he works with only need to fix one thing to trigger massive weight loss without big changes to their diet and exercise. Todd Lamb is a former SWAT member and a fitness expert with extensive experience in the field. He is passionate about helping people achieve their weight loss goals and has dedicated his career to developing effective fitness programs. Through his expertise in exercise and nutrition, Todd has co-created the Eat Sleep Burn program to provide a holistic approach to weight loss.

In the program I learned that lack of sleep is not only bad for your belly, it’s also bad for your health and may cause a lot of medical and mental problems. There is no promotion of any harmful diet or another such thing. The Eat Sleep Burn program is a scientifically-backed approach to weight loss that emphasizes the importance of sleep in the body's ability to burn fat. By optimizing your sleep patterns and incorporating specific exercises, this program helps you achieve sustainable weight loss and improve overall health and well-being. Get ready to transform your body while you sleep! In fact, users are only supposed to correct their sleep. This specific type of deep sleep isn’t about your sleeping time, In fact, even folks who are in bed and asleep for 7 to 8 hours a night are probably not achieving the specific and restorative sleep state that they need to lose weight and rebuild health. By getting ample hours of restorative sleep, hormonal production is made optimal and weight gain is curbed. You will feel your own well being when you eat a well balanced diet. Your body lets you know what it needs to feel healthy, when to eat and when to stop eating. You can eat like a normal person and sleep peacefully every night. Then wake up with vitality and see your sagging belly had gone whoosh! 

Click Here to Download The Eat Sleep Burn eBook Now