Fandom Medical

Avolition (difficulty with starting and staying on tasks, usually because of apathy or executive dysfunction) is a "negative" symptom of schizophrenia (as well as being a symptom of a lot of other disorders such as depression and ADHD) and can affect up to 60% of people with the disorder. People with avolition can have trouble with hobbies, participating in school or work, engaging in hygiene tasks like showering and brushing teeth, maintaining their living space, and even sleeping.

Here are a few things that can help:

If the thing is too much, try to break it down into smaller parts. For example, if washing the dishes is too much, make the first step gathering the dishes, the second step soaking them, the third step washing them, etc... and do those steps in one-step intervals.

If actually starting the thing is too much, consider bargaining with yourself: you'll do 3 minutes of the thing, but if you don't like it you can stop after that. Most people will keep doing the thing for longer once they start, but it gives you an out if you really hate it, and at least 3 minutes of the thing got done, and that's better than nothing.

If the number of tasks in a day is too much, plan things in three step chunks. Have only a vague idea of what you'll do after the first three steps are up and make the next three steps up once you've completed the first three. For example, if you're going to the store, plan to gather what you need to leave the house, get on the bus, and arrive at the store. Then from there you plan the next three steps, like planning what you'll buy, collecting it, and checking out.

If you have a hard time figuring out what to do, sit down with someone and plan out a schedule for daily, weekly, monthly and yearly tasks. You may not care about what you're doing, but knowing what you have to do without having to put thought into it can be helpful.

In conjunction with checklists and schedule, giving yourself permission not to care about a task. Apathy is real, but you don't have to care about yourself to take a shower. You don't have to like showers to take a shower. You just have to do it.

Play pretend with yourself- you're not taking care of you when you shower or brush your hair, you're taking care of yourself as a child or an animal in your responsible care.

If tasks take a lot of energy and starting them feels overwhelming because of that, figure out what you're willing to "pay" for a given task and stick to your "budget". Some tasks are going to give you a certain number of spoons and some are going to take away spoons. Some are going to do both. Pay attention to what tasks are draining and what are giving you spoons. Then you can make a mental spoon bank that allows you to figure out in advance what a task will cost you.

If starting a specific task is challenging, but you can do other things, try doing a little of something you want to do (or that brings you pleasure) first. This builds up some motivation for other tasks. Every time you feel like you can't do a needed task anymore, do a little more of what brings you pleasure.

Establish and meet small goals. Goals can be something like "stood out of bed for 5 minutes." You don't have to write them down, but do something to establish them as something you want to do today, like saying them out loud. Once you do it, try to intentionally feel a sense of accomplishment. The goal of this exercise is that (sometimes artificial) sense of accomplishment that you can build on.

There are a lot of medications in use today whose chemicals can be found in plants/minerals (or which were originally derived from plants/minerals). Note that most of these, while originally derived directly from plant material, are currently made in a lab.

Acetaminophen comes from chemically changing acetanilide, a chemical found in coal tar.

Aspirin comes from chemically changing salicin, a chemical found in a number of plants (willow, poplar, meadowsweet, black haw, cramp bark, among others).

Atropine (used in emergency medicine to increase heart rate and treat certain poisonings, among other things) is found in a number of plants in the nightshade family.

Caffeine is present in a lot of plants (it's a natural insecticide) including tea, coffee, cocoa, and yaupon holly.

Cocaine (both the local anesthetic and the illicit substance) is from the coca plant.

Colchicine is used to treat gout and comes from autumn crocus.

Digoxin (a medication used to treat heart failure) comes from the foxglove plant.

L-Dopa, used to treat Parkinson's disease, comes from Mucuna species (cowage, velvetbean).

Nicotine, a stimulant, comes from tobacco.

Opium is the dried sap of poppy pods. From it can be isolated morphine and codeine. Processing morphine further produces heroin.

Pseudoephedrine and ephedrine, medications used as decongestants (among other things), come from ma huang and ephedra.

Quinine is an antipyretic (fever reducer) that used to work against malaria (malaria is now resistant to quinine). it also comes from the cinchona tree.

Quinidine is an antiarrhythmic drug used to treat bad heart rhythms. it comes from the cinchona tree.

Reserpine is a drug used to treat high blood pressure (among other things). It comes from Indian snakeroot.

Scopolamine, used to treat nausea and motions sickness, comes from black henbane, stinking nightshade, and henpin.

Which may not seem like much, but I haven't written this much in one week since 2022. I haven't written more than about 1,500 words of fiction in the last year.

And like, man, it's a rough rough draft. I'm really just focusing on getting words on a page right now. But it feels really good to write again.

I would offer three products for sale on Etsy:

Product 1: Unflavored electrolyte powder per the WHO 2002 ORS recipe (sodium, chloride, potassium, citrate, and glucose). Rice syrup solids would provide the glucose instead of corn- or wheat-based glucose powder for allergy/MCAS purposes.

Product 2: Saltea: Sweet tea flavored electrolyte powder according to the WHO 2002 ORS recipe (basically the same as above but with instant black tea added).

Product 3: For those of you just looking to up your sodium chloride intake, I would have a POTS special- a lower potassium and no citrate version of Product 1 (or potentially Product 2 if there was interest).

If you are a nurse and you're feeling like you can't work on a floor anymore and clinic/education jobs are really competitive/not for you, consider methadone clinics.

They're literally always hiring and it's a very low spoons (physical and mental) job. I work at a methadone clinic and we used to have a nurse who used a wheelchair that worked there. I have a significant psychiatric disability that makes working on a floor impossible, but I can easily make it through a day working where I work.

You get there really early in the morning so by the time you leave it's like 1300 and you have the rest of your day free. I am literally in full time school right now. I have the time and energy to do that and work 32 hr/week. And I wouldn't consider myself particularly flush with mental spoons.

You get to see people doing their best every day. And you really do get to see people get better over time in this job in a way you rarely do with floor nursing. It's a surprisingly rewarding field of nursing.

The job is repetitive and task-oriented. Once you learn how to do all the tasks there's not a lot of deviation that isn't going to come from a doctor's order. The biggest decision you have to make-LPN or RN- is "is this person safe to take methadone today?" and you have a lot of tools to determine that.

I already have his best friend (not a medical professional) trying to talk him through it, keep his spirits up, give him sips of water, and help him to the bathroom. I have another character (a doctor) administer treatments and painful wound care. The whole thing takes place in a low-resource 35-year-post-apocalypse setting in the summer in Ohio (hot, buggy, and humid).

I am happy to entertain the possibility other characters, but generally I want the friend character to be worried and feeling out of her depth, and the doctor character to be kind of jaded, grizzled, and sad because he thinks there's a good chance the main will die.

A lot of you have been asking me to do a "how to take care of yourself when you're sick" post. There's a lot to that ask, so I'm going to be breaking it up. You can read the one I did on colds here.

This post will be about taking care of yourself when you have nausea/vomiting/diarrhea. Those symptoms aren't limited to just the infectious kind of stomach bug, so take this as more general knowledge.

When we are talking about the infectious kind of stomach bug, you want to be very careful about cleanliness. Wash your hands with soap and water (notably, not hand sanitizer in this case- many GI pathogens just laugh at hand sanitizer) every time you go to the bathroom or vomit. If you are sick, do not handle food other people will eat. If you are the only person who can possibly handle food and there is no way around it, wash your hands extremely well, wear nitrile gloves, and cook any food you have touched thoroughly.

Nausea/Vomiting:

Nausea is the sense of discomfort in the abdomen, chest, or throat that often accompanies vomiting. You can have nausea without vomiting too. It can come from things like infectious stomach bugs, but it can also come from things like motion sickness, chronic GI illness, emotional distress, or side effects from medications. Nausea is multipurpose like that.

Generally the biggest thing with anything GI is that you want to stay hydrated. With vomiting, it can be hard, especially if you are vomiting frequently. Always start by waiting about 30-60 minutes since the last episode of vomiting, then taking very small sips of plain water every ten minutes or so. If you vomit again, start over. If you can't hold down plain water for 24 hours (or less if you have other symptoms of dehydration like very dark, infrequent urine, or your skin stays tented when pinched) seek medical care. You should also seek medical care if there is blood in your vomit (red or "coffee grounds" appearance) or if you have a fever.

If you have nausea/vomiting often you should also see a healthcare provider about that. It's not normal to have nausea/vomiting regularly.

Once you're tolerating water though, branch out to other clear liquids. Clear liquids are things you can see through (or theoretically see through) and are liquid at body temperature. This includes black coffee and tea, juice without pulp, soda, broths, sports/electrolyte drinks without resin (not cloudy), gelatin, and popsicles.

Once you're doing well on clear liquids, move to full liquids. These include everything listed above and also milks, puddings, thin yogurts, ice creams, and custards without chunks.

Once you're doing well with full liquids, move on to pureed foods (like pureed soups without chunks, juices with pulp, and smoothies), or if you're really feeling good move on to soft foods like mashed vegetables.

This progression helps give your stomach time to rest and gradually build up tolerance to foods. Most people can go for a many days as long as they're getting fluids with calories and electrolytes, so don't worry about protein/fiber/vegetables/vitamins as much in the acute phase of nausea/vomiting.

There are a lot of things you can do to reduce nausea and make you more likely to tolerate liquids.

Tasting/smelling things:

Ginger is pretty good for nausea. You can chew or suck on raw ginger (which is pretty intense for most people) or get ginger chews or tablets. You can also consume strong ginger tea hot or iced. Notably, you generally have to taste the ginger instead of just swallowing it.

Mint is also a good option. You can eat mint candy or smell peppermint oil.

Smelling isopropyl (rubbing) alcohol works well too. They sell alcohol wipes for prepping skin prior to injections, and these are super convenient (and often pretty cheap) ways to carry around isopropyl alcohol.

Coca Cola. This one is less about taste and more about the phosphoric acid content and carbonation in Coke. Because of this, it does need to be brand name or it won't work. Phosphoric acid is a great nausea reducer. Do not flatten the Coke prior to drinking. The bubbles are actually really good for nausea too. You do have to basically continually sip it for it to work.

Other sodas/Seltzer water. For the bubbles.

Other strategies:

Hot water. Sipping water or tea that is as hot as you can stand can very temporarily relieve nausea. Like with the Coke, you have to do this pretty much continuously.

Pressure points: pressing on the inside of your wrist can help. Generally the bands designed to do this don't put enough pressure on the spot, so try on your own and experiment with how much pressure you need.

Heating pad: this is more for abdominal pain/cramping, but having a sensation like heat or cold can provide some physical distraction and improve nausea.

Cool damp wash cloth: On the face or back of the neck.

Very hot baths/showers: This is mostly useful for cannabis hyperemesis syndrome.

OTC Meds: Emetrol. This is just phosphoric acid. If Coke is working for you, just use that, it's cheaper and you can take it more often.

Bismuth subsalicylate: Pepto-Bismol. Works by reinforcing the mucous layer in the lining of the stomach and reducing inflammation. It also "collects" (adsorbs) bacteria like H. pylori and prevents it from doing damage. It also thickens poop to treat diarrhea. Don't take with aspirin or if you're allergic to aspirin. Ask before taking with other NSAIDs like ibuprofen.

Dimenhydrinate: Dramamine. This is a first generation antihistamine, which blocks histamine in the part of the brain that causes nausea. Contrary to popular belief this works for all kinds of nausea, not just motion sickness. Don't take it with other antihistamines, but you can take it with phosphoric acid or bismuth subsalicylate.

Diarrhea:

Diarrhea excessive liquid or very loose stools.

You can lose a lot of fluids very fast with diarrhea, so it's important to consume more fluids than you're losing. Drink a cup or two of electrolyte drink with every stool, if your stomach can tolerate it, and watch out for signs of dehydration.

A lot of people are afraid that if they stop diarrhea with diet or meds they won't "flush out" the bacteria, virus or parasite causing it. Because any infection is in the lining of the GI system and can't be flushed out, that's not how diarrhea works. That said, before starting an antidarrheal for acute diarrhea (diarrhea that comes on due to an infection or immediate problem), talk to a healthcare provider. Slowing the diarrhea has advantages in that it prevents dehydration and prevents the spread of certain pathogens. But if the diarrhea is caused by a pathogen that produces a toxin (like C. difficile) or if the diarrhea is caused by a food intolerance or allergy, you do want to get rid of the toxin or offending food. So you need to see a healthcare provider to rule this out.

If you have more than about 24 hours of severe diarrhea or can't stay hydrated, you should see a healthcare provider. They can give you better meds for diarrhea than over the counter, and antibiotics/antiparasitics if you need them. Other reasons to see a healthcare provider include blood your stool (which can be red or very dark black), a fever, a lot of mucous in the stool, pain in the abdomen that is sharp or hurts when you move, or significant changes to the color of the stool (like turning orange or white).

There are a number of things you can do about diarrhea:

Diet:

The BRAT diet is a diet to help make diarrhea more manageable. It is primarily a low-fat, low-fiber diet that classically includes Bananas, (white) Rice, Applesauce, and (white) plain Toast. You can also include things like skinless potatoes, white flour noodles, and lean meats without skin.

Caring for the Skin Around Your Anus:

One of the problems with diarrhea is that your butt hurts due to the constant irritation from the diarrhea itself and the wiping. There are a couple of things you can do here, and you can do basically one or the other at any given time. You can alternate them, though:

Protect the skin: Get zinc oxide cream and apply it after every stool. This protects the skin around the anus from moisture.

Soothe the skin: Use witch hazel or pramoxime pads to make the skin feel better. This makes the blood vessels in the area smaller and prevents pain.

Additionally to one of the above, try using baby wipes or water to clean yourself after pooping instead of dry toilet paper.

OTC Meds:

Bismuth Subsalicylate: Pepto-Bismol. Thickens stools. Don't take with aspirin or if you're allergic to aspirin. Ask before taking with other NSAIDs like ibuprofen.