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https://autisticgirlsnetwork.org/needle-phobia-autism-and-coping-with-blood-tests-and-vaccinations/ Needle Phobia; autism and coping with blood tests and vaccinations Isabella’s story We asked Isabella if she’d like to write something after we were initially contacted by her mum, experiencing a huge lack of support for needle phobia. Isabella had become more and more unwell, but all medical professionals said they couldn’t do anything further without blood tests. The problem was nobody was supporting Isabella to be able to have the testing. From Isabella’s mum “She came home from university at Easter and after days of high temperatures she was told to go to A&E. It was here that an incredibly understanding Doctor listened to what we were saying, took into account her autism and helped to arrange for her to self-administer a finger prick test that allowed them to collect just enough blood for an initial test. To cut a long, night in A&E, story short, she was diagnosed with leukaemia and immediately admitted to hospital and is now undergoing intensive chemotherapy. The autism note on her file and the extremely understanding staff here have helped her navigate numerous bone marrow biopsies and lumbar punctures and allowed her to have tablet forms of other medications that could have been injections. We are just so grateful that we finally found medical professionals who understood, they are few and far between.” From Isabella I’d like to talk about some of the challenges I’ve faced because there’s been a lot of variation and I think it’s very important for medical staff to know what does and doesn’t work. I can now see that being taken seriously can save lives; and it scares me to know that not being listened to can put lives at risk. I think the main things I’ve experienced have been: Secondary school vaccination staff are not properly aware of additional challenges that some students may have. Looking back on my experience in secondary school, I don’t think the community nurses were properly aware that they couldn’t take a one size fits all approach. Their approach to me being too scared to have the vaccines done at school was to simply send me to the catch up clinic for it which unsurprisingly didn’t do anything because it was the exact same set up as school! Sure, they didn’t know that I was autistic (and I had no clue either) so making adjustments wouldn’t have been their first priority; though I suspect it was very obvious by the amount of distress I was very visibly showing that something wasn’t typical about what was happening. We eventually managed to go to a second catch up clinic where they did vaccinate me successfully but it wasn’t overall a successful experience I’d say and it probably did more harm than good. I made sure that I mentioned this time that I wanted them to be clear with me what was happening and they told me that they would let me put on headphones and try and relax myself before they attempted to vaccinate me. But no, they did the vaccine while I was preparing for it and made me lose all my trust in them because they had not listened properly. So when I came back for the second dose of the HPV vaccine the year after it never happened because I couldn’t trust them to make me feel calm enough to start the process of taking my blazer off because I couldn’t trust them to vaccinate me when I felt ready and not to shock me and do it too early and unexpectedly. The main thing they could’ve done that would’ve helped? I’m not sure as it was a long time ago, but I think acknowledging the existence of undiagnosed neurodivergent students (or students who are more anxious about it for other reasons too) going through vaccination who might have heightened anxiety could be a good start and being fully honest and open with them about what’s going to happen and giving them the time and space they need. I think maybe if someone had in the catch up clinic realised that I was too scared and used 20 minutes to talk through arranging another time to get it done in a more relaxed environment with numbing cream for example and reassuring me that it would be ok, I might’ve been more willing to try instead of giving up in fear. Less of a relevant point now but I think still important to mention: they could’ve reconsidered which order of vaccines to offer me. At the time, you needed 2 doses of the HPV vaccine to be fully vaccinated (or 3 if over 15) [I believe the NHS guidance is now only one dose, but may be wrong] and I can’t help but wonder if they could’ve considered that if they did scare me off vaccines completely that it might be worth giving me a vaccine where at least I’d get full protection instead of told that because I hadn’t had the second dose within 2 years that the only one they could give me was effectively useless at the time? I couldn’t help but wonder at the time if I should’ve asked them for the meningitis vaccine instead (even if I’d be given it a few months early) because at least then I’d have protection against something I knew I needed for university but was worried I’d never be brave enough to have. Because if you can’t vaccinate someone fully, surely it’s better to prioritise something that will provide full rather than partial protection? I remember thinking that would’ve been a very important conversation to have at the time but not having the confidence to raise it. I did end up leaving for university without the meningitis vaccine which I know is not good but due to the lack of support from the secondary school immunisation team, it would never have been possible. If you speak to someone willing to be understanding, it can be lifesaving. When I went to A+E and my mum explained to the doctor that my autism meant that I was completely irrationally scared of blood tests and that I hadn’t been able to have one for months I asked if I could self administer a finger prick blood test because it was the only way that I could see myself being able to do it. The doctor was incredible because she could see that even though it wasn’t “the way” of testing it, it would be the only possible way so contacted the paediatrics section of A+E to see if it would be possible and (partially because I’m 19 so close to having been a child anyway) we were told we could do it. The nurse who gave me the test and everything, was incredible! She took her time to be very clear how to administer the test and helped calm all of my nerves and feel calm and confident to do the test and allowed me to do what once felt impossible. The kindness and understanding that she had towards my fears made a once impossible challenge possible. And shortly after that we got the results quite quickly that further needle stabs would be needed because my blood results were very concerning. But this news was delivered to us by the very kind and understanding paediatric nurse who came armed with numbing cream and understanding that I was not going to be happy with the news, which I obviously wasn’t. But she gave me 5 minutes to process it which really really helped because otherwise I would’ve been too overwhelmed and probably refused. Having the same nurse who was willing to take things slower put on numbing cream and insert cannulas / do further blood tests at a pace that suited me being clear with what was happening and when and communicating clearly and checking that I felt comfortable throughout the whole process made it possible to do. I’ve had a very similar experience with all my procedures since being transferred from A+E to the teenage cancer trust ward I’m in. The nurses here are amazing and because they know that my autism makes me scared of needles they make sure that I am always given numbing cream before I need a stab and that I’m given plenty of hours’ notice which really calms my nerves and they are always clear about what happens when which has been great! And I think this is the main message I would love to try and amplify to people; pausing to understand that someone is absolutely terrified and making relatively adjustments (finger prick test over traditional blood test, numbing cream, taking things slower and clearly) can make the impossible possible. I would never have had a blood test without the support of paediatrics and genuinely if I hadn’t had that I would have just refused to do a blood test and walked out of A+E having done nothing and knowing what we know now, I could have possibly died by now without it, and that terrifies me. If A+E had not made those accommodations, I would never have known how ill I am and started treatment which is saving my life. Bio Isabella, 19. Maths student and lover of all things maths.

DOCTORs APPOINTMENTs Before a procédure, get to meet the physıcıans and acknowledge their authority before you mention your sensitivities. Find a way to make a compromise. Even request more time for an appointment if you want to have topical numbing agents wait to work, to discuss alternatives, etc. Before a procédure, look up the physıcıans and/or the clınıcal website. Find pictures of the inner building and search for FAQ, policies, procedures, reviews, etc. Before a procédure, bring a fully charged phone and any sensory necessities such as plastic cups for water, ice pack, self testing kits, written notes and copies, etc. TIPS For CHECKs Feel the instruments and get comfortable with them. Ex: at the dentist, you’re weary of the suction straw. If no plastic cups for rinsing, ask them for some or, have them turn the suction on a low setting and feel it with your fıngers before they use it in your møuth. Perhaps they can put something on if you don’t like the suck¡ng nóise. See how you feel with the specific docтor. Ex: Dr. A seems hurried and strict, but Dr. B seems more empathetic. Or perhaps ask if a nurse can be in the room with you to. Try having the docтor teach you how much you can do. Ex: for a strep thr*at test, ask if you can swab your own thr*at, even have them hold your hand whilst you do it in a mirror. Or tell them the way your thr*at structure may find it easier to tilt, etc. (my search NeuroFabulous)

https://www.bethinking.org/human-life/a-biblical-view-of-disability

| ᵖˢᵃˡᵐ ¹³⁹:¹⁴ ʸᵒᵘ ᵃʳᵉ ᶠᵉᵃʳᶠᵘˡˡʸ ᵃⁿᵈ ʷᵒⁿᵈᵉʳᶠᵘˡˡʸ ᵐᵃᵈᵉ

Going into Doctor settings Pack: Comfortable/ Loose fitting clothing like dresses, skirts Some pairs of undies Sensory items Chewing gum Ice compress Notepad Favourite blanket, pillow, plushies, fidget toys, etc.

hydrate interview the physician before the consult to make sure they are compassionate nerve patch lidocaine cream 20 minutes before to numb, emla cream butterfly needle use a baby (small) gauge needle a mild sedative twilight sleep or under another type of anesthesia midwives as an alternative Communicate your needs and discomfort... it will go a long way 💙 follow your gut feelings

⋆˚࿔ 𝐈𝐬𝐚𝐛𝐞𝐥𝐥𝐚 𝜗𝜚˚⋆

𓏲 　🍼　ﾟ⠀⠀ ･₊ ˚ ⠀ ࿐ 𝗒𝗈𝗎𝗋 𝗋𝖾𝗆𝗂𝗇𝖽𝖾𝗋 𝗍𝗈 𝗍𝖺𝗄𝖾 𝗒𝗈𝗎𝗋 𝗆𝖾𝖽𝗂𝖼𝗂𝗇𝖾, 𝗂𝖿 𝗒𝗈𝗎 𝗍𝖺𝗄𝖾 𝖺𝗇𝗒 ♡ 　ɞ ⠀⠀ ⠀ . 　🌸　⋆༉

😷 If it’s a same day appointment without any preparation beforehand, still let them know any needs. Even if it’s not worth it to spend nearly an hour on preparing something especially for you, still let them know what might work best for you. If they need to use a speculum, ask for a small one! Even if they can’t use all their time convincing you of how convenient something might be, still tell them if you cannot do certain methods while feeling safe. Is there something on hand to relieve even a little pain? Can it be self administered at home? Can you sit in a different chair? If you cannot possibly resolve something as much as you’d like, ask for them to at least tell you what’s going on and ask how they might cope with similar sensations. Can an X-ray be done instead of a biopsy? If not, ask for them to take your concerns into account and go from there, such as a less invasive tool designed for the same purpose. Wear a long skirt or a dress so you can just pull it up rather than take your clothes off. You can also bring a jacket or different pants to change into. Take headphones and listen to music, explain you're nervous and would not like to hear much about what's going on but just to be told when they've started and when they've finished. Focus in on what you're listening to. Say if it’s your first time doing a certain procedure and mention your concerns. Acknowledge you understand people don’t necessarily enjoy it for fun. Knowing can make you less anxious. It’s definitely worth asking something like ‘I do find this procedure extremely painful, could you try with a X?’ The procedure is easier for them to perform if you’re not squirming around in pain so there’s no reason for them not to at least try. Pamper yourself. Count as you breathe. Breathe in 1-2-3-4. Breathe out 1-2-3-4. If the doctor's good, they'll keep you talking and talk to you for further distraction, and walk you through each step they take. Most of the time, certain tests don't take much longer than 30 seconds and afterwards they'll leave you alone so you can recover if you need it. Talk to them beforehand so they know you're anxious, and see what they can do to help you get through it. Knowing options are always open to you if you need it can help put you at ease. Knowing what certain tests feel like can make it go smoother and easier to manage. Mentally walk yourself through the procedure before it happens while doing slow breathing exercises - breath in for five counts and out for five (or longer) while walking yourself through what to expect with your eyes closed. If at any point you get nervous, keep breathing and open your eyes. Once comfortable, continue through the procedure and just keep breathing. Don’t dismiss true concerns so you can decide what might be best for you. Gather all available facts to make informed decisions with the medics. Discuss the procedure with the medic and what they will do and when it happens. While the procedure happens, ask them to explain what which thing it is they’re doing next and how it might feel. Tell them if at any point you express discomfort, they check in with you and do not proceed until you give them the green light. Make sure nothing is put in you if you have not consented to or understand the purpose of. It’ll help you stay in some control if you are allowed to say if you wanted to stop at any given time to get through it. Anyone could find any experience distressing, but one’s distress can be magnified by the facts of how they are autistic, traumatized, etc. Just like with any other condition, doctors should have to take into account a particular person in their office and adjust what they’re doing to meet the needs of said patient. Jot down in advance everything you want to discuss to know exactly why, when and how something is to be. Ask for details and mention anything. Think about the muscles in your legs as you close your eyes. Imagine you’re at home, or think of a show. Anything to make it seem less intimidating. Give them notes you’ve taken. Ask if you can pace. Even if you aren’t a child, you still may need the catering even if you understand what medics are for. Make kits. Ask them to listen to you and to take time with you to make it more comforting. Advocate as feedback. 😷

Concerns to ask the doc if needed 😷 Although benefits can outweigh much, it’s still a worry. Even if it temporarily lasts a second, a person's pain should be taken into account. I’m not saying you should go under deep sedation just to get teeth cleaned, especially if you don’t need it. If you are having trouble tolerating certain exams, tell them to keep it in mind so the procedure can be easier on both of you. If you experience intense pain and find it hard to tolerate, request for ways to make it easier. Thank you for taking the time to care for me (be sure to show gratitude before, during and/or after) Can you explain the procedure to me? How long will it take? Can we count up or down to the number? Can you explain what you're doing as you begin to do it? Because it’s been hard in the past when X, so can we look at some techniques? Can I drink water before or during the procedure? Do you have a heat pack or ice pack nearby? I want to get it over with and I’d like it to be easy for both of us. If you have a distraction tool (like telling jokes) to use I’d still like to let you know about X knowing my concerns will still be taken into account. Can we talk beforehand and walk me through the procedure as it will happen, step by step? Do you have any non invasive ways to check for X? Can you do it another way instead? Do you have any smaller and/or softer instruments to get the job done? Can you apply something (like warmth, gel, etc.) to the instrument beforehand? Is there a way to get around it? Can I say if I wanted to stop (said procedure) during any time? Can I make informed decisions to decline X? When it comes to certain exams, I’ve sensory issues, trauma, etc. Do you know any breathing exercises or any methods to accommodate my specific needs? It’s not anything personal, it’s not distrust, but I want it to go easy for both of us. 😷

Tips 😷 Depending on the procedure, meet the one treating you to see if they are a good fit for you. If they seem nice and willing, find something where you can both agree to make it better for the both of you. If you can notify them ahead of time, mention your needs. “I have autism which might contribute to my discomfort. What can I bring to the clinic? Can I leave my pants on, or can I wear a skirt instead of having to undress? Can you prepare smaller medical tools? Do you have sedatives? Are numbing agents readily available? Do you have a room with an adjustable seat? What’s the best treatment for me? Are there other options to make it easier to get care?” Look up pictures of the place, visit it, read any rule policies and see if they can accommodate to getting special permission for certain aspects. Get a personalized treatment plan. Use telemedicine, an appointment over video, phone call or text chat, when available and appropriate. Ask about at home tests you can send. Tell your doctor about your worries. They might be able to help you address them.

💉 Subcutaneous injections tend to be less painful than intramuscular injections because the needles are smaller and do not have to push through as much tissue. 💉

⭑ ιѕαвєℓℓα ⚡︎

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✧˚ ʚɞ˚ ༘✿ ♡ ⋆｡˚

DIGESTIVE HEALTH MORE DIGESTIVE DISEASES The Stages of Appendicitis Natural Progression of an Inflamed Appendix By Colleen Doherty, MD Published on February 14, 2023 Medically reviewed by Brian H. Wetchler, DO Abdominal pain is the most common symptom of appendicitis. It's typically felt near the belly button before migrating (moving) to the lower right side of the abdomen. Other possible symptoms follow the pain of appendicitis and include Loss of appetite Nausea/vomiting Change in bowel habits Malaise (feeling generally unwell) Low-grade fever Appendicitis signs include tenderness in the lower right side of the belly when pressed on by a healthcare provider. Guarding and stiffness (rigidity) of the stomach muscles may also be present. An appendiceal phlegmon can be felt on physical examination as a bulging structure in the right lower side of the abdomen. It develops in up to 10% of appendicitis cases and is more common in young children than in others Early appendicitis pain tends to be mild, vague, and achy. It's usually located near the belly button and may come and go. As the inflamed appendix comes into contact with the tissue that lines the abdominal wall, the pain shifts to the lower right side of the belly, becoming sharp, continuous, and severe. The timeline of pain migration and increase in intensity generally occurs over 12 to 24 hours, although this is not a hard-and-fast rule. Antibiotics are an alternative treatment option if the appendix has not ruptured and there are no complications, like abscess formation or peritonitis Appendicitis naturally progresses from uncomplicated to complicated appendicitis if not treated. Uncomplicated (also called early or simple) appendicitis is when the appendix is swollen and infected. Complicated appendicitis occurs when the appendix tissue dies and/or bursts open (ruptures). Abdominal pain that moves from the navel (belly button) to the lower right side of the abdomen is a classic and nearly universal symptom of appendicitis. Pain generally becomes severe and continuous within 12 to 24 hours of starting. Rarely, as with chronic appendicitis, the pain remains mild, coming and going for days to weeks.

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RED or BROWN bloody discharge is common during menstruation. Colors might range from cherry red at the beginning of your period to rusty brown. Some people have irregular periods and spotting. Others experience spotting due to their birth control method or hormonal changes. A variety of WHITE shades of discharge, from eggshell to cream, can be common. White discharge can occur for many of the same reasons as Clear discharge. It’s simply natural lubrication. As it cleans itself, it produces a WHITE or CLEAR discharge. Hormonal changes during your menstrual cycle can affect said discharge. Mucus can turn YELLOW when it comes into contact with the air. Very light yellow discharge is more common than you might think. Sometimes the color is daffodil yellow. Other times it’s more of a GREEN chartreuse. If you know you’re probably in the clear (as in it’s a one-off occurrence), what you eat could affect the color. Some people report this color change occurring whenever they take new vitamins or try certain foods. PINK discharge, ranging from a very light blush to the deep pink of a sunset, is often just a sign of the beginning of your menstrual period. Some people may periodically experience light bleeding after penetration.