I am sorry you are going through that. Really awful. Credit to you for tracking the symptoms so closely.
The cyclicality of the nausea in your graph is interesting. Personally, I find cyclic vomiting syndrome is underdiagnosed and exists along more of a spectrum than generally assumed. As others have said, there is often overlap with migraine spectrum and central hypersensitivity. An underlying trigger such as a GI infection in predisposed individuals can 'turn up the volume' of normal enteric nerve signaling. This ultimately describes a lot of functional GI conditions.
With central hypersensitivity, chronic pain, chronic migraine, and cyclic vomiting, one of the goals becomes resetting the sensory nerve volume back to a normal level. Meditation, therapy, etc., can all have a role. Often, antidepressants are often used at lower doses since they modulate peripheral nerves too.
FWIW, you may want to ask your current primary or GI/neurologist about cyclic vomiting syndrome and whether to trial a TCA (first line treatment, amitriptyline has the most evidence)
The counter argument that I have heard is that patient handoffs are where a disproportionate number of errors occur. Increasing the number of shifts means that more patients in the ED or on the floor will have care fragmented between providers, making it more likely that results will not be followed up or that changes in a patient's status will not be recognized.
I don't know at what point the errors from sleep deprivation exceed the errors from patient handoffs. People seem to take different views depending on what side of the work hours debate they fall on.
Interestingly, this gets into the territory of the Framingham Heart Study, a long-running, prospective cohort study of cardiovascular disease risk.
The data are mixed. One analysis, for example, showed that "Type A behavior" was not correlated with CVD[1]. Another showed that increased tension was associated with heart disease[2]. You can find plenty of other papers on the subject as well.
Job-related stress is a particularly interesting aspect of this. Conceptually, it makes sense that demanding work would increase cortisol levels and lead to CVD, but a number of studies don't bear this out after correcting for smoking, exercise, and so on. However, one could argue that job-stress leads to higher rates of smoking, drinking, etc., which makes the interpretation harder. It may also be that stress at work is not the only factor, and that the combination of high stress plus low control over one's work is substantially worse than one or the other alone.[3]
It is a bit unsatisfying to not have a clear answer, but I think the issue is more nuanced than I would have assumed.
PrEP (pre-exposure prophylaxis) is Truvada, which is part of the anti-retroviral regimen given to many HIV(+) patients. The idea is that any virions that enter your body are killed before they have a chance to set up shop.
It is a reasonably simple, safe, and effective drug, so it really should be available from any PCP. However, some community physicians do not prescribe it for one reason or another. HIV/STD clinics are almost always happy to see HIV(-) patients who are interested in PrEP.
It even works the other way around. IIRC, there have been something like 2 documented cases of HIV(-) people becoming seropositive while taking PrEP as prescribed.
Gut bacteria have many functions, and there are likely more out there to be discovered than we know about currently. One of the functions that I find interesting is that bacteria help to synthesize vitamin K, which is required by the liver to build proteins that allow blood to clot. Neonates do not have the gut flora to synthesize vitamin K at birth, which is why they get a vitamin K shot after delivery.
Normal gut bacteria also coat the GI tract, preventing pathogenic bacteria from sticking to the surface of the intestines. This is part of the reason babies under 1 should not eat raw honey (which has C. botulinum spores that can stick to the intestines and produce botulinum toxin), while older kids and adults have no trouble with it.
Along the same lines, a hot (though, admittedly disgusting) area of research in medicine now is fecal transplant for people with a particularly aggressive form of colitis. I believe that the research on glut flora transplantation is also being expanded to weight loss, but I'm not very familiar with the studies.
Payments may affect prescribing, but I think that system factors count for more than many people realize. By way of an example, imagine the following case, which is reasonably common at the outpatient medicine office I am rotating through:
A 46 yo M with diabetes, hypertension, a 30 pack year smoking history, and low back pain that has been treated with oxycodone ever since a failed back operation 1.5 years ago presents to your office for routine follow-up. It's 10am, the hospital allots 15 minutes for routine appointments, and your next patient is in the waiting room. You are his physician -- what do you prioritize?
Smoking, diabetes, and hypertension are a perfect storm for a heart attack in the next 10 years, so how much time do you want to spend optimizing antihypertensive meds and glucose control? You could talk to him about quitting smoking, which is pretty high-yield since it would lower his cardiovascular and cancer risk. On the other hand, he doesn't seem particularly motivated to quit right now.
You would like to see him exercise more and eat better, since his blood sugars are not too bad yet, and you might be able to spare him daily insulin injections. But, his back pain is so bad that walking is difficult and exercise is out of the question. Tylenol and ibuprofen only "take the edge off". Oxycodone is the one thing that seems to really help. He asks you to refill his prescription, especially because "the pain is so bad at night, I can't sleep without it".
His quality-of-life is already poor, and it would become miserable if you took away his opioid script without providing some other form of pain control. You believe that he might benefit from physical therapy and time. He is willing to try PT, but he is adamant that he will not be able to "do all of the stretches and stuff" without taking oxycodone beforehand.
You now have 7 minutes to come up with a plan he agrees on (you're there to help him, after all), put in your orders, and read up on the next patient. How do you want to allocate your time? What if you suggest cutting down on his oxycodone regimen and he pushes back?
I don't know if there is a good answer. But these situations happen all the time, and someone has to make a decision. Most doctors are normal people. The different backgrounds, personalities, willingness to engage in confrontation or teaching, and varying degrees of concern for public health vs. individual patient needs, etc. lead to a variety of approaches. In the end, I think that pharma payments have a marginal effect on most doctors who have families, bosses, insurance constraints, a full waiting room, and are faced with the patient above.
I think by cure they mean eradicate the virus, rather than suppress it. Most people can live relatively normal lives by keeping their viral load low, but this involves taking expensive medications every day for the rest of one's life. The drugs are things like protease inhibitors, modified DNA bases, etc. that muck up the virus' replication machinery so that it cannot make more copies.
The goal of a lot of researchers is basically an HIV antimicrobial that kills the virus in the same way you might treat pneumonia, so that maintenance therapy is not needed.
Type 1 diabetes is an autoimmune disease. The body kills all of its insulin-producing cells, often in childhood. No matter what sort of food you eat, you need insulin if you want your cells to use the building blocks!
As an aside, the story of how insulin was discovered is super interesting. Diabetes used to be an incredibly lethal disease (part of why there were so many nobel prizes given out for insulin research)
It's an unsatisfying answer, but Alzheimer's (and most disease for that matter) is a combination of genetic risk and what you do with your life. It is hard to know exactly how much genes or the environment contribute. There are subsets of neurodegenerative diseases that are almost entirely genetic (Huntington's, some forms of Parkinson's, etc.) and some that are almost 100% environmental (there's an interesting story about a group of IV drug users in San Francisco who developed Parkinson's after taking something laced with MPTP). Most cases are somewhere in the middle though.
Learning other languages or instruments is probably useful from a brain health standpoint regardless of your genetics (even if you already have early-stage AD you can slow progression), but they are just proxies for activity. I would guess that learning something that interests you is more important than what that thing actually is.
Spores formed by bacteria like C. botulinum or B. anthracis are also very difficult to neutralize. The key is knowing if there is an exposure risk and taking added precautions.
The good news is that some people are "immune" to developing an infectious prion disease. Turns out that certain mutations prevent normal proteins from interacting with a complementary prion in a way that would cause them to become misfolded.
The cyclicality of the nausea in your graph is interesting. Personally, I find cyclic vomiting syndrome is underdiagnosed and exists along more of a spectrum than generally assumed. As others have said, there is often overlap with migraine spectrum and central hypersensitivity. An underlying trigger such as a GI infection in predisposed individuals can 'turn up the volume' of normal enteric nerve signaling. This ultimately describes a lot of functional GI conditions.
With central hypersensitivity, chronic pain, chronic migraine, and cyclic vomiting, one of the goals becomes resetting the sensory nerve volume back to a normal level. Meditation, therapy, etc., can all have a role. Often, antidepressants are often used at lower doses since they modulate peripheral nerves too.
FWIW, you may want to ask your current primary or GI/neurologist about cyclic vomiting syndrome and whether to trial a TCA (first line treatment, amitriptyline has the most evidence)