It used to be the recommended practice to change your safeword every 90 days or so, but this is no longer the standard. It doesn't help much with safety and it just encourages users to pick bad safewords.

I have a friend who’s probably dealing with moderate malnutrition. They’ve been trying to get help for it, but there are several limiting factors:

1. Their regular doctor is busy for two more weeks

2. They have severe anxiety that stops them from doing phone calls (so they can’t call their insurance’s nurse hotline or use TTY) (and the last time they tried to get a friend to call for them, the hotline operator refused to speak to the friend)

3. When they tried to set up an urgent care telehealth/video call appointment, they were turned away

4. A hospital would be very dangerous for them (they have severe ME/CFS and cannot tolerate strangers in their environment for more than a handful of minutes, to say nothing of the COVID/Long COVID risk and their severe medical trauma)

5. They considered trying to see if the non-emergency fire department line would send people for a home visit to give a professional assessment, but that would also be very difficult for them and would definitely cause a crash

So they asked me to make a post for them, asking for advice on whether they should wait for that appointment in two weeks, or risk permanent decline for more immediate help. Here is some information on their situation:

Length of time with not enough food: off and on for about 2 years. Most recently, a year of not enough protein. Then starting in mid-August, they dropped to about 80% of their natural calorie intake - but they were also reduced to stuff that someone with severe ME/CFS can buy with food stamps and eat without help, like Doritos and cookies.

Symptoms that are maybe from malnutrition:
- Started a little under a year ago: wounds healing ridiculously slowly, becoming physically larger (especially the stomach) despite eating less, moderate loss of appetite
- Started a few months ago: muscle weakness
- Started after mid-August: significantly increased brain fog and fatigue

They figured out that the situation was serious a couple weeks ago and managed to get help buying takeout. So they’ve been eating somewhat MORE than their natural calorie intake for about nine days now, in stuff that actually has protein and stuff (like spaghetti in meat sauce). But… apparently “refeeding syndrome” is a thing? So that could be dangerous, actually…?

Our friend group doesn’t have anyone who knows what to do here. And, well, the US medical system is a dumpster fire. So we’re hoping we can crowdsource some advice from 1. medical professionals or 2. other disabled people who know what they’re talking about.

I guess the big questions are:
1. What are the risk factors for refeeding syndrome (and do they apply here)?
2. What should my friend do/be aware of?

If you’d be willing to boost, it would be appreciated! I’d like to try to get this post to escape containment out of this little corner of Fedi. Thank you.