#ARDS treatment

[drraviclinic]

Signs and Symptoms of Bronchitis

Chronic Cough: Lasts for at least three months a year for two consecutive years. Excessive Mucus Production: Ongoing production of mucus. Wheezing: Whistling sound when breathing. Shortness of Breath: More noticeable during physical activity. Frequent Respiratory Infections: Increased susceptibility to colds and flu.

DR. K. RAVI VISAKHAPATNAM CONTACT :9390398062

[wishesmsg]

Acute respiratory distress syndrome

Overview

Acute respiratory distress syndrome (ARDS) is a severe medical condition characterized by fluid buildup in the lungs that leads to difficulty breathing and reduced oxygen levels in the blood. ARDS typically occurs as a complication of another underlying medical condition, such as pneumonia, sepsis, or trauma. The exact cause of ARDS is not fully understood, but it is thought to involve an excessive inflammatory response in the lungs triggered by an injury or infection. This inflammation can cause damage to the alveoli, which are tiny air sacs in the lungs responsible for exchanging oxygen and carbon dioxide between the lungs and bloodstream. Symptoms of ARDS can include rapid breathing, shortness of breath, low blood oxygen levels, chest pain, cough, and fatigue. Treatment typically involves addressing the underlying cause of the condition, as well as providing supportive care to maintain adequate oxygen levels and prevent complications. This may include mechanical ventilation, supplemental oxygen therapy, and medications to reduce inflammation or prevent infection. ARDS is a serious condition that can be life-threatening, especially if left untreated. However, with prompt and appropriate treatment, many patients with ARDS are able to recover fully or improve significantly over time.

Symptoms

The symptoms of acute respiratory distress syndrome (ARDS) typically develop rapidly and can include: - Shortness of breath: This is often the earliest symptom of ARDS, and it can quickly progress to become severe. - Rapid breathing: Patients with ARDS often experience rapid breathing, also known as tachypnea. This is the body's natural response to low oxygen levels. - Low blood oxygen levels: A hallmark of ARDS is a drop in the level of oxygen in the bloodstream, which can lead to oxygen deprivation in the body's organs and tissues. - Chest pain: Patients with ARDS may experience chest pain or discomfort, especially during deep breathing or coughing. - Cough: A persistent cough is common in patients with ARDS, although it may not always be present. - Fatigue: ARDS can cause a general feeling of fatigue and weakness, which can be exacerbated by the difficulty breathing. If you experience any of these symptoms, it is important to seek medical attention immediately, as ARDS can be life-threatening if left untreated.

When to see a doctor

If you experience any symptoms of acute respiratory distress syndrome (ARDS), it is important to seek medical attention right away. ARDS is a serious condition that can be life-threatening if left untreated, and early diagnosis and treatment are critical for the best possible outcome. In particular, seek emergency medical care if you experience: - Severe shortness of breath that interferes with your ability to speak or move - Rapid, shallow breathing - Bluish tint to the lips or face - Confusion or altered mental state - Chest pain or tightness - Rapid heart rate If you have been diagnosed with an underlying condition that increases your risk of developing ARDS, such as pneumonia, sepsis, or trauma, it is important to monitor your symptoms closely and seek medical attention if they worsen or if you develop new symptoms.

Causes

Acute respiratory distress syndrome (ARDS) is typically caused by an injury or inflammation in the lungs that leads to fluid accumulation and reduced oxygen levels in the bloodstream. The most common underlying causes of ARDS include: - Pneumonia: This is the most common cause of ARDS, especially in people who are hospitalized. - Sepsis: Sepsis is a serious bloodstream infection that can lead to inflammation throughout the body, including the lungs. - Trauma: Severe injuries, such as those sustained in a car accident or a fall, can damage the lungs and lead to ARDS. - Aspiration: When food, drink, or other substances are inhaled into the lungs, they can cause inflammation and damage that can lead to ARDS. - Inhalation injury: Exposure to smoke, fumes, or other toxic substances can cause damage to the lungs that can lead to ARDS. - Drug overdose: Certain drugs, such as opioids, can depress the respiratory system and lead to ARDS. - Other underlying medical conditions: ARDS can also occur as a complication of other medical conditions, such as pancreatitis, burns, or transfusion reactions. It's important to note that not everyone who experiences these underlying conditions will develop ARDS, and some people may develop ARDS without an obvious underlying cause.

Risk factors

Certain factors may increase a person's risk of developing acute respiratory distress syndrome (ARDS), including: - Age: ARDS can occur at any age, but it is more common in older adults. - Smoking: Smoking can increase the risk of developing lung-related conditions that can lead to ARDS. - Chronic lung disease: People with pre-existing lung conditions, such as chronic obstructive pulmonary disease (COPD), may be more likely to develop ARDS. - Immune system dysfunction: Certain conditions that affect the immune system, such as HIV/AIDS, can increase the risk of developing ARDS. - Alcohol abuse: Excessive alcohol consumption can weaken the immune system and increase the risk of infection, which can lead to ARDS. - Obesity: Obesity can put additional stress on the respiratory system and increase the risk of developing lung-related conditions that can lead to ARDS. - Trauma: Severe injuries, such as those sustained in a car accident or a fall, can increase the risk of developing ARDS. - Certain medical treatments: Certain medical treatments, such as mechanical ventilation, can increase the risk of developing ARDS as a complication. It is important to note that not everyone with these risk factors will develop ARDS, and some people may develop ARDS without any known risk factors.

Complications

Acute respiratory distress syndrome (ARDS) can lead to a number of complications, including: - Multiple organ failure: ARDS can cause low oxygen levels in the bloodstream, which can lead to damage in other organs, such as the kidneys, liver, and brain. - Infections: People with ARDS are at increased risk of developing infections, such as pneumonia, as a result of their weakened immune system. - Blood clots: People with ARDS are at increased risk of developing blood clots, which can lead to complications such as deep vein thrombosis (DVT) or pulmonary embolism (PE). - Collapsed lung: In some cases, ARDS can cause a condition known as pneumothorax, where air leaks into the space between the lung and chest wall, causing the lung to collapse. - Psychological effects: People who have survived ARDS may experience psychological effects, such as post-traumatic stress disorder (PTSD), depression, or anxiety. - Long-term respiratory problems: Some people who have survived ARDS may experience long-term respiratory problems, such as difficulty breathing or reduced lung capacity. It is important to work closely with your healthcare provider to manage any complications that may arise as a result of ARDS. Read the full article

[hayatheauthor]

A Writer's Blueprint for Realistic Drowning Scenes

This guide is designed to help writers depict drowning scenes with authenticity and detail. I’ll walk you through the step-by-step process of drowning, the physical signs to look for and clear up some common misconceptions. With this information, you’ll have the tools to craft vivid, compelling, and believable drowning scenarios that will captivate your readers and add depth to your narrative.

Fair warning; this is a comprehensive and pretty explicit guide, so if you're uncomfortable with those topics, please just scroll away. 

The Stages of Drowning

1. Initial Entry

When a person first enters the water, especially unexpectedly, their initial reaction is often one of shock and panic. The sudden change in environment, temperature, and the feeling of being submerged triggers an immediate response from the body.

Shock Response

Cold Water Immersion: Sudden immersion in cold water can cause a cold shock response, which includes involuntary gasping, hyperventilation, and a rapid increase in heart rate and blood pressure.

Panic and Disorientation: The person may become disoriented and panic, struggling to stay afloat and breathe normally.

2. Involuntary Breath-Holding

As the person struggles to keep their head above water, they instinctively hold their breath to prevent water from entering their lungs.

Burning Sensation in Lungs

The buildup of carbon dioxide in the blood creates a burning sensation in the lungs, which intensifies the feeling of panic.

Increased Heart Rate and Blood Pressure

The body's stress response causes an increase in heart rate and blood pressure, further depleting oxygen reserves.

3. Uncontrolled Breathing

When the person can no longer hold their breath, the body's reflexes take over, leading to involuntary attempts to breathe.

Aspiration of Water

Water enters the mouth and is aspirated into the lungs, causing coughing, choking, and a strong gag reflex.

Coughing and Choking

The person may cough and choke as water enters the respiratory tract, leading to more panic and struggle.

Gasping for Air

The body's desperate attempt to get oxygen leads to gasping, but often results in inhaling more water.

4. Laryngospasm

The body's protective reflex to prevent water from entering the lungs can cause the vocal cords to spasm, temporarily sealing the airway.

Temporary Airway Closure

The laryngospasm closes the airway, preventing both water and air from entering the lungs.

Increased CO2 and Decreased O2

As carbon dioxide levels rise and oxygen levels fall, the person becomes increasingly hypoxic.

5. Loss of Consciousness

Due to the lack of oxygen, the person loses consciousness.

Hypoxia and Hypercapnia

Hypoxia (lack of oxygen) and hypercapnia (excess carbon dioxide) cause confusion, dizziness, and loss of motor control.

Fading Senses

Vision blurs, hearing diminishes, and the sense of touch becomes numb.

Blackout

The brain, deprived of oxygen, shuts down, leading to unconsciousness.

6. Cardiac Arrest

Prolonged oxygen deprivation leads to cardiac arrest, where the heart stops beating.

Cessation of Breathing

Respiratory effort ceases as the brain's control over breathing is lost.

Heart Stops Beating

The heart, deprived of oxygen, stops beating, leading to complete circulatory failure.

Brain Damage and Death

Without intervention, brain cells die from lack of oxygen, leading to permanent brain damage and eventually death.

7. Aftermath (if Rescued)

If the person is rescued and resuscitated, there are immediate and long-term consequences to consider.

Immediate Aftermath

CPR and First Aid: Immediate resuscitation efforts, including CPR and the use of a defibrillator if necessary.

Hospitalization: The person will likely need to be hospitalized for further treatment and monitoring.

Long-Term Effects

Lung Damage: Inhalation of water can cause damage to the lung tissues, leading to conditions like pneumonia or acute respiratory distress syndrome (ARDS).

Neurological Damage: Prolonged lack of oxygen can result in brain damage, affecting cognitive and motor functions.

Psychological Impact: Survivors may experience PTSD, anxiety, and a lasting fear of water.

Physical Appearance During Drowning

1. Initial Entry

Shock Response

Wide Eyes and Gasping Mouth: Eyes are wide open, and the mouth is often open in a gasp or scream.

Flailing Limbs: Arms and legs are moving rapidly in an attempt to regain balance and stay afloat.

2. Involuntary Breath-Holding

Tensed Muscles

Rigid Body: Muscles are tensed, and the body may appear stiff as the person tries to maintain control.

Strained Facial Expression: The face may show strain, with furrowed brows and tightly closed eyes.

3. Uncontrolled Breathing

Coughing and Choking

Reddened Face and Eyes: The face may turn red from the effort of coughing and choking.

Foaming at the Mouth: A frothy mixture of saliva and water may be visible around the mouth.

Gasping for Air

Open Mouth and Wide Eyes: The mouth is open wide in an attempt to gasp for air, and the eyes may be bulging with fear.

Erratic Movements: The person’s movements become more erratic and uncoordinated as they struggle to breathe.

4. Laryngospasm

Silent Struggle

Mouth Opening and Closing: The person may appear to be gasping silently as the airway is temporarily sealed.

Clenching Throat: Hands may instinctively clutch at the throat in a futile attempt to open the airway.

5. Loss of Consciousness

Limp Body

Floating Limply: The body becomes limp and may float face down or sink slightly below the surface.

Pale or Blue Skin: Skin may turn pale or blue (cyanosis) due to lack of oxygen.

Relaxed Facial Features

Closed Eyes: Eyes close as the person loses consciousness.

Slack Jaw: The jaw may go slack, and the mouth could be partially open.

6. Cardiac Arrest

Unconsciousness

Still Body: The body is completely still, with no voluntary movements.

Gray or Blue Skin: Skin color becomes ashen, gray, or blue, particularly around the lips and extremities.

7. After Drowning (Post-Rescue Appearance)

If the person is rescued, their appearance post-drowning can indicate the extent of their ordeal and the immediate aftermath.

Immediate Aftermath

Waterlogged Clothing: Clothes may be heavy and waterlogged, clinging to the body.

Coughing and Vomiting: The person may cough up water or vomit as they are resuscitated.

Shivering: If the water was cold, the person might be shivering uncontrollably due to hypothermia.

Long-Term Appearance

Bruising and Cuts: There may be bruises or cuts from the struggle in the water or the rescue process.

Pale or Blue Skin: Skin color might still show signs of cyanosis if oxygen levels are low.

Labored Breathing: Breathing may remain labored and shallow as the lungs recover.

Ways to Drown

Being Tied Down with a Stone

An ancient method where a person is weighted down with a heavy object, preventing them from surfacing.

Pulled Under by a Strong Current

Strong currents or rip tides can overpower a swimmer, pulling them away from safety and making it difficult to stay afloat.

Trapped Under a Capsized Boat

In the event of a boat capsizing, a person can become trapped underneath, unable to reach the surface for air.

Caught in Underwater Vegetation

Dense underwater plants can entangle a swimmer, restricting their movements and preventing them from surfacing.

Unable to Swim in Deep Water

Lack of swimming skills or fatigue in deep water can lead to drowning if the person cannot keep themselves afloat.

Falling Through Ice

Falling through thin ice can trap a person in freezing water, with the ice making it difficult to find an exit.

Getting Caught in a Riptide

A riptide can drag a swimmer out to sea, making it hard to swim back to shore due to the strong current.

Swimming Exhaustion

Overexertion while swimming can lead to exhaustion, making it impossible to continue treading water or swimming to safety.

Diving Accident

A diving mishap, such as hitting one’s head or getting disoriented underwater, can result in drowning.

Shipwreck

In a shipwreck scenario, a person may be stranded in open water, facing potential drowning due to exhaustion, exposure, or lack of flotation devices.

Common Misconceptions About Drowning

1. Drowning is Always Loud and Dramatic

Many people believe that drowning involves a lot of splashing, shouting, and waving for help. In reality, drowning is often a silent and quick event.

Instinctive Drowning Response: When a person is drowning, their body prioritizes breathing over waving or shouting. The struggle to get air means they can’t call for help.

Quiet Struggle: Drowning individuals might be bobbing up and down, with their mouths at water level, making little noise as they gasp for air.

2. People Always Recognize Drowning

It's a common belief that drowning is easily recognizable. However, many drownings go unnoticed until it’s too late.

Subtle Signs: Drowning can look like someone treading water or trying to swim. Signs can be subtle, such as bobbing up and down, head tilted back with mouth open, or eyes glassy and empty.

Misinterpreted Behaviors: Bystanders might mistake a drowning person for someone playing or simply floating.

3. Only Weak Swimmers Drown

Many assume that only those who can’t swim well are at risk of drowning, but even strong swimmers can drown under certain conditions.

Fatigue and Cramps: Strong swimmers can become exhausted, suffer from cramps, or panic, leading to drowning.

Environmental Factors: Strong currents, cold water, and underwater hazards can overwhelm even the best swimmers.

4. Drowning Happens Immediately

There’s a misconception that drowning happens instantly. While it can be quick, it often takes a few minutes for a person to drown.

Struggling Phase: The initial struggle can last for 20-60 seconds, during which the person is trying to stay afloat and breathe.

Silent Submersion: After this, they may silently submerge, often unnoticed.

5. Drowning Only Happens in Deep Water

Many people think that drowning only occurs in deep water. However, shallow water can be just as dangerous.

Shallow Water Drowning: Drowning can occur in as little as a few inches of water, especially with young children or if someone is unconscious.

Bathtubs and Pools: Many drownings occur in bathtubs, kiddie pools, or even buckets.

6. Life Jackets Are Only Needed on Boats

It's commonly believed that life jackets are only necessary when boating, but they are crucial in many other water-related activities.

Swimming and Water Sports: Life jackets provide essential buoyancy and can save lives in swimming pools, lakes, rivers, and during water sports.

Unexpected Situations: Wearing a life jacket can prevent drowning in unexpected situations, like sudden falls into water.

7. People Float After Drowning

A prevalent myth is that drowning victims float on the surface after they die, but this is not always the case.

Initial Sinking: Initially, a drowned body may sink due to the density of the tissues and lack of air in the lungs.

Later Floating: Bodies often float later due to gas buildup from decomposition, but this can take days.

8. Drowning Victims Always Look Distressed

People often think that drowning victims will look distressed or visibly in danger, but many can appear calm and quiet.

Passive Drowning: Drowning individuals may appear to be calmly treading water or just floating.

Lack of Visible Struggle: There may be no visible struggle, making it hard to identify the danger.

9. CPR is Ineffective After Drowning

Some believe that once a person has drowned, CPR cannot help. However, immediate CPR can be life-saving.

Restarting Breathing: CPR can help restart the victim’s breathing and circulation, buying crucial time until emergency services arrive.

Rescue Breathing: Effective rescue breathing can oxygenate the lungs and increase the chances of revival.

Resources

Books

"The Science of Drowning" by Sports Aid Intl

“It offers a significant departure from how drowning is traditionally treated by combining discussions about medical, prevention, and intervention issues.”

Link

"The Perfect Storm: A True Story of Men Against the Sea" by Sebastian Junger

A gripping account of the 1991 storm that hit the North Atlantic and the fishermen caught in its deadly grip, providing insights into the perilous nature of the sea and drowning.

Link

Articles

"Drowning vs Aquatic Distress" by Crunderwood

An article detailing the science of drowning + some interesting points.

Link to article

"Drowning Victim" by SLRG

How to identify a drowning person besides the typical flailing. 

Link to article

"Drowning Treatment" by WebMD

Guidelines and tips for healing/treating a drowning person.

Link to article

Websites

American Red Cross: Water Safety Tips

Provides extensive information on water safety, drowning prevention, and emergency response.

Link to website

National Drowning Prevention Alliance

A dedicated organization focused on preventing drowning through education, research, and advocacy.

Link to website

Centers for Disease Control and Prevention (CDC): Drowning Prevention

Offers statistics, prevention strategies, and safety tips to reduce the risk of drowning.

Link to website

Looking For More Writing Tips And Tricks? 

Are you an author looking for writing tips and tricks to better your manuscript? Or do you want to learn about how to get a literary agent, get published and properly market your book? Consider checking out the rest of Quillology with Haya Sameer; a blog dedicated to writing and publishing tips for authors! While you’re at it, don’t forget to head over to my TikTok and Instagram profiles @hayatheauthor to learn more about my WIP and writing journey! 

[beguines]

Following the philosophy of moral treatment, regimes of work were established in institutions for the insane so that the chances for idleness among these deviant populations would be minimised and the work ethic could be reinforced as part of the new, dominant approach to "care." Farms were to be attached to asylums to offer the opportunity for "the kind of regular employment which greatly helped to restore men's minds". However, while still stressing the therapeutic benefits of moral treatment, as the asylums grew in size, the work undertaken by patients became more orientated to the goals of the facility. Similar to prisons, inmates of asylums could be found "employed" in the asylum laundries, as farm labourers, and for undertaking other menial tasks within the institution. Thus, "work therapy" became an excuse for patients to be used as cheap labour for the smooth running of the institution. This would be a constant of inpatient existence until such establishments were phased out in the latter half of the twentieth century, with Brown commenting on psychiatric institutions in the 1970s that: "[h]ard work, faith in one's superiors and rule-following are taught, backed up with the wide range of threats available to hospital staff. Everything done to the patients is seen as something for the patients—'work therapy,' 'recreational therapy,' etc. Thus cheap labor on the wards and in 'occupational therapy' is obtained in the guise of help."

Bruce M.Z. Cohen, Psychiatric Hegemony: A Marxist Theory of Mental Illness

[covid-safer-hotties]

Also preserved in our archive (Daily updates!)

By Mary Van Beusekom, MS

New findings from two studies have tied use of the antiviral drug nirmatrelvir-ritonavir (Paxlovid) to a reduction in COVID-19 hospitalizations and death, as well as to faster resolution of symptoms and less use of healthcare resources.

Benefit seen only in older patients For the first study, published in Clinical Microbiology and Infection, a Medical University of Vienna–led research team compared the effectiveness of Paxlovid with that of the antiviral drug molnupiravir (Lagevrio)—and with that of not receiving an antiviral—against hospitalization and all-cause death from January 2022 to May 2023. Participants were adults with mild to moderate infections and one or more risk factors for severe illness caused by the SARS-CoV-2 Omicron variant.

"The oral antivirals nirmatrelvir-ritonavir and molnupiravir are the mainstay treatment for Covid-19 in non-hospitalised adults at increased risk of severe disease," the study authors wrote. "Both oral antivirals were approved at the time of the study period (2022/2023) for the treatment of non-hospitalised patients with mild-to-moderate Covid-19, but the current National Institute of Health guidelines favour nirmatrelvir-ritonavir over molnupiravir."

Of the 113,399 eligible COVID-19 patients in the retrospective cohort study, 10.7% received Paxlovid, 9.5% received molnupiravir, and 80.0% served as untreated controls. Over 96% of participants were previously infected with or vaccinated against COVID-19.

A total of 0.43% of Paxlovid recipients, 1.4% of molnupiravir users, and 1.13% of controls were hospitalized within 28 days (risk difference [RD], -0.7%; Paxlovid vs control RD, 0.26%). No Paxlovid recipients and 0.13% each of molnupiravir users and controls died.

The estimated risk of hospitalization was 0.57% in Paxlovid users and 1.09% in controls (adjusted RD [aRD], -0.53%). The estimated risk of death was 0.0% in the Paxlovid group and 0.13% in controls (aRD, -0.13%).

The number of patients needed to treat to prevent hospitalization and death was 190 in Paxlovid recipients and 792 in controls, respectively. These statistically significant aRDs were seen only among patients 60 years and older.

The estimated risk of hospitalization in the molnupiravir analysis was 1.36% in the molnupiravir group and 1.16% among controls (aRD, 0.2%). The estimated risk of death was 0.12% in molnupiravir recipients and 0.14% in controls (aRD, -0.01%).

"Among outpatients aged ≥60 years with Covid-19 in an Omicron-dominated era, treatment with nirmatrelvir-ritonavir was associated with a lower risk of hospitalisation and all-cause death within 28 days, albeit with wide confidence intervals and high numbers needed to treat," the study authors wrote.

"This finding was not observed in molnupiravir users and younger nirmatrelvir-ritonavir users. Future studies are needed to better define target populations that show greater benefit from treatment with nirmatrelvir-ritonavir," they concluded.

Proportion of patients seeking care slashed 73% The second study, a phase 2/3 randomized clinical trial published today in Clinical Infectious Diseases, also found protection against COVID-19 hospitalization and death in adults receiving Paxlovid and demonstrated a faster resolution of symptoms and lower use of healthcare resources compared with a placebo in high-risk patients.

The research was led by researchers from Pfizer, which developed Paxlovid. The drug was given to 977 symptomatic COVID-19 patients, while 989 were given a placebo, at 343 sites in 21 countries from July 2021 through December 2021, a Delta-predominant period.

Paxlovid significantly shortened the time to symptom relief (median, 13 vs 15 days; hazard ratio, 1.27) and resolution (16 vs 19 days; HR, 1.20) through 28 days and cut the number of COVID-related medical visits by 64.3% and the proportion of patients seeking care by 73.2%.

In total, 0.9% of Paxlovid recipients and 6.4% in the placebo group were hospitalized, for a relative risk reduction of 85.5%. Hospitalized Paxlovid recipients had briefer hospital stays, and none required intensive care or mechanical ventilation. Fewer patients in the Paxlovid group needed other COVID-19 treatments, and none died by 6 months, compared with 15 in the placebo group.

"The importance of having effective COVID-19 treatments such as NMV/r [Paxlovid] to reduce burden on healthcare systems, both ambulatory and hospital based, should not be underestimated," the authors wrote.

Study Links: www.clinicalmicrobiologyandinfection.com/article/S1198-743X(24)00508-1/fulltext

academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae551/7889107

[onddau]

So I was thinking about this incredible fanfic and totally had a vision. This story is super dark and has such a unique concept - I fell in love with it right away!!! It's called 'Happy Pills' by @malf0y101 . I really hope this gets more people to check it out cause it's so worth reading!

Summary

“A few years after the Second Wiz-arding War, a group of Slytherins is drafted into a rehabilitation program created by the Ministry of Magic and one of its determined interns--one of their former classmates and the familiar Golden Girl of Gryffindor. As their marks continue to cause physical and mental pain, the Slytherins undergo intense treatment in order to relearn everything about the Wizarding World and tackle the trauma of their Dark Marks.

And although they are apprehensive, they are also desperate for someone to simply care about them.”

[gaysie]

bad news for ozempic haters word on the streets (translational research community) is that GLP1r agonists are the new statins in terms of their wonderdrug potential and preclinically they’re really good at treating asthma, sepsis, ARDS, a host of autoimmunes and probably more and of course they’re the best diabetes drug to date which like obviously great that people have new treatment options but the cultural reckoning when they become even more ubiquitous is going to be crazy

[mellowscrolls]

morthal & markarth! :D

Morthal - Do you enjoy exploring dungeons and ruins? Why or why not?

Yes! An Emphatic yes! I use Skyrim as a relaxation game, and love poking through old crypts and ards. I think my favorite ruin is Folgunthur, it's usually where I find Meridia's Beacon, and it's also a Galdur's Amulet starter point. I always burn the corpse of the dunmer man (I forget his name) so he gets buried properly, and since I'm usually playing as Aldercaine (my ldb) his journal goes on my bookshelf. Overall I will take my time with every patch of moss, every carved dragon cult frieze, every stone. I love the detail.

Markarth - If you could rewrite one questline in Skyrim, which would it be?

The escape from Cidhna Mine needs a major overhaul and an ability to side with the Forsworn. The treatment of native peoples in the writing of Bethesda is atrocious, and the fact that forsworn still attack you after you rescue their king is stupid. And then they just what, all hide in Druadach Redoubt until the end of time? I need to see this on further. I will note I have similar sympathies to the Falmer. Why can't we help them, learn their language, trade with them? Treating a group of people, any group of people, as inherently more violent, savage, etc is just an infuriating part of Bethesda writing that keeps cropping up, and not as opinions of characters, but as opinion of writers and of narrative.

[inexplicifics]

Hello Inex! How are you doing on this fine (currently) Friday?

I was re-reading the AWAU again, got to the part where Triss tells Jaskier about her fixing the trials, and began wondering if you’d thought about how Warlord Geralt might react to learning about Aretuza’s treatment of their trainees? I feel like the White Wolf would be disapproving of them turning the majority of their students into eels for the sake of power, to say the least. Do you think he would ever make Aretuza (and presumably Ban Ard) change there ways?

Honestly I'm not sure Aretuza in the AWAU turns its failed graduates into eels. They might just send the girls who don't become sorceresses off to become lawyers.

That said, I have Plans for Ban Ard.

[whumpsoda]

Does Ard. recognize he probably won't keep a thrall as long as Darius because the difference between their styles of keeping them? Sure, Malak is well fed/dressed/gets basic enrichment. There's nothing to keep his mind sharp, his muscles in shape, or even anything to keep him actually enriched. He has them be basically turned to babies.

Whereas Darius' thralls get SOME Of that...I think tempers aside his thralls would last longer before they perish. There are things to keep them kind of sharp mentally. Muscles do get worked. Just enrichment isn't a thing. But I think the need to serve is taking place. And Darius is a bossy thing with lots of demands orders...

idk I might feel different later but rn these are just my random musings. 🤔💭 And every thrall is different...really, we're fighting bedsores with blisters here. 😬 (Love all the ocs btw and the story!)

Very sorry but this does sort of irk me, Adrastus strictly goes by they/them pronouns. Thank you.

(Ramble under the cut lmao)

Yes you are completely right on this!! Adrastus has gone through several thralls, not only due to lack of care but their tendency to get bored very easily. Malak is by far their favorite out of all the thralls they’ve had!

I do plan to show this at some point (if I can get myself to write…) but Adrastus is also not the greatest at taking care of their thralls. They keep Malak fairly incapable of doing most things for himself, but will occasionally forget or get distracted from taking care of him with his needs. This includes things like forgetting to bathe or feed him, and so on.

It does sort of help once they move in with Nevan and Darius as Adrastus tends to push some of that responsibility to Nevan, (not all of it of course) and even if he hasn’t been instructed to help he will if he notices Malak needs something.

I can’t wait to show more of how this treatment affects Malak once they’re out… I want to write predominately captivity stuff first though 😭😭

And yes Darius’ thralls do tend to last longer!! He’s had less than Adrastus has and for multiple reasons, the first being what you’ve said above.

Darius has less of a fondness for the conditioning process than Adrastus does. Adrastus has a lot of fun with it, while he more-so wants to get it over with and just get an obedient servant as quickly as possible. This means he wants to preserve and hold the same thrall for as long as possible to avoid having to repeat the process.

One thing though is just that while his thralls last longer than Adrastus, he of course greatly takes looks into account. If he deems his thrall unfit and losing their attractiveness, he is quick to get rid of them :(

I’m glad you’re enjoying the story!! Very very glad :3 and I love the way you think… what you’ve said here is so right :D

[drraviclinic]

Happy Dusserah DR. K. RAVI VISAKHAPATNAM CONTACT :9390398062

[kuripon]

silent watching stones

rating: explicit | Geralt/Jaskier | word count: 1.7k | cw: implied dub-con/non-con but it’s actually enthusiastic consent.

Written for the Possum’s Lair Winter Exchange, for @churchofpossum themself! Reviewed by @unremarkablegirl and @dapandapod

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The weather is turning faster than he thought it would. But it’s hard to keep track of time when one is blindfolded and bound in the back of a rickety cart. Jaskier’s not sure how much time has passed since he was captured. All he knows is that it’s cold and has only gotten colder. 

He’d been on his way to Ard Carraigh to meet with Geralt to make their way up to Kaer Morhen together. Unfortunately,  he’d been ambushed, captured, and bound like a simple cow before he could step foot into the city bounds.

The ropes chafe around his wrist. He would feel much better about this entire situation if he knew which direction he was being taken in, not that he ever had a great sense of direction in the first place. 

“Hello? Can anyone hear me?” Jaskier calls out, but the cart continues to move forward without any acknowledgement, rocking side to side. “I just want to know…” He trails off.

What’s the point of knowing anything at this point? What could he do with that knowledge? Send off a mental message to Geralt, some psychic plea for help? A mage, he is not.

Jaskier clears his throat, rough from days of little to no water. “Is anyone there?” Nothing but a hoarse whisper.

The clink of swords knocking against armor can be heard, and still there’s no answer. He falls silent, heart racing, and time passes. 

Some time later, the cart rolls to a stop. The doors open and he’s jerked from the back.

“Hey!” he yells, indignant at the harsh treatment, thrown carelessly like a sack of rice over someone’s shoulder. He tries to kick at whoever has him grabbed up, but his foot doesn’t make it very far. A grunt sounds in his ear as a hand wraps around his ankle and forces his legs still. The person under him starts walking, driving their shoulder into his gut. If he had something in stomach, he’s sure he’d have thrown it up by now. 

Jaskier can feel himself working up into a proper tirade when he’s suddenly dropped, his ass slamming against a rock floor.

“There’s no need for this! When I tell my witcher what you’ve done to me, how you’ve treated me, you’re going to regret it,” Jaskier claims, struggling against his ties. “Hell, as soon as I get out of these, I’m going to beat your ass myself!”

He hears a snort before everything goes black.

Read the rest on AO3

[beguines]

Revisionist historians of medicine are keen to interpret psychiatry's enthusiastic involvement in the sterilisation and mass murder of hundreds of thousands of people labelled as "mentally ill" during the Third Reich (1933–1945) as an aberration, a perversion of correct medical practice (see, e.g., Birley 2000; Burleigh 1994; Lifton 2000). The official line is forwarded that German psychiatry was progressive, humane, and on the cutting edge of mental health care and treatment until the Nazis came to power in 1933. Hitler's National Socialism then manipulated the institution for its own—ultimately genocidal—ends. Thus, it is argued that a "Nazification" of German psychiatry took place, where the appropriate medical values for the care and welfare of the patient were replaced by a fascist ideology. While there were a small minority of power-hungry, racist psychiatrists who were happy to follow Hitler's orders and send mental patients to the gas chambers, such scholarship suggests that most within psychiatry remained morally opposed to and critical of the regime. Certainly, this version of events is reassuring for workers in the current mental health system, yet it is far from the truth. Belatedly, established figures in German psychiatry such as Michael von Cranach have recently admitted that the psychiatric genocide was "not, as we liked to think in the first decades after the war, a small group of Nazi criminal doctors, but the majority and the elite of German psychiatrists." These seldom uttered admissions from within the profession echo the words of another psychiatrist, Frederic Wertham, who stated of the profession's activities during the Third Reich,

"The tragedy is that the psychiatrists did not have to have an order. They acted on their own. They were not carrying out a death sentence pronounced by someone else. They were the legislators who laid down the rules for deciding who was to die; they were the administrators who worked out the procedures, provided the patients and places, and decided the methods of killing; they pronounced a sentence of life or death in every individual case; they were the executioners who carried out or—without being coerced to do so—surrendered their patients to be killed in other institutions; they supervised and often watched the slow deaths."

"[H]ard though this may be to wrap one's head around," states Burstow, "psychiatrists can be reasonably theorized as architects of the Holocaust." This claim was supported by observers at the post-war Nuremberg trials, including Leo Alexander who stated that psychiatry's operations in the 1930s could be understood as "the entering wedge for exterminations of far greater scope in the political program for genocide of conquered nations and the racially unwanted."

Bruce M.Z. Cohen, Psychiatric Hegemony: A Marxist Theory of Mental Illness

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