#bone marrow biopsy procedure

[kingmanoncology]

Measure patient satisfaction through surveys and feedback tools, focusing on key areas like wait times, communication, and care quality. Enhance satisfaction by improving service efficiency, staff interactions, and personalized patient care.

[kdlmedtech]

Bone Marrow Biopsy Needles : Function in Hematology Diagnostics

Before we begin discussing the role of bone marrow biopsy needles in hematology diagnostics, we first have to understand what hematology diagnostics are. Hematology is the science or study of blood or blood-related diseases. The term is frequently associated with oncology.

In the medical field, hematology includes the treatment of blood disorders and malignancies, including types of hemophilia, blood clots, leukemia, lymphoma, myeloma, and sickle-cell anemia. To conduct hematology diagnostics, the doctors or oncologists use biopsy needles for bone marrow aspiration.

The bone marrow biopsy needle plays an important role in the procedure. Penetrate bone marrow tissue extracts a sample of bone marrow, which is further sent for analysis for various hematologic disorders. In this blog, we will focus on how bone marrow biopsy needles play a crucial role in hematology diagnostics.

How bone marrow aspiration needles help with overall hematology diagnoses

Sample collection

To collect a sample of bone marrow, it is important to use safe aspiration needles. The main function of the bone marrow aspiration needle is to collect bone marrow samples and send them ahead for further evaluation. The needle is insert into the hip bone of the patient under local anesthesia. Once the needle is insert, the bone marrow sample is collect through either aspiration or core biopsy.

Bone marrow aspiration

Bone marrow aspiration is the process of extracting liquid bone marrow contents, including blood, stem cells, and immature cells. The bone marrow biopsy needle is design in a way that allows for the safest possible extraction. The bone-marrow biopsy needle aspirates efficiently and provides accurate and valuable information about the diagnosis.

Bone marrow core biopsy

Along with bone marrow aspiration, the bone marrow biopsy needles are use to perform core needle biopsies that involve removing a small cylindrical portion of the bone marrow and then further sending it for evaluation. The bone marrow tissue extracted provides information about any abnormal cells, malignancies, or any other abnormality in the bone marrow tissues.

Read More : How to Choose the Right Biopsy Needle for Your Practice

Diagnostic evaluation

The bone marrow samples collect through the biopsy needles are sent to laboratories for meticulous tests and evaluations. These evaluations include examinations under a microscope, flow cytometry, and molecular testing. These evaluations further help in identifying the disease prognosis and making treatment decisions accordingly.

Research and clinical trials

Clinical trials and bone marrow research are ongoing endeavors for physicians, oncologists, and other medical professionals. Bone marrow biopsy trials are valuable for research purposes, and they can contribute to progress in the medical field in terms of novel diagnostic tools, therapeutic strategies, and biomarkers for hematologic disorders. The data collect from these studies and trials is further use to monitor a patient’s case and help in coming up with new and advanced treatments as well.

Conclusion

If you are looking for bone marrow biopsy needle manufacturers and suppliers who can supply the best quality biopsy needles for bone marrow aspiration and biopsy purposes, you can trust KDL. Our bone marrow biopsy needles are design to perform core needle biopsy and aspiration with the utmost safety. We believe in employing only the greatest quality because compromise is not an option in healthcare. Please contact us to discuss your requirements, and we will supply bone marrow needles accordingly. We look forward to connecting with you soon.

Source : Bone Marrow Biopsy Needles : Function in Hematology Diagnostics

[haemcares]

"Understanding Bone Marrow Biopsy in Dubai: A Comprehensive Guide"

When it comes to medical procedures, knowledge is your greatest ally. If you or a loved one is facing the prospect of a bone marrow biopsy in Dubai, it's essential to have a clear understanding of what to expect. This comprehensive guide will take you through the ins and outs of bone marrow biopsies in Dubai, from the procedure itself to the reasons behind it and the recovery process.

What Is a Bone Marrow Biopsy?

A bone marrow biopsy is a medical procedure that involves the extraction of a small sample of bone marrow and bone tissue from the hipbone or breastbone. This sample is then examined in a laboratory to assess the health of your bone marrow and blood cells.

Why is a Bone Marrow Biopsy Performed?

Bone marrow biopsies serve several crucial diagnostic and therapeutic purposes, including:

Diagnosing Blood Disorders: They help doctors diagnose and understand various blood-related disorders like leukemia, lymphoma, and anemia.

Monitoring Treatment: For individuals already undergoing treatment for blood disorders, bone marrow biopsies can track the progress of therapy and evaluate its effectiveness.

Assessing Bone Marrow Health: The procedure can also identify conditions affecting the bone marrow itself, such as infections or bone marrow failure.

The Bone Marrow Biopsy Procedure

Preparation: Before the biopsy, your healthcare provider will explain the procedure, discuss any concerns or questions you may have, and ask about your medical history.

Local Anesthesia: You will be given a local anesthetic to numb the area where the biopsy will take place. This minimizes discomfort during the procedure.

Biopsy: During the procedure, a small incision is made in the skin over the hipbone or breastbone. A special needle is then inserted into the bone to extract the bone marrow sample.

Sample Collection: The doctor collects a small amount of bone marrow and bone tissue. You may feel some pressure, but the local anesthesia should keep the pain minimal.

Aftercare: Following the procedure, you will be monitored for a short period. Most patients can return home on the same day.

Recovery and Follow-up

Recovery from a bone marrow biopsy is typically quick, and discomfort can be managed with over-the-counter pain relievers. You may experience some soreness at the biopsy site for a few days, but this should gradually subside. It's essential to follow your doctor's post-procedure instructions, including any restrictions on physical activity.

Conclusion

A bone marrow biopsy in Dubai is a valuable tool in diagnosing and monitoring various medical conditions. Understanding the procedure and its importance can help ease any anxiety and ensure that you or your loved one receives the best possible care. If you have concerns or questions about a bone marrow biopsy, don't hesitate to discuss them with your healthcare provider. Knowledge and open communication are essential for a successful medical journey, no matter where you are in Dubai.

[tomswifty-fr]

Last post got me thinking about horns and okay, people love to draw dragons with piercings through their horns and make accents with whitespace illusions of holes through the horns. I also do this, it looks badass, but horns are bone? They're alive bone? And I've been trying to figure out how to make it work that's not only "magic".

There are all kinds of crazy horn modifications out there that just do things to the keratin - dying, carving, tattoos, caps, getting stuff enameled or embedded in the surface, as well as surface-level piercings - but having something go through the horn itself is Hard Core. That's an extreme level of body modification. It's the kind of thing you have to seek out a specialist for, and vet them thoroughly. If surface level relief carving is getting an earlobe pierced, then an all-through horn piercing is like corneal tattooing or those guys who implant magnets in their fingers.

The procedure is performed with something like a biopsy needle, but larger, and involves plague magic to control pain and sterilize and shape the wound. Even with numbing, it hurts like hell and the infection risk is high. Since you can't just leave your marrow exposed to the air, the opening is fitted with something like a gauge made of bioceramic or, less ideally, a body-safe plastic. It's common for these to made to look like other materials, or to have a veneer applied after it heals.

Recovery is simplified by the fact that there's no open wound and no joint involved, but it still hurts a lot and has to be kept an eye on. This usually includes follow-up visits with the artist or a doctor to check for signs of infection and administer medicine or magic to promote bone healing. The worst-case scenario is finding a crack in either the horn or the gauge, since that means potentially bacteria inside, I emphasize, your bones. The patient may or may not be provided sealant or disinfectant to put around the edge of the gauge, but it's unclear whether these actually help.

Once it's healed, you can either leave it as a hole or put stuff in it. Rings are a classic, as are various dangly things and plugs with cool designs.

[five-rivers]

Checkerboard 2

Big chapter! I'm also changing the rating to M, because I realized that I was tormenting Rex a tad more than is really covered under T.

Warnings for this chapter: 'medical' abuse, torture, brainwashing, semi-detailed description of medical procedures, naked people

Let me know if there was anything important I missed.

AO3

.

Asleep was not the same as sedated or anesthetized.  

People who were asleep could still feel things.  Pain, especially.  That’s why slapping a person across the face woke them up.  They felt it.  It hurt them.  

But Rex couldn’t wake up.  He’d been told to sleep.  

So, when white hot pain splintered across his nerve endings, all his sleeping mind could do was come up with different scenarios for why he was being hurt.  Van Kleiss’s needle-fingers.  Hunter Cain’s special anti-EVO bullets.  Zag-RS’s nanite zapper.  No Face.  Just No Face.

(Years-old incidents he’d more than half forgotten but which still haunted his nightmares.  Memories of being small and soft and drugged, and White, and a man with a scalpel, and the buzz of electricity all over his body.)

Eventually, though, his dreams settled on a single, simple scenario.  Being locked in a small, dark box while long, sharp needles were pushed in from outside.  It was, after all, close enough to reality.  

.

In the observation area, Black Knight watched idly as the doctors took a thorough set of biopsies from Rex.  Broadly speaking, the medical sciences were not her forte.  She tended to operate on the opposite side of things.  But there was always something of a pleasure in watching people who truly knew what they were doing work.  Especially when it seemed that some days she was surrounded by nothing but incompetents.  

Didn’t they know better than to get attached to an asset?  Well, maybe she could forgive Holiday to some degree, the woman was a doctor, not involved in the business.  But White and Six… bad form, boys.  She shook her head, amused by her own train of thought.  

Dr. Donevsky removed a pinhead-sized sample of flesh from Rex’s chest, and the boy’s breath hitched, the first time his breathing had been anything but mechanically even.  

“Make note of that,” said Dr. Donevsky.  “Are we ready for the bone marrow sample?”

“Yes, sir,” said another doctor.  

“Nurses, turn him.”

They flipped him onto his front and swabbed clear the area near his hip they’d chosen for the puncture.  Dr. Donevsky took a long thin needle with an oddly-shaped cross-section and vial from one of the nearby trays and smoothly inserted it in one practiced movement.  

“Okay, then,” he said as he passed the sample off to another doctor, who began the process of splitting it for preservation and study.  “Good job, everyone.  Now, let’s get him fetal for the spinal tap.”

Black Knight was glad she’d had the pawns escort Caesar to his quarters.  Oh, that was mostly to give him time to think about his position, but from her experience, family members tended to get overly emotional about these sorts of things.  Irrational.  

Although, that could be fun, too, sometimes.  Still.  Better not to have any disruptions.  This looked like a very delicate process, despite the bruises that were blooming - and already fading - all over Rex’s skin.  It did take quite a bit of effort, not to mention special tools, to get through the skin and muscle of an EVO like Rex.  She would know.  She’d had more than a few medical examinations herself.

“That’s the last regular organ sample.  What time do we have?” asked Dr. Donevsky as they finished the spinal tap.  

“Two hours, sir.”

Dr. Donevsky paused, then nodded.  “How are we feeling about a nanite extraction?”

“I’d like to get a thorough sampling of those nanite nodules he has in his peritoneal, pleural, and pericardial cavities,” offered another doctor.  “Holiday always had theories about those, but never let us test any of them.”

“Don’t we all know it,” said Dr. Donevsky.  “Okay, let’s do that first, then we’ll do a minor generalized extraction - we’ll have to wait for Purgatory Base for a larger sample.  Dr. Smythe, can you prep the nanite imager?  Janice, the larger magna-scalpels, we’ll need bigger incisions for this part.  Karl, the Faraday jars.”

“Do you think we could take a brain sample at some point?  Just a small one…” said another doctor, wistfully.  “It’s so hard to find sapient EVOs.”

“At this point, we don’t want to do anything that might compromise its ability to cure other EVOs,” said Dr. Donevsky.  He tapped Rex’s thigh with the side of a scalpel.  “We know that all of this can heal without issue, based on previous injuries.  But brains are a different matter entirely.”

It wasn’t anything they didn’t know, but the doctors responded with a smattering of appreciative mumbles and got on with their work.

Black Knight wondered if it bothered them, to cut into flesh that didn’t bleed.  If the rapidity with which the incisions clotted and scabbed gave them an impression of an uncanny valley.  Probably not.  Rex was far from the only EVO they worked with, and far from the only one with superior self-healing abilities.  After all, nanites had initially been developed as a medical tool, even if the focus of the project had changed over time.  

Dr. Donevsky maneuvered one irregular clump of nanites after another into specially prepared and magnetized Faraday jars.  There was a chancy moment when one clump, removed from the pericardial cavity, spasmed, amoeba-like, reaching back towards Rex, but it was small enough, and Dr. Donevsky was fast enough, that it, too, was safely stored.  

“Woof!” said Dr. Donevsky.  “Well, I’m glad that’s the last one.  What’s the time?”

“One hour, sir.”

“Well.  Just enough for a very minor extraction.  Let’s pin him.”

The cuffs on the table weren’t robust enough to stop a conscious escape attempt from an EVO, but that wasn’t what they were for.  During magnetic nanite extraction, even heavily sedated EVOs tended to spasm.  

“Resonator?” said Dr. Donevsky, holding out his hand.  The devices had been loosely based on MRIs - which couldn’t be used medically anymore, with thousands of metallic nanites infecting everyone - but far smaller.  He dragged it over one of Rex’s legs, a silver film bleeding up out of his pores.  One of the scabs from earlier broke, a thin trickle of blood escaping while the nanites were otherwise occupied.  

A common complaint of Providence scientists was that magnetic extraction couldn’t be used as a true cure.  For one, complete extraction usually resulted in unsurvivable physical, internal trauma, as the magnets didn’t care about important organs that might be in the way.  For another, EVOs tended to have abnormal body plans that couldn’t survive without nanites.  White Knight was, in some ways, far more of an outlier than Black Knight and Rex.  The prevailing theories regarding his survival were that he either had an abnormally low nanite count to begin with, or Rex had done something with his nanites prior to the extractor being turned on.  

The doctors used another tool to collect the extracted nanites, avoiding Rex’s twitching fingers.  

“Time?” called Dr. Donevsky, once again.  

“Twenty minutes.”

“Okay, let’s get him wiped down and covered up for the boss.  She said she wanted to be here when he woke up.”

Black Knight had to smile a little at that.  She’d already been in the observation area for nearly two hours, and it wasn’t as if she’d never seen a naked person before.  But she had wanted to see Rex when he woke, so she walked down into the lab.  

“Director!” said Dr. Donevsky, smiling as he dried his hands.  “You’re just in time.  According to Dr. Salazar’s timeline, he should be waking up any minute now.”

Black Knight nodded.  “You were able to take all the samples you wanted?”

“Oh, yes, and then some,” said Dr. Donevsky, beaming.  “It’s been a long eight hours, but very worth it.  Of course, we’ll have to take more.  Test how things change over time, how the nanites respond to different stimuli…”

“Of course,” said Black Knight.  She’d been intimately involved in testing procedures for the original nanite project.  She knew how this worked.  “Send me your recommended testing schedule, so we can accommodate it with Rex’s field missions.”  Although, it would be some time before she approved a field mission for Rex.  She wanted to make sure he was secured before she let him out of sight.

“Yes,” said Dr. Donevsky.  “I’ll have it to you by the end of the day.  Now, I should tell you that with all of this, we’ve strained his nanites and body fairly severely, so he won’t be healing as quickly as he normally would.  If possible, I’d avoid sending him out for at least twenty-four hours.”

“I see.  That’s good to know.”

There was a movement from Rex, an exaggerated twitch, and Black Knight and Dr. Donevsky both turned to watch him.  

His eyes blinked open a moment later, staring flatly at the ceiling. Then he frowned.  “Hol-iday?” he called, his voice cracking in the middle.  Blue lines traced over the surface of the cuffs that the doctors had used to keep him still, and they sprang open.  The lifts on the table also engaged, lowering to a position it would be easier to get off of.  He raised a hand to his chest, and traced the line of an incision, his lips moving silently.  

"Hello, Rex," said Black Knight. 

Rex startled and flailed, sitting up suddenly then pretzeling himself around the tiny modesty towel a nurse had thrown over him. 

"Black Knight!  Hiiiiiiiiiii," he said, a furious blush working its way over his skin.  “I’m– I didn’t– What brings you to the– to the–”  His eyes darted around the room.  “Lab?  Today?”

“I’m here to see you,” said Black Knight, amused.  

“O-oh!  Do you– Do you, um, like what you see?”  The inexpert attempt at flirting was undercut by the obvious uncertainty in his voice.  

Black Knight stepped closer.  Sleeping aside, it was quite possible, even probable, that Caesar had lied to her, that Rex was not truly under control.  But if so, how well would Rex be able to hide it?

She put her hand under his chin and tilted up, so he would be forced to look her in the eye, then readjusted her grip so that her hand lay along the underside of Rex’s chin, her fingernails resting on the collar itself.  His skin was precisely the same temperature as hers, which was strangely pleasant.  The wonders of nanite-regulated homeostasis, she supposed.  

His expression started off startled, surprised, but gradually relaxed into something… strange.  

Once, when Black Knight was young, her family had a dog.  It was a rescue, a floppy-eared, soft-furred mongrel of no particular value or lineage.  It had never warmed up to her.  Her parents said that sometimes animals that had been abused were slow to trust, that she just had to be patient with it.  It didn’t, not in the five years they had it.  But sometimes she’d watched it with her parents, and with them it had often made a face awfully similar to this.  

The boy blinked up at her, slow and calm.  She could feel his breath, his pulse, fluttering under her fingers.  He turned his head and nuzzled into her palm.  

This alone would be good evidence.  Rex hadn’t been particularly inclined to affection with her before, and this level of docility was unprecedented, according to his file.  However…

She swept her eyes down his body, making note of injuries that hadn’t healed yet, lingering on the mottled bruises on his hip and leg, wrapping up to join bruising lingering around incisions on his abdomen.  They’d collected the nanites from the same side they’d taken the bone marrow sample from.  She hummed, contemplatively.  

“Black–  Ms. Knight, what… happened?  Why am I…?”  He trailed off, flexing one hand.  She wondered if a sample had been taken from there earlier, before she’d come to watch.  

She patted his cheek.  “Don’t worry about that, Rex, what matters is that everything is back to normal.”

He perked up.  “So, Six and Holiday are back?”

“I’m afraid not,” said Black Knight, displeased and letting it show in her voice.  

“Did something happen to them?  Should we–”

“Rex,” interrupted Black Knight, dropping her hand to Rex’s shoulder and drumming her fingers on his skin.  A deep divot, all that remained of the hole she’d put in him earlier, was only inches below her hand.  “You don’t need to worry about it.  Don’t think about it.  Don’t talk about it.”  

“I–”  He faltered.  “Okay.  Is, uh, Caesar here?  And–”  His voice cracked, “--can I get dressed?”

Ah.  There was her test.  “We can go see your brother.”  It might be a good object lesson to Caesar as well, insofar as that man ever learned anything.  “Follow me.”  She walked off, without a backwards glance.  She didn’t need a backwards glance.  As with most spaces in Providence where people might be moving expensive and delicate things around without clear sight lines, there were half-dome mirrors scattered all around the lab.  She watched Rex look around wildly, his earlier bewildered expression coming back full force.  Before she had gotten too far away, however, he levered himself up off the table, and, limping heavily, keeping the thin modesty blanket in place with one hand, followed her.  

His leg almost gave out beneath him twice before they left the room, and by the time he had gotten halfway down the hall he was pausing to rub his eyes or temples.  A headache from the spinal tap, most likely, possibly exacerbated by dehydration, anemia, or low blood sugar.  Nanites couldn’t fix everything, after all.  By the end of the hallway, he was using the wall to brace himself.  

The next hallway had a group of pawns passing through, and Rex cringed away from all of them, even though they didn’t do so much as look at him.  He showed the same behavior when humans passed by.  His mounting distress was evident even in warped reflections.

But he didn’t stop.  He didn’t complain.  He didn’t question.  He obeyed.  Not perfectly, perhaps, but you didn’t even get that from animals.

She led him around a little longer, to the point where she could tell he was on the verge of collapse.  It was enlightening for her to map out his limits.  White had never gotten so close.  He hadn’t even been able to fight Rex effectively when the boy was practically passing out from sleep deprivation.  

But it was time to bring him to Caesar.  She did, unfortunately, need Caesar’s cooperation, and there was no foolproof way to ensure his obedience.  Caesar was not, after all, an EVO.  

He could also, undoubtedly, undo whatever he’d done to Rex.  He was a risk, in more ways than one.  But she’d found that credible threats to family members generally were effective.  He just had to keep believing that she could and would kill Rex if he stepped out of line.  

Not difficult.  She could and would kill Rex if he became more troublesome than he was worth.  And even if he did manage to escape from Providence’s immediate control - from her immediate control - it would be oh-so-easy to turn the whole world against him.  She could ensure that he never knew a single moment of peace.  

She opened Caesar’s door.  Nothing in Providence was locked to her.  He was frozen in the middle of the room, obviously caught mid-pace.  

“Black Knight,” he said.  

“Dr. Salazar,” she said, smiling.  He’d been confined to quarters, and she was pleased to see it had worn on him.  His clothing was the same as it had been eight hours ago.  “I hope you’ve had a restful day.”  Rex was lagging.  She could have some fun.  

“Is Rex awake?” asked Caesar.  “If he isn’t following your orders to the letter– What I did just makes him like us, trust us.  He will follow instructions, but he won’t do it mindlessly, he’ll do it because he likes you.  You do understand the difference between that and the control we have over standard EVOs, don’t you?  Even I understand that.  You can’t punish him for not– Not being a robot.  He is under control.”

“Careful,” said Black Knight.  “What I do or do not do isn’t up for you to decide.”  Hearing Rex’s slightly labored breathing, she turned to the door.  “That being said…”

Rex stumbled into the room.  “Caesar!” he said brightly.  Then, his leg gave out.  Caesar caught him just before he hit the ground.  

“What did you do?” demanded Caesar as he maneuvered Rex onto his bed.  Rex whined and clutched at him, breathing shallow.

“When you made the effort to put him to sleep, we thought it would be best to give him a little checkup.  It has been six months, after all.”

Caesar’s eyes widened, and he looked over Rex’s body again.  Black Knight wondered how many of the marks he recognized.  They were fading unnaturally fast and Caesar wasn’t a medical doctor.  “You didn’t.  That command just puts him to sleep.  Asleep isn’t the same as anesthetized.  Did you have your maniacs operate on him without even painkillers?"

"We'll take your recommendations under advisement in the future, Dr. Salazar.  Assuming your work continues to produce results."

Caesar’s jaw clenched, and he stared up at her, even as he tried to wrap a blanket around Rex’s shoulders.  It wasn’t terribly effective.  Rex wasn’t sitting still.  “I always get results,” he said.

Black Knight raised an eyebrow, and he looked away.  

"For security reasons,” continued Black Knight, “we've restricted programming access to Rex's collar to a few select terminals.  However, we’ve made sure you can still access the data from it.  For monitoring purposes." 

“That’s generous of you,” said Caesar, still not looking at her.

Black Knight smirked, and stepped back into the doorway.  “You can catch up with each other while Rex’s room is being prepared.”

“Rex’s room?”

“You didn’t think he was going to stay here with you?  You only have one bed.  Where is he going to sleep?  The floor?  The pawns will come get him.  In the meantime,” she nodded at the camera in the corner of the room, “you’ll be monitored.  In case there are any health complications.”

“Thank you, Ms. Knight,” mumbled Rex, resting his head against Caesar’s shoulders.  

“You’re welcome, Rex.  I look forward to our new working relationship.”

.

Caesar had been locked in his room, which wasn’t something that had happened to him since that time he’d been put under house arrest for– Well.  That hardly mattered.  He’d been absolved of any wrongdoing.  And he’d been a teenager.  Teenagers didn’t have fully developed brains.  He was practically a different person, now.  

Anyway.  

He was locked in his room.  The few human agents still around had searched it before shutting him in, pulling out, well, just about everything except for his clothing and the computer built into the wall - and he’d been restricted from that by the expedient of shutting off its power from somewhere outside the room.  Not much he could do about that.  

But Black Knight couldn’t stop him from thinking, and Caesar flattered himself that his brain was his best quality.  It was certainly the muscle he exercised the most.  Well.  Metaphorically speaking.  The brain wasn’t actually a muscle.  

So, he paced and thought, paced and planned, paced and daydreamed, for a bit, even.  Something felt… wrong about sleeping or resting when he didn’t know what was happening to Rex.  Watching him being wheeled away by those doctors felt bad in a way that Caesar couldn’t qualify or quantify.  Not that he was ever very good with feelings.  

Hopefully, the uncertainty wouldn’t last long.  The Consortium needed him to complete their plans, and both he and Black Knight knew it.  She must also know that he wouldn’t cooperate without some assurance of Rex’s relative safety…  Well.  That was to say, although there were other ways they could force him to cooperate, as they had been before, to some degree, the quality of his cooperation would be poor.  

Once he had contact with Rex, again, he could…  He glanced up at the camera in the corner of his room.  They were everywhere.  Anything he did would have to take constant monitoring into account.  He couldn’t do anything direct.  Or, at least, nothing that was both direct and physical.  When he got his computer back, he could walk back the changes… walk back some of the changes.  Rex wasn’t very good at secrets.  Or discretion.  Or lying.  And he didn’t doubt that what he’d done had been logged and archived for study, and that any changes to what he’d altered would also be monitored, although there were plenty of ways around that.  Even here, very few people were fluent in the programming language used in the nanites.  

Something like a sneer flashed across his face.  Well.  To be accurate, rather than a few, the number was two.  Himself and Rex.  And in Rex’s case, his fluency was less because of study and understanding, and more because a large portion of his thought processes occurred in it.  

Anyway.  

Even if he wasn’t able to, though, Rex should be able to change his own code.  Change the numbers back to normal levels.  Should, if he noticed the discrepancies between what had been written in and reality.  There was a mechanism for that, one that should have worked even without Caesar removing the partition.  With the partition gone, it should happen all that much faster.  Should.  

Caesar wasn’t happy hanging so much on should.  

But that was why it was only a fallback plan.  Or… a bit more than a fallback plan, considering other precautions…

The important thing was keeping Rex alive.  As long as he could do that, then eventually they’d be able to get away, and once they got away, Caesar could fix anything that hadn’t already been fixed.  But until they were ready to escape, Black Knight couldn’t have any doubts about Rex.  

Maybe Rex had made a game of escaping from Providence before, but that Providence hadn’t doubted he’d come back.  As today had shown, he could be overwhelmed, and there was a lot of empty space between Providence HQ and the nearest town.  Lots of space to intercept him, to set up traps, or even to shoot missiles at him.  No.  They needed a better plan than just run.  

A plan that Caesar would come up with.  

His thoughts swirled in increasingly labyrinthine circles.  

Then Black Knight opened the door.  He recognized that as a power move on her part.  Showing she didn’t need to knock, ring the doorbell, or otherwise acknowledge his privacy in any way.  

“Black Knight,” he said.  For a moment, he wondered if he could activate his nanites through the sheer force of hate alone.  Preferably into something with laser eyes, so he could laser Black Knight’s face into oblivion.  

(Of course, laser eyes were very physically unlikely - On the other hand, Breach existed.  He was fairly certain she must be using some variant of Dr. Porter’s batch 3667 nanites, but who knows how they’d gotten to Greenville, Ohio in enough concentration to cause her, and then propagate enough to–)

(Well, that didn’t matter right now.)

“Dr. Salazar,” she said, smiling.  There was absolutely no warmth behind the expression, only poison.  “I hope you’ve had a restful day.” 

“Is Rex awake?” asked Caesar, hating how anxious he sounded.  Black Knight would use any weakness, but he had to know.  “If he isn’t following your orders to the letter–” He broke off.  That wouldn’t help.  That would sound like the exact opposite of what Black Knight wanted.  No good, no good…  “What I did just makes him like us, trust us.  He will follow instructions, but he won’t do it mindlessly, he’ll do it because he likes you.  You do understand the difference between that and the control we have over standard EVOs, don’t you?  Even I understand that.  You can’t punish him for not– Not being a robot.  He is under control.”

“Careful,” said Black Knight.  “What I do or do not do isn’t up for you to decide.”  She turned to the door, as if she had just heard something outside.  “That being said…”

Rex stumbled into the room.  “Caesar!” he said brightly.  

Caesar almost choked.  He almost inhaled his own tongue.  He did stop breathing.  

Rex was…  Well, first off, he wasn’t wearing anything but a tiny scrap of a towel.  He’d never walk around like that of his own accord.  In a bathrobe, yes, but like this?  Not a chance.  He had as an acute sense of embarrassment as any teenager.  But beyond that, his skin was mottled by fading bruises and striped with incisions.  

Precise incisions.

Surgical incisions.

Caesar was… Well.  Not exactly a pacifist, but he wasn’t the sort of person to resort to violence as a first option.  He was educated.  Rational.  Unemotional.  Although, again, that might be some variety of mental or psychological problem.  Even when Rex had told him that Van Kleiss had claimed he’d killed their parents, Caesar had merely made a mental note of their enmity, and resolved to do away with him at the first possible opportunity.  

He wanted to kill Black Knight.  Preferably painfully.  Preferably now.  Preferably with his bare hands.

Then, Rex’s leg gave out.  Caesar lunged forward caught him just before he hit the ground.  

“What did you do?” demanded Caesar as he maneuvered Rex onto his bed, trying to cover up his near slip and continuing bloodlust.  Rex’s breathing was shallow and pained, and he pushed into Caesar’s side as if he were trying to burrow under Caesar’s skin.

“When you made the effort to put him to sleep, we thought it would be best to give him a little checkup,” said Black Knight, carelessly.  As if she hadn’t had her pet monsters vivisecting Rex.  “It has been six months, after all.”

Caesar looked over Rex’s body again, cataloging injuries.  Then the implications of her words caught up with him and he reexamined the cuts and puncture wounds with new eyes.  None of them looked quite like what he’d come to expect from an IV.  

“You didn’t.  That command just puts him to sleep.  Asleep isn’t the same as anesthetized.  Did you have your maniacs operate on him without even painkillers?"  That would have been brutally agonizing.  Even if being asleep meant Rex didn’t remember…

"We'll take your recommendations under advisement in the future, Dr. Salazar.  Assuming your work continues to produce results."

He was going to kill her.

But his little brother needed him.  After all of this, he wouldn’t put Rex under any more risk.  Jerkily, he pulled up the comforter from his bed and tried to wrap it around Rex’s shoulders, give him just a little more privacy, but his hands were shaking hard enough that it just wouldn’t stay put.

“I always get results,” he ground out, finally.

Black Knight raised an eyebrow, and he looked away.  If he had to look at her smug face for even a second longer, he would snap.

"For security reasons,” continued Black Knight, “we've restricted programming access to Rex's collar to a few select terminals.  However, we’ve made sure you can still access the data from it.  For monitoring purposes." 

“That’s generous of you,” said Caesar, still not looking at her.

“You can catch up with each other while Rex’s room is being prepared.”

“Rex’s room?”  No.  No.  They weren’t going to take him away–

“You didn’t think he was going to stay here with you?  You only have one bed.  Where is he going to sleep?  The floor?  The pawns will come get him.  In the meantime, you’ll be monitored,” she said, as if Caesar didn’t know about the cameras.  “In case there are any health complications.”

“Thank you, Ms. Knight,” said Rex, sweetly, as if he were a grade schooler talking to a favorite teacher.  He shifted to rest his head on Caesar’s shoulder, his forehead, sticky with sweat and whatever horrible product he liked to put in his hair, against Caesar’s neck.

“You’re welcome, Rex.  I look forward to our new working relationship.”  And then she left.  

Caesar struggled to get his heart rate under control.  He was no use to Rex like this.  He was no use to himself, for that matter.  He just–

“Mmm,” said Rex, shifting to nuzzle Caesar’s neck.

Caesar went still.  Complex systems always had emergent behavior.  He hadn’t considered how altering numerical values in the relationship matrix might affect how Rex expressed affection directed towards individuals.

“Caesar?” 

Caesar could feel Rex’s lips moving against his neck.  “Yes, mijo?”

“Your nanites are weird.”

Oh, thank goodness, it was about nanites.  He hadn’t considered how changing Rex’s awareness of nanites might influence his behavior, either, beyond the obvious.  

He’d been operating under a lot of pressure, okay?

Caesar chanced a glance downward.  To his dismay, lines of blue light radiated from where Rex’s skin touched his.  

“Weird how?” asked Caesar. 

“Needs update,” mumbled Rex, shifting to lean more heavily on Caesar.  “Old.  They’re not– They’re not– locus h-sapiens two-seven-two-five Caesar Salazar primary composition b-two-two-three-seven-alpha, b-seven-two-five-two-delta, b-four-nine-nine-nine-omicron, b-four-seven-three-nine-beta.  Present nanos iterations of b-two-two-three-seven-alpha and b-seven-two-five-two-delta not compatible with present nanos iterations of b-four-nine-nine-nine-omicron.  Permission to update?”

Caesar had… underestimated how disconcerting it might be to hear Rex rattle off things like that.  It wasn’t quite how Caesar would have read those codes, but it was certainly understandable.  Caesar must have nanites from the first moments after the event in his body.  Over time, nanites outside the pod lab would have modified their programming.  It made sense that not all evolutionary paths would generate programming that meshed.

“Let’s let them sort themselves out for now,” he said.  It was unlikely that the different strains would learn to communicate with one another again without intervention, but they were capable of working around one another, at least.  “I think it’s more important that we get you some clothes, yes?”

“Oh,” said Rex.  “Oh, no.”  He pulled away from Caesar and practically cocooned himself in Caesar’s comforter.  “Oh, no,”  he repeated.  

“It’s okay, it’s okay.  I’ve got plenty of extra clothes.”  None of which would be quite Rex’s size, but better poorly-fitting clothing than nothing.  Which was what Rex was currently wearing.  

He got up and went to his closet.  He… didn’t really have a lot of sartorial variety, to be honest.  He thought this shirt might have shrunk in the wash, though…

“Caesar,” said Rex, voice muffled by the blanket.

On the other hand, he really just needed pajamas right now.  “Yes?”  

“What happened?”

Caesar paused.  There were a few things he could be referring to.  Or, that’s what Caesar would like to think.  In reality, those ‘few things’ were all one big thing.  But it was possible that he meant something else, something Caesar wasn’t thinking of.  “Can you give me some more context?” he asked.  “There have been a lot of things that… happened,” he finished, lamely.  

Rex shifted inside the blanket bundle.  “I was…  The incurable EVO…  The worm from the other day…  I’m sorry, it’s hard to think, I’m just–!”

“It’s okay,” said Caesar, “take your time, get your thoughts in order.”  He found a set of clean pajamas and set them on the bed.  “I’ve got PJs!”

Rex didn’t emerge, but Caesar could hear him mumbling, indistinctly.  “After I caught the worm EVO, I followed it back, under the truck, and I– I saw where you were putting collars on.  And I was upset?  I think?  I was angry?  But I don’t know why I was angry, I mean.  The collars are the right thing to do, aren’t they?  If you and Black Knight both think so.  I don’t know why I was angry.  I don’t know why I– I tried to destroy the– the machines?  I don’t know.  And then Black Knight, she–  I don’t understand what happened.  I feel like I’m– I have to be missing something, right?  I don’t know why she–  I mean, I tried to break the machine, but I must have done something else, because she stabbed me, and– and then you– and then–”  

Rex took several deep, if ragged breaths, then, slowly, pulled back one edge of the blanket so his head was free.  His eyes looked wet.

“I’m thinking about it,” he said.  “I’m trying to narrow down what it was, but it doesn’t make any sense.”

It didn’t make any sense, because what had been done to Rex was wrong.  Caesar couldn’t just say that, though.  “What are your options so far?” asked Caesar.

“One is that, um, what I did was really, really bad.  Worse than I think it is.  Thought it was.  You know what I mean.”

Caesar made a sound that he hoped was interpreted as encouraging.  He… really didn’t know what Rex meant.  

“Because I thought I didn’t need the- the, um–”  Rex’s hands emerged to trace the rim of the collar.  “And it sounded like she didn’t think so, either, before, but I did get angry like that, for no reason, so…  Maybe I did need it, and you needed to do that, to keep me from going on a rampage.  But… After?  Caesar, after–  It really hurt.  It still hurts.  And you don’t– You don’t do things like that without a reason.  You don’t hurt people like that without a reason.  So there’s got to be something I don’t remember.  So– So I need to know.  Caesar, did I–”  His voice broke.  “Caesar, did I hurt someone?  Did I hurt people?”

“What?  No, no.  Mijo, you didn’t hurt anyone.”

Rex’s hands fluttered over the edge of the blanket, uncharacteristically nervous.  “She stopped me?”

“No,” said Caesar.  “Rex, you didn’t do anything wrong.”

“But I must have.  You and Black Knight are good people.  You’re not like White Knight, or, uhm, Dr. Fell, or Van Kleiss.  You don’t hurt people for no reason!”

Being put on the same moral level as Black Knight was somewhat distasteful, but Caesar supposed he only had himself to blame for that.  On the other hand, he couldn’t help but be curious about part of Rex’s statement.  

“Who’s ‘Dr. Fell?’” 

“Oh!  He was the guy before Dr. Holiday.  He and White Knight tried to kill me when I first came here.”

There was so much to unpack there.  “He and White Knight?”  Why hadn’t Rex said any of this before?  Did he not trust Caesar?

Stupid question.  He'd seen the trust metric.

“Uh huh.  Kind of messed up that he was my boss, huh?  But Black Knight is definitely an improvement, because she wouldn’t hurt me for no reason.  So, there has to be a reason, but I don’t know what the reason is and… it’s kinda freaking me out.  Just a little.”

For a moment, Caesar wondered if Rex would figure out the inconsistency, the failure in his logic, the contradiction between program and reality, then and there.  For a moment, he hoped Rex’s long silence was him editing his programming.  

“Like, I know I’m kind of dumb about things,” continued Rex, looking up at Caesar, hopefully, “but you’re not, so, you know what I did, right?”  There was a faint rim of blue light inside Rex’s pupils, and Caesar wondered if the nanites inside Rex’s eye were projecting something onto his retina… If so, that was remarkably inefficient, when they could communicate directly with his brain.  

Caesar refocused.  He could examine Rex’s code later.  For now…  He glanced at the camera again.  Rex followed his gaze.  

“Do you want me to take care of it?” he asked.  “I could.  You’d think Providence would have better security on their cameras, but nope.”

“No, that’s okay,” said Caesar.  “What happened today was…  Black Knight is very… It’s important to her that her orders are followed.”

“Oh,” said Rex, nodding, “that makes sense.  So, it’s because I didn’t follow orders?”

“Yes,” said Caesar.  “The collar just… makes sure you do.”  Not entirely accurate anymore.  For the other EVOs, yes, the collars applied a continuous modification to their behavior, like how software stored on a flash drive might affect a computer it connected to without the computer itself ever containing that software.  Rex’s programming wouldn’t allow something like that.  For Rex, it only provided a wireless connection to his nanites, and the modifications that could be made were limited.

“Oh,” said Rex, sounding dazed.  “That… makes sense?”

“Yeah,” said Caesar, “yeah, that makes sense.  Now will you put on some clothes?  You’re in my bed.”

“Oh, yeah.  I guess so.  I guess– I guess so.  I want to– It’s cold.”

“That’s why you need to put on clothes, mijo.”  He pushed the pajamas closer to Rex.  

“Alert, locus h-sapiens one Rex healthstat abnormal,” mumbled Rex as he pulled the pajamas under the blankets.  “Processing healthstat report to topadmin.”

“What’s that?”

Rex continued to mumble.  “Processing, processing, topadmin unavailable?  Processing…  Initializing program three-six-seven-four-three-eight-one-three-eight-three-seven-nine-eight-four-four-six-four– No, no, no, abort, abort– Healthstat abnormal?  Abort, abort, file report– healthstat report data storage full?”

“What do you mean your report storage is full?”  

“It’s full, it’s full, it’s full.  I don’t know.  Keeps trying– Abort program, going to quarantine–  What were we talking about, bro?”

Caesar considered pushing, but…  “Just getting you dressed.”

“I’m dressed.  I am dressed.”  He swung the blanket back to show Caesar, but quickly wrapped himself up again.  “Caesar, I think something’s wrong with me.  I’m thinking… wrong.  It’s wrong.”

“Hey, hey.  It’s okay."  Caesar sat down on the edge of the bed gingerly.  "You’re just adjusting.  You’ll figure it out in no time.”

Rex leaned against Caesar’s shoulder.  However, to Caesar’s relief, this time there were no blue lines on his skin.  “Really?”

“Yeah,” said Caesar, and even he was aware of how hollow his words sounded.  “Really.”

.

Rex woke slowly.  He didn’t want to wake up.  His whole body hurt.  It had been a while since he’d gotten this beaten up in a fight.  Or maybe he was sick?  That’d explain why he was on one of the examination tables.  

{running healthstat review.  processing…}

He shifted, not quite aware of the motion until he came up against the table restraints.  Holiday only used those if she absolutely had to, like during a nanite extraction.  Was he at Purgatory Base?

{processing… alert: locus-hasapiens1-REX healthstat abnormal. processing healthstat report to topadmin.}

He opened his eyes, and blinked against the light.  The ceiling was Providence HQ.  Holiday’s lab.  

“Hol-iday?” he called.  His voice cracked.  

{processing… processing… topadmin unavailable.  processing… initializing program 36743813837984464…}

That wasn’t one of the normal health and wellness maintenance programs, or the emergency repair programs.  He briefly dipped into the code for program 36743813837984464 and tried to trace the individual commands, but most of them were number codes that weren’t well filed in the system and…

What?  How did he have…  He’d never…  He’d have to review this when he was more awake.  Maybe talk to Holiday about it.  For now…

{abort initialization of program 36743813837984464.}

{confirm instruction: abort initialization of program 36743813837984464.}

{abort initialization of program 36743813837984464.}

{initialization of program 36743813837984464 aborted.  query: file healthstat report for later delivery to topadmin.}

{file healthstat report.}

{error: healthstat report data storage full.  recommend running program 36743813837984464. query: action.}

{standby.}

No, wait, he should probably get out of these restraints, first.  It sounded like Holiday must’ve stepped out, or whatever.  He told them to open up, and while they were at it, to lower the table lifts, so that when he was ready he could get down.  But…

He’d gotten distracted, but he really didn’t feel well.  His skin felt… he felt…  He was cold.  

He raised a hand to his chest.  There was something pinching here… Everywhere, really.  He traced a weird ridge of skin.  What was that?  A scar?  But he never–

He wasn’t wearing any clothes.  That was weird.  Holiday hardly ever had him take off his clothes.  What had happened?

"Hello, Rex," said Black Knight. 

Que–

He sat up, trying to cover himself, because that was way too close.  Way, way too close.  Holiday was one thing - she  was his doctor and basically his mom (and that was a thought he would unpack later) - but Black Knight?  He respected Black Knight, and he did not want her to know what he looked like naked.  

Oh, thank goodness, he had a modesty towel.  

"Black Knight!  Hiiiiiiiiiii," he said, skin prickling with cold heat.  “I’m– I didn’t– What brings you to the– to the–”  He looked wildly around the room, as if he didn’t already know where he was.  “Lab?  Today?”

“I’m here to see you,” said Black Knight.  

“O-oh!  Do you– Do you, um, like what you see?”  Yikes, that was an awful line, even he knew that, and why the heck was he flirting?  He was so stupid.  He couldn’t even look her in the eye, oh gosh.

He was forgetting something.  What was he forgetting?  Something about why he was lying here, something about Black Knight…

Black Knight stepped closer, and Rex tensed, his whole body seizing up.  He was– He was– Why was he reacting like this?  It was just Black Knight.  Black Knight.  {identify: user-BLACKKNIGHT.  status: recognized.  trust 100.  relación 100.  rely 100.} 

She put her hand under his chin and tilted it up.  He met her eyes, surprised.  

{detected: user-BLACKKNIGHT (priloc: b4740-EPSILON, locus: hsapiens2-BLACKKNIGHT).  alert: ping not returned.}

Her fingernails tapped the collar around his neck.  The– The collar.  

Right.  

Okay.  

He remembered now.  Sort of.  Maybe?  What he remembered didn’t make sense.  Couldn’t make sense.  

Black Knight was nice.  She wouldn’t just stab him, would she?  No.  She was nice.  

And… this was nice, actually.  This was nice.  People didn’t really touch him, usually.  Not outside of, like, emergency situations.  Six and Holiday were exceptions, but for Six it was training, and for Holiday it was medical stuff… and maybe a few hugs here and there.  Caesar could maybe be an exception, too, but Rex didn’t always know where he stood with Caesar… or he didn’t, it was different, now.  

{identify: user-CAESARSALAZAR.  status: recognized.  trust 100.  relación 100.  rely 100.} 

That was nice. 

Black Knight’s nanites were weird, though.  

{detected: user-BLACKKNIGHT (priloc: b4740-EPSILON, locus: hsapiens2-BLACKKNIGHT).  alert: ping not returned.}

Rex could detect them easily enough, but it looked like they couldn’t receive contact from other nanites.  That made sense from a security standpoint.  Much harder to be hacked if you could only talk to yourself.  But it must be so lonely… that was sad… Black Knight was nice, he didn’t want her to be lonely.  And she was being so nice to him…

This was nice.  

The… touching?  The holding.  He didn’t know what to call it.  

It was nice.  

Black Knight wouldn’t stab him for no reason.  That was a fact.  She was too nice.  

“Black–  Ms. Knight, what… happened?  Why am I…?”  He trailed off.  There was a weird kink in his one hand, and he flexed his wrist, hoping to get rid of it.  

Black Knight patted his cheek with her other hand.  “Don’t worry about that, Rex, what matters is that everything is back to normal.”

Normal.  What was normal?  Wait, for Providence, normal was–  “So, Six and Holiday are back?”

“I’m afraid not,” said Black Knight, tone…  What was that tone?  It was negative.  Was she disappointed in him?  Somehow?  No, that didn’t make sense.  All he’d done was ask a question, which, yeah, would have been enough for White Knight, but Black Knight was different.  She was more like Six and Holiday.  Somehow.  He couldn’t put his finger on how.

But what else was there to be negative about?  Unless–

“Did something happen to them?  Should we–”

“Rex.”  Black Knight dropped her hand to Rex’s shoulder and drummed her fingers on his skin.  There was one of those places where his skin felt weird just a few inches lower on his torso, on both side.  Wasn’t that where she had stabbed him?  There must have been a good reason for that.  “You don’t need to worry about it.  Don’t think about it.  Don’t talk about it.”  

“I–”  He faltered.  He could do that.  He could.  No reason for her to be disappointed.  No need for… for whatever had happened right before Caesar put the collar on him.  Speaking of Caesar…  “Okay.  Is, uh, Caesar here?  And–”  His voice cracked, “--can I get dressed?”

Black Knight looked happy.  “We can go see your brother.  Follow me.”  

Oh.  No… no clothes then?  Normally, he’d make himself obnoxious over something like this - it was how he’d managed to get White Knight to let him have real clothes, once upon a time - but… he didn’t want to bother Black Knight like that.  She was too nice.  

She must have just not heard him, that’s all.  

He pushed himself off the examination table, and hissed as his legs almost gave out under him.  He caught himself on the table.  

{alert: locus-hasapiens1-REX healthstat abnormal. processing healthstat report to topadmin.  processing… processing… topadmin unavailable. processing… initializing program 36743813837984464…}

{abort initialization of program 36743813837984464.}

{confirm instruction: abort initialization of program 36743813837984464.}

{abort initialization of program 36743813837984464.}

{initialization of program 36743813837984464 aborted.  query: file healthstat report for later delivery to topadmin.}

{no.}

Oh, crud, where did Black Knight go?

{tracking… program 226372192824 running…}

Right, right, the security cameras.  He’d…  Forgotten wasn’t the right word, here, was it?  He hadn’t forgotten, but he hadn’t known?  But he had known.  But he hadn’t?  There were definitely times a nanite-assisted link to nearby security cameras would have been helpful, and he hadn’t used it, but he’d had versions of this program going way back.

There was very much something wrong with him.  And he wasn’t just talking about his skin and muscles and bones.  

Although, he would very much like to know what was wrong with his skin and muscle and bone.  This was the first time he’d really looked down at himself since he woke up and…  Well…  Getting injured was pretty normal for him.  Being injured, staying injured, that was something else.

{locus-hsapiens2-BLACKKNIGHT located.}

He pushed himself to his feet, did his best to make sure the modesty towel covered him, and walked, limping, after Black Knight.  

Now that he was more awake, more aware, it felt like everything was jumping out at him, everything was… loud.  No, that wasn’t the right word.  Bright?  No.  The things he was feeling with his nanites, they all felt new, but that was wrong.  

He’d gotten sensory overload before.  Not often.  That’d be a liability in the field.  But in the beginning, when he’d first come to providence, he’d had trouble.  He was having similar trouble now.  The cameras, the other electronics, the people, the sounds, the sights, the– everything.  It was amazing and beautiful and terrible and just too much.  Too much input.  He could deal with this input.  He had been dealing with this input.  But now, it was like he’d forgotten how.

He kept getting distracted, or overwhelmed, so he set up a quick and dirty program to ping him whenever Black Knight got too far away, to remind himself that he did actually need to follow her.  

Or did he?  Couldn’t he just tap into Providence’s network and find out where Caesar was?  Then Black Knight wouldn’t have to waste her time… but he liked spending time with her…  Caesar might like to spend time with her?  But he didn’t want to waste her time…  She was so nice doing this.  

A group of pawns passed and he flinched away.  A muscle in his shoulder seized painfully.  They’d passed other groups of pawns.  Had he done the same thing, then?  The pawns felt…  They didn’t have as many nanites as they should, and no locus numbers.  Had Providence figured out a way to do nanite extractions from non-EVOs?  For Rex, the only reason nanites could be safely extracted from him was because the remaining nanites would fix the damage.  What had happened to White Knight had been weird.  

All of this was weird.  

How had Rex gotten so hurt, anyway?  He kept coming back to that.  He only really remembered Black Knight stabbing him.  Had something else happened afterwards that he didn’t remember?  It must have been really bad for him to be so beaten up.  An EVO getting loose, maybe?  Or…

Hm.  

He didn’t like this.  

Probably not an EVO, unless someone in the room had gone EVO.  All the EVOs in that area had been fairly well restrained, and the collar machine was good at its job, from what Rex had seen.  EVOs also tended not to go after people who were already down when there were people moving around and shooting at them.  That was true to the point where civilians were sometimes advised to play dead during EVO attacks.  

Unless he’d still been awake and had just blacked out?  His memory of the event was blurry.  

What were the other options?  

He didn’t really understand why Black Knight had stabbed him in the first place.  Logically, she wouldn’t have stabbed him without a reason.  What could the reasons be?  What were the reasons that he would stab someone he cared about?  

That was easy.  If they went EVO and he had to stab them in order to cure them, or hurting other people.  Was that what he was forgetting?  Had he gone on a crazy rampage and… and…  

Freak out about that later.  What was he doing now?  Looking for Caesar’s room.  He should do that.

Oh.  They were pretty close to Caesar’s room already.  

He hurried to catch up.  

“... being said…” He overheard Black Knight say right before he stumbled into the room.  

And Caesar was there!  Caesar was great.  He loved Caesar.  

“Caesar!”

Caesar didn’t look nearly as happy to see him as he was to see Caesar.  Oh no, he really had gone on a rampage.  And the injuries…  He must have gotten them while they were trying to contain him.  That was probably also why Black Knight had been so insistent on the collar.  

That… that made sense, right?  There was something about the order of things, but he couldn’t quite–

His leg gave out.  

Maybe he should have expected it, but he didn’t have any practice at being injured.  Being an amnesiac had given him a unique perspective on learning things, if nothing else.  Sometimes people thought there was something everyone just ‘knew,’ but most of the time it was just something they’d learned when they were young, or learned bit by bit over time just by living.  Sometimes Rex did know those things, but…  Not always.  

Caesar caught him.  

He did still like him!  Thank goodness.  He was worried.  He was really worried.  He was–

“What did you do?” demanded Caesar.

That’s what Rex wanted to know!  But, he realized as Caesar helped lift him and got him onto the bed, maybe he wasn’t talking to Rex.  

That’s… that’s good.  It sort of hurt to breathe right now.  When had he gotten so out of breath?  Walking?  Had he not been paying attention while walking?  He hadn’t… This is what he meant by being practiced at being injured.  

“When you made the effort to put him to sleep, we thought it would be best to give him a little checkup.  It has been six months, after all.”

Oh!  That was thoughtful.  It hadn’t been six months for him, though.  If they’d asked, he could’ve told them that his last checkup was–

“You didn’t.”  Rex startled at how angry Caesar sounded.  “That command just puts him to sleep.  Asleep isn’t the same as anesthetized.  Did you have your maniacs operate on him without even painkillers?" 

Command.  What command?  A command for Rex?

He searched through his command history, looking for anything Caesar might have done…  There!  He’d used the emergency medical commands to tell him to go to sleep.  That was clever.  That was good.  He’d probably stopped him from hurting anyone.  But why did Caesar sound so angry about it?

"We'll take your recommendations under advisement in the future, Dr. Salazar.  Assuming your work continues to produce results."

Of course Caesar’s work would continue to produce results.  It was Caesar.  He was, like, the smartest person ever.  Except maybe for Holiday, but honestly, they seemed smart in different directions, so maybe that evened things out?

But Caesar was angry.  Not at Rex.  Maybe?  Probably.  Angry at Black Knight?  Why would anyone be angry at her?  Angry at… the doctors?  Okay.  Okay.  That made sense.  Sort of.  Why was he angry at the doctors?

“I always get results,” Caesar told Black Knight.  

He was angry at the doctors… because of Rex’s checkup?  Did they not do something right?  Anesthetized, he’d said.  Rex wasn’t anesthetized.  

He’d been avoiding thinking about it, but that dream he’d had…  He thought he’d gotten all of this in some kind of fight, but…  Wow.  There must have really been something wrong with him, for them to do all this as a checkup.  

(He didn’t know what he’d done wrong, but the thought of it was really starting to scare him.)

Program 36743813837984464 tried to start up again, and he aborted it again.  Maybe he should quarantine it or something.  

"For security reasons,” said Black Knight, “we've restricted programming access to Rex's collar to a few select terminals.  However, we’ve made sure you can still access the data from it.  For monitoring purposes." 

“That’s generous of you.”  Caesar still sounded angry.  

“You can catch up with each other while Rex’s room is being prepared.”

“Rex’s room?”

Oh, good.  Even though it was silly, Rex had been worried he’d be camping out in the bathroom or something.  

“You didn’t think he was going to stay here with you?  You only have one bed.  Where is he going to sleep?  The floor?  The pawns will come get him.  In the meantime, you’ll be monitored.  In case there are any health complications.”

“Thank you, Ms. Knight,” said Rex.  He let his head fall to Caesar’s shoulder.  

{detected: user-CAESARSALAZAR (priloc: b2237-ALPHA, locus: hsapiens2725-CAESARSALAZAR). alert: locus-hsapiens2725-CAESARSALAZAR is experiencing performance errors due to nanOS version discrepancies. query: action.}

“You’re welcome, Rex.  I look forward to our new working relationship.”  She turned away and went out the door, but Rex was already focused on this new problem.  

What was wrong with Caesar?  He sometimes got messages like this, mostly in incurables, but…  He adjusted his position for better contact with Caesar’s nanites and sent off a series of pings and data requests.  He didn’t want this to be a sign Caesar was going to go EVO.  

{locus-hsapiens2725-CAESARSALAZAR b2237-ALPHA pop: ping returned. processing data…}

{locus-hsapiens2725-CAESARSALAZAR b7252-DELTA pop: ping returned. processing data…}

{locus-hsapiens2725-CAESARSALAZAR b4999-OMICRON pop: ping returned. processing data…}

{locus-hsapiens2725-CAESARSALAZAR b4739-BETA pop: ping returned. processing data…}

And on, until he got down to a handful of tiny nanite populations that were still registered to other nanite loci.  Mostly lsativa98601245001.  Lettuce.  He must have had a salad, earlier.  Or a sandwich.  Cooking and baking - not to mention microwaving - killed off a lot of nanites.  Far from all of them, but…

… Actually, didn’t that mean that sooner or later, there wouldn’t be anymore nanites?  Between Rex extracting nanites when he cured people, Providence taking nanites from him, people cooking things…  Just from attrition, the number should be going down…

No, came the answer, as if he’d thought just this thing before.  Some nanites have self-replication abilities.  And, of course, some of nanites might evolves those abilities through recursive programing and self-modification, which was something the scientists involved in the nanite project were trying to keep from happening…

“Caesar?”

Caesar could feel Rex’s lips moving against his neck.  “Yes, mijo?”

“Your nanites are weird.”

“Weird how?” asked Caesar. 

“Needs update,” mumbled Rex, shifting to lean more heavily on Caesar.  “Old.  They’re not– They’re not– {locus-hsapiens2725CAESARSALAZAR primary composition b2237-ALPHA, b7252-DELTA, b4999-OMICRON, b4739-BETA. present nanOS iterations of b2237-ALPHA and b7252-DELTA not compatible with present nanOS iterations of b4999-OMICRON.  query: permission to update.}”

Caesar looked at him like he’d said something weird.  Rex tried to communicate that this was important and that Rex was worried about him, but it didn’t look like it got across.  Or maybe Caesar didn’t trust Rex?  Because of… the thing.  The thing that had happened.  The one that Rex didn’t know about.  

Should Rex… ask about it?  He was hesitant.  He didn’t understand what had set everything off in the first place.  

“Let’s let them sort themselves out for now,” Caesar said.  He didn’t sound mad, now.  More… resigned?  Surprised?  Afraid?  “I think it’s more important that we get you some clothes, yes?”

“Oh,” said Rex.  He blindly grabbed at Caesar’s blanket and wrapped himself up.  “Oh, no.”  He couldn’t believe that Caesar was seeing him mostly naked.  Although, maybe Caesar had already…?  He’d been a teenager at least when Rex was a baby…  But– “Oh, no,”  he repeated.  He didn’t remember that and didn’t need to remember that.  

“It’s okay, it’s okay.  I’ve got plenty of extra clothes.”  

Through the security camera, Rex watched Caesar go to the closet and start picking through his clothing.  Caesar really was…  Rex just didn’t deserve Caesar.  

He used the security camera to start picking through the security feeds of the whole complex.  Maybe he could get video of the… of everything.  If he just traced back where he–

Oh.  

He watched the video that had been logged just a few hours ago, in the lab.  The one where Dr. Donevsky cut–

He didn’t want to watch this.

How would– Why would– Did Black Knight– Caesar?  No, Caesar had been in here, pacing.  Caesar had been mad about the lack of anesthetic, hadn’t he?  Black Knight wasn’t, but there had to be a reason, there had to be.  That was the only way this would make sense.  

He could keep going through the security footage but–

“Caesar.”  It was better to ask his brother instead.

“Yes?”  

“What happened?”

There was a long pause, and Rex once again worried that he’d said something wrong, something bad, and he hadn’t even realized it.  There had to be some kind of- of processing problem.  Something wrong with his programming or his brain, for him not to be able to just tell.  

Maybe that was the real reason Providence wanted to keep him locked up, all these years.  The one time he’d tried to leave them for real, he’d almost helped ZAGRS cause the apocalypse, after all.  There basically had to be something he was missing.   

“Can you give me some more context?” Caesar asked, and he didn’t sound mad.  He didn’t sound mad, that was good.  He just sounded cautious.  Rex could deal with cautious.  “There have been a lot of things that… happened.”

“I was…” How did he even begin to put his thoughts into words?  Maybe he could just start from the beginning, from where it seemed like things had started.  “The incurable EVO…  The worm from the other day…”  Had it had a name?  Nickname?  He couldn’t remember if it had been human or not.  “I’m sorry, it’s hard to think, I’m just–!”

“It’s okay,” said Caesar, “take your time, get your thoughts in order.”  Rex heard him get closer to the bed.   “I’ve got PJs!”

Get his thoughts in order.  Yes.  He would do that.  He’d try to remember, from the beginning.  He could do that.  Please.  What happened next?

“After I caught the worm EVO, I followed it back, under the truck, and I– I saw where you were putting collars on.  And I was upset?  I think?  I was angry?  But I don’t know why I was angry, I mean.  The collars are the right thing to do, aren’t they?  If you and Black Knight both think so.  I don’t know why I was angry.  I don’t know why I– I tried to destroy the– the machines?  I don’t know.  And then Black Knight, she–  I don’t understand what happened.  I feel like I’m– I have to be missing something, right?  I don’t know why she–  I mean, I tried to break the machine, but I must have done something else, because she stabbed me, and– and then you– and then–”  

Oh, jeez, he was crying.  He didn’t like that.  He tried to take deep, even breaths.  He pulled the blanket away from his head to get more airflow.  

“I’m thinking about it,” he said, after he got himself more or less under control.  “I’m trying to narrow down what it was, but it doesn’t make any sense.”

“What are your options so far?” asked Caesar.

What were his options?  He’d been doing nothing but think about this the whole time he was up, and yet he hadn’t come up with very many options, had he?

“One is that, um, what I did was really, really bad.  Worse than I think it is.  Thought it was.  You know what I mean.”

Caesar hummed, encouragingly. 

“Because I thought I didn’t need the- the, um–”  Rex raised his hands to brush fingers against the surface of the collar for the first time.  It really was there.  “And it sounded like she didn’t think so, either, before, but I did get angry like that, for no reason, so…  Maybe I did need it, and you needed to do that, to keep me from going on a rampage.  But… After?  Caesar, after–”  He couldn’t put what he’d seen in the lab security footage into words.  “It really hurt.  It still hurts.  And you don’t– You don’t do things like that without a reason.  You don’t hurt people like that without a reason.  So there’s got to be something I don’t remember.  So– So I need to know.  Caesar, did I– Caesar, did I hurt someone?  Did I hurt people?”

“What?  No, no.  Mijo, you didn’t hurt anyone.”

No, no.  That didn’t make sense.  He ran his hands up and down the edge of the blanket, trying to ground himself.  He didn’t hurt anyone– That didn’t mean he hadn’t tried to hurt someone.  

“She stopped me?”

“No,” said Caesar, firmly.  “Rex, you didn’t do anything wrong.”

“But I must have.  You and Black Knight are good people.  You’re not like White Knight, or, uhm, Dr. Fell, or Van Kleiss.  You don’t hurt people for no reason!”

Caesar blinked.  “Who’s ‘Dr. Fell?’” 

“Oh!  He was the guy before Dr. Holiday.  He and White Knight tried to kill me when I first came here.”  Did… Caesar not know this?

“He and White Knight?”

“Uh huh.  Kind of messed up that he was my boss, huh?” Unless the reason for that was the same as the reason for this, and no one had told him.  But, then, White Knight was terrible, and if it was something Black Knight would do something like this over…  White Knight would probably have just killed him outright, yeah.  “But Black Knight is definitely an improvement, because she wouldn’t hurt me for no reason.  So, there has to be a reason, but I don’t know what the reason is and… it’s kinda freaking me out.  Just a little.”

Caesar didn’t respond, and Rex continued, hopefully.  “Like, I know I’m kind of dumb about things, but you’re not, so, you know what I did, right?”  

Caesar still didn’t answer.  He wasn’t looking at Rex anymore, either.  Rex followed his gaze to the room’s camera.  Rex had… Well, the constant state of surveillance had worn on him, now and then, but he’d had ways around it.  Ways that Caesar didn’t.

“Do you want me to take care of it?” he asked.  “I could.  You’d think Providence would have better security on their cameras, but nope.”  Compared to usual, the joke felt hollow.

“No, that’s okay,” said Caesar.  “What happened today was…  Black Knight is very… It’s important to her that her orders are followed.”

“Oh, that makes sense,” said Rex, because it must.  Both Caesar and Black Knight had said it, so… following the orders of…  Hm.  Maybe it was just because Black Knight was so good at what she did that it was so important?  Six, after all, had never done anything like this.  White had, though.  Did that mean White was actually a good leader?  Gross.  “So, it’s because I didn’t follow orders?”  Even as he said it, it didn’t quite sound true.  He was missing something.  He knew it.  But he had no idea what.  

“Yes,” said Caesar.  “The collar just… makes sure you do.”  

“Oh,” said Rex.  It was a safeguard.  To make sure he didn’t… disobey orders and hurt people?  Probably.  “That… makes sense?”

“Yeah,” said Caesar, “yeah, that makes sense.  Now will you put on some clothes?  You’re in my bed.”

“Oh, yeah.  I guess so.  I guess– I guess so.  I want to–” He started to take off the blanket, then thought better of it when a bit of outside air snuck into his warm blanket bubble.  “It’s cold.”  And the new scars ached.  His bones ached.  And also his head.  And his everything.  

“That’s why you need to put on clothes, mijo.”  Caesar pushed the stack of PJs at Rex.  

Rex started to pull the PJs under, and then that stupid alert came back.

{alert: locus-hasapiens1-REX healthstat abnormal. processing healthstat report to topadmin.}

“What’s that?”

{processing… processing… topadmin unavailable. processing… initializing program 36743813837984464…}

{abort initialization of program 36743813837984464.}

{confirm instruction: abort initialization of program 36743813837984464.}

{abort initialization of program 36743813837984464.}

{initialization of program 36743813837984464 aborted.  healthstat abnormal.  query: file healthstat report for later delivery to topadmin.}

{file healthstat report.}  He might as well try again, after all.  

{error: healthstat report data storage full.  recommend running program 36743813837984464. query: action.}

{standby.}

“What do you mean your report storage is full?” asked Caesar, pulling a small fraction of Rex’s attention away from the twin tasks of getting dressed and figuring out what was wrong with his code that it kept doing this.

“It’s full, it’s full, it’s full.  I don’t know.  Keeps trying–”

{alert: locus-hasapiens1-REX healthstat abnormal. processing healthstat report to topadmin. processing… processing… topadmin unavailable. processing… initializing program 36743813837984464…}

No, no.  He didn’t want that.  

{abort initialization of program 36743813837984464.}

{confirm instruction: abort initialization of program 36743813837984464.}

{abort initialization of program 36743813837984464.}

{initialization of program 36743813837984464 aborted.  healthstat abnormal.  query: file healthstat report for later delivery to topadmin.}

{no. quarantine program 36743813837984464.}

{confirm instruction: quarantine of program 36743813837984464.}

{quarantine program 36743813837984464.}

{program 36743813837984464 quarantined.  query: set timeout for quarantine of program 36743813837984464.}

{set timer of quarantine of program 36743813837984464 to indefinite. add review of program 36743813837984464 to pending admin tasks.}

{timer set.  admin task added.}

Great, which let him… um…

“What were we talking about, bro?”

“Just getting you dressed,” said Caesar.

“I’m dressed.  I am dressed.”  He swung the blanket back to show Caesar.  Oh, wow, that was cold.  “Caesar, I think something’s wrong with me.  I’m thinking… wrong.  It’s wrong.”  Adjusting those programs should not have taken so much of his attention, and he still didn’t understand the reasoning behind– behind what happened in the lab, and that should have been easy.

“Hey, hey.  It’s okay."  Caesar sat down on the edge of the bed, but he seemed tense, not giving it his full weight.  Was he worried Rex would attack him?  "You’re just adjusting.  You’ll figure it out in no time.”

But even if Caesar was cautious…  Rex must be a terrible person, because he leaned up against Caesar, taking all the comfort he could get. “Really?”

“Yeah.  Really.”

Rex nodded.  He hoped Caesar was right.  

[dustydahorse]

Make the mistake of watching a video on bone marrow aspiration and biopsies...

I'd rather redo my vascular stent procedure again but fully awake with no numbing instead of the aspiration/biopsy. Shit straight up looks like torture and they don't put you to sleep.

They better, because my pain response is to throw hands and I'll 100 percent deck a doctor in the nose when they're grinding into my bone.

[hazey-moonlight]

Talking medical stuff woof

I'm scheduled to get a bone marrow biopsy next month. It's not supposed to be too long of a procedure but from what I can tell it's very uncomfortable and painful and I'm very scared about it. I've been given two very strong anxiety meds to take before the procedure.

It's a heckin big needle guys in my back through my bone BIG NEEDLE

[luckypoppymilliemama]

We really need help y’all. Poppy’s procedure is on Thursday. Right now all we can afford is the cheaper surgery, which isn’t doing much because for all we know, it can come back just like the lymph node did and say “uh yeah let’s just add more confusing info!”

Getting both the spleen/liver aspirations AND the bone marrow biopsy are out best bets right now. The bone marrow can tell us so much more, like *why* she isn’t making baby red blood cells, or why the cells that are supposed to stay in the bone marrow are flying freely around the circulatory system, doing whatever they want. These next 24 hours in funding is crucial. We need at least 2k. The vet says they haven’t gotten any donations in, and the go fund me is only at 1/5 of what we need, because I *can* use some of my SSDI, but that money usually goes elsewhere like doctors appts, medications, that kind of stuff, traveling to new specialists to find someone who has experience with my problems and can gain me admittance to a hospital team to fix me.

But Poppy comes first. Without her, I can’t breathe through the day at home.

I’ll post a video and recent pic of Poppy from this morning. Hopefully it makes y’all smile like it did me. I’ll also in another post add her blood work and another, bigger diagnostic that will explain a little more. And I’m here to answer any questions, don’t forget that.

[not-so-mundane-after-all]

"About the Blogger" Meme

@ambeauty thanks for tagging me, love 💕

Star Sign(s): All I know is that it's Pisces. What does that mean really? No clue, never checked.

Favorite holidays: Halloween, even though it's not that wildly celebrated where I’m from, barely at all. But I love watching the craze about it online and participate in online celebrations. Other than that, Christmas, because of food and family.

Last meal: one of my favorite traditional Polish dishes - bigos

Current Favorite Musician: Does Rachel Zegler count? Because I am obsessed with The Ballad of Songbirds and Snakes Soundtrack

Last Music Listened To: Marjorie by Taylor Swift and some other Evermore tracks for Evermore’s and Taylor's birthday (Dec 11th and 13th)

Last Movie Watched: in theaters - Renaissance: a film by Beyonce! Blew my mind! And at home it was my beloved Prospect - a watch party + live reaction (screaming about Cee and Ezra) with my friends the Bees on Discord. As Ezra would say, “This is so exciting!”

Last TV Show Watched: I am making my way through a Supernatural rewatch, finished 7x05 last night. I’m excited to finally be on S7 because S7 introduces my favorite female character ever, Charlie Bradbury!

Last Book/Fic Finished: Book - The Rule of Wolves by Leigh Bardugo (right before S&B was c*nceled, not fuckin fair), and Fic - “The Stag” by AFireInTheAttic about Katniss and Haymitch going hunting because I am in my Hunger Games Renaissance era and PapaHaymitch feels are roaming free

Last Book/Fic abandoned: I bought the entire The Witcher series just to struggle through the first book 🫣 the story is good but the way it's written, my god. Why do our Polish writers have to make everything so difficult? All the fat jokes and sexist jokes and misogyny, you can tell these books were written by an old grumpy douchebag. As for fics, I had to drop out of some Katniss and Haymitch fics because they had shippy undertones and weren't tagged right (please people tag your fics appropriately when it comes to relationships, I am begging on my knees)

Currently reading: Book - Percy Jackson and The Chalice of The Gods by Rick Riordan, Fic - “After All We've Been Through” by TheFelineQueen96 aka my darling @ellies-little-gun, an incredible Joel and Ellie story

Last Thing Researched for Art/Writing/Hyperfixation: spinal taps and bone marrow biopsy for my Titanstober fic I am flesh, bones... I am skin, soul… I needed to learn about this to figure out the balance between medical accuracy and using these procedures in unethical ways/as forms of torture, as I’ve seen done on some TV shows in the past, like The 100. I even rewatched those scenes for inspiration

Favorite Online Fandom Memory: as my bestie mentioned before me, definitely the day we all lost it over Brenton's birthday post dedicated to Anna. I had my phone in my hand when that notification appeared and I nearly dropped it, that's how bad I was shaking.

Favorite Old Fandom You Wish Would Drag You Back In/Have A Resurgence: probably The Magicians for me. I wasn't active in that fandom, only a little towards the end of the show, but I loved it so much and it has two very strong platonic pairs that I was absolutely obsessed with, Quentin & Julia and Margo & Eliot, and I kind of wish I could write for them. Maybe after a rewatch though 👀

Favorite Thing You Enjoy That Never Had an Active or Big "Fandom" but You Wish It Did: Let me use this part for advertising and say PROSPECT!!! WE ARE SMALL BUT MIGHTY, ALL 5 OF US! Jk there's a bit more of us, but not by much and the movie is incredible. So go watch Prospect everyone!!! Come lose your mind with us over Cee and Ezra!!!

Tempting Project You're Trying to Rein In/Don't Have Time For: My brain is flooded at the moment with Katniss and Haymitch, I already cave in and wrote one fic even though I am officially on a break till January. I want to write more for them and definitely will, but I need to go back to my two ongoing Titans projects. Only my love for writing Titans is currently the size of a dying candle flame and I am trying to stoke that fire up (rereading my own fic to get back to the story) and failing (it's not working, I got nothing)

No pressure tags for the besties @undertheknightwing @legendsofentity @skoulsons @ellies-little-gun @sotvtaughtmehowtofeel @dilf-din

[kingmanoncology]

Impact of liver Cancer on your skin health 

Cancer is an illness that not only affects your particular body part but has a serious impact on your other body organs too. Your physical health is inseparable from your mental setup.  

Researchers point out that certain illnesses in the human body are the outcome of our mental stress. They point out that stress in your mind leads to poor indigestion, stomach imbalance can result in numerous other problems, and the inability to speak or throw out stress results in throat-related issues or thyroid which will take the shape of thyroid cancer sometimes. So, all the body organs show an inseparable relationship with each other. 

According to WCRF data, "liver cancer is the sixth most common cancer in the world and the fifth most prevalent cancer in men, while it is the ninth most common in women." China leads the list, followed by the United States and Japan, while Brazil ranks last among the countries most usually affected by this type of cancer. Though the results are frightening, it is possible to heal it with proper attention.    

Understanding what is liver Cancer? 

Liver cancer is an insidious illness that develops within the liver's complicated cellular surroundings, frequently going undetected until it has progressed to an advanced stage. Unlike many cancers that cause solid tumors, liver cancer, particularly hepatocellular carcinoma, quietly alters the liver's delicate network of hepatocytes, disrupting critical activities. This cancer affects not only the liver's ability to cleanse blood, manufacture critical proteins, and control hormones, but it also has systemic effects, altering everything from metabolism to skin health. Because the liver plays such an important role in the body's biochemical operations, liver cancer can cause a swing of seemingly unconnected symptoms, making it a particularly elusive and severe type of cancer. This complexity emphasizes the necessity of early identification and a thorough awareness of its far-reaching consequences. 

Symptoms of Liver Cancer and Their Effect on the Skin 

Liver cancer, a stealthy and formidable foe, frequently manifests as a succession of modest but informative signs showing its underlying presence. One of the most concerning indicators is a rapid, unexplained weight loss as if the body's reserves are being discreetly drained off. This is typically accompanied by a significant lack of appetite, with even the most popular dishes losing their attraction, resulting in a chronic sense of malaise and exhaustion. 

The abdomen region becomes a battleground, with discomfort and swelling being common symptoms. This can range from a mild aching behind the ribs to severe and chronic bloating, making even the simplest chores feel difficult. The liver is now enlarged and can be felt as there is a hard bulk on the right side, indicating that all is not well internally. 

To put simply common symptoms of liver cancer are:  Unintentional weight loss.  loss of appetite  Upper stomach pain or discomfort  Nausea and vomiting  General weakness and weariness  Swelling of the abdomen  Jaundice (yellowing of skin and eyes)  White, chalky stool  Urine in dark.  Enlarged liver (felt as a lump under the right ribcage).  Fever  Persistent itching (pruritus  Swollen legs  Feeling fuller after a tiny amount of food 

The Effect of Liver Cancer on the Skin 

Liver cancer, a serious and often quiet disease, manifests not only in the liver but also in a variety of obvious skin changes. Jaundice is one of the most obvious and early indicators. This disorder develops when the liver fails to adequately process bilirubin, a yellow pigment formed by the breakdown of red blood cells. As bilirubin accumulates, the skin and whites of the eyes turn yellowish, making jaundice a reliable diagnostic of liver dysfunction. 

Pruritis, or extreme itching, is another common skin-related complaint. This discomfort is caused by the accumulation of bile acids in the bloodstream when the liver's function is impaired. Itching can be widespread and severe, frequently resulting in Scratching that can cause skin injury. 

Spider angiomas are another cutaneous manifestation linked to liver cancer. These are minute, spider-like blood veins that form beneath the skin, most commonly on the face, neck, and chest. They are caused by hormonal imbalances, specifically elevated estrogen levels, which the sick liver can no longer regulate effectively. 

Battling and Surviving Liver Cancer:  Overcoming liver cancer and being a survivor requires resilience, determination, and comprehensive medical treatment. This method frequently includes a combination of treatments, such as surgery, chemotherapy, radiation therapy, and, in some cases, liver transplantation. Patients rely on the expertise of trained healthcare professionals, innovations in medical technology, and steadfast encouragement from loved ones at every stage of their journey. Lifestyle modifications, including eating a healthier diet, exercising regularly, and abstaining from alcohol, are critical to recovery and overall health. Surviving liver cancer also entails prioritizing mental and emotional well-being, as dealing with the psychological effects of the disease is just as vital as the physical battle. To survive this illness you need to stay proactive, retain a positive attitude, and adhere to follow-up care. 

frequently extend beyond the liver and visibly damage the skin. Jaundice, persistent itching, spider angiomas, and palmar erythema are not only superficial alterations; they are important indicators of underlying hepatic distress. These skin signs show the liver's important involvement in body functioning and the interconnection of our organs. Recognizing these warning signs early can lead to timely intervention, which is critical for effective treatment and improved patient outcomes. The process of coping with liver cancer necessitates a comprehensive strategy that recognizes the substantial impact on the skin and overall health. Through attentive surveillance, early discovery, and comprehensive care, we may traverse the hurdles offered by liver cancer, hoping to improve health and quality of life. If you know someone diagnosed with liver cancer or find certain symptoms common in your body and looking for a reliable counseling session then Kingman Oncology can certainly help you to detect the type of cancer using appropriate cancer screening tests. You can blindly invest your trust in Kingman Oncology for any blood-related or cancer-related problems.

[stormr]

BONE MARROW BIOPSY IN 8 POINTS (From my personnal experience)

- No preparation required before the procedure. My advice: Eat well and stay hydrated! - The nursing staff will ask you some routine questions and have you sign a consent form. My advice: Arrive early and take your medication list with you. -After the wait, you will be taken to the procedure room. In my case, it was a very small room with a bed/stretcher. Two nurses and a student were present to assist the doctor. The team prepares the necessary equipment (Cannulas, syringes and disinfection/bandage equipment). The doctor will review the procedure and outline their guidelines. I was asked about my medical allergies at that time. My advice: Write them down on your medication list. This is also the time to state your uncertainties/questions. - You will be asked to lie down and pull down your pants to free access to your hip (if the procedure is taking place there). You will have to raise your arms a little towards you so as not to disturb the intervention. - The area will be disinfected. The contact is cold, nothing more. The doctor performs local anesthesia with a syringe. In my case, this intervention will be done three times. A very tolerable slight pinch fade quickly. ** Important to know: If the skin can be anesthetized, the bone cannot be. Don't be surprised** - The doctor will tap down to the bone to make sure everything is okay (It doesn't hurt). He will then proceed to the puncture of the liquid. It will reach the desired area without causing pain. It is only when extracting the fluid that the pain occurs. I liken this pain to a "big toothache" that goes away as soon as the fluid is removed. Each puncture is 3-5 seconds long. In my case, it happened 4 times (The syringe broke, but that normally never happens. It's my usual bad luck). - The biopsy is a little different. A syringe again travels to the marrow, but rather than withdrawing fluid, the doctor removes a piece of marrow. It must therefore "drill" by turning to remove a piece. The pain sensation is similar, but “longer”. Tip: Breathe! It only lasts a moment (10 sec.). - A simple bandage is applied to the area. No stitches needed. Tips: No shower for the next few days and no big physical efforts for the next 48 hours. Stay safe. I fell the day after the procedure and I still have pain to this day. Stay strong! ⚡

[farmacuticals]

Key Players and Competitive Landscape in the Aspiration Biopsy Needle Industry

The Aspiration Biopsy Needle Marketa Size was projected by MRFR analysis to be 0.95 (USD Billion) in 2022. Forecast growth for the Aspiration Biopsy Needle Market is 1.6 (USD Billion) by 2032, up from 1 (USD Billion) in 2023. Over the projected period (2024 - 2032), the Aspiration Biopsy Needle Market is expected to develop at a compound annual growth rate (CAGR) of about 5.4%.

An Aspiration Biopsy Needle is a medical toolin procedures to obtain tissue or fluid samples from a patient’s body for diagnostic purposes. This minimally invasive procedure is commonly referred to as fine-needle aspiration (FNA). The needle is designed to be thin and long, allowing doctors to reach deep tissues or organs without needing to perform open surgery. The main purpose of using an Aspiration Biopsy Needle is to diagnose conditions like cancer, infections, or inflammatory diseases by analyzing the extracted sample in a laboratory.

Aspiration biopsies are generally performed under imaging guidance, such as ultrasound, CT scan, or fluoroscopy, to ensure the accurate positioning of the needle and to minimize damage to surrounding tissues. This technique is commonly used to investigate abnormalities in the breast, thyroid, lungs, liver, and lymph nodes, among other areas. Because of the minimally invasive nature, the Aspiration Biopsy Needle has become a preferred choice for many healthcare professionals to quickly and effectively diagnose various medical conditions.

Aspiration Biopsy Needle Size

The Aspiration Biopsy Needle comes in various sizes depending on the area of the body being biopsied and the type of sample needed. Needle sizes are usually measured by gauge, with a higher gauge number indicating a thinner needle. Common gauge sizes for aspiration biopsy needles range from 18G to 25G, where a 25G needle is quite thin and generally used for more delicate tissues or smaller lesions. Thicker needles (18G) may be used when a larger sample is required, such as in bone marrow aspiration.

Selecting the appropriate needle size is crucial for both the accuracy of the diagnosis and the patient’s comfort during the procedure. Smaller needles tend to cause less discomfort, but they may not always provide a sufficient sample for certain diagnoses. Therefore, healthcare providers carefully assess the situation before choosing the correct Aspiration Biopsy Needle size.

Aspiration Biopsy Needle Share

The market share for the Aspiration Biopsy Needle is witnessing significant growth due to the increasing number of minimally invasive diagnostic procedures across the globe. The rise in cancer cases, combined with the preference for less invasive methods, is driving the demand for these needles. Furthermore, advancements in imaging technologies, such as ultrasound and MRI, have improved the precision and efficacy of biopsies, making them more reliable and accessible. As a result, healthcare facilities are increasingly adopting Aspiration Biopsy Needle technology as part of their diagnostic toolkits.

This market segment is expected to expand steadily over the coming years, driven by technological innovations, growing healthcare infrastructure in developing regions, and increased awareness of early detection of diseases through biopsies. Major players in the industry are continually improving product quality, focusing on developing needles with better ergonomics, increased safety features, and higher accuracy in sample extraction.

Aspiration Biopsy Needle Trends

Several trends are shaping the future of the Aspiration Biopsy Needle market. These include:

Technological Advancements: New innovations in imaging techniques have made it easier to perform more precise aspiration biopsies, improving diagnostic accuracy and reducing patient discomfort.

Growing Demand for Minimally Invasive Procedures: Patients and healthcare providers are increasingly favoring less invasive diagnostic methods, leading to a rise in the use of aspiration biopsy needles.

Increased Focus on Early Disease Detection: With the emphasis on early diagnosis of cancers and other serious conditions, the demand for accurate and reliable biopsy tools, such as the Aspiration Biopsy Needle, is on the rise.

Development of Safety Features: Manufacturers are focusing on improving the safety and ergonomics of biopsy needles, with innovations such as retractable needles and anti-contamination measures to reduce the risk of infection or injury.

Rising Healthcare Infrastructure in Developing Countries: Emerging economies are investing heavily in healthcare, driving demand for modern diagnostic tools like the Aspiration Biopsy Needle.

Reason to Buy Aspiration Biopsy Needle Reports

Comprehensive Market Analysis: The report provides detailed insights into the current and projected trends in the Aspiration Biopsy Needle market, enabling informed decision-making.

Technological Insights: Understand the latest advancements in needle technology and how they are improving diagnostic precision and patient outcomes.

Market Forecasts: Gain access to future growth trends and forecasts in the Aspiration Biopsy Needle market, helping businesses strategize effectively.

Competitive Landscape: The report provides a deep dive into the competitive dynamics, including major players, product innovations, and market share.

Regional Opportunities: Identify growth opportunities in emerging markets with detailed regional analyses of the Aspiration Biopsy Needle sector.

Recent Developments in Aspiration Biopsy Needle Technology

In recent years, the Aspiration Biopsy Needle market has seen several important developments. One of the most notable advancements is the introduction of more flexible and ergonomically designed needles that minimize patient discomfort and allow for smoother, more precise sample extraction. Additionally, improved imaging technology, particularly the integration of real-time guidance systems, has significantly enhanced the accuracy of needle placement during procedures.

Another key development is the incorporation of safety features, such as retractable needle designs, which reduce the risk of contamination and accidental needle sticks. These innovations are helping to improve both patient safety and clinician efficiency during biopsy procedures. As demand for minimally invasive diagnostic tools continues to grow, the Aspiration Biopsy Needle industry is expected to keep evolving, driven by ongoing technological advancements and a growing focus on early detection and personalized medicine.

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Bone Marrow Needles: Role in Cancer Diagnosis and Care

Cancer is a complex disease that affects millions of people worldwide, and early detection and treatment are crucial for improving outcomes. Among the various tools and techniques used in diagnosing and managing cancer, bone marrow needles play a significant role. This article explores their importance, different types, risks, and future trends, providing valuable insights into how they help in the fight against cancer.

Introduction to Bone Marrow Needles

Specialized medical instruments, known as bone marrow needles, enable doctors to access the soft tissue inside bones, called bone marrow. This tissue produces blood cells, making it essential for diagnosing and treating blood-related cancers such as leukemia, lymphoma, and multiple myeloma. Procedure involving bone marrow needles often includes biopsies or aspirations, in which healthcare providers collect a sample of the marrow for analysis. By providing a window into the bone marrow, these needles help doctors determine the presence and severity of cancer.

The Importance of Bone Marrow Biopsies in Cancer Diagnosis

Bone marrow biopsies are one of the most reliable methods for diagnosing blood cancers and other disorders affecting blood cell production. During a biopsy, a doctor uses a bone marrow needle to extract a small amount of bone tissue, and then examines it under a microscope. This helps doctors identify abnormalities in blood cell production, detect the spread of cancer from other areas, and assess how well the body responds to cancer treatment.

Bone marrow biopsies are crucial because they offer a more comprehensive view of the patient’s condition than blood tests alone. For instance, blood tests may indicate abnormal cell counts, but a biopsy can reveal the root cause of these changes. By diagnosing cancer early and accurately, healthcare professionals can create personalized treatment plans, improving the chances of successful outcomes.

How Bone Marrow Needle Are Use in Treatment

Doctors use bone marrow needle not only for diagnosis but also play a role in cancer treatment. During bone marrow aspiration, professionals extract liquid bone marrow to assess treatment effectiveness, like chemotherapy. In some cases, they use bone marrow aspiration to harvest stem cells for transplantation. This procedure involves the collection of healthy stem cells from the patient’s own marrow or a donor, and then medical professionals transplant these cells back into the patient to rebuild healthy blood cell production after intensive cancer treatments.

Doctors often use bone marrow transplants, also known as stem cell transplants, to treat patients with leukemia, lymphoma, or other cancers affecting the blood and bone marrow. These procedures can be lifesaving, especially when other treatments have failed. Bone marrow needles enable the precise collection and reinfusion of stem cells, helping restore the patient’s immune system.

Types of Bone Marrow Needles and Their Specific Uses

Several types of bone marrow needles are use in clinical settings, each designe for specific procedures:

Aspiration Needles: These needles are use to collect liquid bone marrow samples for diagnostic purposes. They are typically thinner and have a hollow center to allow the easy extraction of marrow fluid. Aspiration needles are commonly use in procedures like bone marrow aspiration and stem cell harvesting.

Biopsy Needles: Biopsy needles are thicker and designed to extract a core of solid bone marrow tissue. These needles have a unique cutting mechanism that allows them to penetrate the bone and capture a sample. Biopsy needle are essential for diagnosing various blood disorders and cancers, as they provide a more detailed tissue analysis than aspiration alone.

Jamshidi Needles: This is one of the most widely use types for both biopsy and aspiration procedures. The Jamshidi needle also know as bone marrow biopsy needle has a tapered tip that helps minimize patient discomfort while obtaining adequate samples. Its versatility makes it a preferred choice in many clinical settings.

Read More About : 7 Things to Consider Before Acquiring a Bone Marrow Biopsy Needle

Semi-Automatic Biopsy Needles: These needles are design to improve the ease and accuracy of bone marrow biopsies. They feature a mechanism that allows for the rapid and controlled collection of tissue samples, minimizing the manual effort required by the practitioner. The semi-automatic feature enhances precision, which can be especially beneficial in obtaining high-quality samples for diagnostic analysis. As a result, practitioners are increasingly using semi-automatic biopsy needle in both routine and complex bone marrow procedures.

Read More : What’s a Semi Automatic Biopsy Needle and How Does It Work?

Understanding the different types of bone marrow needles helps healthcare providers choose the right tool for each procedure, ensuring accurate results and minimizing patient discomfort.

Risks and Consideration

While bone marrow procedures are generally safe, they do carry some risks. Common side effects include pain at the needle insertion site, bruising, or minor bleeding. In rare cases, complications such as infection, excessive bleeding, or damage to surrounding tissues may occur. To reduce these risks, healthcare providers take precautions, such as using sterile equipment and employing proper techniques.

Patients should discuss any concerns with their doctor before undergoing a bone marrow procedure. Factors such as age, existing medical conditions, and overall health can influence the risk level, making personalized consultations essential for safe and effective care.

Future Trends in Bone Marrow Technique

Advancements in medical technology are continuously improving the field of bone marrow procedures. Innovations such as image-guided bone marrow biopsies, which use ultrasound or CT scans to guide needle placement, are helping increase the accuracy of sample collection and reduce complications. Additionally, research into minimally invasive techniques aims to make bone marrow procedures less painful and more accessible.

There is also ongoing exploration into the use of artificial intelligence to analyze biopsy results more rapidly and accurately. AI-driven algorithms can help detect subtle changes in bone marrow samples, potentially leading to earlier and more precise cancer diagnoses. These advancements promise to enhance the effectiveness of bone marrow procedures, offering better outcomes for patients.

Conclusion and Final Thoughts

Bone marrow needles play a vital role in the diagnosis and treatment of cancer, especially in blood-related malignancies. From biopsies for early detection to bone marrow transplants, these tools are crucial in modern cancer care. Although their use involves risks, advancements in technology continuously improve the safety and precision of bone marrow procedures.

Patients and healthcare professionals should stay informed about new bone marrow techniques for potential future solutions. When dealing with cancer, discussing bone marrow procedures with a medical professional is crucial for effective treatment planning.

Source : Bone Marrow Needles: Role in Cancer Diagnosis and Care

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Thrombocytopenia Nursing Care Plan

Introduction to Thrombocytopenia

Thrombocytopenia is a medical condition characterized by a low platelet count, which can lead to increased bleeding and bruising. Thrombocytopenia Nursing Care Plan This condition can result from various causes, including bone marrow disorders, autoimmune diseases, certain medications, and infections. Effective nursing care is crucial for managing symptoms, preventing complications, and promoting patient education.

Nursing Assessment

Patient History:

Assess the patient’s medical history for any underlying conditions contributing to thrombocytopenia.

Document any medications taken, especially those that may affect platelet production or function (e.g., anticoagulants).

Physical Examination:

Monitor vital signs, focusing on signs of bleeding (e.g., hypotension, tachycardia).

Assess for petechiae, purpura, or ecchymosis.

Evaluate mucous membranes for pallor or signs of bleeding (e.g., gums, nose).

Laboratory Tests:

Review complete blood count (CBC) results to determine platelet levels.

Monitor additional laboratory tests as indicated, such as peripheral blood smears, coagulation profiles, or bone marrow biopsy results.

Nursing Diagnoses

Risk for Bleeding related to decreased platelet count.

Fatigue related to chronic illness or treatment side effects.

Knowledge Deficit regarding the disease process and management strategies.

Goals and Outcomes

Prevent Bleeding:

The patient will demonstrate no signs of bleeding during the hospitalization period.

The patient will verbalize understanding of activities to avoid that may increase the risk of bleeding.

Promote Energy Conservation:

The patient will report decreased fatigue levels through proper rest and activity balance.

The patient will participate in light activities as tolerated.

Enhance Knowledge:

The patient will demonstrate an understanding of thrombocytopenia and its management by discussing dietary modifications and medication adherence.

Nursing Interventions

Monitor for Bleeding:

Regularly check for any signs of bleeding, such as bruising or blood in urine/stool.

Implement precautions to minimize risk (e.g., using soft toothbrushes, avoiding invasive procedures when possible).

Educate the Patient:

Provide information about thrombocytopenia, including causes, symptoms, and treatment options.

Teach the patient about dietary changes that may help improve platelet counts, such as foods rich in vitamin K (e.g., leafy greens).

Supportive Care:

Encourage rest and assist with activities of daily living as needed to prevent fatigue.

Offer emotional support and counseling as the patient copes with the impact of the disease.

Coordinate Care:

Collaborate with other healthcare providers, such as hematologists, for ongoing management and treatment adjustments.

Ensure timely follow-up appointments for continued monitoring of platelet levels and treatment response.

Evaluation

Continuously assess the patient's response to interventions and modify the care plan as needed.

Document any changes in platelet counts and overall health status in the patient’s medical record.

Reassess the patient’s understanding of their condition and reinforce education as necessary.

Conclusion

Nursing care for patients with thrombocytopenia focuses on prevention, education, and supportive measures to enhance quality of life. Thrombocytopenia Nursing Care Plan By implementing a comprehensive nursing care plan, healthcare providers can significantly impact patient outcomes and promote safety in those affected by this condition.

For a comprehensive guide on nursing care plans for various diseases, including thrombocytopenia, visit Comprehensive Nursing Care Plans for 40 Common Diseases.

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Understanding MDS in Melbourne: Comprehensive Care and Treatment Options

Myelodysplastic Syndromes (MDS) are a group of rare blood disorders that affect the production of healthy blood cells in the bone marrow. In Melbourne, Australia, healthcare providers have made significant strides in diagnosing and managing Mds Melbourne cutting-edge research, advanced treatment options, and patient-centric care.

What is MDS?

MDS occurs when the bone marrow, the spongy tissue inside bones, fails to produce enough healthy red blood cells, white blood cells, or platelets. This leads to symptoms such as fatigue, frequent infections, easy bruising, and anemia. In some cases, MDS can progress to acute myeloid leukemia (AML), a more aggressive form of blood cancer.

Diagnosis and Treatment in Melbourne

Melbourne boasts some of Australia’s leading medical institutions, offering advanced diagnostic tools and personalized treatment plans for MDS. Diagnosis typically involves:

Blood tests to check for abnormalities in cell counts.

Bone marrow biopsy to analyze the bone marrow’s condition.

Genetic tests to identify chromosomal changes that may indicate MDS.

Once diagnosed, treatment for MDS in Melbourne is tailored to the individual’s needs based on their disease severity, age, and overall health. Some common treatments include:

Supportive care such as blood transfusions or medications to manage symptoms.

Medications to stimulate the production of blood cells or suppress abnormal bone marrow activity.

Stem cell transplants, which may be recommended for younger patients or those with more aggressive forms of MDS. Leading Melbourne hospitals like the Peter MacCallum Cancer Centre offer such advanced procedures.

Research and Clinical Trials

Melbourne is at the forefront of MDS research, with several hospitals and universities participating in global clinical trials to develop more effective treatments. These trials provide patients with access to the latest therapies, often offering hope when standard treatments have not been successful.

Support for MDS Patients in Melbourne

Living with MDS can be challenging, both physically and emotionally. Melbourne has several support networks that offer guidance, counseling, and resources to MDS patients and their families. The Leukaemia Foundation, for instance, provides educational materials, support groups, and patient advocacy services.

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