#i may have tetanus and also lead poisoning

[gremsnleir]

mondays amirite *quivering, soaking wet, covered in dirt and some trace amount of blood, limping, heavy eyebags, million yard stare*

[askthekuvaqbrothers]

Previous part

“This one! It’s red!”

Rufus leapt up towards the board, snagging the corner of the map and freeing it from its pin. Now in hand, he unfolded it, his brother leaning over his shoulders to get a look.

“Oh look, it’s got pictures.” Argus exclaimed, jamming a finger into a shape that looked like one of the local hat-shaped houses. 

Cletus frowned, “There’s hardly any words though, only a few are labelled.”

“Do any say Portafisco?”

He scanned the different shapes. ‘Interesting sights of the Three Quarters’ was the maps title, highlighting different landmarks to see in the area. Kuvaq simple had a bubble that read ‘Funny hats!’, and the monorail was called ‘the dark snake’, but following past ‘the last accent’, the ‘So rusty red you’d meet Tetanus sea’, and the ‘floating garbage heap’, there was a blob labelled ‘Our grand Port’

“Port, that matches!”

“Barely.” Cletus rolled his eyes, “but I suppose it’s a start.”

Rufus twisted the map, “So if we go from here, to there, to there, to there, easy peasey!”

Watching his finger trace across the page, Argus pondered, “Isn’t that water though? We can’t walk across that.”

“Have you ever tried?”

“Well, no, but-”

Snatching the map, Cletus stepped aside with his nose in the air, “That’s what a boat is for. We’ll get as close as we can, and then find a boat.”

The three shared looks, before all nodding in agreement. They had a plan; it was time to find their father.

“I’m tiiiired.”

Rufus dropped onto the metal beam they’d been following, bowing his head, while Cletus struggled not to copy him. It was now becoming clear the map omitted a very important thing: How long it would take to get from one place to the next.

It was also dawning that this was the furthest they’d been from Kuvaq, the town now only seen as the dip in the land behind them. If they went further, it would disappear entirely.

“May… Maybe we should turn back.” Cletus clenched the front of his jacket, regretting having left Poisonous at home, “It smells even worse out here, a-and I’m not sure we’ll be able to find where home was amongst the hills…”

Rufus looked up, scanning the area around them. So far they’d followed a dirt path, then the pair of wiggly beams that were for mine carts, because they were supposed to lead to the ‘last accent’ where there should be a boat. His legs hurt, and curling up in bed did sound very good right now, but the nagging thought that their dad wouldn’t be there to tuck them in put a damper on that desire. Besides, they’d barely had an epic quest yet, he couldn’t go home without an epic tale.

“Hmf, well if we find dad, he’d surely know the way home and be able to lead us! Even more reason to go!”

“But we don’t know how long any of this will take! What if by the time we get to the port, dad’s already on his way home? What if we get stuck and miss him? What-“

“I think I see something!” Argus called, scurrying down from a tall pole he’d used as a scouting point, “The tracks go into a tunnel up ahead, but over that I think there’s a tower.”

Rufus threw himself back onto his feet, “Onwards then!”

Neither of his brothers had time to comment as he marched ahead, leading them up to a little warehouse built through the junk. After a glance around his eyes lit up at the sight of a machine with wheels.

“A chariot!”

“Rufus wait!”

Argus took a firm hold on the sleeve of his shirt, yanking Rufus back into line.

“Hey, what’s the big deal?”

“Gizmo always said that when you enter a junk mine, you have to make sure it’s safe first.”

“Tsk tsk,” Cletus shook his head, “And here I would have gotten a good laugh if something fell on his head.”

Rufus pulled his arm from the hold, “Ugh, I can hear nothing is falling, it’s fine. Besides we gotta hurry.”

He scurried over to the cart, clambering into the seat and began pulling at the leavers. 

“Bleh, it’s not moving.”

Crossing his arms, Argus frowned, “See, you didn’t have to rush.”

He was ignored, “Guess it’s up to me to fix it!”

Dismounting, he began flipping panels on the cart until one revealed an empty socket, just big enough for his fists. Then he plucked at the wires, watching them wiggle so he could trace them back to what they connected to. 

“Hmm, Uh hu. So that, mmmh… ah ha! Cletus!” He grinned as his brother jumped, “I need a square doohicky on a ball dowhatsit. Then a fandngle on a puzzler in green!”

Cletus stuck up his nose and pouted, to which Rufus rolled his eyes.

“Don’t you wanna get to Dad quick?”

“...You didn’t say the magic word.”

Argus nodded, “You didn’t.”

“UUUUGH. Pleeeeease go get me everything I just said you big headed party pooper.”

There was a sound of annoyance in reply, but Cletus did turn to begin picking over the scrap around them. Argus watched on as his brothers worked, eyeing Rufus in particular as he pointedly ignored his presence. The red-head had been pushing back against his authority recently, and while Gizmo would say that independence was a party of growing up, it made him very annoyed to suddenly be questioned and rebuked so often. 

For now, he had to let it go. Their main goal took precedence over his brothers rebellious nature, so he took it upon himself to help Cletus lifting heavier objects, and eventually forcing the random shapes into the combination Rufus wanted. When Cletus handed them over, they were shoved into place with little finesse. 

Then he clambered back on and tried to turn the cart on again, this time it's engine roared to life. 

“Bingo! Hop on!!”

Sitting far enough forward to reach the pedals left room for his brothers to climb on the seat behind him, each having to hold onto whatever was near.

“Hey, do we know where this is going to-”

“GO!!”

"““AHHHHHHHH”””

The cart suddenly rocketed down the tracks, vanishing into the mouth of a tunnel, tipping left and right as it rounded corners and bends, of which there were a lot. The veritable maze of track spun them around and around, bumping and shaking all the while.

“SLOW DOOOWN!!”

Squinting through the wind, Rufus reached about for a leaver that would hopefully be the break. However the one his hand wrapped around simply pulled away from the machine as he yanked on it.

“Uh-oh.”

He felt his brothers tightly grip his back as they circled around yet again. They were stuck in a loop, their speed not decreasing.

“L-look!” Cletus came right beside his left ear, pointing to the right, “That post- Arrows!”

As they zoomed past it, they all noticed the track split in two.

“We need to pick the right path!”

On the next loop, they all squinted into the wind, searching for a solution.

“There should be a switch!” Argus hissed through gritted teeth. “Should.”

There was certainly a hole, but no lever for the switch, though Rufus glanced at the break still clenched in his hand. 

“Okay so-!”

On the next round, the three had created a chain from themselves. Argus had his legs wrapped around the base of the steering wheel, and his arms cinched around Cletus waist, face pressed to his belly. Cletus had his legs wrapped around Argus' chest, while his arms held Rufus, who dangled as far off the cart as possible, stick in hand. As they sped towards the split, Rufus drove the lever into the hole and held on tight, pulling it enough to trigger the switch.

However, the act had caused the cart to begin to tip to the side, the left wheels lifting up, and with the cart now taking the right track into a massive bend, they were staring down a steep junk hill. 

“We’re gonna falll!!”

“No. We’re. Not.” Argus gritted out, daring to unhook one leg from the steering column to then throw it over the air-born side, using it to pull himself and the other two further to that side, until the weight evened out and the cart returned to four wheels with a bounce. 

The three remained interwound as the cart continued its speedy travel, though the turns felt different this time, until light suddenly assaulted them from the caves exit. They sailed out into the open air, but the ends of the track here had been curled up at its completion, creating a ramp that sent the cart flying.

“““AAAAAAAAHHHHHHHHH!!!”””

The brothers flew, the massive tower waiting for them just by the water. 

Next Part

[greenpaths]

My name is Baraa Al-Shorfa, I am 15 years old. We are a family of 6, my mother, father and 4 children, my youngest brother is 8 years old, since October 7, 2023, we have been suffering from a brutal war that has destroyed our dreams and hopes, and has gone beyond the limits of human comprehension. During this brutal war, we have endured hardships that mountains cannot bear. We suffer from severe water shortages, and we often walk about a kilometer to get one gallon of water, which is equivalent to about 16 liters, barely enough for five family members. We also suffer from severe food and nutrition shortages due to the blockade imposed on northern Gaza for 10 months, which prevents the entry of basic materials such as meat, vegetables and fruits. This situation has forced us to eat animal feed such as barley, which has caused us to lose weight, suffer from multiple diseases, and greatly weaken our immune systems. As a result of the war, our home and agricultural land that provided us with our daily sustenance were completely destroyed and bulldozed. We also suffered from repeated displacement, moving from one place to another and from one area to another due to the horrific and brutal bombing. We also suffer from fear and terror due to the heavy bombing, fire belts and explosives, the sound of tanks was very terrifying. In addition, we were deprived of education and the opportunity to build a future. My younger brothers suffer from skin diseases, but the hospitals, which are the lifeline for every patient and needy, were also destroyed. We face a shortage of medicines and vaccines while diseases are increasing and spreading among us, with no solution in sight as there are no hospitals or medical supplies available here in Gaza. We live in constant fear for my younger brothers because they have not received their general vaccinations, especially after the spread of polio due to the lack of cleaning supplies and the massive accumulation of waste in the streets. I also should have been vaccinated against Tetanus and Typhoid fever, but I did not receive them due to the lack of vaccinations, and sewage water flooded the streets, posing a serious threat to our children. We suffered from jaundice, where we struggled for about two weeks with fatigue, dizziness and other symptoms. It is a deadly disease, my brothers' little bodies became full of red pimples and as I mentioned before there is no treatment available due to the destruction of hospitals and health centers.

We also suffer from the absence of cooking gas, which forces us to use wood and plastic to light fires, which can lead to poisoning. We have been without electricity since October 7th, spending days in the dark, causing immense fear for my little brothers. This has also made it very difficult to charge our phones and night light batteries. We had to travel kilometers from our home to find places with electricity, which costs us a lot to charge our phones and batteries.

Moreover, we have not had a steady income since the beginning of the war.

This is our goal to achieve with your help.

I appeal to you to help my family so that we can live a better life.

https://www.gofundme.com/f/uybndx-alhrob-mn-alhrb?utm_campaign=٨p_nacp+share-sheet&utm_medium=copy_link&utm_source=customer

https://docs.google.com/spreadsheets/u/0/d/e/2PACX-1vTKQYInYewFiGUX4afdHK-rANJDT4dgOC4IV6elKYNvYI2HvOTf_6IsTqt5m2KXcr_pGxcqR8AvsAJi/pubhtml#

VETTED BY BUTTERFLY 🦋NU 911

I'm sorry you and your family are going through such a horrible situation, and I wish you all the best!! may you all one day live in a free 🇵🇸!!

[gojuo]

My name is Baraa Al-Shorfa, I am 15 years old. We are a family of 6, my mother, father and 4 children, my youngest brother is 8 years old, since October 7, 2023, we have been suffering from a brutal war that has destroyed our dreams and hopes, and has gone beyond the limits of human comprehension. During this brutal war, we have endured hardships that mountains cannot bear. We suffer from severe water shortages, and we often walk about a kilometer to get one gallon of water, which is equivalent to about 16 liters, barely enough for five family members. We also suffer from severe food and nutrition shortages due to the blockade imposed on northern Gaza for 10 months, which prevents the entry of basic materials such as meat, vegetables and fruits. This situation has forced us to eat animal feed such as barley, which has caused us to lose weight, suffer from multiple diseases, and greatly weaken our immune systems. As a result of the war, our home and agricultural land that provided us with our daily sustenance were completely destroyed and bulldozed. We also suffered from repeated displacement, moving from one place to another and from one area to another due to the horrific and brutal bombing. We also suffer from fear and terror due to the heavy bombing, fire belts and explosives, the sound of tanks was very terrifying. In addition, we were deprived of education and the opportunity to build a future. My younger brothers suffer from skin diseases, but the hospitals, which are the lifeline for every patient and needy, were also destroyed. We face a shortage of medicines and vaccines while diseases are increasing and spreading among us, with no solution in sight as there are no hospitals or medical supplies available here in Gaza. We live in constant fear for my younger brothers because they have not received their general vaccinations, especially after the spread of polio due to the lack of cleaning supplies and the massive accumulation of waste in the streets. I also should have been vaccinated against Tetanus and Typhoid fever, but I did not receive them due to the lack of vaccinations, and sewage water flooded the streets, posing a serious threat to our children. We suffered from jaundice, where we struggled for about two weeks with fatigue, dizziness and other symptoms. It is a deadly disease, my brothers' little bodies became full of red pimples and as I mentioned before there is no treatment available due to the destruction of hospitals and health centers.

We also suffer from the absence of cooking gas, which forces us to use wood and plastic to light fires, which can lead to poisoning. We have been without electricity since October 7th, spending days in the dark, causing immense fear for my little brothers. This has also made it very difficult to charge our phones and night light batteries. We had to travel kilometers from our home to find places with electricity, which costs us a lot to charge our phones and batteries.

Moreover, we have not had a steady income since the beginning of the war.

This is our goal to achieve with your help.

I appeal to you to help my family so that we can live a better life.

https://www.gofundme.com/f/uybndx-alhrob-mn-alhrb?utm_campaign=٨p_nacp+share-sheet&utm_medium=copy_link&utm_source=customer

https://docs.google.com/spreadsheets/u/0/d/e/2PACX-1vTKQYInYewFiGUX4afdHK-rANJDT4dgOC4IV6elKYNvYI2HvOTf_6IsTqt5m2KXcr_pGxcqR8AvsAJi/pubhtml#

VETTED BY BUTTERFLY 🦋NU 911

May Allah SWT protect you and your family

[drama-glob]

My name is Baraa Al-Shorfa, I am 15 years old. We are a family of 6, my mother, father and 4 children, my youngest brother is 8 years old, since October 7, 2023, we have been suffering from a brutal war that has destroyed our dreams and hopes, and has gone beyond the limits of human comprehension. During this brutal war, we have endured hardships that mountains cannot bear. We suffer from severe water shortages, and we often walk about a kilometer to get one gallon of water, which is equivalent to about 16 liters, barely enough for five family members. We also suffer from severe food and nutrition shortages due to the blockade imposed on northern Gaza for 10 months, which prevents the entry of basic materials such as meat, vegetables and fruits. This situation has forced us to eat animal feed such as barley, which has caused us to lose weight, suffer from multiple diseases, and greatly weaken our immune systems. As a result of the war, our home and agricultural land that provided us with our daily sustenance were completely destroyed and bulldozed. We also suffered from repeated displacement, moving from one place to another and from one area to another due to the horrific and brutal bombing. We also suffer from fear and terror due to the heavy bombing, fire belts and explosives, the sound of tanks was very terrifying. In addition, we were deprived of education and the opportunity to build a future. My younger brothers suffer from skin diseases, but the hospitals, which are the lifeline for every patient and needy, were also destroyed. We face a shortage of medicines and vaccines while diseases are increasing and spreading among us, with no solution in sight as there are no hospitals or medical supplies available here in Gaza. We live in constant fear for my younger brothers because they have not received their general vaccinations, especially after the spread of polio due to the lack of cleaning supplies and the massive accumulation of waste in the streets. I also should have been vaccinated against Tetanus and Typhoid fever, but I did not receive them due to the lack of vaccinations, and sewage water flooded the streets, posing a serious threat to our children. We suffered from jaundice, where we struggled for about two weeks with fatigue, dizziness and other symptoms. It is a deadly disease, my brothers' little bodies became full of red pimples and as I mentioned before there is no treatment available due to the destruction of hospitals and health centers.

We also suffer from the absence of cooking gas, which forces us to use wood and plastic to light fires, which can lead to poisoning. We have been without electricity since October 7th, spending days in the dark, causing immense fear for my little brothers. This has also made it very difficult to charge our phones and night light batteries. We had to travel kilometers from our home to find places with electricity, which costs us a lot to charge our phones and batteries.

Moreover, we have not had a steady income since the beginning of the war.

This is our goal to achieve with your help.

I appeal to you to help my family so that we can live a better life.

https://www.gofundme.com/f/uybndx-alhrob-mn-alhrb?utm_campaign=٨p_nacp+share-sheet&utm_medium=copy_link&utm_source=customer

https://docs.google.com/spreadsheets/u/0/d/e/2PACX-1vTKQYInYewFiGUX4afdHK-rANJDT4dgOC4IV6elKYNvYI2HvOTf_6IsTqt5m2KXcr_pGxcqR8AvsAJi/pubhtml#

VETTED BY BUTTERFLY 🦋NU 911

I reblogged the post, so hopefully it'll help and I'll see if I can do more. I'm so terribly sorry for the awful conditions that no one should ever suffer through and I hope you'll be able to reach your goal in the near future. Take care, stay safe and may this war end soon.<3<3<3

[puppyluver256]

[Image Description: Two fan-made Pokemon resembling slugs with rusted metal spikes on their bodies.

The first Pokemon resembles a small yellow slug with a purple mantle (the top part of a slug). Four rusted metal barbs are attached to its top. Its eye stalks are drawn in close and its eyes are closed. Silver text outlined in red-violet on the right side of the image reads "Sloop".

The second Pokemon resembles a large yellow slug with a purple mantle and pale yellow foot (the bottom part of a slug). Six rusted metal barbs are attached to its back, and two are growing along its "neck". Its eye stalks are extended, and its eyes are purple and yellow. Silver text outlined in red-violet on the right side of the image reads "Slugore".

End ID.]

-----

Sloop - Slurry Pokemon - steel/poison Children in Cantessy are always warned about sticking their hands in strange places, lest they get pricked by a hidden Sloop’s poison barbs. In the case of such an event, immediate hospital attention is required. / Sloop attach metal bits to their gooey bodies for added defense. Not only are these bits typically covered in rust, they are also imbued with its own natural toxins, making them very dangerous to touch.

Slugore - Filthy Sludge Pokemon - steel/poison Slugore’s body is incredibly filthy due to both the natural toxicity of its mucus coating and the sharp and hazardous detritus both attached to and growing from its body. Trainers bold enough to raise one must be careful when attending to its needs, though it may reduce its own toxicity when around those it trusts. / Large metal barbs grow from this Pokemon’s slimy body. A single prick from one of these barbs can inject enough toxins into the bloodstream to hospitalize even a hearty and healthy adult, and coming into contact with its mucus trail may lead to one feeling ill.

More Cantessy Fakemon with Sloop and Slugore! I realized a little too late that the Cantessy Pokedex was lacking both poison and steel original Fakemon, and as there is currently no official steel/poison Pokemon I decided to jump at the opportunity. These guys are obviously based on slugs, alongside toxic sludge from industry waste akin to Grimer and Muk (specifically inspired by my dad's job having a designated "sludge pit") and errant sharp bits of rusty metal that can potentially give you tetanus. Sloop and Slugore, like the Opalith family, are exclusively found in the postgame areas around the Boonesburg ruins, though unlike Opalith they were never endangered. Rather they seemed to just move in after the town was destroyed, as the ruins provide a much more suitable sort of environment for them than a bustling farm town turned tech center turned...well, I'll explain the other thing contributing to the town's downfall some other time.

...I really need to draw Sloop's eye stalks poking out, hehe. Also apparently "sloop" is a real world which iirc refers to a type of boat?? Totally not intentional, but I've heard of worse seemingly made-up words matching with real words... ^^:

Reminder that if anyone wants to suggest moves for any Cantessy Fakemon to learn and some physical stats where I haven’t yet figured them out, feel free to throw ‘em at me :3 Links to their info pages will be provided in the replies!

💖🐶 Check out my pinned post for ways to support my artwork, among other things! 🐶💖

~If you like, please reblog to show your friends! Likes are appreciated, but reblogs let more people see my content! If you have something to say, feel free to give feedback in tags/comments/replies as well!~

Pokemon and related concepts © Nintendo/GameFreak Sloop, Slugore, the Cantessy region, and artwork © PuppyLuver Studios

[ghostinthebau]

Super Fanfic Rec List -- Iron Dad Edition (because I just wanna share the love)

I’ve had such a blast reading fanfic of the IronDad and SpiderSon variety over the last 6 months or so, and I thought I’d just make a rec list of some of my favorite stories.  Most of them are angsty, with whump and hurt/comfort because that’s what I live for.  

This is in no particular order or in any way complete because there’s just way too many amazing fics/authors in the Iron Dad fandom, but it will still be hella long, so....here goes! 

First off, @yellowdistress:

What We Are series - Bio-dad Tony series that goes all the way through Infinity War.  Endgame AU.

Someday I’ll Make it Out of Here series - Adoption AU!  It’s so good.

The Missing 92 Days - A take on HYDRA Peter that destroyed me emotionally.

Reviving Peter Parker - This about killed me.  Peter actually died during his fight with Toomes and SHIELD brings him back a la the TAHITI project like they did with Phil Coulson.  

A Sailor Went to Sea - Gut-wrenching Endgame fix it.  

Double, Double

@losingmymindtonight:

Webcams and Webshooters series

I Never Lived ‘Til I Lived In Your Light series - !!! TISSUE WARNING !!! Peter dies, but there’s another one shot with a happier ending if you need it.

And You’ll Blow Us All Away - Adoption fic!  A lovely one at that.

5 Times Peter’s Mental Illness Made Him Stumble And The 1 Time He Refused To Falter - I really love a well-depicted take on mental illness, and losingmymindtonight delivered 100%.

If You Can’t Catch A Breath (You Can Take The Oxygen Straight Out Of My Own Chest)

Cyanide? In My Shawarma?

@justme--emily:

The Guardian - Adoption AU with a lovely Loki and Peter friendship!

Radioactive - Peter endures the after effects of the spider bite, and scares bio-dad Tony to death.  Lovely, lovely, lovely.

The Good Fight - Peter gets hurt at the airport in Germany instead of Rhodey.  

@iron--spider:

ever in your favor - Hunger Games AU and an epic work of art!  

Lazarus, come forth - The Endgame fix it before Endgame.  Peter will break your heart.

dear mr. fantasy

this isn’t a game - Highly underrated fic based off the PS4 Spider-Man game.  I’ve never even played the game, and I loved this story.

what if there is no tomorrow? - This story actually made me kinda like Justin Hammer, if you can believe it.  

blindness

@tempestaurora:

hydra’s not a home series - HYDRA Peter, and also bio-dad Tony and bio-mom Pepper!

i’ll find you in the drift - Pacific Rim AU, and I have never seen PR, but I adored this so much.

it’s okay, we’re okay [whumpvember 2018] series

@jolinarjackson:

Lights To Guide You Home series - Another adoption AU.  They are my weakness, and this is one of the best out there.  

... and when you can’t crawl ...

Damaged At Best (Like You’ve Already Figured Out)

@blondsak:

No Life But This

come morning light (you and I’ll be safe and sound)

Burying Grounds - Eeeek!  Tony has to choose between saving Peter or Pepper and it hurts.

hold on, hold on

Something the Soul Needs

@madasthesea:

turn back the clock (and I’ll try again in the morning)

when my body won’t hold me anymore (where will I go)

They have so many other lovely looking fics--including an adoption au series (which I, of course, love), but I just haven’t gotten around to reading them yet.  I’m pretty sure anything they write is golden.  :)

@signofuncertainty:

It’s Always the Little Things

I’m sure their other fic, The Third Option, is fantastic and I really, really wanna read it but I’m trying so hard to wait until it’s complete!  It’s really difficult to wait, though, tbh....I may give in soon.  

@upcamethesun:

Twelve Days Of Peter Parker - So cute and fluffy, and then it kills you at the end.

5 Times Peter Made Tony Laugh Out Loud

5 Times Tony Didn’t Need To Worry About Peter

5 Times Peter Pretended To Be Tougher Than He Was

@frostysunflowers:

Between how it is and how it should be - This story made me love a Peter and Bucky friendship.

@kitcat992:

Identity Theft - This was one of the very first Iron Dad fics I read, and it was a doozy.  Full of whump, medical accuracy, and hurt/comfort!  The author is posting a sequel now, too: Identity Crisis.  :D

For Pete’s Sake!

@camelot-queen:

Goner - A perfectly heartbreaking kidnapping fic, but heed the warnings!

Who Saves The Hero

Never Meet Your Heroes

i’m the satellite (and you’re the sky) - Tony is Peter’s bio-dad but Peter doesn’t know it.  I haven’t actually finished this yet, but it’s good.  So, so good.

@peter-stank:

built from scraps - YOU GUYS, this is one of the best fics I’ve read on AO3.  It’s a ‘Tony gets dusted instead of Peter’ AU, and it’s got such an amazing dynamic between Peter, Pepper, and Morgan.  It’ll also make you tear up a few times, at least.

@geekymoviemom:

Sins of the Fathers - So, I’ve only read the first 5 chapters of this epic length (303k words@) adoption AU so far, but I’m LOVING it so I wanted to add it here.  They also have an even longer bio-dad Tony with added Stony bonus series, Pieces of Echoes, that they’re posting the 3rd installment to right now.  I’ll definitely be checking it out!

@too-many-bees:

let’s kick it

like a bridge over troubled water

@jbsforever:

it’ll be over (and I’ll still be asking when)

@tnyystark:

where the memories reside

@whumphoarder:

Quieting the Void series - Peter kinda has an eating disorder due to the spider bite, so take care if you read!

Poison Apple - Loved how medically accurate this was, and Ned’s reaction to Peter’s condition was heartbreaking.

@seek-rest:

It Hurts to Become

Someday We’ll Know - This is a Walk to Remember AU, so there’s MCD.  I’ve gotten about halfway through, but I can only read it when I’m in the right mindset.  But it’s lovely and so well done.  

This author has so many fics that I’m sure are amazing, and they’re on my ‘to read’ list when I’m in the mood for beautiful Spideychelle stories.

@caraminha:

The Primary Reason Tony Stark Would Throw Down With an Anti-Vaxxer in the Street - Hella scary depiction of Peter with tetanus, and it’s SO GOOD.

@tonystarkstan:

it all comes back to this

skeletons series

to build a home series - I love recovery fics, and this was a beautiful story of Peter dealing with the aftermath of being snapped and coming back.

lay your weary head to rest

@foolscapper:

Exploding Head Syndrome - Everyone comes back when the snap is reversed, but Peter is sort of catatonic--stuck between the living world and the soul stone where he’s with Gamora.  It’s such a lovely fic.

@alice-in-ink:

It’s a Little Bit We Do

Danger Pizza

@legalassie:

oh, darling - Peter’s kidnapped and Tony frantically searches for him--one of my favorite things.  Peter uses his smarts to help him get out of the situation, too, which is also one of my favorite things.

don’t think about tomorrow. 

@blackwatchandromeda:

Broken Thoughts (I Remember Everything)

Leave Me to Dream

A Nightmare to Remember

@emma--anacortes: 

Accepting the Tides - Here I am with another adoption AU.  Can you see a pattern yet?  I love them, and this one has danger and whump and comfort as well.  

@ardenskyedarcy221b:

they are standing in the garden - This hurt.  Several times the author had me tearing up and there’s a few lines that will stay with me forever.  It was just immensely lovely to read.

@iamallyetnotatall:

At the Start of the Universe - This was so much better than I was expecting! Peter is an Angel, and he knows Tony from the very beginning of the universe. It’s different, but absolutely gorgeous.

@starktowr:

somewhere outside my life - I don’t wanna say too much, but just read this.  It’ll break you and you’ll love it.

@jessicagoddamnjones: 

too bad (but it’s the life you lead)

@silver-bubbles:

The Fire’s Out (But Still It Burns)  

@day-dreamer176:

Like A Strike of Lightning - I kinda took this as a demonic possession a la Supernatural, but I don’t think it actually was.  Either way, it was fantastic.

fifty-four

five, tops

The World Stopped

@ambivalentmarvel:

Into His Fold series - Where Thanos brings Peter back from the ashes to make him into his new son (a la Nebula and Gamora).

@notaparty-trick:

Doom and Gloom - A ‘Peter doesn’t get dusted’ AU, filled with whump and Iron Dad and an awesome Carol Danvers.  Angst!!!

Dust and Blood - Peter is hurt much worse when Toomes drops the building on him.  More angst!!!!  This author does angst very well.

@ema--vee:

You don’t have to hold your head up high - Peter can’t thermoregulate!  I love that trope.

@forensicleaf:

All the Things We’ve Lost (And All the Things We’ve Gained) - This one gutted me, and then made it better.  But there’s pain to be had before the comfort!

They just posted the first chapter of a new WIP that looks AMAZING, too: Can’t Part the Sea, Can’t Reach the Shore.

@plnkblue:

foolish, fragile spine - Peter’s severely injured in his fight with Adrian Toomes and Tony finds him.  

@helloitisiafellowgay:

god did not craft us as altars, but as dying gods - Okay, guys.  This one is heavy.  It deals with Skip coming back into Peter’s life, and it’s not pretty but it’s handled superbly.  It’s a tough read, but one I definitely recommend if you can handle it.  Take care of yourselves first and foremost, though.  <3

~ ~ ~ I’m not sure if the following authors have a tumblr, so I just linked their AO3 pages ~ ~ ~

eccentric_artist_221b:

Only for a Little While - This is a Titanic AU, and it’s AMAZING.  There’s several scenes that just took my breath away and brought me to tears (not an easy feat). They’re also working on a WWI sequel!!!!

tiaylasglass:

the one who made it out - Short, simple in a gorgeous way, and poignant.  

And finally, I thought I’d humbly add my own little contribution to the fandom.  So far, I’ve only written the one fic, but I hope to write more in the future!

@ghostinthebau:

For Want of a Dad (in need of a son) - There’s a bit of blood, and a very distraught Tony at one point, so warning for angst and injury!

Again, this list is probably severely lacking, and if someone has a rec that’s not on here please please please reblog this and let me know!  I’m always in the mood for more fics.  

And I hope anyone reading this finds something they enjoy!  

I’m sure you will.  

ilu 3,000

:)

[hmsusa]

How Telemedicine Can Keep You Safe during the COVID-19 Pandemic

Doctors and hospital holders can communication us through HMS TELEMEDICINE official website for conduct all their Medical Billing-related matters

Imagine awakening up with a strange pain in your tummy. It started about your stomach key, but then it stirred down to your right side—and you’re also sensation handsome sick. Do you have food poisoning? A stomach bug? Weird period cramps? You dial up your doctor’s office for a quick video conference … and he tells you it could actually be appendicitis, so you should head to the ER.

Turns out he’s right. In a pair hours, you’re improving from operation, and back home within a day—a very important analysis made so easily and rapidly, you can barely believe it.    

That’s what telemedicine is all about. Fundamentally, telemedicine is near healthcare: You can see your doc via video, or check with him/her via email to discuss signs, work to an analysis of a medical tricky, or check in speedily when an in-office choice isn’t available or fitting. But that’s just one aspect of what telemedicine can do for your health.

Telemedicine can deliver you with data on situations, allow your healthcare team to screen a chronic infection, allow you to easily ask queries about your care, and contribute with greater proactivity in relations of attaining great health results.

“As a family doctor, I feel that telemedicine is an excellent adjunct to traditional healthcare,” says Dr. Jennifer Caudle, DO junior professor of private medicine at at Rowan University in Glassboro, New Jersey.

Visit HMS USA’s website and contact us for better Medical Billing and Credentialing experience.

What is telemedicine?        

“Telemedicine is the isolated delivery of health care services among health care breadwinners and patients using communications systems,” explains Caudle. This often happens via telephone, computer, video or other skills.

Because telemedicine can be modified for a widely varied range of amenities, using it can be wholly modified, depending upon your health state: the conditions you have, a precise question or worry you have, or areas you have concerning your care.

Telehealth tools are the arrangements you can use to advance remote medical services and data.

For example, if you have a continuing disorder like diabetes that revenue you need to test your lifeblood sugar daily, or your doctor wants you to screen your blood density at home, all you have to do is upload your stages and/or records to your phone, send them in to your doctor’s nurse or medical associate, and rapidly receive info on pill adjustments.

You can also watch videos about nearly any condition you can think of, to healthier understand indications or a analysis you’ve received.

Another great benefit of telemedicine: patient portals. These are gamely and broadly available via the website of many healthcare establishments and hospitals, and agree you prompt access to test results, your medical accounts and records scheduled your office visits. You can also use telehealth outfits to email your doctor with queries, order medical provisions you need, refill your medicines, or receive cues about upcoming actions or events.

How does telemedicine diverge from outdated replicas of healthcare?

One word: immediacy. Telemedicine rejects the bother of preparation an office visit for a minor matter, or waiting for hours in the extra room when you truly don’t need to be got at all. For instance, nurse call centers, which sundry health plans offer their fellows, is a telehealth tool that can remove guesswork as to whether you need a tetanus shot after walking on that nail.

Or answer more complete queries, such as what to do about a pesky pain or a cold you just can’t wobble, by asking you about your indications. Then there’s the handiness factor: Telemedicine services are repeatedly accessible 24/7/365.

Your doctor may plan an effective evening or vacation visit with you when he or she is engaged up during steady office hours, for sample. Your doctor can screen how you’ve been responsibility in regard to side effects of a new medication, talk through test results with you, outline changes to your behavior plan, or answer queries you have in much more complexity than he or she could do in the same quantity of time consumed on a phone call.  

Another matchless benefit of telemedicine: It agrees your PCP to connect easily and in gritty detail with any specialists you’re being mentioned to or already see. You can also be video meetings in to conferences with your health care team if you’re being treated for a chronic or serious condition, something that rarely happens outside of certain hospital locations yet telemedicine styles it a applied, achievable answer.

Who benefits from telemedicine?

One of the welfares of telemedicine is that it can growth admission to health care for patients.

Studies have shown that a wide range of patients can do extremely well when telemedicine is part of their treatment plan. One study found that patients who received virtual obstetric care were highly satisfied with it; another study found that telemedicine can be quite cost-effective for pediatric patients.

 As for serious illness, a third study found that telemedicine can be very effective for symptom monitoring in cancer patients, leading to positive clinical benefits.Should telemedicine play a central role in your healthcare?

It’s significant to recall, however, that even if telemedicine shows helpful to you in selling with an current health matter, it should not ever be seen as an complete interchange for seeing your doctor face to face.

Your best bet: ask your doctor precisely how he or she thinks it’s appropriate to incorporate telemedicine into your care plan or treatment. Telemedicine can be a great cost-saver, but you need to know how much out-of-pocket expense you may be responsible for, as opposed to what you currently pay for in-person appointments and services.  

Your best move: Make telemedicine part of your healthcare—but never lose sight of the fact that your doctor needs to physically see you in order to completely evaluate and examine you. So think of telehealth tools as a compliment to your care, not a be-all, end all.

We provide the best Telemedicine services to physicians and hospital owners at HMS USA Medical billing. If you need our services, visit our website and reach out to us with your current problems.

[muthur9000]

1. Clostridio tetani - sanaerobic pathogena

2. Euniceral strains

are found on countless varieties of substrate and requires acid fermentation in harsh conditions. to produce acid for its offspring

3. Once the spore has reached fertility, toxins are injected into the hosts bloodstream or lymphatic system.

If spore bacteria enters the hosts circulatory system Clostridio tetani will cause a violent reaction.

4. Clostridio tetani - sanerobic pathogena

Clostridio is a cone shaped sanerobic species of pathogena of genus Elostridium

Fig. V.

During infancy the organism will not survive the presence of Eunicium, it is sensitive to heat and exhibits minor mobility.

Fig. L.

Once spore has reached fertility, toxins are injected into the hosts bloodstream of lymphatic system.

Fig.M.

If spore bacteria enters the hosts circulatory system Clostridio tetani will cause a violent reaction.

5. Euniceral Dane Eforedium

A. Euniceral

B. Lactate succinate

C. Chemoheterotroph

This bacterium is cultured with relative ease in most settings

Growth factors depend on Marsh negative culture quality

Euniceral is a facultatively Penile-shaped bacteria of the sub-genus Wershipsaytan that is often found in the gut lining of endotherms.

Until maturity Euniceral strains are  harmless but once sexual maturity occurs it will poison the its hosts.

Euniceral strains

are found on countless varieties of substrate and requires acid fermentation in harsh conditions. to produce lactate acid for its offspring.

6. Puffball

7. Puffball

8. Puffball

In David’s documentation of this particular species, drawing conclusions from the factual information regarding Clostridium tetani and puff balls; I am assuming the puff balls on Planet 4 caused similar reactions to their host.

Painful muscular spasms that can lead to respiratory failure and, in up to 10% of cases, death.

Once the spore has reached fertility, toxins are injected into the hosts bloodstream or lymphatic system.

If spore bacteria enters the hosts circulatory system Clostridio tetani will cause a violent reaction.

Given the puff ball can cause a violent reaction, and there was no statement of ‘death’ or ‘forcible alien incubation’ then I can only assume that this species was unaffected from the pathogen drop on the city. 

The Engineers had been living on the planet, demonstrating the puffballs were ‘safe’ enough to live around and not cause as much damage as they did until David tampered with them.

This experimentation shows that he was looking for an effective way to infect hosts, puff balls are triggered by touch. The ovomorph is a more effective way to impregnate the host because it takes a longer period of gestation, this gives the xenomorph a better survival instinct compared to it’s neomorph predecessor. 

The neomorph is violent and more animalistic, more vulnerable because it doesn’t have the patience to stalk it’s prey till it has fully matured. It’s pale outer skin can be susceptible to bullets so it is not an effective killer.

This information tells me David had experimented this on ‘someone’ or ‘something’ or simply observed. In the clip ‘The Crossing’ you can see many engineers ran for the cathedral, shielding them for the pathogen dropped on the city. How else was he able to vivisect the engineer or have any live biological  items to experiment on? His other drawings show male and female engineers, most in drawn in medical illustration. Showing their morphology and biological structure.

One particular picture shows a female engineer who’s chest cavity had been cut open to access what I could only assume to be a chestburster.

That means she would have to be alive for the alien to incubate it.

Given Elizabeth’s body was dissected in the same way, I believe David had either experimented on her living body or had tried to keep her alive by repeatedly removing the alien from her body before it could burst out from her, killing her.

In his research for the cobra lily he writes

The Cobra Lily grows mainly in the out world, a subservient counterpart of Shoa Khania (the wrath oak) It’s seeds can be ground into a superb opiate It’s curls are vast, it’s reach firm and simply stunning.

He would have had to travel out of the city to find specimens and had experimented it to find out its effectiveness. Given his dislike of the engineers I doubt he would have made the opiate for them to lessen their pain when being experimented on.

I can only assume he had made it for Elizabeth, given she may have been intentionally/unintentionally infected by the spores. Either before they had been tampered with, David discovers it causes a violent reaction and she did not die. But wanting to prevent her from feeling pain or looking for a cure he had stumbled onto the Cobra Lily.

Since the pathogen only reacts to Engineer and Human DNA to give a successful outcome, and given the amount of blood bursters on the table in the lab. Elizabeth must had played host multiple times, and suffered greatly.

His human traits have started to overcome the synthetic ones, he’s afraid of things leaving him, so he incubates them. David doesn’t want things he loves to leave him, so he kills them and keeps them in caskets or preserved one way or the other. David killed Shaw, essentially, to prevent her from leaving him. - Alien: Covenant Official Book

So Elizabeth must have been alive, unaffected by the pathogen. She had living quarters and David’s research had shown he was also investigating what food was edible on the planet apart from the wheat which the ground crew of the USCSS Covenant found.

In the movie we can see he had experimented on her while she was alive in order to extend her life.

I kept her alive for quite a while. I like to think that was another testament to my creativity, although she might have disagreed. She was my most beautiful subject.- David, Alien: Covenant Novelisation

I washed this world clean as a gift to her, we could have built anew. A second Eden. But she refused. What choice did I have? She was the perfect specimen. I tried so desperately to make her more than human. Evolved. But without her cooperation, I had to salvage her parts to begin work on my masterpiece. - Transmission D964ZB to Weyland-Yutani

Clostridium tetani is a rod-shaped, anaerobic species of pathogenic bacteria, of the genus Clostridium. Like other Clostridium genus species, it is Gram-positive, and its appearance on a gram stain resembles tennis rackets or drumsticks. C. tetani is found as spores in soil or in the gastrointestinal tract of animals. C. tetani produces a potent biological toxin, tetanospasmin, and is the causative agent of tetanus, a disease characterized by painful muscular spasms that can lead to respiratory failure and, in up to 10% of cases, death.

This micrograph depicts a group of Clostridium tetani bacteria, responsible for causing tetanus in humans. Tetanus is an acute, often fatal, disease caused by an exotoxin produced by C. tetani. It is characterized by generalized rigidity and convulsive spasms of skeletal muscles, usually involving the jaw (lockjaw) and neck, then becoming generalized. 

Puffball fungi from Eaglenest Arunachal

A puffball is a member of any of several groups of fungi in the division Basidiomycota. The distinguishing feature of all puffballs is that they do not have an open cap with spore-bearing gills. Instead, spores are produced internally, in a spheroidal fruitbody called a gasterothecium (gasteroid (‘stomach-like’) basidiocarp). The fungi are called puffballs because clouds of brown dust-like spores are emitted when the mature fruitbody bursts, or in response to impacts such as those of falling raindrops. 

Lycoperdon pyriforme 

Puffballs were traditionally used in Tibet for making ink by burning them, grinding the ash, then putting them in water and adding glue liquid and “a nye shing ma decoction”, which, when pressed for a long time, made a black dark substance that was used as ink. 

If you didn’t spot it, one of the writings says ‘ Wershipsaytan ‘

Advent Table of Contents | Analysis of Alien: Covenant Table of Contents

[autographedcat]

A Fistful of Mithril: The Journey Begins

I was delighted recently to be invited by my friend Aron Wolf to participate in a D&D one-shot he was putting together.   I’m a long-time RPG fan, but I haven’t really had a group of my own recently.  Our old regular weekly D&D group in Atlanta scattered across the country, and while we managed to get things going again for a while over Skype, life intervened and we never got it back up again.  So I was really excited to not only play, but play around a table in a room with a bunch of other people I already knew i liked and enjoyed spending time with!

Because this was intended as a shakedown cruise for the world Aron is building, he gave us all pre-rolled 3rd level characters with specific backstories, which let us drop into the “meeting the party” phase without a lot of time for chargen.  This was useful, because our group was pretty evenly divided between D&D veterans and folks who had never played before, and even among the vets, some of us hadn’t really played 5th edition yet, so our knowledge of the system was rather out of date.

(Author’s note: I am not the DM of this campaign, so all of my reports will necessarily be titled towards my own perspective as a player. I will do my best to report on the happenings fairly and accurately, but I won’t always have all the information to hand about what is important, and that may influence my account.) Our setting is a land that is somewhat modelled on the Italian renaissance, and is set about 10 years after a very nasty war with a neighbouring nation-state devastated the region, and from which it is still recovering.  Our characters all had various connections back to that war. 

My own character’s story had a lot of interesting and tragic threads.  She was born into nobility, but her family’s house was betrayed by collaborators and  fell during the war, when she was a child.  Her parents were executed by the invaders, and she was held hostage for a time in the occupier’s court.  When the war ended, she found herself without land or title, and has been making a life on the streets in a variety of shady pursuits, with a speciality in skycraft and the acquisition and brokering of information to those willing to pay for it.  As a result, she’s had a hard life for one so young, but can still, thanks to her upbringing and early education, still move as easily through high society as she does the criminal underworld.  She’s still bitter about being cast out, and has ambitious to one day reclaim her birthright. 1 In addition to Kyrial, my rogue, we had the following PCs to round out the party: A cleric, Jane (Julie), A dwarven bard, Belle (Shawna) A fighter, Gordon (Marcos) A musketeer2, Lex (Jasmine/Leah)3 Another Rogue, Splendid (Paul) (Shawna helpfully live-tweeted some of the better dialogue, which I will be including throughout this report. Thanks, Shawna!) We had all been brought together to guard a caravan that was taking supplies up from the regional capitol to a mining town on the edge of the mountains, about two days travel away.  Our benefactor, Elmo Bartolo, was one of the scions of the frontier town, which was still rebuilding after the war. We had a fit of giggles over learning the name of our employer, which lead the the DM referring to him exclusively by his last name for the rest of the session.

Elmo does not travel! Elmo is the money!#dnd5e #fistfulofmithril

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

The first day of travel passed uneventfully. We set watches for the night, which also passed uneventfully. Well, one of us heard a noise and investigated, but it turned out to be nothing.

“Bunny.” “…Bunny?” “Bunny.”#dnd5e #fistfulofmithril #belle #gordon

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

Midway through the second day, we were approaching the entrance to a narrow gulch in between two rises.  Off to one side, the wreck of an overturned wagon could be seen.  Though the first two wagons in our caravan had passed into the gulch without incident,  Splendid decided he would stealthily try to circle wide and scout it out from the higher ground.  The bard was already wary of the entire scenario.

Belle, singing “It’s prooobably a traaaap, it’s prooobably a traaaap”#dnd5e #fistfulofmithril #belle #bard

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

Successfully sneaking up onto the ledge, Splendid spotted four goblins–one rather larger than the others–waiting in ambush behind the cart, which he signalled back to us via a message spell Belle had established.

Belle: “It’s deeefinitely a traaaap, it’s deeefinately a traaaap” Gordon: “Really, Belle?” Belle: 🤷🏻‍♀️#dnd5e #fistfulofmithril #belle #gordon #bard #captainobvious

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

#dnd5e #fistfulofmithril #goblin #ogre Image description: four goblins and an ogre on a rise of rock. pic.twitter.com/uiPvdKfm72

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

Just as the wagon in front us had passed through the ravine, a rock slide fell down into the path.  Above the ridge on the opposite side from where the previously spotted goblins were hiding, there were four more goblins and an ogre.  All of whom came from hiding to engage the party.

Spoiler: it was a trap.#dnd5e #fistfulofmithril #goblinsandogresandrockslides #ohmy

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

With the trap sprung, we leapt into action.  Splendid pegged the goblin leader in the back with a arrow from his hiding spot, while the cleric sent a spiritual weapon spell forward to smack him in the face as well. Between the two of them, he was not having a very good ambush.

The goblin boss is, obviously, not happy.#dnd5e #fistfulofmithril #jane #goblin #boss

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

Lex went wide to the left and fired a shot off at the ogre, which hit but, thanks to poor die rolls (a theme of the evening), it did so little damage the ogre, not knowing what a rifle was, didn’t actually associate the loud far off noise with the damage.  Meanwhile, Belle and Gordon moved forward to engage the smaller goblins with their preferred weapons, respectively an enormous warhammer that was taller than she was and…a cast iron frying pan4

Kyrial, who had been brought up never to walk up to a strange group of goblins without a proper escort, kept to her perch on top of the wagon and took crossbow shots at whatever target appeared most favourable from that vantage point, declining to take a move action at all unless she was forced.

#dnd5e #fistfulofmithril #jane #lex Image description: dnd minis, 2 on a cart, one on the ground, and two horses. pic.twitter.com/wS1XDL6YLj

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

Aron (DM): “Are you gonna fall off the wagon?” Kyrial: “It depends on my Dex check!” 😅#dnd5e #fistfulofmithril #kyrial #dm

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

Belle's first attack with the hammer left hes target on death's doorstep, a mighty blow that nearly reduced the hapless goblin to pulp.  ((Put a pin in that thought.  We'll be back for it later.)).

DM: “He is hurt, but not paste. (He has one hit point left.)”#dnd5e #fistfulofmithril #belle #Goblin #dm

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

In the second round, the ogre and his retinue of goblins had scrambled down the hill.  Lex took a second shot at the ogre, and this time connected with a more substantial amount of damage.  The ogre, now aware that the human with the boom stick was creating the hurt, peeled off to make a beeline for the musketeer, and tagged him for half of his hitpoints. (Ouch!).  Belle, meanwhile, cast a shatter spell on the four goblins he’d just abandoned, obliterating two and badly hurting the others.  At one point, Gordon did a massive amount of damage to a goblin who didn’t have much health left, and Aron wrapped his knuckles on the edge of the table while reaching out to turn over the mini.

“You did so much damage, you killed the goblin and injured the DM!”#dnd5e #fistfulofmithril #gordon

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

The goblins did manage to get some minor hits in against their melee targets, poking them with their rusty short swords, but it was clear the battle was not going the way they had planned.

“Does tetanus count as poison?”#dnd5e #fistfulofmithril #belle #rustysword #goblin

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

Of course, this being our first combat (even for the D&D veterans in the group, this was the first time a lot of us had been playing 5th Edition, so a lot of what we knew about combat was no longer applicable. One person noted it was a lot like trying to figure out the controllers on a new video game, and not being sure which button was the one to attack with.

“Which of these buttons isn’t crouch?”#dnd5e #fistfulofmithril

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

At one point, I was asking about attacks of opportunity, recalling that in 3.5 days the rules were so complicated that our friend Mary had written an entire song just to teach everyone how they worked. 5

“@DrMaryCCrowell wrote a song just to explain attacks of opportunity.” “Remember that that was for 3.5.”#dnd5e #fistfulofmithril #filk

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

Meanwhile, between spells, arrows, and melee, the goblins were in a world of hurt, and the Goblin Leader decided that the better part of valour was abandoning his cannon fodder and going to gather more, healthier cannon fodder.  He turned to flee, but in the process ran right past our hidden rogue, who managed to tag him for the last of his health.

DM: “The goblin sees you.” Splendid: “I wink at him.”#dnd5e #fistfulofmithril #splendid #goblin

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

Lex, on the other hand, took one more shot at the ogre before deciding also to abandon his now close-range target for the warm embrace of the cleric’s healing spells.  Unfortunately, leaving the ogre’s threat radius did provoke an opportunity attack, which was substantial enough to help him cover most of the distance between himself and the cleric in the air.  Luckily, the cleric was prepared with a healing touch.

“Boop of Healing!” 10 points!#dnd5e #fistfulofmithril #jane #lex

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

The ogre closed the gap to where Lex, Belle, and Gordon were standing.  At this point, between Kyrial picking them off and Belle and Gordon smacking them with hammers and pans, the goblins were pretty much off the table, but the ogre still had a big mad on, and he was looking to take it out on someone.  Kyrial suggested this was not how the creature had expected his afternoon to go.

“He just wanted to read you his poetry.”#dnd5e #fistfulofmithril

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

With three targets to choose from, the ogre picked randomly, but missed, but so did we trying to hit.  But that set up the moment in the next round that brought us victory. Splendid, having run out of targets, had moved around to the front of the ridge, and managed a critical sneak attack with his bow that brought the giant foe crashing down.

DM: “How do you want to do this?” Splendid: “It’s through the femoral artery, pinning him to the ground.” Ogre: “blaaaghlrrlrlrlrlrlrlrrrrllllll” x_x#dnd5e #fistfulofmithril #splendid #criticalrole

— Shawna Universe (@SheIsTheWeather)

November 23, 2019

We looted the bodies, which didn’t net us much, and then surveyed the rest of the caravan.  The lead wagons had been fighting off a goblin band of their own, but had dispatched them.  Unfortunately, the path was no longer navigable, so we were told to take the longer way around through a nearby pass and meet up with them in town.

And thus ended the first combat.  I have to say I’m quite impressed with the way combat flows in 5e. They’ve managed to streamline it substantially, without taking away all of the strategy or skill synergy that makes putting different builds and styles  in a group to see how well they work together.

The session continued when we reached town, but this post is already long and full of tweets, so I’ll continue that story in another post.

Much of this information is still largely unknown to the party, and in turn, I only have some glimpses into the backstory of the other characters myself. ↩

Gunpowder is a relatively recent and rare invention, so this is a notable character ↩

Jasmine was not feeling well, and had to leave partway through the game, so Leah took over her character for her. ↩

Don’t judge.  It was super effective. ↩

It’s true, and it’s a bop.  You should listen to it even if it isn’t necessarily useful for teaching D&D anymore, because it’s a bop. – https://marycrowell.bandcamp.com/track/opportunity-tango  ↩

[buffdolls]

Rough week

I’m gonna write this out because...its not been the best week, but, the sheer bizarreness of everything is really rather spectacular. I shall try to do it justice.

So, last Thursday, I cleared out a bunch of poison ivy from the yard. I was really careful and I wore gloves. Afterwards, I also showered and scrubbed with All-Stop scrub and then afterwards used the All-stop gel. However, none of this prevented me from getting poison ivy basically everywhere on my left side. The worst is all down my left arm...but, apparently I managed to get the oil on my waistline, torso, left breast left ass, and forehead. So...things got steadily worse and by Sunday I was on steroids. 

Lets put it this way...the steroids are trying. They may actually be helping on the torso bits, but...the arm is like “HAHAHAHA, that’s funny...why don’t I just keep heading towards your armpit because that’ll be amazing!”

Meanwhile, my daughter is in a camp this week, so, this is my one week to GET STUFF DONE. But...by Monday I basically had no more function from my left arm, other than things I could do with it extended straight, and sometimes the pain was so terrible that all I could do was lay with the fan blasting on me and wait for it to chill out. I kept on trucking though, determined to make the most of my ‘alone hours’. I have finished two dolls for DragonCon in this time, but I wasn’t able to do things like...face-ups because I’d need to bend my arm. 

Yesterday, despite being stuck in a wonderland of pain and oozing blisters, I finished up my Showcase doll for the artshow. He’s really going to impress, I hope. I’m really proud of him. So, today I decided...I will get out all my photography equipment and take some nice shots. I go into my walk-in attic to get the folding table and that’s when I see it.

Bats.

Now, the occasional bat taking up roost in the slats of my attic is usually OK by me. However, they are ALWAYS on the other side of a screen, so they can’t actually be INSIDE the attic. But though there were a few bats chilling on the other side of the screen, there was one bat that was INSIDE. That’s not good. I don’t want bats inside the attic, pooping all over stuff, so, I ran to get the broom. A few seconds later, I’m shooing all the bats off the screen, and that leaves me with just the one bat that’s on MY SIDE of things. I scared him and he flew around really confusedly, and then thankfully, landed on the floor. I dropped a box over him, then slid another flat box under that one, and trapped the bat, then carried the whole thing outside. Thankfully, we’re getting some painting work done on the house and there was someone to get the door. 

I go back into the attic and continue to shoo bats that tried to come back a couple of times, until they finally gave up, and then I got the vacuum so that I could clean up and decide what to do about the screen. I decided to stand on one of my storage benches, and guess what...the bench broke and I broke two of the shelves. At this point I needed two bench shelves, and new screening for the attic slats, because I determined that I couldn’t just fix the hole, that a lot of it was compromised.

Off I go...painfully trucking around Lowes to get the new shelves and the screening, a staple gun and staples. Man...I live in South Carolina, and believe me when I tell you that playing in an attic at 1PM was not /exactly/ on my list of things to do today. ALL I WANTED TO DO WAS TAKE PICTURES. Its hot. I’m sweating super lots. Like dripping sweat all over my poison ivy but this has to be taken care of right away or who knows how many bats could get inside when I’m not watching! I’m moving everything around to get the ladder up in there, to staple the new screen. 

I do know that its a mistake to not wear shoes, but my attic is part of my workspace and I keep it really clean. Anyway, I regret that decision. I was nearly done and I dropped some staples on the floor, but I was just trying to get done and get out of the heat and get a shower so I could pick up my daughter from zoo camp, and I stepped off the ladder and right onto a row of staples. Immediately, blood is everywhere. Dripping, bloody footprints leading from my original location, to the bathroom, to immediately wash the wound, and that’s when I realize that not only am I alone in the house now with no one to help me, but that I have gone from ‘human mobility’ to basically...’baby mobility’ and I can’t drive myself or handle this on my own. So I called my Dad, because the hubby is at work. 

Dad comes rushing over and does some boyscout first aid action and gets me into the van and off to the ER. I spent the next two hours in the ER. The ER doctor, even, was super impressed by the sheer amount of poison ivy I am dealing with. They tried to do suture tape...I stood up and blood went everywhere. Meanwhile, the ER doctor calls DHEC to see if I need to go into another hospital for a round of rabies vaccines because I was wounded in an area with bats. And I get a tetanus shot. As the doctor continues to listen to the story of my week, he just boggles more and more at the strange circumstances, and I’m a little proud of that. So, on to stitches. He asked if the stitches were hurting too much and I was just, ‘bring it’. 

So, now I have 5 stitches in my left foot, a set of crutches because I can’t walk on it, raging poison ivy, mobility issues and no pictures. 

I don’t need money, sympathy or a pep talk. I haven’t cried yet and I can make it through. 

But please reblog my Dragon Khan doll when I do get those pictures, because...I have never suffered more while making a thing.

[shannrussell-blog1]

Courage. Endurance. Mateship. Sacrifice. Engraved upon the four pillars that stand at the memorial site near the village of Isurava, it’s these values that the Kokoda Track symbolises for many Australians.

Equal parts a physical and mental challenge, it’s also somewhat of a spiritual pilgrimage, honouring the personal sacrifices of the diggers who fought a bloody campaign here over 75 years ago, as you follow in their footsteps.

Where in Papua New Guinea is the Kokoda Track?

The network of native walking tracks that make up the ‘Kokoda Track’ stretch from coast to coast. The section most popular for adventurous souls to tackle stretches 96km over the Owen Stanley Range, between the village of Kokoda and Owers’ Corner. Owers’ Corner is some 50km or so east of Port Moresby, and accessible via road.

It would not be considered a long hike in terms of straight distance, however, to assume that this means it’s an easy trek is naïve, to say the least! The Track takes you through some incredibly treacherous and isolated terrain, as you cross the saw-toothed mountains.

The Kokoda track stretches from coast to coast. Photo: Daniel Milne 

How long is the trek?

As far as time is concerned, most trekking companies allow 8-9 days to cover the distance, and this breaks down to roughly 7-8 hours hiking a day.

The tour we booked through Adventure Kokoda was 8 days in total, travelling North to South, Kokoda to Owers’ Corner.

The view as you fly over the Owen Stanley Range, whilst stunning, also gives you a good idea of the steep terrain you’re in for! Photo: Daniel Milne

How do you get there?

If you’re uncomfortable with flying then Kokoda isn’t for you, as there is a 40-minute flight between Kokoda and Port Moresby, regardless of which direction you hike.

Your only safe option is to head from Owers’ Corner to Kokoda, then turn around when you get there and walk back! By the time you arrive in Kokoda though, I can guarantee the flight will seem the better prospect!

Walking the Kokoda Track with my father is something we have spoken about for nearly a decade. It was a wonderful experience to share with him. Photo: Daniel Milne

Why Kokoda?

The allure of Kokoda lies not only in the obvious challenges of getting yourself from one end to the other, but also in the rich war history that, like the shrouding mist that often rolls in of an afternoon, hangs heavy over the track.

Brigade Hill, which we reached on day 5, is the site of a particularly bloody battle. The red poppies that adorn the stumps erected here in honour of the fallen soldiers, is a moving image.

For those interested in Australia’s wartime history, the Kokoda campaign is considered by many to be up there with Gallipoli in terms of significance. For me, it’s arguably of even greater importance though, being that:

It was fought so close to home soil

It involved both militia and AIF soldiers fighting side-by-side for the first time

This isn’t the time or place for a history lesson, but even with a limited knowledge of the Kokoda campaign one can’t help but be moved when you stand in the exact spot where battles raged over 75 years prior, and listen to the stories of the incredible bravery and heroism that shone through.

Dawn service at the Isurava memorial site –  simultaneously sobering and stirring. Photo: Daniel Milne

Training and preparation

Kokoda tests you in many surprising ways. In a group that ranged in age from 20 to 64 years old, there was not a single person in our cohort who did not have a moment that pushed them to their limit, and then beyond it.

Whilst you can train and prepare yourself to take on the distance and terrain of Kokoda, there are certain elements that are more difficult/impossible to simulate. You may have to contend with challenges such as:

Possible injury

Food poisoning or stomach upsets (which could, as in my personal experience, have you ducking off the track into the bush when suddenly caught short).

Quagmires of thick mud

The ever-oppressive, energy-sapping, drench-your-clothes-in-5-minutes humidity

10+ hour days on the track

Early starts (4 am), and hiking in the dark, with a head torch.

Social media withdrawal – an issue for Gen-Y and younger. With limited patches of reception along the track, and NO power available, your phone is only good for taking photos and using as an alarm – until the battery runs out!

It wasn’t easy to grip the thin logs strategically placed across the thick, ankle-deep quagmires of mud we often had to cross. Photo: Daniel Milne

Physical and mental stamina requirements for Kokoda

Kokoda requires a high level of stamina, both physically AND mentally. Of course the more fitness training and hiking you do in preparation, the better foundation you’ll give yourself to handle any of these elements (phone withdrawal aside) if and when they arise.

You may potentially get away with limited training if you’re a young person with above-average athleticism. As any sportsman will tell you, though, general fitness and MATCH fitness are two completely different things.

You’ve got to prepare for the physical and mental challenges of the track. Here’s one of the tamer creek crossings. Photo: Daniel Milne

Training for the track

The best way to simulate the conditions on the track is with long multi-day hikes. The more days you can string together the better.

Getting time off work/escaping worldly responsibilities/etc. is easier said than done. You may, like us, have to settle for a few two-day weekend hikes to test out yourself and your gear. The guide given to us by our tour company suggested ensuring that you’re walking a decent distance EVERY DAY (5-10km) in the last couple of weeks leading up to your trek, to really get the legs prepared for continual use!

Just walking isn’t enough, though. The terrain along Kokoda is anything but flat – the gradient is always changing, and nearly always steep, so find yourself a way to simulate that. Long walks along the footpath through your neighbourhood won’t cut it – you need to get climbing!

On a multi-day hike, you’re going to be carrying a daypack or rucksack, so it’s important to train WITH a rucksack, WITH weight in it! Going a bit heavier than you plan on carrying on the Track won’t kill you, either!

The descents are often more treacherous than the climbs, and you’ve got to watch your footing in the slippery conditions. Those who had a carrier were grateful for the extra pair of hands following them, ever-ready to catch them when (not if) they slipped. Photo: Daniel Milne

Training for city dwellers

If you live in the city, as many of us do, and struggle to get out to the bush then fear not, for I have a simple training regime that is as follows:

Put on a daypack.

Find the largest set of stairs possible (ideally more than 80 flights).

Walk up said stairs.

Once at the top, turn around and come back down.

Repeat this process at least 20 times.

Congratulations, you are now prepared to take on a morning’s hike on the Kokoda Track!

Time of shot: 6:35 am. We’d been trekking since 5 am, in the dark – the trade-off of which was getting to witness a pretty stunning sunrise. Photo: Daniel Milne 

Health and vaccination checks

Above and beyond getting your fitness up to scratch, it’s important your vaccinations are in order. Whilst there are no vaccinations required for entry to PNG, the ones recommended to us were for Cholera, Typhoid and Hepatitis-A, as well as ensuring our tetanus shots were up to date.

On top of this, it’s VITAL that you have anti-malaria medication. Doxycycline is a popular choice, however, a number of people have had adverse reactions to this. It’s important to note that these reactions often only show up when the body is under stress – as it will be on the track!

My father and I opted for Larium, an alternative medication available via prescription. Though, it’s best to discuss the options with your GP.

Our trekking cohort: 12 trekkers, and 18 crew – personal carriers, gear carriers, and food carriers, as well as a medic, head guide, and our trek leader, Bernie. Photo: Daniel Milne.

Tour guide or no tour guide?

There are many reputable companies that run treks along the Kokoda Track. While going with a trekking company may seem a more expensive option, the benefits far outweigh the costs. For us, the logistics of accommodation (both either end of the trek, as well as the campsite bookings), trekking permits, transfers, meals, etc., were all taken care of by Adventure Kokoda. In the months leading up to our trek, they sent us suggested physical training guidelines, as well as a planning guide covering the essentials.

On the track, having someone, as experienced as our trek leader Bernie (with 44 treks under his belt), put our collective mind at ease when it came to how we were fairing each day, whether we needed to pick up the pace, etc. Bernie was also a wealth of knowledge about the WWII history side of things, and we had daily ‘battle briefings’ about what battles took place at each location, etc. This gave us a much deeper appreciation for it all and enriched what I had read prior to leaving.

Above all else is the safety of being in a large, organised group. The Track spans a vast stretch of isolated terrain, and in case of emergency, the trekking company has UHF and satellite phone communication available.

A motley crew of adventurous souls – strangers to each other at the start, but the friendships forged in the fire of Kokoda will last for many years. Photo: Daniel Milne

Carrier or no carrier?

If you’re going with a trekking company then chances are you will have the option of a carrier for your rucksack. In my humble opinion, this is an option that most people, particularly those over 50 (no offence to those 50+ year-olds who are absolute fitness guns), should consider. It can mean the difference between being able to enjoy the experience of Kokoda and having to withdraw from the trek.

I set myself (29-year-old male, with a decent level of general fitness) the challenge of carrying my own pack, and made sure that I undertook a number of long hikes carrying weight in the lead-up, to ensure that I was well-prepared.

Even then, I found it challenging, thanks in no small part to the humidity and extra fluid I was constantly having to replace through sweat-loss – which leads me to…

We spent every moment in camp making sure our feet were dry, powdering them, and applying layers of tape or Band-Aids on potential blisters. Meanwhile, the carriers happily strolled along the entire Track in BARE FEET… Kind of makes you feel a bit soft. Photo: Daniel Milne

Useful Gear to take

Below is a short list of some very useful items you may or may not have considered, that I found to be of great use:

Clothes made of a lightweight material

Long sleeves are recommended for protection from mozzies/the sun/stings and scratches. Don’t go packing heavy cotton work shirts or similar – you’ll be sweating buckets as it is, without adding a personal oven bag.

A hydration bladder

Being able to keep hydrated without stopping to get a water bottle out of your bag all the time is a big plus.

Purification tablets

There are plenty of freshwater streams to fill up your water bottle along the way, but not all of them are guaranteed potable water, so having your puri-tabs handy is a must.

Blister-block pads

Nothing worse than getting a blister on the first or second day and having to then deal with the discomfort for the rest of the trek. Whack one of these on any “hotspots” and you’ll save yourself some strife further along.

Dry sack(s)

Having dry clothes at the end of the day is a luxury that you do not want to surrender, and a good dry sack will help ensure that you have just that, by keeping all your essentials sealed up within your rucksack even if that gets wet.

Tea tree oil

Really handy for helping dry out your feet in the evenings, and also stopping any bacteria from building up and turning into something nasty. I found a spray bottle full of antibacterial goodness at the chemist, which had the added benefit and marvellous fragrance of lavender and eucalyptus oil. This also saved me having to touch my feet and then spread the scent onto anything I subsequently touched.

Compression tights or shorts

These were an absolute lifesaver when it came to preventing chafing.

A firm-soled hiking boot with a good tread

In terrain such as that on the track, I would value tread over flexion, as you’ll need as much grip as possible on muddy inclines and declines.

Spotting the arches at the end of the track certainly spurs you on up the last climb to Owers’ Corner.

Tips and advice

There are many great books written about the Kokoda Track. Having an understanding of the history of the campaign allows you to relate more easily to the events from over 75 years ago when standing in the various locations.

This, in turn, allows you to draw inspiration from these stories when you yourself are struggling along at times (and there will be those times!)

Relics such as this ammunitions site were remarkable to see, left relatively untouched since the war itself. Photo: Daniel Milne

There are a few simple facts that you need to accept if you decide to take on the Kokoda Track:

You are going to be wet whilst walking, due to:

Sweat

Rain

Both

You are going to be wet even BEFORE you START walking, due to:

Sweat

Rain

Both

You are going to be uncomfortable, and feel fatigued at times.

You won’t have hot showers or other home luxuries.

Despite the above points, you will be warm and (relatively) dry at night. You’ll also be fed three square meals a day, know when you’re returning home, and don’t have anyone shooting at you.

If you keep this last point in mind and remember to train hard in the lead-up, then you’ll have a truly enjoyable and rewarding experience on the incredible Kokoda Track. Now get training!

En route to the airport, we made a stop at Bomana War Cemetery, to pay our respects to those who made the ultimate sacrifice. Lest we forget. Photo: Daniel Milne

Are any of you up for the trek of a lifetime? Or have you trekked Kokoda yourself? Let us know in the comments. 

The post Planning and Trekking the Kokoda Track appeared first on Snowys Blog.

[electricoutdoors]

Diseases in an SHTF or Post Collapse Environment – Remaining Healthy in a Long Term Survival Situation

Diseases in an SHTF

Many people prepare for all kinds of situations, but the one thing they don’t prepare for is how to deal with Diseases in an SHTF event. Diseases after SHTF will be deadlier than any band of marauders.

That’s why I always recommend focusing on things like food preservation, water filtration and stockpiling medicines over stockpiling weapons and ammo.

Today, if we’re sick we can simply go to the doctor and have them prescribe medication to us. After a collapse, that luxury will be gone. Something as simple as a small cut or an eye infection could eventually become fatal. [wc_toggle title=“Table of Contents” padding=“” border_width=“” class=“” layout=“box”]

Diseases in an SHTF

Common Ways to Contract a Disease After a Collapse

Poor Hygiene

Poor Sanitation

Contaminated Water

Diseases Caused by Insects

Lung Diseases and Infections

Food-Bourse Disease

Wounds

How to Tell if You Have an Infected Wound

Conclusion

[/wc_toggle] This makes dealing with diseases after an SHTF event one of the most important things that you can prepare for.

Common Ways to Contract a Disease After an SHTF

After an SHTF there are going to be a lot of changes in the way that we live our lives. With no modern conveniences like running water, indoor plumbing (at least to an extent), and curbside garbage pick-up there is certain to be a lot more people getting sick and we’ll probably even see a resurgence of diseases that haven’t been common for decades.

People just aren’t used to getting rid of their garbage and waste anymore so there will certainly be trash and human waste in the streets in certain areas. (Look to the homeless encampments in places like L.A. for an idea of what you’ll probably see.) I don’t even think it’s going to be because they’re lazy, it’s most likely going to be because they won’t know how to deal with the trash they produce.

Poor Hygiene

Hygiene will become even more important after a collapse than it is today. The bad part is keeping yourself clean is going to become much more difficult!

After a collapse, we most likely will not be cleaning ourselves daily. It will simply be too difficult for us to collect the amount of water needed to wash our entire bodies every day.

Instead of cleaning your whole body, keep your hands clean, and wash your armpits, groin, and feet daily. Taking a bath every few days is more than enough when water may be scarce.

Poor hygiene can lead to a whole host of bacterial viral and parasitic infections. These diseases transmitted either directly, which is most commonly the fecal to oral route, or indirectly which means that infected people or animals have come in contact with your food or water.

Poor Sanitation

Sanitation is another aspect of survival that everyone must take seriously. There are many ways to handle sanitation in an emergency. Possibilities include building an outhouse, using a composting toilet, or using premade options such as a Luggable Loo.

One of the easiest permanent solutions is to build an outhouse. The work upfront is strenuous, but the end result is well worth it. If you are staying in an area for any length of time, this is the option that I would suggest.

For a temporary solution, you can dig a simple hole and dispose of your waste in that. These are often referred to as cat holes. The downside with this method is that every time you wish to bury your waste you must find a new place to dig a hole and aren’t using an area that’s been used before. Another drawback is that you must make sure you are disposing of your waste far enough away from where you’re living so that bugs and animals aren’t attracted to your living area.

Contaminated Water

Gathering clean, drinkable, water will become a daily activity in an SHTF environment. Even if you have a working well, it’s going to be hard work.

Feces is often the cause of contaminated water around farms and areas where humans are living. Therefore, we have to take exceptional care to dispose of our feces and waste properly. If we don’t, we can easily contaminate an otherwise perfectly good water source.

Read our article about contaminated water supplies to find out more about all the diseases that can be contained in water.

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Learn to make your own insect repellent.

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Diseases Caused by Insects

In many parts of the world, diseases are commonly spread by insects. Some of the deadliest disease outbreaks in history have been spread via insects.

In the United States, many of these insects are kept at bay by insecticides sprayed by communities and local governments. If a major disaster occurs many of these programs would become unsustainable. This means that we should be ready to expect a massive increase in the insect population in a post-collapse environment.

One of the best ways to keep mosquitoes from growing is to ensure that pools of stagnant water are not allowed to sit around. This can be done by covering water collection devices with a screen or by simply not allowing water to gather in things like spare tires, buckets, or shallow pools.

A great way to prevent water from becoming a breeding ground for insects is to use it to water plants or as drinking water.

Another great way to prevent insects from spreading disease is mosquito netting. By making sure everyone in the family has a mosquito net you can prevent mosquito bites and many types of other biting insects from getting a chance to bite you while you sleep.

Ticks and fleas can also spread disease. Having the means to prevent fleas and ticks from infesting your animals is a necessity. This goes for both livestock and any household animals.

Malaria, dengue fever, yellow fever, West Nile disease, Japanese encephalitis, sleeping sickness, Lyme disease, and tick-borne spotted fevers are all spread by insects.

Geographical Regions Diseases North America Leishmaniases, Lyme Disease, West Nile Disease Central and South America Malaria, Dengue Fever, Yellow Fever, Leishmaniases, Chagas Disease, West Nile Disease North Africa Leishmaniases, Lyme Disease, West Nile Disease Sub-Saharan Africa Malaria, Chikungunya Virus, Dengue Fever, Yellow Fever, Lymphatic Filariasis, Human African Trypanosomiasis, West Nile Disease Asia Malaria, Chikungunya Virus, Dengue Fever, Japanese Encephalitis, Lymphatic Filariasis, Leishmaniases Europe Leishmaniases, Lyme Disease, Tick-borne Meningoencephalitis Virus Oceania Malaria, Chikungunya Virus, Dengue Fever, Japanese Encephalitis, Lymphatic Filariasis, Leishmaniases

Lung Diseases and Infections

Lung diseases are one of the most common medical conditions found in the world. Because lung health is so important to living a full life, it makes these diseases one of the most important to be aware of.

Lung diseases that affect the windpipe are things like asthma, COPD, bronchitis, emphysema, and cystic fibrosis. Bronchitis is a sudden infection of the airway that is usually caused by a virus.

Lung diseases that affect the alveoli ( air sacs in the lungs) are pneumonia, tuberculosis, pulmonary edema, and pneumoconiosis.

Pneumonia is usually caused by bacteria. Tuberculosis is a form of slow, progressive, pneumonia that’s caused by the bacteria Mycobacterium tuberculosis. Pulmonary edema is caused when fluid leaks out of the blood vessels and into the air sacs within the lungs.

This can be caused by either heart failure or injury to the lung. Pneumoconiosis is caused by inhalation of a substance injures the lungs. Black lung disease from inhaled coal dust and inhaled asbestos dust are both examples of this.

Most common causes of respiratory infections are the common cold flu and sore throat. However, other diseases caused by bacteria and viruses are also possible. These will be one of the major causes of death in an SHTF environment.

Living closely with others in cramped, closed in conditions can make the transmission of lung diseases extremely common. This means that families with infants, the elderly, and the wounded will need to ensure that they keep an eye out symptoms of lung disease.

Covering your mouth when you cough, washing hands frequently, and not sharing utensils whenever you can help contain the spread of respiratory illness. If you, or a member of your group, contract a respiratory disease, it’s best that you maintain some distance from the remainder of your group and don’t sleep in the same room.

Food-borne Diseases

Food poisoning is something that is extremely uncomfortable but is rarely fatal in modern society. However, in the event of a societal collapse, severe diarrhea and vomiting could become a death sentence.

Foods that you gather from animal sources such as dairy products, eggs, and meat have the potential for being contaminated with salmonella. These items can also cause cross-contamination in other food items such as produce and vegetables.

A rare steak always tastes great but in a survival situation, you’re going to want to make sure that you thoroughly cook all meat before you consume it.

Canned foods can be another source of foodborne disease. Botulism can also grow in canned foods that are not properly processed.

One way to avoid contracting any disease from home-canned foods is to boil them for 10 minutes before you consume them. For factory canned items, you’ll want to ensure that the can is not dented, punctured, split or leaking. If it is, it’s better to skip a meal then risk food poisoning.

Wounds

Without easy access to a doctor, the likelihood of gaining access to a tetanus shot or large quantities of antibiotics is limited. Simple wounds that you get during a survival situation could become massive problems in the long run if not properly treated.

Be sure to clean any wounds, cuts, scrapes, etc. that you may get as soon as possible. Use soap and water or other means to sterilize the area and then cover it with a bandage. Band-Aids should be used to cover small cuts and scrapes.

How to Tell if You Have an Infected Wound

If you’re feeling exhausted and run down or begin sleeping more than usual this could be a sign that your body is fighting an infection.

A fever is one of the easiest ways to tell if someone is suffering from an infection. Temperatures over 101 degrees typically mean that the body is suffering from an infection of some kind.

Fluid draining from a wound should be expected, however, the color should remain clear or just slightly yellow. If the fluid is cloudy, green, or has a foul smell this means that the wound is most likely infected.

After contracting a wound, pain is normal, however, in the coming days, the pain should gradually subside. If the pain continues to increase over time this is sometimes a sign of infection or further damage.

Swelling, redness, and heat are all expected at the site of the wound. Similar to pain, if swelling and redness don’t begin to go away within a few days, or get worse, this could be another sign that the wound is infected.

Most of these symptoms will show up in conjunction with one another so it should be relatively easy to identify an infected wound.

Conclusion

Right now we have modern conveniences like running water, curbside trash pick-up, and doctors on call 24 hours a day. If we ever lose the things that keep us clean, healthy, and disease-free there are a whole host of problems that we’re going to have to learn to cope with on a daily basis.

Diseases in an SHTF are going to run rampant in certain areas, but hope certainly isn’t lost. Take the time to learn now, while we have access to the internet and endless amounts of knowledge.

Diseases in an SHTF are going to be a real thing, we’re all going to have to deal with them, but that doesn’t mean that we can’t figure out how to live with them. Learn basic ways to keep yourself clean, get rid of trash, waste and even the dead and you’re going to be fine if everything does eventually go belly up!

The previous post Diseases in an SHTF or Post Collapse Environment – Remaining Healthy in a Long Term Survival Situation was originally published on: readylifestyle-staging.gtgrgq9c-liquidwebsites.com

Diseases in an SHTF or Post Collapse Environment – Remaining Healthy in a Long Term Survival Situation published first on https://readylifesytle.tumblr.com

[thewebofslime]

NEWS R. KELLY INTERVIEW SHOWS LIVE Watch CBSN Live Ex-CIA chief Michael Morell resigns Harvard post over Chelsea Manning BY STEFAN BECKET UPDATED ON: SEPTEMBER 14, 2017 / 8:57 PM / CBS NEWS Michael Morell, former deputy director and acting director of the CIA, is stepping down as a senior fellow at Harvard University after the school extended a fellowship to Chelsea Manning, the soldier convicted of leaking classified information to Wikileaks. Morell, a CBS News senior national security contributor, wrote in a letter to Doug Elmendorf, dean of Harvard's Kennedy School of Government, that he can't remain at an organization "that honors a convicted felon and leaker of classified information, Ms. Chelsea Manning." The Harvard Institute of Politics, part of the Kennedy School, named Manning a visiting fellow for the academic year on Wednesday. Manning is the first transgender individual to be awarded the prestigious post, joining a class of fellows that includes Sean Spicer, Robby Mook, Mika Brzezinski and others. Manning was arrested in 2010 for leaking classified information to Wikileaks, and sentenced to 35 years in prison in 2013. She served seven years until her sentence was commuted by President Obama at the end of his term. Morell served 33 years in the CIA, including as deputy director for three years in the Obama administration. He served as acting director of the agency for several months in 2011, then again between November 2012 and March 2013. Morell retired in 2013 and was named a senior fellow at the Belfer Center for Science and International Affairs at the Kennedy School. In his resignation letter, Morell criticized the school for its decision to bring Manning on campus for the fall semester. Former CIA Deputy Director @MichaelJMorell resigns as Senior Fellow at Harvard Kennedy school over their hiring of Chelsea Manning pic.twitter.com/JORdp4ysHR — Mosheh Oinounou (@Mosheh) September 14, 2017 "The Kennedy School's decision will assist Ms. Manning in her long-standing effort to legitimize the criminal path that she took to prominence, an attempt that may encourage others to leak classified information as well," Morell wrote. "I have an obligation to my conscience -- and I believe to the country -- to stand up against any efforts to justify leaks of sensitive national security information." Morell said he had a duty to resign in protest "to make the fundamental point that leaking classified information is disgraceful and damaging to our nation." He added that "it is important to note that I fully support Ms. Manning's rights as a transgender American, including the right to serve our country in the U.S. military." Morell also recognized Manning's right "to publicly discuss the circumstances that surrounded her crimes as well as the IOP's right to invite whomever they believe will further the education of Harvard's student body." On Thursday night, CIA director Mike Pompeo, who has a law degree from Harvard, announced he would not speak at that night's forum, stating that "after much deliberation in the wake of Harvard's announcement of American traitor Chelsea Manning as a Visiting Fellow at the Institute of Politics, my conscience and duty to the men and women of the Central Intelligence Agency will not permit me to betray their trust by appearing to support Harvard's decision with my appearance at tonight's event." His statement went on to say that his decision "has nothing to do with Ms. Manning's identity as a transgender person. It has everything to do with her identity as a traitor to the United States of America and my loyalty to the officers of the CIA." Pompeo's letter concluded saying, "I applaud the decision of Michael Morell, a past and dedicated servant of the same agency that I now lead, to resign as a result of Harvard's decision. I am saddened, however, at Harvard's loss. You have traded a respected individual who served his country with dignity for one who served it with disgrace and who violated the warrior ethos she promised to uphold when she voluntarily chose to join the United States Army." Manning was released from a military prison in Kansas in May. She has since written columns for The New York Times, advocated for transgender rights, and become an avid Twitter user. She reacted to Morell's resignation Thursday afternoon: good 😉🌈💕 #WeGotThis https://t.co/UGBAPmnaHM — Chelsea E. Manning (@xychelsea) September 14, 2017 First published on September 14, 2017 / 4:31 PM © 2017 CBS Interactive Inc. All Rights Reserved. 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The Ethics of Keeping Alfie Alive

By SAURABH JHA

Of my time arguing with doctors, 30 % is spent convincing British doctors that their American counterparts aren’t idiots, 30 % convincing American doctors that British doctors aren’t idiots, and 40 % convincing both that I’m not an idiot.

A British doctor once earnestly asked whether American physicians carry credit card reading machines inside their white coats. Myths about the NHS can be equally comical. British doctors don’t prostate every morning in deference to the NHS, like the citizens of Oceania sang to Big Brother in Orwell’s dystopia. Nor, in their daily rounds, do they calculate opportunity costs for keeping patients alive on ventilators.

Conversations such as this are vanishingly rare.

Administrator: “It’s costing an arm and leg keeping this sick baby alive – to balance the annual budget we need to stop dialyzing a granny.”

ICU doctor: “We’ll have to send poor Ethel to her grave. That’s a shame. She was beginning to grow on me.”

Health Ethicist: “Wait, let me check with National Institute of Clinical Excellence, the rationing experts, who should be relieved of intensive care first. Perhaps it should be Winston, not Ethel – because Winston is an alcoholic. We need to make rationing scientific and fair.”

For the most parts, doctors in both systems do their best for their patients – the constraints of biology play a greater role in influencing physician decisions than the economics of fee-for-service or capitation. This doesn’t mean the system is unimportant – the system sets the stage which shapes decisions systematically – and differences between systems are most evident in gray zones. For instance, British doctors don’t relish missing STEMI anymore than American physicians – but their propensity to get a triple rule out study for vague chest pain may be lower.

To wit, if American doctors do more and British doctors do less, it’s because they believe, respectively, that more and less are in their patient’s best interests. Part of the challenge analyzing physicians, ever since the Dartmouth studies on variation in physician practice, is reconciling in opposite medical decisions similar intentions.

And some differences between the two systems can be stark, and not just in how we spell (o)esophagus. The starkest differences are in the nature and intensity of care, specifically when and who decides medical intervention should be withdrawn, in end-of-life (EOL). The recent case of baby Alfie Evans illustrates these transatlantic differences.

Ventilated without hope

Known to have marked developmental delay, Alfie presented to Alder Hey Hospital, Liverpool, at seven-month age with febrile seizures and pneumonia. Alfie had severe difficulty in breathing and was intubated and transferred to pediatric intensive care unit (PICU). It turned out that fever was not causing seizures – nor were they primary seizures, i.e. seizures for no good reason. His seizures were secondary to severe encephalopathy – severe brain dysfunction.

How severe was Alfie’s encephalopathy? MRI showed substantial areas of reduced diffusion in his brain. The existential struggle of neurons is in throwing sodium out and bringing potassium into the cells by the sodium-potassium pump against their gradients, i.e. against their will – politics at a cellular level is all fascism. When the neuron gives up, meaning the pump fails, sodium builds up in the cells. Then water rushes in, but as the cell swells with water, the diffusion of water slows. Restricted diffusion meant that vast territories of Alfie’s neurons had surrendered.

Failed neurons still express themselves electrically. Afie’s EEG showed purposeless electrical activity, essentially seizures. Though the analogy is not exact, Alfie’s neuronal activity was like ventricular fibrillation – the electrical activity existed for its own sake; it was extreme anarchy without a purpose.

Alfie had infantile spasms. First described by English surgeon, James West, infantile spasms are pernicious not just because they often imply an incurable encephalopathy, but because of their nature. West described these attacks as “…. a complete heaving of the head forward towards his knees, and then immediately relaxing into the upright position, something similar to the attacks of emprosthotonos.” Seen also in tetanus infection and strychnine poisoning, in emprosthotonos the head and feet come together with the back fully arched. It’s not a pretty sight. Infantile spasms are difficult to treat.

Alfie’s repeat MRIs showed that the encephalopathy had progressed. The thalamus, the headquarters of sensation, was barely extant. Not only had the cerebellum, the fine tuner of movements, been replaced by water but so had the basal ganglia, through which commands for gross movement travel. It’s not the volume of neurons per se which is important, but what the neurons are doing.  Alfie had too few neurons doing too little.

As radiologists recognize, diagnostic tests don’t stand on their own – clinical correlation is advised. Alfie’s clinical situation portended an even graver prognosis than his MRI suggested. He was in coma and depended on mechanical ventilation. Alfie’s muscle tone was too weak to even form contractures. Deep pressure above the eye – a richly innervated area – elicited no response. There was no response to loud noise. And, most portentous, his pupillary reflex was abnormal.

When light is shone in the eyes the pupils constrict. The optic nerve, via the command center in the mid brain, tells the oculomotor nerve – a doer, not thinker, nerve – to close the blinds. The absence of normal pupillary reflex, taken in context of Alfie’s MRI findings, confirmed that his midbrain was gutted.

Because of Alfie’s semi-vegetative state his physicians believed that palliation, not ventilation, was in his best interests. Alfie’s parents, devout Catholics, disagreed and sought the counsel of the Pope. Alfie was granted Italian citizenship. A military helicopter was ready to transfer Alfie to a hospital in Rome, but Alder Hey Hospital stopped the transfer. Finally, the courts were involved. The High Court sided with the hospital. The Court of Appeal sided with the High Court. After an aggressive legal battle, and after a year of being dependent on ventilation, Alfie’s ventilator was stopped. Five days later Alfie died.

Alfie’s case elicited strong responses from pro-lifers, libertarians and American conservatives, ranging from parody to disgust. Joe Walsh, with his tongue somewhere near his cheek, used Alfie’s example to underscore the importance of the Second Amendment – though how AR-15s titrate the dose of inotropes in the ICU was not explained by Walsh. Some likened stopping ventilation in Alfie to murder. Even more thoughtful observers were disturbed and saw over reach of medical paternalism, a triumph of the state over the individual, and a moral failing of the NHS.

The crux of the dispute is who has the last say in a child’s treatment decisions – parents or physicians. Many believe that in EOL the right exclusively belongs to parents, which Alder Hey violated by stopping Alfie’s transfer to Italy. However, the matter is not as ethically clear cut as it first appears.

Doctors versus Parents

Parent’s right to ignore physician’s management of their child is not absolute. For example, parents can’t stop antibiotics for acute bacterial meningitis just because they have an objection to antibiotics. But they can object to their child being immunized – even though immunization benefits their child. Medical paternalism isn’t absolute but there are zones in which it becomes absolute and zones in which it is ineffective.

Why can doctors treat a child against parent’s wishes for meningitis but not vaccinate a child against parent’s wishes? Intuitively we see the difference – meningitis has a high mortality untreated. Though, with labored reasoning, we can also create an indistinction. An unvaccinated child is also at risk of death from the infection the vaccine seeks to prevent – though the mortality risk is nowhere near that from untreated meningitis, it is not zero.

Thus risk, in and of itself, cannot be what permits medical paternalism in one but not the other. One may reason that it’s not risk per se but the degree of risk which distinguishes the two. This is an argument of degree. The trouble with arguments of degree, as scientific and logical as they sound, is that they inevitably lead to the question: where do we draw the line? By line I mean a threshold of risk – a numerical or even a descriptive threshold of mortality above which medical paternalism is permitted and below which it is not.

No such line in the sand exists though it need not exist for us to see that the risk of imminent death from meningitis vastly exceeds risk of death from an infection one doesn’t have but might have. And here is the important point: one need not have defined a precise threshold of risk over which doctors prevail over parents should a conflict arise, in order that medical paternalism prevails in the treatment of bacterial meningitis. The child is in danger – arguing where imaginary lines are drawn would be silly. Nor do we need to define “danger.” Some things are self-evident – obvious without explicit definitions.

There are situations where the diagnosis is less clear cut than acute bacterial meningitis, where doctors still prevail over parents when it comes to a child’s well-being. Take a child with fever, rigors, cough and weight loss with nodules on the chest radiograph, and the doctors make a presumptive diagnosis of military tuberculosis and ask that the child be admitted in hospital for treatment. The parents cannot transfer the child to Spain for a second opinion if that transfer interferes with the treatment and may harm the child. However, if a child has headaches and the physician decides against an MRI, believing that the headaches are tension headaches, the parents have every right to get the child checked by any physician anywhere in the world.

Let’s return to the case of parents objecting to their child being vaccinated. An unvaccinated child places other children at risk by potentially disrupting herd immunity. Vaccination is for both individual and greater good. Yet NHS doctors, doctors in socialized medicine, a system – let us remind ourselves – in which society pays for the individual, can’t vaccinate children against parent’s wishes even though vaccination increases net societal welfare by building herd immunity. Put it this way – medical paternalism can’t prevail over parents’ wishes to help other children. Doctors only prevail if a particular child’s welfare is in jeopardy. Far from being in service of utilitarianism, of greatest good for the greatest number, doctors in the NHS triumph over parents only when a specific child is in danger.

Medical Paternalism in End-of-Life

To recap, there are three points. First, neither parental wishes nor medical paternalism is absolute. Second, when doctors and parents have opposing views on medical management of a minor there is no explicit line in the sand which separates situations where doctors prevail from situations where parents prevail. Third, increasing net social welfare is not a reason for doctors to prevail over parents.

The question is should parents have the last say in end-of-life decisions about their child. Specifically, when parents wish to prolong the life of a terminally ill child with profound neurological compromise at all costs – by costs I don’t mean financial costs but medical intervention – but doctors believe palliation, not prolongation of life, is in the best interests of the child, who should prevail?

Palliative care is clearly different from the antibiotics-meningitis example in which the doctors prevail because antibiotics save the child’s life. At first it may seem odd, not just to a restless logician, that medical paternalism prevails over parental wishes both to extend a child’s longevity and not to try to extend it. Surely, there’s a distinction between starting treatment and stopping treatment.

The distinction between palliative care and antibiotics for meningitis is not a distinction of degree but a categorical distinction. Palliation seeks not so much to curtail life but to relieve it from suffering. If the appropriateness, or lack thereof, of medical paternalism in EOL decisions is to be explored, we must explore the role of doctors in palliative care.

The goal of medical care isn’t always to prolong life by any means necessary, is often just symptom relief, and sometimes to keep the terminally ill comfortable, to ensure that they’re treated with dignity. These goals aren’t always congruent, and sometimes oppositional.

There are fates worse than death. Keeping the cardiorespiratory system intact by aggressive modern medical techniques in persistent vegetative state may seem humane to some but does seem inhumane to many. End-of-life is at best an ethical gray zone – by that I mean you can understand both the stance of the family and the point of view of the doctors. As the patient, the rightful decision maker, by the very nature of their terminal and profound neurological compromise is unable to articulate their preferences, someone must make a decision.

The role of medicine in palliative care is not absolute – there is much to palliation which is metaphysical. But doctors do have an important role in determining prognosis, in ascertaining that prognosis is indeed hopeless, and establishing that palliation, whatever may comprise it, is appropriate.

The conclusion that Alfie’s neurological deficit was substantial, progressive and incurable was fundamentally a medical analysis, which Alfie’s physicians, world experts in pediatric neurology, made by their in-depth understanding of biology and careful assessment of Alfie. It would be humane including Alfie’s parents in the decision making, encouraging and indulging all the questions they have. It would be naive concluding they knew more about Alfie’s prognosis than his physicians.

Alfie’s father believed that Alfie was summoning him for help. He thought he saw Alfie yawn. It is humane respecting his beliefs. It is unwise abandoning medical judgment. When experts studied videos of Alfie’s movements they concluded that they were nothing more than seizures. Alfie’s father, a non-physician, a grieving father in understandable denial, could not possibly be expected to make the same analysis.

Some have asked how letting Alfie die can be in his best interests. The argument advanced is that stopping ventilation couldn’t possibly be in Alfie’s best interest because it hastened his death. Others have gone a step further and compared stopping ventilation in Alfie to euthanasia, or even murder.

I’m tempted to ignore the charge that stopping Alfie’s assisted ventilation is murder – but it’s worth thinking it through just to show how unfettered logic becomes fanatical. The rationale is that it’s murder stopping Alfie’s ventilation against his parent’s wishes but not murder if the parents consent to withdrawal of ventilatory support. Imagine if I said – it’s murder if you shoot a child but not murder if the parents ask you to shoot their child. You would think that I have lost the plot.

Was taking Alfie off the ventilator state-sponsored euthanasia, as former leader of UKIP, Nigel Farage, insinuated? Was this the same as a neurologically intact eighty-year-old man with untreatable pain from metastatic prostate cancer flying to Switzerland to receive a lethal dose of morphine? In our conflationary zeal we see similarities when we wish to – but the two situations are different. In the latter, a person capable of making their own decision enters a mutual agreement with a physician to end life. Are we unable to distinguish between stopping intensive care to reduce suffering in the terminally ill from administering a drug with the express purpose of ending life? Is intention irrelevant?

I can put it no better than the Catholic church which distinguishes between withdrawal of ventilatory support and euthanasia, and says eloquently in their catechisms, (2278): “here one wills not to cause death. One’s inability to impede death is merely accepted.”

Was Alfie Suffering?

How could it possibly be in Alfie’s best interest to die? This question is usually accompanied by another: who are doctors to decide that Alfie needed palliation?

The first question is a partial strawman. His doctors’ intention with palliative care wasn’t to end Alfie’s life but to give him dignity in the attenuated life he had left. This is not a distinction without a difference but a nuanced distinction which hinges on intent. Physicians must be judged, or at least judge each other, by intent, not just outcome. If a physician gives thrombolysis to a patient with acute stroke and the patient gets a brain hemorrhage and dies, the intention of the physician was to open the artery and restore function, not cause hemorrhage and end life. To ask how substituting life prolonging mechanisms with palliative care could possibly be in Alfie’s interest is to question the very essence of palliative care.

Let’s reframe the first question. In a person in a vegetative state is there something inherently inhumane about constantly changing artificial feeding and respiratory access, manipulating support lines, fighting infection, getting numerous x-rays and CT scans, and breaking ribs in attempts at cardiopulmonary resuscitation?  The question isn’t whose call it is to switch the ventilator off – that’s an important question, too – the question is whether there is indignity in prolonging life of someone in a vegetative state. Science can’t help you here – it’s your moral intuitions you have to call upon.

It is the patient, not the doctor, who determines their quality of life. However, if the patient can neither feel, that is they lack consciousness, nor articulate that they can feel or not – we do not know whether they prefer palliation over prolongation of life. The second question is a paradox. However, when we do not know we must assume – there is no getting away from assuming – but no normative ethics says that we must assume that a patient in a vegetative state would wish for life to be prolonged, rather than assume that they desire palliation, instead.

The retort is that if a person in a mall has a cardiac arrest would you not assume the person wishes to live and administer CPR? The nuance is in appreciating that we do not know the neurological prognosis in a person unknown to us, which is a different kettle of fish from Alfie’s situation – where the dismal neurological prognosis was without reasonable clinical doubt.

Putting aside pain and suffering, which have some objectivity to them, let’s consider indignity. Alfie could neither feel nor express whether he was experiencing indignity which is, admittedly, a more nebulous concept, but not that nebulous. For example, it is disrespectful being casual about the body of the deceased and there is dignity in giving the deceased a decent burial. Even Osama bin Laden’s body was treated with respect. We treat the body of the deceased with respect not because of the feelings of the deceased, who can’t feel, but for ourselves. It is we, not the deceased, who decide that there is indignity in treating their body with disrespect.

Similarly, the indignity, or lack thereof, in prolonging life in a patient in a vegetative state cannot be decided by the person in a vegetative state – this ought to be so obvious that you should berate me for saying it. Though it is still disputable who has the final say when ventilator should be switched off, doctor or the family, there should be little dispute that it can be the person in the vegetative state, unless that person has an advanced directive specifying their preferences ex ante.

Stopping the Airlift to Italy

After Alfie’s father, Thomas Evans, posted about Alfie’s condition on Facebook, Christine Broesamle, a pro-life activist in Italy got in touch with him. Broesamle moved to Liverpool and began counseling the Evans – who accepted her help in sheer desperation. Also helping the Evans was a law student from Christian Legal Center, Pavel Stroilov.

Broesamle had substantial influence. She had at her beck and call a network of non-NHS doctors who she called upon to assess Alfie. The doctors, pretending to be family friends of the Evans, assessed Alfie behind the back of Alder Hey physicians. Professional courtesy was thrown to the wind. Though it is unclear whether it was because of Broesamle’s influence, the Pope met Evans. The Pope is a busy chap and can’t possibly meet every parent in the world with a dying child – there are millions dying in Africa, hundreds from snake bite, thousands from treatable malaria. But somehow the Pope found the time to meet Thomas Evans.

Thus, the Evans were surrounded by enthusiastic pro-life Christians. There’s, of course, nothing wrong with that – faith has a role in easing the pain of EOL. However, the new friends of the Evans had their own axes to grind. They were interested in Alfie not because he had a treatable condition, but precisely because his condition was untreatable – i.e. he was at the end-of-life.

Neither Broesamle nor Stroilov had kind words to say about Alder Hey Hospital. Broesamle accused Alder Hey physicians of being determined to kill him. Stroilov was described by Justice Hayden, the judge who presided over the legal dispute, as a “fanatical and deluded young man” – particularly harsh words from a usually temperate British judge. After Alfie died, Stroilov egged Thomas Evans to sue Alfie’s physicians for conspiracy to murder in private courts. Thomas Evans, wiser than his advisors, decided against it.

As the media sensationalism began, the rift between the Evans and Alder Hey physicians widened. Alfie was to be air rescued to Bambino Gesu Hospital (BGH). The Alder Hey physicians stopped the transfer. There was uproar. Mobs gathered outside the hospital.

Even thoughtful observers can’t understand why Alfie’s transfer to Italy was stopped. The dispute isn’t that Alder Hey violated the parent’s right to a second opinion. BGH were not offering a second opinion – and I’m assuming that the Pope wasn’t going to re-attempt the Raising of Lazarus miracle on Alfie. BGH was offering long term ventilation and feeding by means of a tracheostomy and gastrostomy, respectively.

The dispute is this. When the Alder Hey physicians knew that Alfie’s condition was hopeless, what was the harm in allowing Alfie to be airlifted to Italy? They were not using the public purse – the transfer and care were to funded by private money. There seems at once little moral, ethical, medical or financial reason to stop the transfer. Was this an ego battle between Alder Hey Hospital and pro-lifers?

Things spiraled very quickly out of control.  The Italian government – who, once they granted Alfie Italian citizenship, threatened to hold the British government responsible for the homicide of an Italian citizen.

Were I Alfie’s neurologist I’d have allowed the transfer. I might have written a book, “Alfie and Me,” taken a selfie with Alfie and the helicopter and posted it on Twitter. I’d have invited the Pope to bless Alder Hey Hospital – and seen what would happen to the all-cause mortality. If a poor infant’s predicament was going to be made into an international circus show, I’d have milked it. But Alder Hey physicians aren’t as ostentatious as I am. And before we accuse them of being agents of the state, a particularly dishonest accusation coming from physicians, who rely heavily on the state for protectionism, it’s worth exploring their reasoning.

Their rationale cannot be strewn to one dimension. Alfie’s case was complex, and the sum of the parts shouldn’t be disrupted by attacking the individual parts. Alfie was in coma with no prospect of any motor or sensory function, with no capacity to express himself, whose only neuronal activity was seizures, which were resistant to treatment. Alfie’s neurological condition was not static, like cerebral palsy, but progressive. Though Alfie had too little thalamus to feel pain, they could not rule out that he was feeling pain – there’s a raging debate, not just of the philosophical nature, whether the brain is even necessary for consciousness.

They speculated, based on their strong clinical judgment, that there was a risk that the helicopter ride would have increased the frequency of Alfie’s intractable seizures. Indeed, the physicians in Italy made this assessment, too. This doesn’t mean that infants with epilepsy shouldn’t be air lifted. But Alfie’s situation was different, and any logic which counters the rationale of Alder Hey physicians must acknowledge Alfie’s unique case. It’s one thing flying an infant with status epilepticus when the purpose of transfer is treatment of the epilepsy, or another life-threatening condition. It’s another thing worsening the frequency of intractable seizures when the purpose of transfer isn’t cure but continuation of care. In the latter situation, it is imposing suffering – i.e. suffering from seizures – for no gain.

Alder Hey physicians were challenged –what’s the evidence the helicopter ride would have worsened Alfie’s seizures? “Show me the data” is a common refrain as it adds a patina of science but asking for data is ignoring the uniqueness of Alfie’s condition, ignoring the value of clinical judgment, of expertise in unique situations.

The irony is cute when the same physicians who laud physician expertise over journalists and economists, challenge the medical judgment of Alder Hey physicians. Why do they not extend the same professional courtesy they seek for themselves to Alfie’s physicians, who are experts in their own realm? I suspect it’s because of a lingering mistrust of NHS doctors. British doctors are believed to act for the state, society or greater good, rather than the patient. Mistrust of physicians is a transatlantic phenomenon. American physicians are thought to act for their financial interest rather than patient’s welfare. Mistrust of physicians is difficult to palliate because, as Othello discovered, once you start off with suspicion, it is difficult to be convinced otherwise.

Though it is hard seeing how Alfie’s physicians were wrong in believing that palliation, not prolongation of life, was in his best interest, the question remains: when family disagrees with doctors in EOL who should prevail? In the US, the family seems to prevail. I need not labor about the brutality of EOL in the US – and American physicians have spoken more lyrically on this topic than I ever could. Suffice to say that no normative ethics supports that the parents have the veto when the ventilator should be switched off in cases such as Alfie’s.

The Court

Britain is different but not that different. Even in Britain, doctors do not have a veto over parents in EOL decisions. Given the impasse between Alder Hey and Alfie’s parents the case went to the high court. The case was meticulously analyzed by Justice Hayden. He requested a broad range of medical opinion – from Great Ormond Street Hospital, from Rome, from Germany. The consensus supported the prognostic assessment of Alder Hey physicians.

Hayden praised Alfie’s father for his probing questions about the prognosis of Alfie but noted that he was understandably in denial about Alfie’s prognosis. Hayden was careful in not letting any histrionics enter his decision. For instance, he chided German physician, Dr. Haas, who in making the case that Alfie’s ventilator should not be switched off, alluded to his country’s legacy in treating disabled people. Hayden considered such allusions tendentious and inflammatory.

Through meticulous reasoning Hayden concluded that stopping ventilation was in Alfie’s best interest because his neurological impairment was advanced, progressive, incurable and, and this is the important addition, that there remained a possibility that Alfie was suffering.

Some see in his decision an over reach of the state. It is tempting invoking the state – but who is this nefarious entity we call the “state”? Elected members of parliament in Westminster, most of whom know little about terminal illness? Bureaucrats? Judges? The secret police? MI5? What did this nebulous, nefarious, entity gain from switching off Alfie’s ventilator?

A common sentiment is that the courts decided that Alfie’s life wasn’t worth living. In any contentious issue it’s a useful exercise re-framing the issue and seeing if you arrive at an alternative conclusion. That the courts were involved showed the limitations of medical paternalism. That Hayden solicited the opinion of pediatric neurologists showed the importance of medical expertise. That the experts agreed on Alfie’s prognosis wasn’t a medical conspiracy, but a moment of medical clarity. That Thomas Evans represented his case, and cross examined the experts, showed that extreme humanity is still possible in extreme circumstances. That Justice Hayden agreed with Alder Hey hospital showed that the hospital got it right.

Thus, far from the courts determining that Alfie’s life wasn’t worth living – by endorsing palliative care, they gave Alfie dignity, they gave his life its due worth by giving the possibility of his suffering considerable importance.

Was Alfie’s ventilator switched off because the NHS rations care?

One argument advanced was that if the issue was constrained resources, it was perfectly fine to switch Alfie’s ventilator off, so long as we all agree that it was about money. The argument, far from being exculpatory, makes the hospital seem reptilian, performing cost-benefit analyses on dying kids. Though resources are always constrained, even in the US, Alfie’s care was not subjected to the usual economic constraints in the NHS – he was in PICU for over a year. Not a dime was charged to his parents. Just imagine the medical bill if he was treated in the US.

The rationale of rationing is withholding expensive treatment which has small benefits because the benefits aren’t worth the costs – note, for rationing to even occur the intervention must have some, i.e. non-zero, benefit. By its very definition, you can’t ration an intervention which has zero benefit and may, in fact, have some harm.

Alder Hey physicians weren’t concerned about the costs of keeping Alfie alive. And costs were irrelevant precisely because Alfie’s condition was incurable. You can only do a cost-effectiveness analysis if there is effectiveness.

The slippery slope argument

A common argument made not just by pro-lifers but Burkean conservatives is the slippery slope argument, which goes like this. Once you decide that Alfie’s life is not worth living who is next? The kid with cerebral palsy? Trisomy 21? Autistic kid? Was Stephen Hawking’s life not worth it, either?

The slippery slope argument dominates public discourse these days. Many believe that Donald Trump’s election is a short step to National Socialism. And it’s not just Trump. When Obama was president, even thoughtful conservatives felt the outgrowth of government was a short step to fascism. In the slippery slope argument everyone templates their political prejudices to an imagined dystopia. It’s Orwell’s Room 101 – where you face your biggest fears.

The slippery slope rationale is first order thinking at its most primal. It is a type of Malthusian error – Malthus believed that the world would be so over populated that we’d be eating each other’s livers. His rationale assumed a linear progression of events, a sort of linear regression where everything else was held constant. It was a mark of a furtive, unchecked, imagination – aka, paranoia. Dystopians make great fiction. They are less useful as public policy.

Let’s examine the rationale because it’s worth introspecting. When history is assessed, it is assessed backwards – we see in Nazism and fascism culmination of several events which started off somewhat innocuously. This is historiography – where we see that short step which led to an evil regime. The error lies not in historiography, which is an analysis in hindsight, but in reverse historiography – which is a forward analysis – where we see in an event a short step to an evil. The trouble with reverse historiography is that many disparate events can potentially be a short step to whatever your most feared political regime happens to be.

Thus, in Alfie’s case we see a short step to the NHS deciding that kids with cerebral palsy will be deemed by the courts as “not worth living.” This is generalization writ large, a Kantian universalism, which is as disingenuous as it is wrong. It is ironic that the same people who laud individualism are so keen to generalize Alfie.

End-of-life is fertile grounds for slippery slope arguments, in part because it’s so difficult getting a grip on nuance. But EOL isn’t a spectrum; it comprises categories and each individual is their own category. You can’t compare Alfie’s predicament – a ventilator-dependent infant with progressive encephalopathy in coma, facing intractable seizures – with a conscious child with cerebral palsy. To conflate is to abandon judgment. For all the rugged individualism, nothing delivers individual nuance in medicine more than clinical acumen.

Physicians in End-of-Life

So long as life is prolonged by modern medical techniques, doctors will be involved in EOL decisions. End-of-life is an emotive area and clashes between family and physicians happen frequently. Spare a thought, though, for Alfie’s physicians who remain anonymous, who faced a mob outside the hospital, faced death threats, faced accusations of murder, faced vituperative attacks on social media. They are humans, too. Caught between doing the best for Alfie and relinquishing to populism they chose the former. You may disagree with their choice. But there’s little doubt that they were courageous physicians who stuck to their convictions. I, for one, give them a standing ovation.

  About the author:

Saurabh Jha is a contributing editor to THCB and can be reached @RogueRad

The Ethics of Keeping Alfie Alive published first on https://wittooth.tumblr.com/

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Diagnosing Snakebite Symptoms in Horses and Livestock

By Heather Smith Thomas – It’s important to know the various snakebite symptoms in case you need to take action in a quick manner. Horses and cattle are sometimes bitten on the leg if they walk over a snake and startle it, but if they are curious and approach the snake they are often bitten on the face. Pit vipers are the most common poisonous snake in the United States. These snakes have heat-sensing organs on their heads which help them locate prey. This group of snakes includes rattlesnakes (most common in western states), copperheads, cottonmouths, and water moccasins (more common in Midwest and South).

The danger/potency of a snakebite often depends on the amount of venom injected by the snake and type of toxins in the venom which can vary depending on species of snake. Most of the toxins affect muscles and blood vessels.

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Rattlesnake venom contains a toxin that creates rapid swelling, pain and bleeding at the bite site and another toxin that damages blood vessels. The poison’s damage is often relative to the size of the animal. A large animal like a horse or cow will often recover without complications from rattlesnake bites unless secondary infection develops. A dog, calf, foal, or child may experience severe snakebite symptoms and have serious complications. Rattlesnakes get rid of rats and other small rodents by immobilizing them with toxins. This causes them to die quickly, enabling the snake to eat them.

The toxins (and amounts of each) can differ in various bites and have different effects, but any bite can have serious complications if the bite becomes infected. Some of the worst cases are bites on the nose or face. Swelling may shut off air passages, making it difficult to breathe. The exertion of being herded or caught for treatment may make it even harder to breathe, and the increased heart rate from exertion may spread the poison.

It’s usually easy to diagnose snakebite symptoms, especially on the face or muzzle. A snakebite on a foot or leg can make the animal lame, and lameness and swelling might be mistaken for foot rot or a badly strained/sprained joint or even a broken bone.

Snakebitten cow

Treatment

Cattle often recover without treatment and have more chance of survival than a horse when bitten on nose or face since they can breathe through the mouth. Horses are more likely to suffocate. Swelling is the first snakebite symptom that will affect the animal. If you notice the bite when it is just starting to swell, you can insert a piece of hose or flexible tubing into each nostril.

Horses often get bitten on the nose because they are curious and approach the snake to smell it or see what it is. One veterinarian says the first thing he does when he goes on a call to see a horse that’s been bitten on the nose is to try to open the airways with whatever he has. One time many years ago, he sent the farmer’s wife to get her hair curlers–the pink foamy kind. He shoved the curlers up into the horse’s nostrils to keep them open, and the horse survived.

If the swelling is too advanced and airways are already squeezed shut and the animal can’t breathe, an emergency tracheostomy is necessary. It’s best if this can be done by a veterinarian, but if a veterinarian can’t get there on time and the animal is going to die, you can try to do it.

With a clean, sharp knife, make a vertical incision through the skin, along the windpipe, right in the middle of the throat—so you can get down to the cartilage rings of the trachea (similar to the ribs in a vacuum cleaner hose). Then use your fingers to open that slit a bit wider side-to-side so you can make a stab incision between the rings. If that���s not enough of a hole to let air go in and out, cut in a small circle, removing a portion of the cartilage ring to make a bigger hole. Often a pocketknife stab is enough between the rings to get it open for air flow. You can slip a small piece of hose or tube into the hole to keep it open. Having a snakebite first aid kit handy can buy some extra time until the veterinarian arrives.

Llama with tracheotomy

Llama with tracheotomy

Llama after tracheotomy

A bite on the leg is usually not as serious, depending on where it is. The higher up the leg (near armpit or groin) the worse it might be. Toxins can then get into the bloodstream quicker, with more risk for anaphylactic shock. Toxins may also rupture red blood cells, and lead to organ failure, starting with the kidneys.

Usually what you see first is localized swelling from the bite. It may progress along the leg in the soft tissues. Your vet may have to surgically remove the dead tissue and get down to healthy tissue, and clean the wound.

Treatment for snakebite symptoms in horses and cattle is aimed at reducing the swelling and inflammation and may include anti-inflammatory drugs. Ice packs or cold packs can help reduce swelling and inflammation. Corticosteroids such as dexamethasone are often used, to decrease the risk for anaphylaxis (severe allergic reaction and shock). Non-steroidal anti-inflammatory drugs like bute or Banamine are very beneficial for reducing swelling and inflammation.

Be aware that when you give a cow steroids in late pregnancy there is high risk for abortion. Corticosteroids don’t seem to have the same effect on pregnant mares, and depending on the case, are often used on horses with snakebite symptoms.

DMSO (dimethyl sulfoxide) will also reduce the pain, swelling, and inflammation. DMSO gel or liquid can be rubbed over the area that’s swelling. If the animal was bitten on the face, having trouble breathing, DMSO can also be given orally–mixed with a little warm water and squirted into the back of the mouth where it is rapidly absorbed and can keep the air passages open by halting tissue swelling. DMSO does a good job as an anti-oxidant and anti-inflammatory but it is also a penetrant and could take the toxin deeper into the tissue. Be careful how you use it.

Snakebitten cow

The main goal in treating snakebite symptoms is to keep the toxin isolated and minimize spread. Confine the animal so it won’t be moving around. Decreasing activity can slow down the spread of toxin by decreasing blood flow. A big dose of rattlesnake venom presents the risk of going systemic and causing organ failure after it gets into the bloodstream.

Antibiotics are often recommended, to minimize secondary bacterial infection from the affected area, especially if there’s a lot of tissue damage. A bite with a lot of muscle toxin can cause necrosis in a large area. The secondary bacterial infection from a dirty bite (with a lot of necrotic tissue) may kill the animal, especially if you didn’t find it early. If the animal is septic and ill, it will definitely need antibiotics.

Snakebites often become infected, and this can be more dangerous than the bite itself. There usually isn’t enough poison in the venom to kill a large animal, but a serious infection may get started because of contamination from bacteria that enter with the bite; the dying tissue makes an ideal place for bacteria to multiply and send toxins into the bloodstream. If this type of infection (blood poisoning) is not treated promptly, the animal may die. Many veterinarians recommend broad-spectrum antibiotics until any possible infection is controlled. Tetanus antitoxin is also a good idea (especially for a horse or pet) if the animal’s tetanus shots are not current. If the bite is several days old before discovered, there may be a large infected swelling that should be lanced and flushed.

Snakebite Vaccine

If you should notice snakebite symptoms in your dog, there is a snakebite vaccine available for them. More recently a vaccine for horses became available which is intended to protect the horse throughout the summer from effects of rattlesnake venom. The dose is important; you want to achieve a high enough antibody level to protect the animal, based on its size. The smaller the animal, the more at risk it will be.

The recommendation when vaccinating horses is to start the first year with three doses (a few weeks apart) and then a booster every six months if you live in areas like parts of Texas and southern California where rattlesnakes are out year-round and never go dormant.

Barney Nelson giving a snakebite vaccine

Snakebite vaccine vial

Owning a horse in northern areas where snakes are out for only a few months in summer, give a booster once a year–about a month before snakes start coming out. This gives horses enough time to ramp up immunity and be fully protected by the time they come into contact with rattlesnakes.

This vaccine was created specifically against venom from Western Diamondback rattlesnakes and is most effective against this snake’s venom, but since venom from many other rattlesnakes is similar, this vaccine may also provide protection against venoms of the prairie rattlesnake, great basin rattlesnake, northern and southern Pacific varieties, sidewinder, timber rattlesnake, massasauga, and copperhead. This vaccine does not provide much protection against venom from water moccasin (cottonmouth), Mojave rattlesnake or coral snake, however, since their venom is different.

Have you had the unfortunate experience of dealing with snakebite symptoms in your livestock or pets?

Diagnosing Snakebite Symptoms in Horses and Livestock was originally posted by All About Chickens