#shes 11 now with a prognosis of 6-8 months

[goldstappen]

Because I'm spiraling right now, here's your reminder to spay your cats as soon as possible. If anyone from SE Michigan is reading this and needs resources for low cost sterilization please message me.

[theevangelion]

Soulmates: Chapter XXX

(Previous Chapters: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29)

The room was dark. Cat awoke to a dry throat, balm on her lips, and some faint surprise that she had awoken at all. The sense of surprise was incremental like a bruise in her conscience that pressed and announced the state of things; an ending meandering towards itself in its own good time.

It was coming undone now.

It was the hard to ignore feeling that Kara had brought her home here in dribbles over the months, by the canvas tote bag, until the hospital became somewhat hybrid because...there wasn’t a home to go back to at the end of this.

Silk pyjamas, curled on her side most days with little movement, in a different bed than her original room, Cat still had zero regrets—plenty of complaints. Not the change of scenery. This room was bigger and much more comfortable with real pillows and comforters that smelled like home, stayed smelling like home, vanilla and old books and a touch of essence, Kara laundered them with the right things—in just the right ways—despite it never being asked, not once.

The view beyond this window was better. Cat didn’t know it was possible. It looked over the lower side, at just the right angle, so she could see her building sprouting tall in the distance like a solitude creature in the skyline; her radiant, proud, towering life’s work.

In the world of treatment, timeframes and ordinate doctors, it was never a good sign when they pulled out stops. They ceased with incessant disapproval about the champagne; no side glances to the empty ice bucket, then the two giggling grown-ups indiscreetly discrete about it, with water marks on top of the ugly, dinged steel cabinet that had been hidden away beneath a patterned silk kimono to make it somewhat less ghastly. The doctors said nothing anymore. Things had gotten bad, all the paths ahead leading nowhere but champagne.

Cat saw it all for what it was and she did not mind.

The dog on sore knees and silver whiskers always found its good fortunes when the six cheeseburgers arrived for dinner after a long day of good, lovely things; Cat took the champagne, every drop, until her hands struggled somewhat, and then Kara proved most useful for that too.

Kara seemed to mind a great deal despite saying she didn’t mind at all.

Her refusal to leave seemed quite indicative. Against the adjacent wall there was a camping cot. Cat squinted and saw the huddled shape of a Kara-sized lump. Moonlight struck a distinct, bolting sheen of light through the cracked blinds. It fell across the blonde hair on the pillow as Kara laid turned to the wall. Cat saw the sleeping cot when she was awake in sporadic jaunts through the day, a distinct wrinkle in the made-up blankets, yet she had never seen Kara sleep much—if ever—at all.

Cat smiled and sincerely hoped that even through the hard times there were still lovely dreams for the foolish, optimistic, loyal Kara Danvers of the world. The girls who, despite crippling anxiety, run from their doldrum lives while shaking in their boots for what is waiting at the finish line. The ones with good hearts who say horrible things anyway. The people who, without merit or reward, stick it out until the very end.

She closed her eyes. Tiredness came with immediacy despite the good long sleep, which wasn’t anything new anymore. Laying there, she became aware of her body—the proximate parts of her skin. Her face. Her hands. Her lips. It was a comfort that Cat hadn't expected for the last stretch of her days, back when the news arrived last year, her mind immediately wandering, there while they talked prognosis, simultaneously not there, running through all sorts of sad notions.

This had never been considered. The clean, balmy tack of solid deodorant under her arms. Her face clean and moisturised—the full Korean programme—cleansed, swiped with toner, then serum and ampule, moisturised, then moisturised some more. She could tell from the slipperiness of the silk pants on her shins that her legs had been shaved too, which was silly, almost obsessive, and she rolled her eyes because it felt too much. Then it didn't feel silly. Cat sat with her thoughts, for the briefest moment, then hurried her mind elsewhere.

It got her throat a little tight otherwise.

Kara took it seriously.

Cat didn't need to ask some underpaid stranger to help her use the bathroom, that was the main thing, that had been the big fear. There was preservation to her dignity. A procedural silliness to it. Kara carrying her some days, dipping around the room, supporting her waist on others, joking about conga lines, but always hanging by the door for just a moment too long with something in her eyes.

“Yeah?” Cat glared the first time.

“Sometimes it takes looking at just the right woman, on just the right commode, to realise you do have a pee fetish after all—”

“Do you say that to all the girls?”

“Oh just the ones who get my name off their skin with a Bic lighter and some sense of determination for a better life. Shout if you need anything.” Kara always left it right there, on the line, precisely between silliness and respect.

The spritz of perfume. The little mirror set-up on the bed tray so she could check her lipstick. Things were coming undone, rapid and quickening. Catherine still felt entirely her own creature. She felt respected. She felt like a woman. She felt beautiful, human, and as though her life still had some good moments ahead too.

It wasn’t anything new.

Kara was consistent.

Cat closed her eyes and took herself for a brief waltz. She never used to sleep easy. She slept in this rare, sporadic and fraught way that dictated her understanding of how assistants should model themselves. Cat slept much easier now. It came to her as a form of escape; a prolonged dream of warm days, that she could pick up and put down, consistent and reliable; the mid-eighties, the first sports car she ever purchased—a boxy little thing with head lamps that came up mechanically from the hood when the engine started—and taut, tight twenty-something year old eyes in the rear-view mirror.

Good skin, great hair, and a silk navy blouse without tags in the collar anymore.

Her memories were worth reliving. The initial success of the magazine had brought a wave of correctness to her young, youthful life; there would be no more returns, no more tags, not ever, Catherine always knew what she wanted, always stood by it.

Plus it felt good spending money.

In her dreams it all came back to her, the early days, when money was a new thing and her attitude towards it was young, gauche and cavalier. Her life had gone from some humdrum, boring, cycling food menus back-and-forth to afford a Vanity Fair; into everything Catherine had ever dreamed overnight, with immediacy, all in the blink of an eye. Thirteen with ladylike ideas of herself one moment, twenty-three and put-together the next.

In her mid-twenties she lived very fine. A demitasse with her coffee in the morning. A caviar spoon—carved from precious mother of pearl with her name engraved along the handle—that coincidentally proved to be just the right size for a less than conservative blast of cocaine.

Catherine Grant never did think much of caviar.

In her dream, Cat dipped into an enormous bump with the Tiffany’s spoon, true to the old days as it had all once been, back when it was a procedural and professional thing to do; she drove, with the top down, men in suits with blowing ties in the passenger seats talking numbers for a local news network that she wanted to purchase.

It was the delicious, perfectly precise moment right at the very start of the CatCo expansion.

Cat rubbed her nose and didn’t care, not particularly knowing much about the mechanics of the business or what she was getting herself into, simply giddy and away with it all. It was a smash and grab way of living; an economic boom that had arrived precisely the same time she did, with skyscrapers sprouting up, stock prices up-ticking, Duran Duran and Pet Shop Boys, and it felt good to remember.

She wondered if that was what people had meant when they said life flashes before one’s eyes at the end. The best parts, the things that were worth remembering, they had come back to her in a loud, bright, and colourfully trumpeting hello; there were no hospice-shaped goodbyes, not in her nineteen-eighties.

Cat had never told Kara the majority of these things for her story spread. She regretted withholding some of the details. On some level, the messy things; the candour, the ruthless and cut-throat bad things she had done too would have made a much more exciting read.

One Kara wouldn't have enjoyed learning about.

Cat kept things abridged for the sake of her own image. Maybe just a bit to protect the little fool too—her little fool—who had come to believe in fairies and giants, and that Catherine Grant was somehow both of these things.

“Kara?” Cat murmured with her eyes still closed—aware time had moved.

“Mhm. I’m here. Are you ready for something to eat?”

There was a distinct pressure on her bed as though someone had sat down. Then a shift in weight, legs pulling up, until Cat felt someone laying beside her. She opened her eyes. It was daytime, bright and warm, Kara laying there in clean clothes and damp hair and a cheek settled against Cat’s ribs.

“I’m not hungry just yet.” Cat observed the distinct, persistent lack of hunger or thirst as a symptom of progress. “Is there a reason you’re laying all over me like some sort of remedial, drooling and rather overly personable puppy?”

“Because it’s a small bed and the best view of the television. Lena has a live broadcast interview airing this morning.” Kara nudged her to look at the photographs and exposition on screen, glancing up with the most tender and excited blue eyes. “I took her for lunch yesterday. She was so nervous about it but we practiced, and I think.” She didn’t seem so confidant. “Well. You know. I think…she’ll do great.”

“That bad, huh?”

“She forgot her name.”

“Ha!” Cat’s chest hurt from the push of her lungs. “She is terrible in front of cameras. The worst social anxiety. Enjoy the rest of your forever, kiddo.”

“Hush,” Kara said, the silly mood detectable, slinging an arm over Cat’s waist absentmindedly. “I still love that boy, Daddy, think I might just go ahead and be his wife one day.” She joked and parroted the hammy, transatlantic accent in all of the old classic films she had been forced to watch over the last few weeks.

“Alright. You don’t like Turner Classic Movies. We can watch other things if you’re going to be fucking petulant.”

“Not true.” Kara gawked, her brow furrowing. “Why do you think I put them on?”

Cat smiled, not saying anything, trying very hard not to think too much about anything, just watching the television as it all went by, and the interview carried alright enough.

Lena remembered her name.

Surprisingly, she even remembered Kara’s too.

Now the world knew Lena Luthor had found love again and Kara Danvers, soon to be Luthor, would be wearing white in the spring.

“What colour do you think I should wear for your wedding?” Cat felt a certain sudden possession on her soul. Aware she wasn’t going to make the day, just not quite ready yet. “I think floral, maybe something with a little colour?” she whispered.

Kara didn’t say anything for a moment, she laid there, cheek to her ribs, arm slung like a seat belt, thinking about it or holding in her tears, but Cat had grown somewhat expert in not thinking about things, and so she didn’t think about it.

“Navy blue,” Kara quietly replied, an absolute certainty in the rasp of her voice. “You should wear that navy silk blouse, and the matching-coloured pants. I would like that. Will you sit close to the front?”

The smoke struck and the sting grew tense.

“Well, I am Catherine Grant”—she said the line often, it was different this time, meant something very different altogether—“I should be as close to the front as possible.”

It was Kara who cried first, which felt more of a surprise than it should have been. Cat had not seen any tears, for months, for this whole thing, not since the argument on the doorstep.

It had been a good thing.

Cat didn’t like mess.

Yet there Kara finally was, a little contained mess, and Cat felt a warmth flood her heart at the sight of these little stinging tears and the corner of her blanket suddenly repurposed as a hanky.

“It’s okay.” The whimpers on her ribs huffed in breaths that tickled. “We’re going to have so much fun at your wedding. You’ll see. But, you know, I don’t think I’ll be drinking on the day.” Cat wasn’t very good at joking but she kept her tone as bouncy and light as she could. “Will you have two glasses when they get you dressed in the morning? One for you, one for me?”

“You’re the meanest woman I ever met and I want you there on my wedding day.” Kara grabbed a slender wrist and brought it around herself. Cat didn’t know what to do, but she allowed herself to be turned into a seat belt, quite determined to keep the little girl safe for now. “It’s supposed to be you and me. On my wedding day. And I…” Cat grew tense. “I’m getting dressed in the morning and I don’t know what to do, what shoes to wear, feeling ugly and awkward, because I always feel ugly and awkward. But you would be there. You would do the thing you do.”

“The thing I do?”

Kara inhaled and seemed to decide if she couldn’t have the real thing, they would just have to make a wedding day, here and now; put it in her heart and tuck it away for later.

“You grab my shoulders and do the awful mean thing you do with words—but in the Catherine Grant way—that puts everything into perspective.” Kara nuzzled with the saddest smile one woman could possess. “And we look in the mirror together at my wedding dress. It’s not me and my mom. Or, me and my sister. It’s supposed to be you and me—” The tears marched in and they didn’t stop this time. “And I get to see myself different because you fixed whatever thing I didn’t realise needed fixing, something only you could fix, and suddenly I get to feel beautiful and attractive and put-together and ready for it all, like I can go and marry Lena Luthor, because you are there.”

Cat nodded and smiled.

“It’ll be your glasses and your earrings.” Cat moved some hair off her face with gentle fingers. “Take your glasses off and make sure your earrings match either the bouquet or your eyes. And, in God’s name, whatever you do please don’t release doves. It’s tacky and gross—”

“You’re the most hateful person I know.”

“You’re the most irritating, foolish and blindly-optimistic woman I have ever had the displeasure of tolerating an elevator ride with much less the final months of my life.” Cat rolled her eyes, then dramatically softened her tone. “And I want to be there on your wedding day too, Kara, very much, so for now I’m saying that I am going to be there.”

“You’re going to be there.” Kara understood what was being asked of her. “Cat?”

“Mhm.”

“I figured it out—by the way.”

“The thing you said you had originally figured out for your article?”

“Mhm.” Kara nodded. “The thing I was trying to…capture.”

“My forties?”

“Your scar.”

“No.” Cat felt angry. “We agreed. I understand it’s your story too. I understand it’s a big request—but it’s one you agreed too. I do not want reporters making insinuations or asking Lena for the rest of her life whether there was a rift between us after she proposed to ‘my soulmate’ while I was dying of cancer. Does that sound like a fluffy, nice portrait piece for either of you?”

“Cat.” Kara pushed up on her arms. Cat glanced, noticed the tautness, the biceps, the blonde hair sitting crooked in her blue eyes. “You said you didn’t want an obituary and I don’t want to write it. You were right, with what you said, and I want to put that perspective in the story. Most of all because I am selfish and it…keeps you alive, forever, beyond always.”

“I’m always right, be specific.”

“Soulmates.” Kara had this emphatic look in her eyes. “It’s bullshit. It’s…” Kara paused. “I think it’s not the universe designing perfect marriages. You could have more than one perfect marriage, or more than one great love. Look at Lena. I met other people too. I even met a woman once who loved two boys, both called Harry, and I think she preferred the wrong one more.” Kara’s eyes flickered and brought thoughts together into words.

Cat grinned too big for her cheeks.

“Two boys called Harry?”

“The first one tattooed her name on his arm just so she would talk to him,” Kara whispered, astounded and romanticising new things. “Isn’t that the most beautiful little thing you ever heard?”

“Maybe.” Cat nodded. “So, hurry it along. If it’s not romance—then what?”

A slow smile, a deep inhale, the optimist blinked slowly and looked like a scared little girl who needed to believe her own dreamy outlook.

“I think it’s a buddy-system.” Kara propped her chin on her hand and stared off. “I think we come from star dust, on some great adventure, some big school bus trip down to earth, and that’s your person—your unconditional person—on your birthmark.” Kara adjusted her weight, lifted the hem of her shirt and trailed a finger over something that had once been important. “It’s not romance. It’s not even love sometimes. It’s the person who understands how to care for you in the right ways in the exact moment you need it. And you, ballsy and knowing everything, decided you weren't in the business of taking care of people.” Her expression exaggerated as though it were enough explanation.

It wasn’t.

Cat didn’t understand Kara’s point.

“Sorry if it still gives you a boo-boo in your feelings?”

“It doesn’t.” Kara scoffed, impressed by it this time. “You were only nineteen years old, and you knew, despite all of human history and the entire world insisting you...force yourself into the idea of marriage?” Kara smiled. “In your very Catherine Grant way—you set your eyes on bigger things. You did it all for yourself. You were selfish, and you were better off for it, you had the biggest life and chased all your dreams. I think…” Kara inhaled. “I think people should fall in love more, with different people, different things, for different reasons at different points in their life. Not just take the safe bet or the road mapped out for them. I think you are my buddy-up person. I think I’m yours. We found each other to take care of right when we both needed a little help, and that?” There was a forced calmness in her tight throat. “That is a happy ending, it's our happy ending, because nobody in my life has ever got it quite so right as helping me grow the way you have, Catherine.”

Cat didn’t say anything.

It struck her funny.

It struck her right in the heart.

“You sound like you have found your story.” Cat pushed a smile. “I don’t think I was ever wife material. I think, probably, I made a much better…” She sighed and didn’t know what to say. “I liked listening to your perspective, but I don’t think I’m much of a buddy either.”

“Just my person then.” Kara patted her hand, teeth on the rim of her lip as she staved off the tears. “A person I probably would have married if I had been born thirty-years earlier.” She tilted her head and left it at that.

“Mhm. Well, let’s just get you to the alter of your actual wedding.”

“She is going to be quite the bride,” Kara grinned.

“Kara?”

“Mhm.”

Here it was, Cat realised.

“You’ll be a good girl won’t you?”

“For Lena?” Kara softened. “I’ll eat healthy and take care of myself just so I outlive her, yeah. I think she’s earned that much.”

“No, no.” Cat shook her head and—for the first time in her life—felt stupid. “Just, in general. You’ll be a good girl, and find all those different things to fall in love with, and never lose your optimism and keep trying to do good things for people?”

“Like you do?” Kara gave her the sarcastic look.

“Fuck off.”

“Mhm.” Kara smiled sweetly and pecked the back of Cat’s hand with a chaste kiss. “Will you be a good girl? You’ll get home safe—wherever it is we’re all going in the end. Tell everyone I said hello?”

“Good girl? I’m fifty.”

“Still a pretty little girl to me.” Kara was not joking and her expression said as much too.

That did it.

Cat felt those words puncture through her soul.

“Thank you.” Cat stroked Kara’s hair. “Really. For everything, for coming around, but for that too. I can’t even remember the last time somebody dared to speak to me like that.”

“Well, you are a pretty little girl,” Kara murmured as she settled a cheek back on her belly. “You should consider yourself lucky. If I had been born thirty years earlier? Your life would have looked a lot different. I could have married a pretty little girl like that.”

“Nah,” Cat said with a shake of her head. “I'm selfish, Kara, not made for taking care of others—never was made that way.”

[prettyinlimegreenboots]

I love you. You enormously stubborn pain in the ass.”

I’ve been watching a lot of “Code Black” and “ER” so I decided to put our favorites in as Medical Professionals. Normally, family isn’t allowed to treat other family members but just pretend that doesn’t exist. There are cuss words in this one. 

December 18, 2019 8:30AM

It was a normal shift, well as normal as the emergency room could be. There had been no major shootings or stabbings though the day was still young, he thought as he sat at the nurse’s station filling out paperwork. 

“Why did I choose to go into Emergency Medicine again?” A chart was thrown on the desk as Katherine “Plums” Plumber, PA slumped over looking at Spot. “I just diagnosed my fifth case of the flu. This should be for the general practice peeps, not me.” 

Spot grinned at his favorite colleague. “I’m sorry princess, but you’re drawing alllllll the short straws tonight.” 

“Damn you Conlon - if I find out you’re the one assigning me cases, as head nurse, it’ll be your head. Next one I get I’m requesting you to join me!” She pointed at him as the bay doors were thrown open and a stretcher was pushed through. She grabbed her stethoscope and pointed to him. “Guess I spoke too soon. You’re with me. What do we have?”

“A 29 year old male who is complaining about severe back pains. Pain level is between 6-7. Blood in urine.” The EMT announced as they wheeled him in, screaming about drugs. 

Spot followed along already prepping an IV line and anticipating any directions Plums would throw his way. The two worked in tandem as additional nurses and orderlies made their way to the bay. 

Within minutes, they had diagnosed him with kidney stones and sent him for an ultrasound to see what the prognosis would be. Making his way back to the nurse’s desk, he threw his gloves in the trash and sighed as he sunk into a chair. He relaxed as he listened to the soothing sounds of the ER; it truly was his home away from home. 

“What are your plans for when you leave this place?” He looked up and grinned at Albert, who had his own chart and running his hand through his hair, messing it up. 

Looking at the clock on the wall, he groaned seeing he had another 2 hours. “Sleeping. Race will be home around 4 so I’m hoping I can get a good nap before he gets home. You?” 

“Surprising Finch with dinner tonight.” Albert grinned. 

Spot studied him for a minute before his hand slammed the desk. “You’re proposing tonight aren’t you?” 

“Why dontcha tell the whole department, Conlon?” Albert dragged out as Plums slid over in her chair. 

“He’ll say yes, Albert. You don’t have to worry.” Plums grinned. “He’s been dropping hints for the last four months.” 

Albert smiled. “Thanks Plums. At least someone knows what to say.” 

“Hey now! I gave you all my advice two months ago when you bought the ring.” Spot scrawled his signature across the paper looking between his two friends. “Besides I haven’t told Racer anything and that’s a damn miracle for sure.”

Albert chuckled at his best friend's antics. “Does he suspect anything?” 

“Nope and he won’t.” Spot said as the doors were thrown open with the sight he didn’t want to see. 

“Plums.” He called her name as he pushed off the desk, rolling his chair backwards and onto his feet running to the doors before anyone could comprehend what was going on. He heard feet behind him as he grabbed a stretcher and rolled it towards the door. 

“What the hell happened?” Spot asked, looking between the two males, one of which had blood running down his face. 

“Your fiancé is an idiot.” Jack Kelly looked between Spot and his wife. 

Between Jack and Spot, they heaved him onto the stretcher before wheeling him back to the bay. “What happened?” 

“He has first period planning as do I so he came down to the shop. The next thing I see his head is bleeding and his arm is weird.” Jack said looking between Kat and Spot. 

“Albert, take Jack out to the waiting room.” Kat said, giving her husband a look as Spot started mopping up the blood on Race’s head. Kat was busy checking on a concussion and his injured arm. 

Kat looked up and sighed. “He needs stitches and a possible cast. Spot, you okay doing that?” 

Shaking his head, he looked at her. “I’m not steady. Get Romeo to do it. I'll start his IV.” 

She nodded, calling Romeo to start the stitches as he focused on inserting the IV. At that time, Race started to come around. “Where am I? Don’t infect me with anything …. My fiancé’s a nurse.” 

“Hey, hey Race. You’re in the ER, Jack brought you in. Do you remember what happened?” Spot asked, leaning close to him. 

“Spottie? No what happened?” Race cracked an eye open, squinting at the brightness. “I hurt, Spot.”

Lacing his fingers with Race’s he squeezed them. “What hurts, Race?” 

“My head and my arm.” He groaned. “It’s fuzzy, Spottie.” 

He looked up at Kat before looking at Race. “What’s fuzzy, Race?”

“Your face.” Race said, closing his eyes. 

Kat put a smile on her face as she leaned over Race. “Hey Race, can you open your eyes for me?” 

He cracked them open with a slight grin. “Lucky me, I got the dream team.” 

“You did.” She smiled. “How many fingers am I holding up?” 

“Three.” He rolled his eyes, his non-injured hand flying up to cradle his head. “Ow Ow ow …. that was dumb, make it stop.” 

Spot bit his lip to keep from laughing. “Make what stop?” 

“Spinning of the room.” Race shut his eyes tightly, willing it to stop. 

Uncapping the IV, Spot pushed the syringe that Kat had handed him full of pain medicine. “There, you should be okay in a few minutes. Can you open your eyes for me and Plums? We have a few questions for you.” 

He sighed, cracking open an eye. “Alright, hit me with these questions.” 

“What year is it?” Kat asked, flashing her penlight in his eyes, watching them slowly dilate. 

“2019, unless I was knocked out longer than that.”

Race chuckled. 

Shaking her head, she smiled. “Nope, you’re good. When’s your wedding date?” 

“January 17, 2020.” 

“What’s your dog’s name?” 

“Uhh … Sassie.” 

Kat looked over at Spot giving him a look. “I’m going to diagnose him with a mild concussion. I want him up in radiology getting a look at that hand. We’ll brace it here but he may need a steadier cast. Spot, wanna take him while I go talk to Jack?” 

She had him a chart and left the room. Removing his gloves, he gave a look at his husband. “How are you feeling?” 

“Like I’m floating. Is that normal?” Race asked, as Romeo smoothed a white bandage on his head. Spot smiled in appreciation. 

“Yea but you’ll be okay. We’re going to get you upstairs for a X-Ray.” Spot patting his shoulder, reaching for the phone to call an orderly to move Race. He braced his arm and stood back when a man came to move the bed. “We’re heading to Radiology, Specs.” 

Race gave his fiancé a look. “Is radiology really necessary? My arm is fine.” 

“Uh huh. You heard Kat, we’re gonna go get it looked at.” Spot walked beside the gurney as they got in the elevator. “You don’t have a choice in the matter.” 

Race pouted. “But Spottie, I’m fine.” 

Specs snorted hearing Race call Spot his nickname. “Racetrack, stop while you’re ahead.” 

He sighed, closing his eyes feeling the gurney move from the elevator. Specs parked the gurney across from radiology as Spot quickly thanked him. “I’m going to see where you are in line. I’ll be right back.” 

Race hummed before Spot disappeared into the adjacent room. Luckily, radiology was empty and they were able to take Race right away. 

“Told ya I’m fine, Spot. Quit worrying.” Race said as they moved him back to the gurney as the tech looked at the x-rays. 

“Actually Mr Higgins, you have a fracture on your ulna, which is probably going to require a cast.” The Radiographer, named Blink, gave Spot a look. 

Blink held up the x-ray that had a circle around a thin silver line. “It’s thin but it’s there.” 

“Thanks Blink.” Spot took the X-ray from him before moving the gurney through the door where Specs was waiting. 

The two moved Race through the halls before putting him in an actual room within the ER. “You’re also staying here a lot longer than planned, Racer.”

“What?!?” He exclaimed, sitting up which agitated his head causing him to groan. “Why?” 

Race texted Kat that they were in the room before giving his fiancé a look. “You have a mild concussion, they’re gonna want to keep you most of the day to make sure you’re not gonna die. Also we need to get a cast on that arm.” 

“Hey guys. How’s it going?” Kat asked, coming into the room, grabbing the x-ray, holding it up to the light to review it. 

“I wanna go home, tell Spot that I’m fine and I don’t have to stay.” Race said as Race adjusted his bed so he was on an incline instead of laying flat. 

Kat’s tongue poked out of her mouth as she studied the x-ray and shook her head. “Sorry, Race, but Spot’s right this time. You’ve got a mild concussion, along with the stitches and the cast we’re gonna put on, I want to keep you in here for a bit to watch you and make sure nothing crazy happens.” 

“I wanna have a second opinion ….. I don’t like the dream team so much anymore!” Race gave them both a pout as Spot chuckled. 

Kat gave the two a look. “I could have Talmore come in and look at him.” 

“Oh no! He already thinks Race is pretty - he’s not touching him. Race, a couple of more hours in here and you’ll be free.” Spot shook his head, looking at Race. “I love you. You enormously stubborn pain in the ass.”

Race’s eyes lit up. “ I love you too but you love my stubborn ass.” 

“No comment.”

Kat laughed, shaking her head. “Only you Race. Spot, go clock out. I’ll get Albert to do his cast.” 

“I can do it...” He gave her a look. 

Motioning to the nurse’s station, she smiled. “Go clock out, gather your stuff, grab Jack and come back here. You are almost dead on your feet.” 

He nodded, leaning over and kissing Race’s head, whispering an ‘I Love You’ before promising he’d be back shortly. 

“So how much longer do I need to be in here?” Race asked looking at Kat. 

Looking at the clock that now read 11:00, Kat sighed, handing him a menu from the bedside table. “We need to get some food in you first and you’ve got to finish that IV bag. I’ll come check up on you at 1:30 and if you’re good, I’ll release you.”

“I’m sorry.” Race looked at her whispering the apology. 

Kat sighed, setting the chart down, sitting in the chair beside the bed, relaxing for the first time since Jack brought him in. “For what?” 

“Making yours and Spot’s worst nightmare come true.” Race played with his fingers, avoiding looking at his sister. 

Reaching up, she caught his fingers and laced them with hers. “It’s alright Race. We’re just glad you’re not more seriously hurt. Yea, we dread the day any of our family ends up here but I’m glad it wasn’t anymore serious. Now figure out what you want for lunch and when Spot comes back, you can order. Let him or I know if anything doesn’t feel right or you feel dizzy, alright?” 

“Thanks Kat.” 

“You’re welcome.” She leaned over and kissed his forehead. “Don’t give Spot too much of a hard time. He’s really worried about you.” 

She left the room, leaving him alone as he flipped through the menu. Spot always hated the food, but did mention the mac and cheese was actually pretty good. He decided on that along with a salad and a chocolate chip cookie when the door was pushed open. 

Jack grinned seeing his brother while Spot looked annoyed. “Where’s Kat? Did you decide lunch?” 

“I think she went to do rounds.” Race said as Spot nodded, putting his stuff in the corner of the room. “Mac and cheese, salad and a chocolate chip cookie.”

“Anything to drink?” Spot gave him a look while picking up the phone. 

“Coke.” Spot tilted his head, trying to figure out if the saline in the IV would dilute the Coke enough - it wouldn’t. “Try again, Race.” 

“Ugh killjoy.” Race groaned. “Sprite then.”

Spot nodded, placing the order as Jack looked over Race’s injuries. “You doing alright?”

“Yea, got a fracture on my ulna, a pretty new bandage and apparently I’m concussed.” Race said, as Spot hung up the phone. “And I’m getting a cast at some point.” 

A knock on the door caused them all to look up. Albert grinned pushing open the door. “Hiya fellas. I hear someone needs a cast.” 

“Albie, I have a fracture on my ulna and the dream team thinks I need a cast.” Race pouted giving his best friend a look. 

Albert gave Race a look. “And you’re gonna be the dumbass to defy them?” 

“Well ….. not me but you could.” Race grinned. 

Laughing, he grabbed the necessary supplies before shaking his head. “Dude, I actually like my job. Besides you don’t piss off head nurse Spot or doctor Plums. It ain’t pretty. Just ask Spot about the other day.” 

“Dude, I’m gonna stick you with all the flu cases for the next two weeks if you don’t shut up.” Spot gave him a look as Albert held his hands up innocently. 

Albert turned to Race and gave him a look. “Sorry you’re on your own with defying them. Leave me outta it. What color do you want your cast?” 

“Wimp. What are my options?” Race asked, as Albert crossed the room to open a drawer, looking at the packages inside. 

Albert sighed. “Pink, green, blue, yellow, red, or purple.” 

“What color green?” Race asked with a grin. 

Albert and Spot both groaned while Jack chuckled. “Lime green like your ugly ass shoes at home.” 

“That’ll work.” Race nodded as Spot collapsed on the couch and threw his arm over his face. “What’s wrong Spottie?” 

“I’m tired Race. I was really looking forward to a nap after work before you got home.” Spot sighed, throwing his arm off his face. “I didn’t anticipate the day going like this.”

Jack looked between the two, starting to feel the tension in the room. “Do you guys need anything?” 

“Nah, I think we’re good. Thanks Jack.” Spot stood and gave him a hug before settling in the chair beside the bed. 

Jack leaned over, gave Race a kiss on the forehead before whispering something to him. “I’m heading out but let me know if you need anything. Bye Al.” 

Watching him leave, the room was quiet as Albert put the cast on. Spot held onto Race’s fingers as they watched Al work. “There it should be set in about 5 minutes. Don’t get it wet, Race. Spot knows how to take care of it.” 

“Thanks Albie.” 

“You’re welcome, Race.” Looking over at Spot, Al gave him a look.  “Need anything, Spot?” 

Shaking his head, Spot smiled. “No, I added something to Race’s order and I stole a can of Mountain Dew from the nurse’s station. But if I don’t see you before we leave, have fun tonight.” 

Albert’s face lit up at that. “Will do. Thanks.”

Watching him leave, Spot sighed, leaning back in the chair. He wanted to say something but he didn’t want to unload on Race. He felt Race squeeze his hand, looking up at him. “I’m sorry.” 

“For what?” Spot’s face softened, hearing the fear in Race’s voice. 

Race’s eyes were wet with tears as everything hit him from the morning. “For scaring you, making you worry and having your worst nightmare come true.” 

Standing up from the chair, Spot sat on the side of the bed and pulled Race into his arms, letting him sob. “I’m sorry you got hurt but dammit Race, my heart stopped when I saw you and Jack at the doors. I think I might’ve aged at least 10 years. I want to be pissed off at you but I’m just really glad you’re okay. Just promise me you’ll be more careful?” 

He felt Race nod on his chest as someone knocked on the door. Looking up, Spot rubbed his fingers under his eyes before calling to come in. An orderly came in and delivered Race’s lunch before asking if they needed anything else. She left after they said they were good. 

Spot grabbed a covered cup before sitting in the chair giving Race a look. “Eat!” 

“What did you get Spot?” Race sniffled, wiping his eyes before pouring the dressing on his salad. 

“Mac and cheese. They always have it for the patients but not always for the staff.” Spot popped a forkful in his mouth savoring the taste. “There’s one good thing about you being here - Mac and cheese for me for lunch.” 

Pulling out his phone, he looked at the texts that had come through. He didn’t see one from Medda, not knowing if she knew about Race yet. He sent her a quick text. 

Race’s in the ER with a concussion, 8 stitches and a fracture ulna. He’s okay and we’ll be going home shortly. I’ll have him call you in a bit. 

“Anything interesting going on in the world?” Race asked, motioning to his phone. 

Locking it and slipping it in his pocket, Spot shook his head. “Nah. You’re not missing a thing. Did you drive this morning or did Jack pick you up?”

“Jack picked me up. Why?” Race replied, starting on his Mac and cheese. “Holy shit this is amazing.” 

“Toldya.” Spot ate some more with a grin. “Trying to figure out if I needed to get your car home. I’m guessing you’re off work for a week or so. Do you need anything from school?” 

“My bag but Jack can grab that.” Race said, trying to think if there’s anything else. “I’ll text him later.” 

Silence enveloped the room, as Race slowly ate his chocolate chip cookie. He couldn’t get Spot’s earlier confession out of his mind. “Do you wanna take a quick nap?” 

Spot bounced his feet, shaking his head at Race’s question “Nah … was actually thinking of going to get some charts to work on. Why?” 

“I was going to see if you want to come lay with me. I’m not feeling the best and wanna cuddle.” Spot toed off his shoes, carefully crawling into the bed with his arm around Race as he laid his head on Spot’s chest. Spot gently ran his fingers through Race’s hair as his breath evened out. Looking up at the bag of saline, Spot sighed knowing they had at least an hour more to go. 

Looking down, Spot relaxed seeing Race sleeping soundly. He sighed, running a hand through his hair and thanked his lucky stars that his world was okay. A quiet tap sounded at the door as he said to come in. 

Kat’s face softened seeing the two of them in the bed. “How is he?” 

“He just ate and cried but he’s doing good. No complaints of pain but the meds we gave him would eliminate that.” Spot said looking up at the saline bag. “I’m guessing he has 30-45 minutes left on that.” 

She nodded. “Yea that’s what I’m thinking. I’m going to keep him off work for a week, I don’t want that concussion getting worse. But that’s not why I came in. There’s some paperwork you need to fill out.” 

“Surprised I’m just getting it now.” Spot rolled his eyes. “If you bring it in, I’ll complete it.” 

Kat put a hand on his arm. “Will do. How are you doing?”

“Better now that he’s fine and sleeping. But I was scared there for a moment.” He looked up at her with a smile. “And you, how are you?” 

Shrugging, she looked at Race. “The same. Broke down with Jack earlier and had a good cry so that seemed to help but I think my heart stopped when I saw them in the doorway.” 

“I told Race the same. I’m just glad he’s alright and it wasn’t anything more serious.” Spot pressed a kiss to Race’s forehead, sighing. 

She patted his arm. “Same, Spot. I’ll get those papers and I’ll be right back. You need anything?”

“Alcohol?” He asked, giving her a grin as she laughed. 

“Sorry that’ll have to be later. But Race won’t be able to have any for a couple of days.” She grinned. 

Spot gave her a look before shooing her from the room. “Thanks Plums.” 

“You’re welcome. Let me know if you need anything.” She took her leave, returning a few moments later with a stack of papers before leaving the two alone.

He quickly filled out the admission paperwork that was a couple of hours late. Reviewing them a final time, he scrawled his signature on the line before throwing them on the table at their feet. 

“Mmmmm what time is it?” Race murmured, shifting slightly. 

Running his hand through his hair, Spot started humming before whispering. “You’ve been asleep about 20 minutes. You’ve got some time before your saline bag is done.” 

“It’s bright, Spottie.” Race whined, burying his head deeper into his chest. “Can you turn the light off?” 

Reaching behind him, he flicked the light above the bed off. “That better?” 

“Yes. Thanks Spot. Love you.” He murmured sleepily. 

Pressing his lips to his head, Spot smiled, humming. “Love you too.” 

The opening of the door startled him as he yawned. “You okay?” 

Looking over at Kat as she washed her hands, she smirked at him. “Yea I must’ve fallen asleep. What time is it?” 

“1:30. Saline bag is almost done so I’m going to disconnect it. Wanna wake sleeping beauty up?” She put a pair of gloves on before smiling at the pair. 

Leaning near Race’s ear, Spot pressed a kiss to his cheek before coaxing him away. “Wake up Racer. Kat’s here to kick us out.” 

Groaning, he stretched before cracking his eyes open “I can go home?” 

“If you wake up.” Kat smiled at the grogginess in his voice as she clamped the IV line as the door opened. 

Albert grinned at them. “Thought you guys were already gone?”

“Nah he had to finish a bag of saline before Plums released him.” Spot said as Albert grabbed a pair of gloves and some supplies. 

Spot pushed himself out of the bed, standing near it gripping Race’s hand. “Hey Race, look at me. Don’t look at them.” 

Race looked over at Spot with a grin “Why?”

“Just don’t. Tell me a story, Race.” Spot said, motioning Kat and Albert to go ahead. 

“A story huh? Well Jack likes to come hang out in my Science Class. He has a habit of leaving something random in the room. Some of my students have him as a teacher so he always tells them to look for something out of place. It drives me absolutely bunkers but the kids really enjoy it.” He shrugged, as Albert put gauze on the IV site.

“Race you gotta keep the gauze on for a couple of hours then you can replace it with a bandaid.” Albert gave his friend a look before looking up at Spot who grinned. Albert threw the IV materials always before leaving the room. 

Race flashed them a thumbs up before looking over at Kat. “Can I leave?” 

“Slow your roll.” She gave her brother-in-law a look. “I’ve gotta draw up discharge papers. You’re going to be off work for a week, giving you some time to heal. Take it easy, Race.” She paused, giving him a no-nonsense look. “No alcohol, no strenuous activity, and no baths. Sponge baths for the first couple of days, then you can shower. Spot, you know what you’re looking for. Any questions?” 

Race’s face fell at the restrictions as he looked at Spot who shook his head. “I think we’re good. Thanks Plums.” 

“I’ll come check up on him the day after tomorrow. You’re welcome. Let me get those papers then I’m kicking you to the curb.” She grinned at them, walking out the door. 

Race leaned up and kissed Spot’s chin, the closest place he could reach. “Thanks Spottie. Can we get pizza for dinner?” 

“If that’s what you want, sure we can get pizza for dinner. No pineapple.” Spot shot him a look. “I don’t care if you’re hurt, no pineapple.” 

Race pouted, as the door was pushed open revealing Kat and Specs with a wheelchair. “Kat back me up - pineapple is good on pizza right?” 

“Sure is. Spot let him have pineapple. He’s hurt.” Kat winked at Race as he laughed. She handed Spot the stack of papers. “You know what’s included in here. Let me know if you have any questions. Race, seriously take it easy tonight, watch movies and hang out on the couch type of night.” 

“Thanks Kat. Can I go?” Race looked between the three in the room. 

Spot grabbed his bag from the corner before heading for the door. “I’ll meet you at the exit in a few minutes. Thanks Plums, Specs.” 

He disappeared as Kat and Specs helped him into the wheelchair before pushing him from the room. Several stops were made along the way as their friends said goodbye to him. As promised, Spot was waiting by the exit, his truck idling with the passenger’s door open. With some help, they got Race into the truck, Spot thanking Kat and Specs again. “Ready to go home?” 

“Take me home Spottie.” Race said with a yawn as he pulled away from the curb and headed home. 

Thanks @wide-eyed--wonderer for sending this prompt. This is 4390 words of pure mayhem and Race being Race. Let me know what you think! 

[curiosity-killed]

a bow for the bad decisions

canon-divergent AU from ep. 24 (on ao3)

part 1 | part 2 | part 3 | part 4 | part 5 | part 6 | part 7 | part 8 | part 9 | part 10 | part 11 | part 12 | part 13 | part 14 | part 15 | part 16 | part 17 | part 18

They were so close to fixing this, so close to bringing him home safe and whole. They’d been hours away from having their family together once more and then only a few steps shy of having them safe. If Jin Zixun hadn’t gone — if Wei Wuxian had just restrained himself — if, if, if. A-niang would whip him with Zidian if she could hear him now. If it was anyone else, any other disciple — but Wei Wuxian isn’t any other disciple. He’s family, no matter his blood. They’ve grown together, fought together, bled for each other. Jiang Cheng gave up his core for him, his dreams and goals. Wei Wuxian gave up his chance to meet his grandmaster, his last fragile connection to his past. He could sooner cut out his own heart than abandon his brother. The night stretches long and sleepless before him. He goes to find Yanli. Though the surgery ended hours ago, Jin Zixuan still has not woken. A-jie sits beside his bed, face pale and drawn. Beside her, Wen Qing is a sallow shadow. She wears the same worn robes he last saw, ruddy colors of the earth so at odds with all the Jin gilt. Blood has stained the grey of her robe, the edge of her sleeves. She rises, still, and dips in a curtsy. “Jiang-zongzhu,” she greets.

Exhaustion is written into the line of her shoulders, the shadows under her dark eyes. He wants to reassure her, comfort her, but he can’t even think where to begin. They’re all captives here in one form or another, but she is the one with the least hope of escape. For so long the Jins have hungered for Wen blood; they won’t release her now that she’s caught in their golden snare.

“A-Cheng,” jie greets, reaching out her hand. He takes it in both of his, holds tight like he can help if only he doesn’t let go. Swallowing, he makes himself look at Jin Zixuan. He’s too pale, in that grey-tinged pallor of deep sickness, and he lies far too still. Only the faint rise and fall of the blankets over his chest give proof of life. “They say he’s in a healing sleep now. He should wake up within a week,” jie says. She pauses and twists to look over her shoulder at Wen Qing. “Is that right, Wen-guniang?” As if stirred from a trance, Wen Qing startles a little and swallows before giving a short nod. “Yes, Jin-xiao-furen,” she says. “The physical trauma was significant but has started healing with the aid of the infusions. The greater damage is to his golden core. If he wakes within the week, we will have a better idea of his prognosis.” Despite everything, she gives her report in a steady, even tone. They could be talking about a sprained wrist for how calmly she speaks. Somehow it settles the wild, terrified thing howling behind his ribs. Everything is wrong and he has no idea how to fix it but — but he has responsibilities, duties even now. He turns to face her without letting go of a-jie’s hand. “What happened?” he asks. He’s asked once before, but there’s a difference in what Nie Mingjue would be able to report and what Wen Qing might. He’s never received correspondence from her like he has from Wei Wuxian, but they’ve been working toward a shared goal regardless. She studies him a long moment, that unflinching evaluation that had unnerved him at first and then made something strange and bright shoot down his spine. Even now, he finds himself standing a little straighter under her consideration. “I didn’t see the attack,” she says, much like Nie Mingjue’s forewarning. “One of the Nie disciples flew to the edge of the wards and demanded I come help. I didn’t believe her at first but—” She pauses, shakes her head. “When I arrived, Jin Zixuan and Wei Wuxian were both unconscious. A— a-Ning had come back to himself,” she says, and there, for the first time, Jiang Cheng hears a faint tremor. “He knew better than to remove his hand and was trying to help, but he was — shaken. He said he remembered Jin Zixun surprising them, archers shooting at the both of them, but after that was dark.” Her hands are held tightly before her belly, like a lifeline or maybe a shield over her softer parts. “Once Jin Zixuan was stabilized, I made a-Ning take Wei Wuxian back,” she continues. “It seemed the best recourse, considering.” He’s grateful, briefly, for her clarity of mind in such a blood-soaked crisis. If Wen Ning and Wei Wuxian were brought here with Wei Wuxian incapacitated and Wen Ning still bloodied from killing Jin and Lan disciples— The thought alone makes cold horror creep frost-like up through his lungs. “And a-Xian?” a-jie asks. “Chifeng-zun said he collapsed.” Wen Qing hesitates a moment, expression tightening, before she gives a slow nod. “He overexerted himself,” she says. Her hand pinches tight around her fingers. “Between maintaining the wards from afar and then the summoning he did at the pass— His control has been slipping.” She stops abruptly, averting her eyes as her throat works. What does that mean? Jiang Cheng wants to demand, but the truth is that he already knows. He was given all the pieces to the answer months ago; he’s only been refusing to look at the way they align. “Is he—” jie starts but she stops short, as if she doesn’t want to ask for fear of the answer. Slow anger burns up where the frost-work horror traced. They’d been so close to fixing this. “The idiot,” he seethes. “He couldn’t just think for once? All he had to do was get here. All he had to do was not start a fight and then we could—” “A-Cheng.” A-jie looks at him with a horrible, heart-breaking softness. A bone-deep weariness seems to permeate her, sorrow already soaking into her soul. He bites down and swallows his words. It’s not fair, he knows. It wasn’t Wei Wuxian’s fault this time, really — except for the way it feels like they’ve been slipping down this road ever since Yiling, ever since Wei Wuxian promised he could fix Jiang Cheng’s core. Looking back now, he can see the path laid out so clearly it seems impossible he ever thought it could lead to any other end. “There is to be a pledge conference tomorrow night,” he says. His voice comes out strangely even, as if he is giving instructions to his disciples rather than speaking with his sister and his brother’s close friend. “All the sects have agreed to take the Burial Mounds by force and bring the Yiling laozu to justice.” A-jie’s hand tightens around his, hard enough it pinches the bones of his fingers. He swallows and holds steady. “Nie Mingjue has claimed custody over you,” he says, looking to Wen Qing. “Jin Guangshan has demanded Wen Ning as well.” There’s no need to say what sentence they’ve passed for Wei Wuxian. By technicality, he is Yunmeng Jiang’s disciple to punish, but he stands alone against the world now. Whoever kills him first will have the right. Wen Qing accepts the information without so much as a flinch. His chest tightens, clenches with frustration and anger at the way she seems so unbothered at being traded from hand to hand like chattel. It’s no surprise, nothing more than common practice. She is a prisoner, after all, even if she escaped. All of them are and as such, they have no right to ask for mercy or better treatment. After all, as much as Wei Wuxian had railed against the unjust treatment of the Wen prisoners in the camps, the argument the sects had used to actually relocate them had hinged more on the way dispersing them across the sects would reduce the likelihood of rebellion rather than concerns for the prisoners themselves. Watching her acceptance before him, though, feels deeply and innately wrong. Wen Qing has always held herself with pride, whether as a member of Wen Ruohan’s inner court or cast out by all the cultivation world. That she would resign herself to such a fate seems a perversion of her nature. “A-Cheng,” jie says, giving his hand a gentle squeeze. Her eyes are beseeching. “Please, don’t let them hurt him. Bring him home, a-Cheng.” There are tears in her eyes, and her voice shakes as she pleads. That wild thing in his chest cracks, breaks like a fault-line through his ribs. His sister should never have to beg, his sister should not be sitting here with her husband dying and her little brother condemned. This is wrong, wrong in a way that cannot be mended no matter how tightly he holds on. “A-jie,” he says, voice breaking. How can she ask this of him? How can he refuse? How can he give her a promise he knows he won’t be able to keep? Tears sting his eyes, break burning on his lips. He cannot give her the answer she needs; he cannot give her a lie. His knees buckle underneath him and he slips down to kneel before her, supplicant, bowing. She folds over him as he presses his tears into her skirts. Her hand still holds his, her body shuddering with sobs. He clings to her and he weeps.

[bloojayoolie]

7/11, Being Alone, and Bad: Juliet Gorgeous, young. friendly. affectionate, playful. housetrained. relaxed & respectful with resident child 46718-I years old. 46 Ibs @brooklyn aco **** TO BE KILLED - 11/17/2018 **** IMAGINE loving your two legged Mom & Dad and thinking you mean as much to them as they to you.... Then during your time of need, they dump you off at some strange place, a scary place where you could die. Juliet is a gorgeous girl whose going to need a hero, a home and love but she also needs medical attention because she is suspected of having a GI foreign body that may need follow up care. Juliet is a petite girl with an adorable face and she lived in complete harmony with a small child, she was housetrained, affectionate and playful. Juliet has been dealt a bad hand by her callous former owners and needs a real family to step in and pick up where they left off. Juliet is just a year old and deserves a chance at life, family and love. Please help share her for a second chance. A new hope rescue will also need pledges for her vetting so they can insure she goes to her new home and family in good health. JULIET@BROOKLYN ACC Hello, my name is Juliet My animal id is #46718 I am a female tan dog at the Brooklyn Animal Care Center The shelter thinks I am about 1 years old, 46 lbs Came into shelter as owner surrender Nov. 7, 2018 Reason Stated: animal health - other. Juliet is rescue only Juliet is at risk for both medical and behavioral concerns. She has been reported to have resource guarding behaviors and is prone to growl or snap. She has not acclimated well to the shelter environment and remains challenging to handle. She is suspected to have a GI foreign body that may need follow up care. Please read full medical assessment for details. My medical notes are... Weight: 46.2 lbs Vet Notes L V T Notes 7/11/2018 triage only due to history of vomiting and diarrhea: growling and lunging at front of cage 6/9 bcs, bright and alert--does not seem critical. will let dog calm down for a day and get trazadone 11/11/2018 DVM Intake Exam Estimated age: 1 yo Microchip noted on Intake? Scanned Microchip Number (If Applicable): History : O surrender due to chronic vomiting and O unable to provide/fund medical care Subjective: Observed Behavior - BAR, ears back, very anxious, will bite Evidence of Cruelty seen - No Evidence of Trauma seen - No Objective: PE performed under sedation. Sedated with butorphanol 0.2 mg/kg IM and dexmedetomidine 10 mcg/kg IM T = NT P = wnl R = eupneic BCS 4/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: pink and moist oral MM. Mild dental calculus and gingivitis PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Tense, firm tubular structure noted in cranial abdomen U/G: Grossly normal MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Externally clean Assessment 1) hx of vomiting/regurg - r/o: GI (FBO vs. gastroenteritis vs. esophagitis vs. other) vs. Non-GI (renal vs. hepatic vs. other) 2) Suspect FBO 3) Underweight Prognosis: Fair to guarded Plan: 1) Sedated with butorphanol 0.2 mg/kg IM and dexmedetomidine 10 mcg/kg IM. 2) CBC/CHEM 3) 2-view abdomen 4) 2-view chest 5) Reversed with antisedan (equal volume to dexmedetomidine) 6) If foreign body suspected on rads, will transport Juliet to MACC 7) Recommend GI ultrasound +/- abdominal explore surgery SURGERY:Temporary waiver due to suspect foreign body 11/11/2018 CBC - All parameters were within the normal reference range CHEM - All parameters were within the normal reference range Chest rads - wnl Abdomen rads - Intestines appear distended with heterogenous material. - r/o: foreign body obstruction vs. fecal material Recommend GI ultrasound +/- abdominal explore surgery. Notified management to secure transport to MACC for monitoring and abdominal explore. 12/11/2018 Pt - BAR - No vomitting or diarrhea since arrivig in ACC yesterday. Stool normally formed. Takes treats! R - WNL, eupnic EENT - no ocular or nasal discahrge. Eyes clear Abdominal palpation - palpable round soft tissue structure (4cm diamter) in the cranial abdomen Rule out: foreign body vs normal anatomical structure (kidney) vs mass vs other A - Pt stable/BAR/Eating and drinking - no vomitting or diarrhea in shelter - Abdominal structure still palpable in cranial abdomen cannot rule out mass/fb versus normal anatomical structure (e.g. kidney) P - Continue to monitor - Repeat xrays now that pt has passed stool RECOMMEND PLACEMENT FOR AN ABDOMINAL ULTRASOUND 14/11/2018 H: Intake on 11/11. Noted to have chronic vomiting and diarrhea per owner. Initial abdominal radiographs on 11/11 concerning for fb (Abdomen rads - Intestines appear distended with heterogenous material). Since being in the shelter, no V/D witnessed. Repeat radiographs performed on 11/13 and sent out for interpretation. RADIOLOGY REPORT: ABDOMEN (November 13, 2018): Right lateral, left lateral, and ventrodorsal views are available for review (3 images). An additional study dated November 11, 2018 is available for comparison (7 images). FINDINGS: The included portion of the thorax is normal. Peritoneal and retroperitoneal serosal margins are well-visualized. The gastric axis is normal and the liver margin is sharp, suggesting normal liver size. The spleen is normal. Both kidneys are partially obscured by superimposition. There is no retroperitoneal mass-effect or mineralization. When compared with the prior study, there is marked reduction in the volume of small intestinal and gastric content. Small intestinal diameter is reduced. There is mild persistent granular soft tissue opaque material within the small intestine and there is a larger amount of feces in the descending colon. The urinary bladder is minimally distended and poorly visualized. The musculoskeletal structures are normal. No other abnormalities are appreciated. CONCLUSIONS: The appearance of the gastrointestinal content on the initial study is suggestive of foreign material, but there is no segmental dilation to suggest complete mechanical obstruction. In the more recent study (November 13, 2018), there is reduction in small intestinal and gastric content suggesting normal gastrointestinal motility. Gastroenteritis secondary to dietary indiscretion or inflammatory bowel disease seems to be the most likely cause of clinical signs. RECOMMENDATIONS: Medical management is appropriate if clinical signs recur. Biopsies would be required for definitive diagnosis of inflammatory bowel disease. If clinical signs persist, abdominal ultrasonography or an upper GI contrast series is recommended, depending on which is more feasible for the patient's temperament. CBC- wnl Chem- mild elevation in ALT (134) Assessment: Vomiting, Diarrhea - historic, not witnessed in shelter Prognosis: fair Plan: Continue to monitor for further clinical signs Details on my behavior are... Behavior Condition: 4. Orange Behavior History Behavior Assessment Behavior upon intake: Juliet seemed a little tense when she entered the room. She snapped once when the counselor was approaching her. No further handling was done after this. Date of Intake: 11/7/2018 Basic Information:: Juliet is a one year old tan and white female dog that was surrendered to the center due to health concerns. The owner had her for four months. The last time that she was taken to the vet was on September, 2018. Previously lived with:: Two adults and one child How is this dog around strangers?: As per owner, Juliet might growl at strangers or sniff them until she gets to know them. How is this dog around children?: She has lived with a two year old child. She was relaxed and playful around her. She plays in a gentle manner. How is this dog around other dogs?: She didn't live with dogs. How is this dog around cats?: She didn't live with cats. Resource guarding:: Juliet growls or snaps if you go around her food while she is eating however she is not bothered if a toy or treat is taken away from her. Bite history:: No bite history with a person or animal. Housetrained:: Yes Energy level/descriptors:: Medium Other Notes:: She is not bothered when she is held or restrained. She is afraid of being bathed however enjoys being brushed. The owner never trimmed her nails. She growls when someone unfamiliar approaches the house. Has this dog ever had any medical issues?: No Medical Notes: As per owner, Juliet has been vomiting and has been having loose bowels right after eating for over a month. For a New Family to Know: She was described as affectionate and playful. At home, she tends to follow people around and be in the same room. She likes to play with balls, stuffed and squeaky toys. She was kept indoors. She used to sleep in besides the owner's bed. She eats dry food and was fed three times a day. She is house-trained and goes potty on wee-wee pads. She is well-behaved when she is left alone in the house. She has never been crated. She knows the sit command. She is used to walks on leash for exercise. She pulls hard when she is on the leash. Date of intake:: 11/7/2018 Means of surrender (length of time in previous home):: Owner surrender Previously lived with:: 2 adults, 1 child Behavior toward strangers:: Growls, lunges Behavior toward children:: Relaxed, playful with resident child Behavior toward dogs:: Unknown Behavior toward cats:: Unknown Resource guarding:: Growls, snaps when approached while eating Bite history:: None reported Housetrained:: Yes Energy level/descriptors:: Affectionate, playful with a medium energy level Date of assessment:: 11/11/2018 Summary:: Due to the high level of fear displayed in the care center combined with her propensity to escalate quickly, Juliet is not a candidate for a handling assessment at this time. Summary (1):: According to Juliet's previous owner, Juliet did not socialize with other dogs while in their care. 11/8: We were unable to safely collar Juliet today. She was giving us clear distance increasing signs that she was very uncomfortable- whale eye, head flipping. She did greet a novel male through the gate and her posture softened, with a slightly tuck tail. 11/9: After successfully collaring Juliet, she was allowed to greet the novel male. Juliet briefly exchanges sniffs then paces the yard. She frequently checks in with the greeter and joins a bit of chase play. 11/13: Juliet maintains her space from a sexually motivated male by spinning around. Date of intake:: 11/7/2018 Summary:: Tense, snapped upon approach Date of initial:: 11/10/2018 Summary:: Growling, snapping ENERGY LEVEL:: Juliet is reported to have a medium energy level in her previous home environment. BEHAVIOR DETERMINATION:: NEW HOPE ONLY Behavior Asilomar: TM - Treatable-Manageable Recommendations:: No children (under 13),Place with a New Hope partner Recommendations comments:: No children (under 13): Due to the level of fear Juliet has displayed in the care center, we feel she may be best set up to succeed in an adult only home. Place with a New Hope partner: Juliet has not acclimated well to the shelter environment and remains challenging to handle; because she has displayed threats of aggression on multiple occassions, we believe she may be best set up to succeed through placement with an experienced rescue partner. We recommend a period of decompression as well as time to acclimate at her own pace. Guidance from a professional trainer or behaviorist is highly advised as we cannot be certain of how her behavior may be outside of the care center. Potential challenges: : Resource guarding,Fearful/potential for defensive aggression Potential challenges comments:: Resource guarding: Juliet's previous owner notes that he may growl and snap when her food bowl is approached. We recommend that Juliet be left alone while eating, and that food guarding behavior modification steps (available at ASPCApro.org) be utilized if this behavior is problematic in his future home. Nothing should ever be taken directly out of Juliet's mouth, and any time something is removed she should be rewarded with a high value treat or toy. She should be taught the "drop" cue and trade-up games. Fearful/potential for defensive aggression: Juliet seems to quickly to snapping, so this is an established behavior that she offers when she feels threatened. Juliet needs careful behavior modification and management to prevent future bites. We recommend only force-free, reward-based training methods for Juliet as more aversive techniques are likely to increase fear and increase the risk of aggression. JULIET IS RESCUE ONLY…..TO SAVE THIS PUP YOU MUST FILL OUT APPLICATIONS WITH AT LEAST 3 NEW HOPE RESCUES. PLEASE HURRY!!! IF YOU CAN FOSTER OR ADOPT THIS PUP, PLEASE PM OUR PAGE FOR ASSISTANCE. WE CAN PROVIDE YOU WITH LINKS TO APPLICATIONS WITH NEW HOPE RESCUES WHO ARE CURRENTLY PULLING FROM THE NYC ACC. PLEASE SHARE THIS DOG FOR A HOME TO SAVE HER LIFE.

[tabloidtoc]

National Enquirer, February 1

You can now buy a copy of this issue for your very own at my eBay store: https://www.ebay.com/str/bradentonbooks

Cover: Conspiracy Exposed! White Supremacists Caused Capitol Riot 

Page 2: Friends of scandal-scarred Shia LaBeouf fear he is sliding off the rails now that galpal Margaret Qualley has suddenly dumped him and Shia feels deserted and completely alone since Margaret walked out on him and he was blindsided when the actress took off in the wake of abuse accusations by his past girlfriends and colleagues labeled him difficult -- Shia thought he could count on Margaret to be at his side while he defended himself but she’s been warned by friends and family he’s toxic in Hollywood and that staying with him could ruin her career 

Page 3: Siegfried Fischbacher’s sad last days have been full of tears and regret as the ailing entertainer prepares to be reunited in the afterlife with cherished partner Roy Horn -- the German-born illusionist has been fighting pancreatic cancer but after having a malignant tumor removed during a 12-hour surgery last month, Siegfried left the facility to die at Little Bavaria which is the Las Vegas home he long shared with Roy

Page 4: Angelina Jolie has been digging up dirt on ex-husband Brad Pitt’s pals in a desperate bid to get the upper hand in their toxic divorce war -- Angie and her team are still looking for whatever they can get on Brad but he’s so squeaky clean these days they’re turning their attention to the rockers and grungy types that he hangs with in L.A. and it’s all very twisted but Angie is willing to try anything at this point -- Angie and Brad’s custody battle is at a standstill with Angie refusing to budge with her demand for full custody of the kids while Brad wants more visitation rights -- Angie is likely to be barking up the wrong tree because Brad’s friends are sober clean-living types who have been a huge influence in helping him turn his life around but she’s leaving no stone unturned in this divorce fight 

* Consciously unconventional Gwyneth Paltrow and husband Brad Falchuk are taking mini-breaks to prove that absence makes the heart grow fonder -- the love is there but Gwyneth is suggesting they try mini-me breaks to keep the embers burning in their relationship and she believes separating from time to time will stir up the passion ad anticipation between them -- Gwyneth often slips off for short trips without Brad and feels no guilt or remorse for it and she encourages Brad to do the same and says it makes her miss him when he’s away

Page 5: Sandra Bullock has become buddies with Will Smith and wife Jada Pinkett Smith and is reaping the benefits of the longtime couple’s hard-earned advice and Sandra’s five-year romance with photographer Bryan Randall has never been better -- the new friendship blossomed after Sandra appeared on Jada’s Red Table Talk show to celebrate frontline workers during the pandemic and Sandra and Jada have gotten really close since then and Jada’s been giving Sandra tips about how to handle the highs and lows of a relationship and learning to appreciate her man 

Page 6: Newbie twosome Olivia Wilde and Harry Styles are already shopping for a love shack and they want to be with each other all the time and they both need permanent places to live because Olivia’s been staying at a temporary place and Harry’s been staying with friends and they both want someplace where they can be together in private -- Olivia wants two places which is one where she can be a mother to her kids with ex Jason Sudeikis but she also wants a love nest to share with Harry and they’ve been looking in the Pacific Palisades and Malibu areas because they’re in love but they don’t want to flaunt their relationship in front of her kids; Olivia has too much fondness and respect for Jason to do that

Page 7: Carrie Underwood and husband Mike Fisher have been gushing all over each other but they’ve worked 24/7 for months to avoid a divorce -- they had very real problems that stretched back years because Carrie was either working too hard in the recording studio or on the road or in their home gym and their issues never really got addressed head-on and they were even talking divorce but lockdown has done them both a world of good by forcing them to get to know each other all over again 

* Covidiot of the Week -- Bruce Willis got booted from a Los Angeles Rite Aid rather than put on a mask to protect his freaked-out fellow shoppers -- Bruce was wearing a bandana around his neck as he strolled the aisles of the pharmacy but he apparently lacked the strength to pull it up and over his nose and mouth because he refused to wear a mask and he walked out of the store leaving his intended purchases behind rather than respond to a manager’s plea to have some respect for other people 

Page 8: Love-starved Kelly Clarkson is having a little “Office” romance with one of the beloved sitcom’s former stars Craig Robinson -- a recent flirt-fest on Kelly’s chat show has left the newly single mother of two singing the comic actor’s praises to pals and he totally swept her off her feet and she thinks he’s cute and one of the funniest guys she’s ever met -- the mutual attraction between the two was immediate and obvious and she’s been reaching out to him on the phone and they’ve been continuing their funny and flirty repartee -- Kelly thinks he’s the perfect catch and wants to start 2021 off on the right foot after all the hell she’s going through in her divorce from Brandon Blackstock 

* Embattled Ellen DeGeneres has cooked up a new plan to save her troubled career and marriage: a baby -- last year was the toughest year of her life let alone her career and she’s hoping a baby may be the answer to all her problems -- it was hell at home for wife Portia de Rossi because Ellen was blasting her about anything and everything and Portia declared she had no intention of being Ellen’s personal punching bag and Ellen has now realized how harsh she had been on her spouse of 12 years and that’s when Ellen cooked up the concept of having a baby to bond over and Ellen is convinced that sharing a child will bring them closer together again and is willing to go the surrogate route to make it happen -- she also believes bringing a baby into her life will improve her image and it’s a can’t-lose scenario in her mind 

Page 9: Kelly Ripa is pushing pal Ryan Seacrest to find new romance online -- Ryan spent the holidays alone after being dumped by his on-off galpal Shayna Taylor but Kelly believes he can find lasting love with an age-appropriate partner -- Ryan is 46 and he’s dated some of the most beautiful women in the world but Kelly thinks he’d do a lot better if he looked for women closer to his age and Kelly has been pushing him to try a dating app like Raya which caters to a star-studded clientele -- Kelly has been happily married for 21 years and wants the same happiness for Ryan and she thinks he can find that by using an app where he can find a woman in his age bracket with similar interests and attitudes 

Page 10: Hot Shots -- Malin Akerman hit the road on her bike in L.A., shirtless Justin Bieber hitting the shore in Hawaii, Good Morning America co-host Robin Roberts smoothed back her hairdo on the morning show set, Larsa Pippen posed on her Porsche outside her Miami mansion, dapper dresser Chris Pine shot scenes from the upcoming thriller All the Old Knives in London 

Page 11: Dustin Diamond has been hospitalized with searing pain and is undergoing tests to pin down the cause of the mystery ailment but he feared prognosis is cancer which is said to have a history of the disease in his family

* Carol Burnett is overjoyed her temporary guardianship of grandson Dylan Hamilton-West has been extended but remains heartbroken her troubled daughter Erin is not yet prepared to resume her role as a parent -- Los Angeles Superior Court Judge Deborah L. Christian extended the guardianship until November 30 and praised Carol and her husband Brian Miller saying that everything seems to be going along swimmingly -- the judge also ruled Erin will be allowed supervised weekly visits with Dylan 

* The house that tragic Glee star Naya Rivera shared with her son Josey in Los Feliz, California is up for sale for $2,695,000 -- Naya purchased the four-bedroom, three-bath home in May 2018 for $1,660,000 just a month before her divorce from Ryan Dorsey with whom she she shared custody of Josey 

Page 12: Straight Shuter -- Katie Couric desperately hopes her guest host stint on Jeopardy! will turn into a full-time job replacing the late Alex Trebek -- it will be positioned that Katie is guest-hosting for a week but it’s actually an audition; all the upcoming Jeopardy! guest hosts are being tested out and depending on how they do and how the audience responds one of them will get the gig full-time -- the show is moving very carefully to replace Alex because they get one shot at this and if they hire the wrong person the show is over 

* Kathy Griffin won’t ever be able to mend fences with former BFF Anderson Cooper after she posted a gruesome image of Donald Trump’s decapitated head -- Anderson holds a grudge like no other and once you upset him it’s for life -- he isn’t rude and he’s not vindictive but he has zero interest in ever being friends with Kathy ever again 

* Image-obsessed Tom Cruise has boosted security since audiotapes were leaked of his meltdown on the Mission: Impossible set -- all phones and non-official recording devices have been banned from the set and Tom has become increasingly annoyed at anything being leaked from his closed set and he’s very controlling when it comes to his image and he’s upped his security to make sure a breach in protocol like that never happens again 

* Selling Sunset’s Christine Quinn glams it up for a photo shoot in Bel-Air (picture)

Page 13: Sylvester Stallone is ready to relinquish his title as Tinseltown’s reigning action champ to enjoy the final rounds of his heavyweight career at his new Florida mansion surrounded by his family -- he isn’t hanging up his gloves in the movie business just yet but is content to coast to the final bell at the $35 million West Palm Beach estate with Jennifer Flavin his wife of 23 years -- Sly’s been working his butt off for decades and he’s finally got the perfect place where they can settle down and host their children whenever they want a proper family gathering 

* Jennifer Garner hasn’t even moved into her $7.5 million home yet but she’s already installed a state-of-the-art security system to keep it safe -- the safety-conscious mom of three is building her Los Angeles dream home from scratch right around the corner from where she lived with ex-husband Ben Affleck and while the finishing touches aren’t complete she has made serious security arrangements like motion detectors and lights and safes and up to 20 surveillance cameras around the posh pad to keep intruders away from her and the children she shares with Ben: Violet, Seraphina and Samuel -- it’s costing her a fortune but she’ll spend whatever she needs to keep her family safe 

Page 14: Crime 

Page 15: Accused rapist Danny Masterson could be dumped by the Church of Scientology to protect its leader David Miscavige -- the Church of Scientology is not loyal to anyone but itself and it has no interest in its parishioners even Danny Masterson and if their leader is going to be exposed they will take out Danny in a heartbeat; he’d be excommunicated -- Masterson faces criminal charges he raped three women and he’s also battling a civil suit filed by four women who accuse him of rape and Scientology of intimidating them into silence and not reporting the crimes to police -- attorneys for the fourth woman Marie Bobette Riales are trying to serve a subpoena on Miscavige in a bid to expose the ruthless tactics used by Scientology to hide the twisted secrets of its celebrity members -- the controversial church will do anything including dumping Danny to prevent Miscavige from being dragged into court but if Scientology turns on Danny he could spill all their secrets on the stand 

Page 16: Hollywood kid Rumer Willis has rewarded herself for four years of sobriety with a plastic surgery tune-up -- in a photo she recently posted to Instagram her face appeared more streamlined and her new look is likely due to cosmetic enhancements 

* Nagging allegations that Kanye West is gay and had affairs with two male beauty gurus could not have come at a worse time for the troubled rapper -- Kanye is furious at the salacious accusations just as his marriage to Kim Kardashian is hanging by a thread and although Kanye is far from homophobic but the last thing he needs right now is to try and fight off rumors about his sexuality just when he’s desperate to save his marriage and he thinks the accusers are just trying to capitalize on his current problems and trying to crush any hope he has of staying together with Kim -- TikTok influencer Ava Louise dropped the first bomb in early January when she claimed Kanye slept with male YouTuber Jeffree Star and that it played a role in the current fractured state of his marriage and less than 24 hours after Ava shared her shocking claims she received a cease-and-desist letter from Kim’s mom Kris Jenner’s communications company -- Jeffree Star took to YouTube to deny the affair -- another male beauty influencer Cole Carrigan then jumped on the bandwagon and claimed to have had a sexual encounter with Kanye at Hollywood’s W hotel and said he had receipts and texts between him and one of the rapper’s bodyguards adding he didn’t want to say too much because he didn’t want a lawsuit from Kim Kardashian West but two days later Cole posted a video of himself with a cease-and-desist letter from the bodyguard’s attorney 

Page 17: Only a week after Larry King was hospitalized with a life-threatening COVID-19 diagnosis his estranged wife Shawn splurged on a three-hour shopping spree -- Shawn didn’t seem to have a care in the world when she was snapped browsing for beauty supplies and home furnishings in L.A. while at the same time her soon-to-be ex-husband remained hospitalized in Cedars-Sinai Medical Center after being transferred from the intensive care unit 

Page 18: American Life 

Page 19: Kim Cattrall’s feud with Sex and the City co-star Sarah Jessica Parker just won’t die -- Kim who played Samantha Jones recently liked a tweet from a fan praising her for not joining her former castmates in an upcoming SATC reboot -- Kim and Sarah reportedly clashed behind the scenes for years 

* Amber Heard splashed out more than $1 million in donations toward fulfilling her pledge to give away her $7 million divorce settlement from Johnny Depp -- one of Amber’s attorneys challenged charges from Depp’s legal team who claimed Amber had pocketed the princely sum -- Amber has been delayed in that goal because Johnny filed a lawsuit against her and consequently she has been forced to spend millions of dollars defending his claims against her 

Page 20: Daring Duchess Sarah Ferguson has written a racy romance novel and she’s taken inspiration from her very own love life -- the ex-wife of Britain’s Prince Andrew who was scandalously snapped having her tootsies sucked by a suitor in 1992 penned Her Heart for a Compass which is set to be released this summer -- Sarah said the page-turner was inspired by the life of her great-aunt Lady Margaret Montagu Douglas Scott and the work incorporates research into the duchess’ heritage and draws upon her own unique life journey and experiences -- the historical saga is set in the late 1800s 

* Hollywood Hookups -- Luke Evans and boyfriend Rafa Olarra split, Megan Fox and Machine Gun Kelly move into together, LeToya Luckett and husband Tommicus Walker split 

Page 21: Prince Harry’s sporting a new crowning glory which is a ponytail -- that’s the dish from Rob Lowe who spotted Harry’s new ‘do while driving in their California neighborhood -- Rob said it looked that his hair had grown very long and was pulled back very tightly in a ponytail and he even followed the car to Harry and wife Meghan Markle’s mansion to make sure it was him -- Rob said Harry lives about a mile from him and he’s been very reclusive and seeing him is like seeing the Loch Ness Monster 

* George Clooney’s face has blown up like a balloon -- he looked painfully gaunt for months after rapidly dropping 28 pounds to play an ailing scientist in his latest movie The Midnight Sky but once the sickly star has bounced back and judging from his mug he’s apparently been pigging out in a bid to regain the weight he lost 

* Brendan Fraser is gearing up for a big career comeback as a 600-pound recluse in Darren Aronofsky’s The Whale -- the choice of the role is ironic as the once-chiseled star seemed to fall out favor with Tinseltown bigwigs when his own weight ballooned -- Brendan is poised to make a whopper of a return to leading man status with meaty character Charlie who is a grief-stricken compulsive eater who seeks to reconnect with his estranged daughter 

Page 22: Explosive evidence reveals Earth is in great danger from attacking space aliens but despite a 3000-document cache released by the CIA, the government is still finding ways to classify extraterrestrial information -- the CIA dossier was obtained by John Greenewald Jr. and published on his Black Vault website -- the documents were likely released because of a new law that is part of the recent $2.3 billion COVID-19 relief package passed by Congress requiring government agencies to spill the beans on the UFO data they’ve amassed over 70 years 

* Agonizing health woes threaten to push long-suffering Lisa Marie Presley over the edge -- Lisa Marie has been in a lot of pain and years of drug and alcohol abuse have devastated her body -- she’s recently battled liver ailments and an abdominal muscle tear and suffered a hernia and had to have two teeth removed -- in addition to being in physical torment Lisa Marie had to move out of her Los Angeles home while workers addressed a problem with toxic mold -- Lisa Marie was already close to rock bottom after her son Ben Keough killed himself in July and amid her grief she’s still embroiled in a lawsuit with her former manager  and locked in an ugly divorce and custody battle with fourth husband Michael Lockwood the father of her twins Harper and Finley 

Page 23: As more shocking details emerged from Armie Hammer’s former girlfriends about what they claim are his sick and twisted fetishes for rape, bondage and cannibalism his career is crumbling before his eyes -- although many had trouble believing the depths of depravity allegedly revealed in private messages an anonymous woman claimed the actor sent her, even his estranged wife is shocked and sickened by Armie’s tawdry reported sexual tastes -- this is not the kind of scandal any actor would want to be linked to -- his pals are urging him to get counseling as the scandal could kill the trust-fund actor’s career 

Page 25: Cover Story -- It’s just the beginning! Capitol riot conspiracy exposed -- Proud Boys led blood-soaked siege -- 5-page investigative special 

Page 29: Outspoken Arnold Schwarzenegger likened the recent attack on the U.S. Capitol which left 5 dead to Nazi violence -- the former California governor and staunch Republican compared the January 6 riots by protestors, who refused to accept the outcome of the 2020 presidential election, to German’s Kristallnacht in 1938 -- in a video address Austrian-born Schwarzenegger who’s held U.S. citizenship since 1983 said Wednesday was the Day of Broken Glass right here in the United States 

Page 32: Health 

Page 38: Tormented actor Gabriel Byrne confessed he finally confronted the priest who abused him when he was 11 years old and it didn’t go well -- Byrne phoned the pedophilic priest in 2002 but the sicko said he has no recollection and even thanked Gabriel for reaching out -- Gabriel wanted in those last seconds to say that even though he doesn’t believe in Hell he hopes the priest did because he wanted him to be terrified and burn forever but he said nothing because some part of him did not want to hurt an old man with a kindly voice stuck in a retirement home 

* Miley Cyrus decorates her home with X-rated doodads -- she said in an interview that she likes sex toys and she buys them for herself but ends up using them for interior design

Page 40: Sleazy sex creep Jeffrey Epstein was nearly snared in a To Catch a Predator-style sting almost five years before the pedophile’s suspicious death in a Manhattan prison dished journalist Chris Hansen -- the former NBC host recently claimed in 2014 or 2015 after Epstein’s first jail stint for soliciting a minor he met with lawyers for some of the sex offenders alleged victims who claimed the financier was abusing underage girls -- they had a big file on it according to Hansen and he was trying to fashion a Predator-like sting operation in which they could catch him but he gave up on his quest because security at Epstein’s NYC and Florida homes made it very difficult to come up with something -- Hansen admitted not nailing Epstein was his biggest career regret 

Page 42: Red Carpet -- Taylor Swift at the Grammys 

Page 45: Spot the Differences -- Mayim Bialik on the premiere episode of her sitcom Call Me Kat 

Page 47: The Odd List 

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High Risk HPV, HSIL and Primary Diffuse Large B Cell Lymphoma of Cervix: An Unsual Case- Juniper Publishers

Abstract

Primary malignant non-Hodgkin’s lymphomas in the female genital tract are rare, accounting for less than 1% of all extranodal non-Hodgkin’s lymphomas. HPV infection has well been documented as the causative factor for Carcinoma cervix; not malignant lymphoma of cervix. Here we report an interesting case of primary non-Hodgkin’s lymphomas of uterine cervix with proven HPV 16 infection and High grade squamous intraepithelial lesion with co-existing diffuse large B-cell lymphomas (DLBCL) on histopathological examination and immunohistochemical study. The patient was successfully treated with chemotherapy after Cervical Conisation for HSIL and is now in complete remission with follow up period of 11 months. Gynecological lymphomas can be a diagnostic challenge due to nonspecific symptoms. However, when diagnosed and treated they have a good prognosis. Clinicians should therefore include lymphoma in their differential diagnosis when investigating gynecological symptoms.

Case report

28-year-old lady went for a routine gynecological checkup where a Pap smear was taken. The report came as Low grade squamous intra-epithelial lesion (LSIL). HPV test was done; it came as positive for genotype 16 which is consistent with high risk HPV, which is a proven carcinogenic virus for cervical cancer. Colposcopic biopsy soon followed and it showed (Figure 1) High grade squamous intraepithelial lesion (HSIL) (CIN III). Cervical LEEP excision was done to cure the disease. The specimen measured 4.5x3x1cm and was oriented at 12 o’ clock. It was inked and serially sliced. The sections showed foci of epithelial dysplasia involving the entire thickness with loss of maturation and presence of hyperchromatic pleomorphic nuclei with involvement of the endocervical glands. The features were in keeping with High grade squamous intraepithelial lesion (HSIL) (CIN III) (Figure 2a). No histological evidence of stromal invasion was seen.

The sub epithelial region showed (Figure 2b) sheets of neoplastic lymphoid cells with irregular nuclear contours, vesicular nuclei, occasional prominent nucleoli and moderate amount of eosinophilic cytoplasm. Mitosis was frequent. Spindling of tumour cells was evident in areas. Immunohistochemical work up showed the tumour cells were positive for CD20 (Figure 2c) while negative for CD3, CD10, Bcl-6 and Cyclin D1. The neoplasm extended up to the deep resection margin. The final diagnosis was given as High grade squamous intraepithelial lesion (HSIL) (Cervical intraepithelial Neoplasia III/ CIN III) with Non-Hodgkin’s Lymphoma B-cell type; Diffuse Large B Cell (DLBCL) Further staging work up and imaging was done (Figure 3) which showed extension of neoplasm to the vaginal fornices, the anterior vaginal wall and the parametrium with involvement of the left ureteric wall and subsequent mild hydronephrosis.

CT neck, chest and abdomen showed no evidence of metastasis. In chest and abdomen; no significant abnormality noted. No significant lymphadenopathy or metastasis in chest. In abdomen, liver was displaying multiple hepatic focal lesions with progressive fill in the contrast likely hemangiomatous left hydroureteronephrosis, left ovarian cyst, retained fluid within the uterine cavity. PET CT scan impression came as hypermetabolic lesions involving the cervix with vaginal and parametrial involvement in keeping with biopsy proven metabolically active lymphoma. The remainder of the study shows no evidence of FDG avid lymphoma. Mild left hydronephrosis was noted. Since Lymphoma of cervix is a very uncommon lymphoma type and surgery has removed most of the disease, in the tumour board it was planned to consider chemotherapy followed by radiotherapy based on available data; measures that could be used in treating lymphoma of cervix. Different options of treatment was discussed and finally planned to give her 6 Cycles of R-CHOP followed by PET- CT and involved field Radiotherapy.

Since the patient was just engaged only and with no children, fertility issue had been discussed with her. Patient decided not to do any fertility preservation procedure. So prophylactic Goserelin injections to increase the chance of being fertile was also planned; once every 4th week up to 6 months after last chemotherapy. After 6 cycles of R- CHOP the patient was sent for PET- CT and impression showed a complete response to therapy. Hence a follow up PET- CT was planned after 3 months. This also showed complete response. The case was rediscussed in the tumour board and since the patient being young, unmarried and with no children and had a complete metabolic response to treatment, it was decided not to give her any Radiotherapy; but to follow up with 6 monthly PET- CT and bloods. To date 13 months after the diagnosis, she is healthy and disease free.

Discussion

Primary cervical lymphoma is rare and involvement of the cervix by a lymphoproliferative disorder is more commonly seen in the setting of systemic disease [1]. It affects adult women over a wide age range. Vaginal bleeding is the most common symptom. Lymphomas are often bulky tumours, sometimes with circumferential enlargement of the cervix (“barrel-shaped” cervix) [1,2]. Cervical diffuse large B-cell lymphomas, which is the predominant type are are often associated with prominent sclerosis and may be associated with a cord-like arrangement or spindle-shaped tumor cells (“spindle cell variant”) [3]. Rare cervical marginal zone lymphomas (MALT lymphomas), Burkitt lymphomas [4] and extranodal NK/Tcell lymphomas, nasaltype, have been described. Differential diagnoses of cervical lymphomas include sarcoma, poorly differentiated carcinoma, neuroendocrine tumours, Malignant Mixed Mullerian tumour, Melanoma, extraosseous Ewing’s sarcoma, and chronic cervicitis. Most cases of NHL involving uterine cervix presents at stage I or II. The optimal treatment of such tumours is not clear. These tumours have been managed with chemotherapy, [5] radiotherapy, and surgery, alone or in combination [6]. Heredia et al. demonstrate the use of combination of CHOP × 3 plus involved field radiotherapy as therapy for this malignancy [7]. The association of HPV infection with cervical cancer is well known; though literature on HPV association to cervical lymphoma is scanty. A Danish study [8] noted that HPV infection is associated with an increased risk of Lymphoma. This association may be attributable to a chronic immune activation induced by persistent HPV infection and/or failure of the immune system both to clear HPV infection and to control lymphoma development.

Conclusion

In our patient the rare combination of High-risk HPV, Lymphoma and High grade squamous intraepithelial lesion was quite interesting. But the efficient interdisciplinary discussions gave her a wonderful outcome.

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Seinfeld: 10 Fake Movies That Should Actually Get Made

Seinfeld had many signature running gags, from a snarling “Hello, Newman!” to answering the phone with “Who is this?,” but one of the subtler ones was all the fictional movies that the characters would mention. They mention real ones, like The English Patient, but the overwhelming majority are made-up. Some of these fictional movies were just mentioned in passing, but others became running gags as we saw the characters go to theater to see them, then rent them on home video, then catch them on TV, then date the lead’s understudy for a Broadway musical adaptation over the course of multiple seasons.

RELATED: Seinfeld: The Best Episode In Every Season, Ranked

So, here are 10 fake movies from Seinfeld that should actually get made.

10 Firestorm

In the season 7 premiere “The Engagement,” George gets engaged to Susan. The scene that demonstrates what a mistake this was has Jerry picking up George to see a new action thriller starring Harrison Ford called Firestorm and George telling Jerry that he’s instead going with Susan to see a melodrama starring Sally Field called The Muted Heart. Later, we see Jerry and a fellow moviegoer exiting the screen, talking about how awesome the movie was.

Apparently, it included such set pieces as an underwater escape, a helicopter landing on a car, and Ford jumping out of a plane and shooting back at the plane as he fell.

9 Chunnel

Chunnel is an action thriller in which there’s an explosion in the Chunnel (the tunnel connecting the UK and France) and the U.S. President’s daughter has become trapped inside. This would actually make a great installment in Gerard Butler’s Has Fallen series: Chunnel Has Fallen!

The plot of this one proved to be so convoluted that Jerry and Elaine couldn’t follow it, and their persistent questions annoyed Susan so much that she decided not to be their friend anymore. Just because Jerry and Elaine don’t pay attention to movies, this doesn’t mean it’s a negative mark on the movie. Complex plotting is great!

8 Ponce de Leon

Larry David himself reportedly wrote a script based on the life of explorer Ponce de Leon once. Ponce de Leon is famous for his search for the Fountain of Youth. In Seinfeld, George describes watching a movie called Ponce de Leon that dramatized this quest. There was apparently a scene at the end where Ponce and his crew actually found the fabled Fountain of Youth. So, they jumped in and started splashing around in it.

Then, Ponce got out of the water and went to find a mirror, only to face the heartbreaking discovery that he hadn’t changed. This scene made George Costanza, lord of all things evil and duplicitous, shed a tear.

7 Blimp: The Hindenburg Story

This one should get made if only so Seinfeld fans can yell out, “That’s gotta hurt!” when the Hindenburg goes down. They’d just have to hope that no one brought “one of those funny laser pointers” to the theater to upstage them. In all seriousness, a movie about the Hindenburg disaster would be a lucrative opportunity for Hollywood.

RELATED: Seinfeld: The 11 Funniest George Costanza Quotes

It has the historical grounding to make it a contender at the Oscars, but the big-budget spectacle of a disaster movie to make it appeal to mainstream audiences. It could be the new Titanic – tack on a love story before the Hindenburg goes down and you’ve got a movie.

6 Sack Lunch

This fake Seinfeld movie title is actually being used by Marvel Studios right now as the fake working title for their upcoming film about the Eternals. It’s the movie that Elaine wants to see instead of The English Patient, which everyone is raving about, but she finds to be overrated.

All we see of this movie is its poster, which sees a family popping out of a brown paper bag, suggesting it’s some kind of family comedy, but that’s enough to hook Elaine. She can’t tell if the family is in a giant paper bag or they’ve been shrunk down to fit in a regular-sized bag.

5 Cry, Cry Again

Described by Kramer’s volatile friend Brody as “an arty movie,” Cry, Cry Again is one of the movies that Jerry was forced to bootleg (well, he only had to be forced to do it until he got a taste for it and gained some artistic vision). It appears to be set in Paris, with a lot of symbolic imagery, like a loaf of bread that represents a man’s soul.

Anyone who makes this movie should leave in the shockingly bad moves of the “lone dancer” who appears at the end, because as Jerry explained, it ties in thematically with the title of the film: “So, you cry, and then when you see the dancing, you cry again.”

4 Checkmate

This historical drama about a king who likes chess might also be about a conspiracy. We only hear the dialogue from one scene of this movie, but it’s enough to hook us in for a two-hour runtime. It sees a servant, voiced by Larry David, asking a king, voiced by Jerry Seinfeld, why he plays chess, “because the king is always in jeopardy.” The king says, “Yes, but it’s only a game!” and the servant suspiciously adds, “Yes, of course...only a game.”

Clearly, this will start off as a movie about chess, but it will build into an epic uprising against a tyrannical king – the cinematic equivalent of a well-played game of chess.

3 Prognosis Negative

The movie that Jerry tries and fails to see throughout the whole of the infamous season 3 episode “The Dog” is called Prognosis Negative. In the show, it seems to be framed as a medical thriller, but the title is, in fact, taken from a screenplay for a comedy that series co-creator Larry David wrote in the 1980s. In an interview with NPR, David described the unproduced gem. Its lead character was “a single guy who is unable to commit to a relationship,” and the plot went like this: “He finds out an ex-girlfriend has six months to live and decides it’s perfect – he can commit without worrying about the long-term consequences.”

It was actually through this script that David met Robert B. Weide, the guy who would go on to direct the mockumentary that became Curb Your Enthusiam, as well as many of the series’ episodes.

2 Death Blow

Jerry was able to get tickets to an advance screening of this action-packed blockbuster and he ended up being forced at gunpoint to bootleg it. After having to leave the movie early, Kramer speculated on which character would be dealt “the final death blow.” He felt that one Hawaiian man “really had it comin’.”

RELATED: Seinfeld: The 10 Worst Things Jerry Ever Did, Ranked

When he was stealing business from Moviefone, Kramer recited the poster tagline for Death Blow: “When someone tries to blow you up, not because of who you are, but because of different reasons altogether!” That sounds even more high-concept and convoluted than the Two Brothers movie from Rick and Morty’s multiverse – but it also sounds like an awesome cinematic ride.

1 Rochelle, Rochelle

In the Seinfeld universe, this little erotic indie darling turned out to be so popular – for reasons that are made obvious by the guys’ obsession with the movie – that it was adapted into a Broadway musical starring Bette Midler. As any Seinfeld fan will be able to recite, word for word, Rochelle, Rochelle is about “a young girl’s strange, erotic journey from Milan to Minsk.”

According to George, it’s “a foreign movie...a film is what it is.” This is easily the most well-known fake movie from Seinfeld lore and any fan of the show would kill to see it in all its glory on the big screen.

NEXT: Seinfeld: The 5 Best (And 5 Worst) Guest Stars

source https://screenrant.com/seinfeld-fake-movies-should-get-made-tv-show/

[businessliveme]

Singapore to Unveil Stimulus; Deaths Top 346,000: Virus Update

(Bloomberg) — Dominic Cummings, Boris Johnson’s most senior adviser, refused to quit his job in the U.K. government, refuting claims he flouted lockdown rules that he had helped to draft. Germany agreed on a 9 billion euro ($9.8 billion) bailout for virus-hit airline Lufthansa.

Japan ended its state of emergency everywhere in the country and made reviving the economy its top priority. Singapore is set to unveil a fourth stimulus package.

The World Health Organization temporarily halted tests on hydroxychloroquine in its Covid-19 drug trials pending more data because of safety concerns.

Key Developments:

Virus Tracker: Cases top 5.4 million; deaths over 346,000

Singapore economy could contract 7%, most since independence

Germany to take Lufthansa stake in landmark $9.8 billion bailout

Johnson aide refuses to quit over claim he breached lockdown

WHO’s hydroxychloroquine trial suspended pending safety data

Subscribe to a daily update on the virus from Bloomberg’s Prognosis team here. Click VRUS on the terminal for news and data on the coronavirus. For a look back at this week’s top stories from QuickTake, click here.

Hong Kong to Reopen Karaoke Parlors, Resume Airport Transits (10:41 a.m. HK)

Hong Kong will further ease social-distancing measures this week as concern over the coronavirus pandemic wanes.

Karaoke parlors, bathhouses, party rooms and nightclubs will be allowed to return to business starting this Friday, Chief Executive Carrie Lam said at a regular press briefing. Transit services will gradually resume at the Hong Kong International Airport starting June 1, she said.

Philippines Seeks $26 Billion Stimulus (10:03 a.m. HK)

The Philippines’ Trade Department wants lawmakers to pass a 1.3 trillion peso ($26 billion) stimulus package that will aid the recovery of industries and workers.

Of the total stimulus being discussed at the House of Representatives, about 628 billion pesos is planned for wage subsidies and loans for businesses hit by the lockdown, the Trade Department said in a statement. The remaining half of the proposed package will be used to build facilities for health, education and food security.

Saudi Arabia to Ease Lockdown Restrictions: SPA (9:55 a.m. HK)

Saudi Arabia said it will begin gradually easing coronavirus lockdown restrictions on May 28, the state-run SPA reported, citing the interior ministry.

In the first phase May 28-30, travel is allowed in and between cities from 6 a.m. to 3 p.m., except for Mecca and Medina. Malls and stores should be open during that time with social-distancing considerations.

China Reports 7 New Cases, All From Abroad (8:29 a.m. HK)

China reported seven additional coronavirus cases by the end of May 25, with all of them from abroad, according to a statement from the National Health Commission. Of the seven cases, five were reported in Inner Mongolia.

The country also reported 29 asymptomatic cases, with one of them from abroad. It had no coronavirus deaths for May 25.

Singapore Slashes Growth Target With 7% Contraction Possible (8:01 a.m. HK)

Singapore’s economy will probably contract 4% to 7% this year as the coronavirus outbreak and measures to contain it pummel the trade-reliant city state.

The government revised its forecast from a previous projection for a contraction of 1% to 4% as the outlook for external demand deteriorates, the Ministry of Trade and Industry said in a statment.

“There continues to be a significant degree of uncertainty over the length and severity of the Covid-19 outbreak, as well as the trajectory of the economic recovery, in both the global and Singapore economies,” the MTI said.

Deputy Prime Minister Heng Swee Keat is set to unveil a fourth stimulus package in Parliament later Tuesday to further counter the economic pain.

U.S. Resets Brazil Travel Limit (6:40 a.m. HK)

The Trump administration advanced the effective time for limiting the entry of non-U.S. citizens traveling from Brazil, a nation that has the world’s second-most infections. The order will take effect at the end of Tuesday, two days earlier than stated in a proclamation issued Sunday by the White House.

Air New Zealand Forecasts Loss (6:30 a.m. HK)

Air New Zealand forecast its first full-year loss in 18 years as the pandemic halts travel, grounds aircraft and forces the layoff as many as 4,000 workers.

The carrier will post an underlying loss in the year ending June 30 but can’t provide a range, it said Tuesday in Wellington. The airline will post an impairment charge on aircraft of at least NZ$350 million ($213 million), restructuring costs of as much as NZ$160 million and losses on fuel hedges of as much as NZ$105 million, it said.

Airlines are reeling from the impact of the pandemic, forcing them to review fleets, routes and spending and seek government help. Germany on Monday offered Deutsche Lufthansa AG a $9.8 billion bailout. Air New Zealand agreed a NZ$900 million debt facility with the government in March.

U.S. Says 200 Million Tests Possible (5:55 p.m. NY)

The Trump administration said sufficient quantities of Abbott Laboratories’ ID NOW Covid-19 test and Quidel Corp.’s Sofia 2 instruments exist to support 200 million U.S. tests per month.

The Department of Health and Human Services, in a report to Congress, said 18,000 ID NOW devices and 20,000 Quidel instruments are available to states. The U.S. also is buying 100 million swabs and 100 million tubes of viral transport media to help states meet testing goals.

“This large-scale acquisition reflects a significant expansion of current capacity,” according to the report, and reflects use of the Defense Production Act to increase swab manufacturing.

Minneapolis Mayor Worried by Church Rules (5:30 p.m. NY)

Minneapolis Mayor Jacob Frey said he is concerned by Minnesota state guidelines taking effect on Wednesday that let churches resume services, with limits on attendance and requirements to follow social-distancing measures.

“A move up to 25% capacity and up to 250 people in places of worship is a recipe in Minneapolis for a public health disaster,” Frey said Monday on CNN. “That is not the route that we can or should be going on right now.”

Novavax Starts Vaccine Study (4:35 p.m. NY)

Novavax Inc. began human testing of its coronavirus vaccine candidate and anticipates providing a first look in July at what sort of immune responses are generated.

In the first phase, 130 healthy adult volunteers at two sites in Australia will get two doses of NVX-CoV2373, the biotech’s experimental vaccine. If initial results look promising, the company plans to quickly move into the second phase — expand testing to other countries and age groups outside of 18 to 59.

The Gaithersburg, Maryland-based company is one of about 10 that are testing vaccines, according to the World Health Organization. Moderna Inc. reported the first Covid-19 vaccine results in humans last week.

U.S. Cases Rose 1.3%, Less Than Week’s Average (4 p.m. NY)

U.S. cases increased 1.3% from the same time Sunday to 1.65 million, according to data collected by Johns Hopkins University and Bloomberg News. The increase was below the average daily increase of 1.4% over the past week, and has the same for three days.

Deaths rose less than 1% to 97,948 from 97,424 — the smallest one-day increase in more than a week.

California Sets Church Limits (3:45 p.m. NY)

California will limit attendance in houses of worship to 25% of building capacity or 100 people and is discouraging choir singing, group recitations and passing of the collection plate.

“Convening in a congregational setting of multiple different households to practice a personal faith carries a relatively higher risk for widespread transmission of the Covid-19 virus, and may result in increased rates of infection, hospitalization, and death, especially among more vulnerable populations,” according to the guidance.

The state is also discouraging potlucks or similar family-style eating and drinking events that increase the risk of cross contamination.

England to Reopen Showrooms, Stores (2:50 p.m. NY)

England’s outdoor markets and car showrooms can reopen from June 1, as soon as they can meet guidelines to protect shoppers and workers, Prime Minister Boris Johnson said as he urged the public to spend money in stores when the curbs are lifted.

All other non-essential outlets including shops selling clothes, shoes, toys, furniture, books and electronics, plus tailors, auction houses, photography studios and indoor markets, are on track to reopen June 15 if the government can control the spread of the virus, Johnson told a daily news conference. Scotland, Wales and Northern Ireland are on a different timetable determined by local administrations.

U.K. cases rose to 261,184. The government reported 121 new deaths, up from 118 a day earlier, bringing the total to 36,914.

Dubai to Ease Limits Wednesday (2:20 p.m. NY)

The emirate of Dubai will resume economic activities and ease lockdown restrictions starting Wednesday, the emirate’s media office said in a statement.

Travel will be allowed from 6 a.m. to 11 p.m. local time. The airport will operate only for residents leaving Dubai, some clinics will reopen and elective surgeries that take up to 2 1/2 hours will be allowed, the statement said.

Training academies, indoor sport venues, gyms and movie theaters will be open with social distancing in place.

The post Singapore to Unveil Stimulus; Deaths Top 346,000: Virus Update appeared first on Businessliveme.com.

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[enzaime-blog]

Charlie's Story – Thriving after Leukemia and Relapse

New Story has been published on https://enzaime.com/charlies-story-thriving-leukemia-relapse/

Charlie's Story – Thriving after Leukemia and Relapse

When Charlie Rider began receiving care for acute lymphoblastic leukemia at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center at age 4, his mother, Caroline, sent email updates to her large family and circle of friends. After a brief remission, Charlie’s cancer came back, and he returned for more treatment, including a stem cell transplant. Caroline’s reflections grew into a touching chronicle of four years in the life of a child with cancer. In 2011, when Charlie was 8 years old, we interviewed him, his brothers Harry and Max, and his parents Caroline and Mike about the family’s cancer journey. Today, Charlie is a healthy 14-year-old and remains cancer-free.

This four-part series includes excerpts from Caroline Rider’s email updates, video reflections by family members, and interviews with clinicians at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center.

Charlie at the Jimmy Fund Clinic Charlie is diagnosed with acute lymphoblastic leukemia (ALL) and undergoes two years of treatment at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. Below are excerpts from a series of emails that Caroline Rider wrote to her extended family and circle of friends.

10/16/06 Our Charlie has been diagnosed with leukemia. We know what a shock it can be to hear this. The type of leukemia he has is called ALL and it is the most common and the most treatable. The good news is that we live close to the one of the best children’s cancer centers in the world, and Charlie has an excellent prognosis. He will be in Children’s Hospital for at least a month. When he is discharged, he will be in remission. Once he goes home, he will return to Dana-Farber’s Jimmy Fund Clinic once a week for two years.

10/27/06 Charlie is HOME!!!

After being told that he would have to be in the hospital for at least a month, the doctors say he is doing so well that he could go home. We are thrilled because we all get to sleep under the same roof again. We are also TERRIFIED because we have a long road ahead. https://www.youtube.com/watch?v=RP1Hod6_EZU 11/05/06 Charlie started to lose his hair this week. We don’t have pets, but our furniture looks like we have shedding cats in the house. It was driving him crazy so he asked if he could get it cut. His Aunt Krista obliged with a backyard buzz cut. His hair is now only about a ¼ inch long, but soon he won’t have any hair at all. The new look suits him. He has a beautiful round head.

11/18/06 Charlie is in remission! A recent bone marrow biopsy showed there are no cancer cells in his body. Alas, the doctors know from years of studying this disease that there are still some leukemia cells lurking somewhere. The crafty little devils are waiting for us to drop our guard so they can attack again. But we won’t let them. That is why Charlie is in the hospital again – this time to get a massive dose of chemo.

12/21/06 Other than the first few numbing days after Charlie’s diagnosis, the past few weeks have been the hardest. Charlie had nine Jimmy Fund Clinic visits in three weeks (four of them surgical procedures). I have never felt so bone tired in my whole life.

Charlie has not been his happy, charming self and that has been hard to watch. He has been very clingy, needy, whiny, angry, and at times in pain. I have found it difficult to get to know the other parents at the clinic because, frankly, I have a hard time wrapping my brain around the fact that my child is sick.

2/05/07 We continue to make weekly visits to the Jimmy Fund Clinic where every single person there is truly amazing. What a place! I don’t know how they do it day in and day out, but they will all always have a special place in our hearts.

3/02/07 I find myself referring to situations as BD and AD (Before and After Diagnosis). Our life is certainly not what it was BD, but we seem to have found a sort of normalcy that works for us. Charlie is doing well … considering.

During the first few weeks, every time a doctor or nurse came in the room I really believed that they were going to say, “We are so sorry. There has been a huge mistake. Your child is perfectly healthy and you are free to go.” But after six months it has finally sunk in that this is happening to us.

9/09/07 Love and War

For a few weeks, Charlie had excruciating leg pain as a result of his medications. Once while his visiting nurse, Kathie, was here, Charlie was complaining about the pain. Kathie explained that it was probably the bone marrow regenerating itself. The next day Charlie said, “Mum, my bow and arrow are really hurting again.”

10/12/07 From the beginning Mike and I talked about how one day we would like to give back to the Jimmy Fund Clinic and Dana Farber and Children’s Hospital. Since we don’t have deep pockets, building a new research wing is unlikely. However, we have just been invited to join the Pediatric Patient Family Advisory Council.

This is a group of doctors, nurses, administrators, bereaved parents, parents of children who have completed treatment, and parents like Mike and me whose children are still in treatment. We attended our first meeting last month and it was very interesting. The main function of the council is to make the whole experience at JFC better.

Stuck in a Moment

One of my favorite songs is “Stuck in a Moment” by U2. It begins, “I am not afraid of anything in this world. There’s nothing you can throw at me that I haven’t already heard.” I thought that was true until October 12, 2006. During the first month of Charlie’s illness, we survived on adrenaline, fear, and the unending support of all of you. I do feel less scared now. I hope we never have to face anything else like this again, but if something does happen I know we can handle it.

Luke, I Am Your Father

During Charlie’s last lumbar puncture (spinal tap), his nurse, Mary, said the recovery room nurse had a tough time waking him up from the anesthesia. Mary just happened by, and knowing Charlie’s love of anything Star Wars, she whispered to him in a deep voice, “Luke, I am your father.” Charlie opened his eyes and said, “Mary, do you even know what episode that is from?”

Wisdom from Our Poet Laureate

A few weeks ago Charlie said to me, “Mum, I feel really weird. The whole inside of me feels really angry, but the whole outside of me feels really happy. I am all confused.”

12/08/08 The following words are the happiest I have ever written: CHARLIE IS CURED!

He received his last dose of chemo at home the day after Thanksgiving. We are thrilled beyond words but I am also feeling a ton of other emotions that I didn’t really expect: happy and sad, numb and exhilarated, confused and focused, hopeful and fearful, calm and anxious, relieved and scared, anchored and adrift.

How do you thank the medical professionals who saved your child’s life? We have lived under the watchful eyes of some of the best doctors and nurses in the world. Moving away from that security is a scary thing. And there is an ever-so-slim chance of relapse.

Looking back, I am amazed that we are all sane. I took my cues from Charlie. Even on his darkest, weakest days, he somehow mustered the strength to carry on. He is the bravest person I know.

Part 2: Relapse and Stem Cell Transplant Charlie at Dana-Farber/Boston Children’s Cancer and Blood Disorders Charlie at Dana-Farber/Boston Children’s Cancer and Blood Disorders Charlie’s cancer returns and he undergoes a stem cell transplant at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. Charlie will need to spend several months in the hospital in preparation for the stem cell transplant and for a period of time after transplant.

5/21/09 It is with the heaviest of hearts that we write to tell you our Charlie’s leukemia has returned. Needless to say we are all – including his doctors – stunned. His new protocol will most likely include stronger drugs than he took the last time, and it may even entail a bone marrow transplant.

5/31/09 Charlie started treatment on May 23. His doctors worked very hard to get him into a clinical trial that includes a new experimental drug they are very optimistic about. The protocol includes three 36-day blocks of treatment.

After Charlie has completed all three blocks he will start the bone marrow transplant process. This begins with five consecutive days of full body radiation. If all goes well, he will have the transplant, then he will be in isolation in the hospital for four to six weeks. After discharge, he will be in isolation at home for six months to a year.

We have been teaching our boys how to play poker, and even as novices they realize we have been dealt a lousy hand. 6/20/09 Being in the hospital with Charlie for nearly five weeks is finally getting to me. At least Mike and I and Harry and Max get to go home, but home is a hollow and strange place. Every time I go in Charlie’s bedroom or see his backpack hanging behind the kitchen door, I burst into tears.

Harry and Max were not bone marrow matches for Charlie, but the transplant team has found over 900 potential donors. They will cull the list to weed out all but the most perfect matches.

6/28/09 We have reached the end of the first chemo cycle, and Charlie has only gone into partial remission. Full remission is required for a the transplant, so his doctors have decided to bring out the big guns and change his current protocol to one that is much more aggressive.

Lego Master

The staff at Children’s have been telling Charlie he has done so much with Legos that he should have a show. Well, now it is official. When Mike and Charlie returned to the hospital after Charlie’s first furlough, they found the following invitation waiting for them: 7/21/09 Today marks nine weeks to the day that Charlie was admitted to the hospital. The most important news is that he has gone into remission. Also, the transplant team found a donor who is a perfect match. He is a 27-year-old man from somewhere in the United States.

8/24/09 A big poster on Charlie’s door reads “Happy Transplant Day” and it is adorned with stars and pictures of Legos. Charlie received his new bone marrow cells (also known as stem cells) right on schedule. The transplant took about four hours, and other than some nausea and fatigue, he is doing quite well.

It really hit me that a healthy stranger had checked himself into a hospital and suffered a few days of pain and discomfort in order to save my child. I wanted to hug him and tell him that I love him.

With all that Charlie has been through, getting his new cells was actually quite anti-climactic. The cells arrived in a bag (the same as what all blood products arrive in) and they went directly into his central line just like any other IV medication. As I am sure you can imagine, though, the process to get to the actual transplant is much more involved. 9/11/09 Nothing but Blue Skies Skin

One weird thing I wasn’t expecting was the change in Charlie’s appearance after the transplant. Except for a couple of rogue strands, all of his eyelashes and eyebrows had fallen out. His skin was a decidedly blue color and his eyes were freaky. His eyes can look brown, grey or green, depending on the time of day and/or his clothing. However, after the transplant they looked translucent. It was as though I could see into his soul.

Medical Ease

A “new normal” conversation I had with one of Charlie’s nurses:

Nurse: “Charlie has been in a fair amount of pain today, so I think it is time to hook him up to a personal pump for morphine. Would you like him to get a continuous drip with that as well?”

Me: “No. I think we’ll just start with the pump and perhaps order the drip later.” We might as well be ordering bacon and eggs with a side of hash browns. I hate that I know this stuff.

9/22/09 Charlie’s new bone marrow has engrafted, which means the new cells are taking hold. Of course there are still a lot of risks to face in the coming months, but this is a major step towards overall success.

9/25/09 CHARLIE IS HOME! He arrived at about 2 p.m. and immediately began playing with his brothers as though no time had passed. Charlie’s return feels like a rebirth. We made so many preparations for his return, and we are exhausted. However, we are finally all together again and we couldn’t be happier.https://www.youtube.com/watch?v=GM-BNObCz_g8/8/10 Well, it’s official! After a long year of isolation, Charlie no longer has any restrictions or precautions. He can now do whatever, go wherever, or eat whatever he wants (subject to parental approval, of course).

We celebrated by going out to dinner. We ate in a busy restaurant and Charlie ordered his first fountain drink in more than a year. Later we walked to a local bakery and ate cannolis, another formerly forbidden delight. Perhaps the best part about the end of isolation is that we can now have our friends and family in the house again. On Saturday morning all three boys called their friends and said, “Come on over.”

10/12/10 It’s hard to believe, but four years ago today Charlie was first diagnosed with cancer. He turned 8 last week, so for exactly half of his life he has been battling cancer or dealing with the repercussions of the various treatments. I am thrilled to report that Charlie is doing GREAT! To look at him you would never know the hell he has been through. He is happy, healthy, smart, and really enjoying life. He loves school, and friends, and baseball, and everything that 8-year-old boys are supposed to love.

Life’s a Party

So, my dear friends, parting is such sweet sorrow. Writing these updates has been a lifeline for me, and I will miss sharing them with you. But I am grateful that there is no longer a need to keep you informed of our life with cancer. Instead I hope to stay in touch with you all “just because.”

Part 4: Looking Back: The Rider Family’s Cancer Journey Charlie Rider Charlie Rider In this final installment, Caroline Rider reflects on Charlie’s cancer journey, and the impact it has had on the family. Charlie’s cancer has remained in remission for the two years since coming home from his stem cell transplant.

When I go back and read my own words about Charlie’s experience, I wonder how we all survived. But survive we did. In fact, I would argue that we thrived.

I can’t quite put my finger on it, but when your child gets diagnosed with a life-threatening disease, all of the important things come crisply into focus and the other things recede into the background.

Although it was very hard to learn Charlie had cancer, his experience the first time was good. He only spent 3 1/2 weeks in the hospital and he was a textbook case with very few setbacks. The relapse was much harder. This time, he spent six months in the hospital and had a lot of related problems. I used to wonder, how much more can his body take? In the early days after diagnosis, we asked our doctors how Charlie got this disease. They said: Bad luck. Well, since that day, we have been very lucky and I try very hard to concentrate on that. Charlie is lucky because acute lymphoblastic leukemia (ALL) is the most common form of childhood cancer, so it gets a lot of attention and money. What about the children who have rare forms of cancer that don’t get the same funding and attention? More than ever we are dedicated to the Jimmy Fund and Dana-Farber and all of the fabulous people who work there. We will continue to help raise money for them and work with them to help make cancer history.

Once while watching the Boston Marathon I thought, how cool to be an elite runner, leading the pack. Then I realized that Mike and I are part of an elite group of caregivers who run marathons every day in order to save our children.

Throughout this ordeal people asked us, “How do you do it? How do you keep moving forward and keep everything straight?” We didn’t have a choice. Like most parents, we will do anything to save our children. It helps to have a great partner and a support group of friends and family.

Here are some tips for others in our shoes:

Choose a group of caregivers who will treat your child like he is their own and will fight tooth and nail to cure him. Take help when it’s offered. Be specific. Our neighbors mowed the lawn, trimmed the hedges, did errands, and brought us food. Try to have fun. The Jimmy Fund Clinic has festivals and parties and offers free tickets to shows and games. Take advantage of these offerings, more for the rest of your family than for your sick child. We were a family of five who took a turn we didn’t expect. We’ll never know where the other road would have gone, because we took this one. We met people who enriched our lives in ways we never could have imagined – caregivers, experts, and other families. As a family we love each other more, because we almost lost one of us.

[anthonycharlestabone]

Having trouble viewing? View in Browser Friday, October 27, 2017 TOP OF THE MORNING Welcome to Fox News First. Not signed up yet? Click here. Developing now, Friday, Oct. 27, 2017: Anger over partial delay in release of JFK records Uranium, dossier scandals cap bad week for Clinton, Democrats High stakes for GOP, Trump after House paves way for tax reform Fox News poll: NFL's popularity takes a hit PROGRAMMING ALERT: Don't miss two new shows premiering Monday: "The Ingraham Angle" hosted by Laura Ingraham, will air at 10 p.m. ET, followed by "Fox News @ Night," anchored by Shannon Bream at 11 p.m. ET!   THE LEAD STORY: The delayed release of hundreds of records related to the assassination of President John F. Kennedy has sparked backlash among scholars and researchers ... President Donald Trump said he had "no choice" in the matter, citing "potentially irreversible harm" to national security if he were to allow all records to come out now. Trump placed sensitive files under a six-month review while letting 2,891 others come out. White House officials said the FBI and CIA made the most requests from within the government to withhold some information. Expect the conspiracy theories surrounding JFK's assassination to continue, now more than ever. JFK files include memo on U.S. plans for killing Fidel Castro J. Edgar Hoover called killing of Oswald 'inexcusable' Top questions the JFK assassination files could answer HILLARY'S BAD WEEK: Hillary Clinton might look back on this week and ask, "What happened?" She was rocked by a 1-2 scandal combination in the controversies over the infamous, but discredited, Trump dossier and the Obama-era uranium deal with Russia ... Clinton claimed the controversy over the 2010 Uranium One deal between Russia and the Obama administration had been "debunked." However, following a report by the Hill, three congressional committees are investigating alleged corruption in the Obama-era deal in which Uranium One, a Russian-backed company, bought a uranium firm with mines in the U.S. The agreement was reached while Hillary Clinton was secretary of state, and some investors in Uranium One donated to the Clinton Foundation. And now that a former FBI informant has been cleared to testify before Congress, this scandal will not go away for Clinton. Besides the Uranium One developments, it was revealed that the Democratic National Committee and Clinton's presidential campaign funded the salacious Trump dossier. From Fox News Opinion: Hillary Clinton and Democrats lose the high ground on Russia TAX REFORM CLOSER? The House has paved a way, but will Republicans pass tax reform and give President Trump a much-coveted legislative victory before year’s end? ... That's the big question after the House narrowly approved a $4 trillion budget that cleared the way for Republicans to focus on tax reform. The vote was 216-212, with 20 Republicans, including conservatives unhappy about deficits and debt, opposing it. The tax bill is the top item on the GOP agenda and would be Trump's first major win in Congress. Marc Thiessen: Trump should make Democrats vote for tax reform or pay a political price Steve Forbes, Ken Blackwell: Think big on tax cuts NFL SACKED: The National Football League's popularity is taking some heavy hits. A new Fox News Poll finds the league’s favorable rating has dropped 18 points since 2013 ...  Today, 46 percent of voters have a positive view of the NFL while 41 percent view it negatively.  Four years ago, 64 percent had a positive view of the league and 19 percent were critical. The national anthem protests by players have not helped. According to the Fox News poll, 78 percent of voters who have an unfavorable opinion of the NFL think kneeling is inappropriate, while 62 percent of those who view the NFL favorably think it's appropriate. Read the full Fox News Poll results   ABOUT LAST NIGHT PROFILE IN 'CROOKEDNESS': "[This is why] a significant majority of Americans found Hillary Clinton to be dishonest ... There's always something dirty and disreputable going on there." – Kellyanne Conway, special counselor to President Trump, on "Special Report," discussing the latest revelations in the Trump dossier and Uranium One deal controversies. WATCH SCANDAL DODGER: "You only have me on to talk about nonsense." – Democratic Rep. Brad Sherman, on "Tucker Carlson Tonight," trying to avoid discussing developments in the Uranium One deal scandal and talk about a subject he preferred - Trump's tax reform plan. WATCH   MINDING YOUR BUSINESS State, local deductions could still stymie tax reforms. The real reason CVS wants to buy Aetna? Amazon.com. Insured losses from deadly California wildfires could hit $3 billion.   NEW IN FOX NEWS OPINION Ralph Peters: Bergdahl sentencing isn't about him -- It's about setting an example for any future traitors. Leave the mommy wars out of tax reform. Karl Rove: The Democrats' impeachment mania.    HOLLYWOOD SQUARED Harvey Weinstein sues former company. Sex and the City star Kristin Davis gives hope for a third movie. Nicki Minaj goes off on Twitter about sexism in hip-hop.   DID YOU HEAR ABOUT THIS? WATCH: Couple wows fans with epic 'Kiss Cam' smooch. Rare Revolutionary War sword to go on display for the first time. Strange 'alien activity' causing Arizona couple to sell home.   STAY TUNED On Fox News: Fox & Friends, 6 a.m. ET: N.J. Gov. Chris Christie on President Trump declaring the opioid crisis a "public health emergency." Is pro-Trump singer Joy Villa considering running for Congress? She gives us in the inside scoop. Plus, former deputy assistant to Trump Sebastian Gorka sounds off on the Trump dossier and Uranium One deal scandals. Tucker Carlson Tonight, 8 p.m. ET: Tucker goes one-on-one with a former FBI operative who infiltrated al Qaeda and helped thwart terror attacks planned for New York and Toronto. On Fox Business: Mornings with Maria, 6 a.m. ET: The first steps toward tax reform will be the big topic of the day and Maria's guests will include: Tom Farley, NYSE president; Ken Luce, Whitefish Energy spokesman and Rajeev Misra, SoftBank Investment Advisers director. Varney & Co., 9 a.m. ET: Football great Joe Theismann takes on the NFL's woes amid ongoing player national anthem protests. Plus, House Ways and Means Chairman Kevin Brady on tax reform's prognosis following Thursday's house approval of a budget. On Fox News Radio: The Brian Kilmeade Show, 9 a.m. to Noon ET: Kevin and Sam Sorbo give the inside story on their new film, Let There Be Light.   #OnThisDay 2004: The Boston Red Sox win their first World Series since 1918, sweeping the St. Louis Cardinals in Game 4, 3-0. 1922: The first annual celebration of Navy Day takes place. 1947: You Bet Your Life, a comedy quiz show starring Groucho Marx, premiered on ABC Radio.   Thank you for joining us on Fox News First! Enjoy your day and weekend and we'll see you in your inbox first thing Monday morning.   Unsubscribe ©2017 Fox News Network, LLC. All Rights Reserved. 1211 Avenue of the Americas, New York, NY, 10036. Privacy Policy.

[bloojayoolie]

Apparently, Cats, and Children: 10 yrs old 1.8ths-Walang on Loce @ 7MafalanACC Stunna # 46610 Lovely older Gent! Stunna was a family dog all his life. He is great around kids, lived with a small dog, he is strikingly handsome, very smart and friendly and has been great in playgroup with other dogs. TO BE KILLED - 11/16/2018 Sweet Senior Stunna <3 Exceptionally handsome, friendly, well behaved playgroup greeter - You will be absolutely stunned when you meet him! A volunteer writes: I remember seeing at the Smithsonian Museum, in a display about "Dogs of War", an Amstaff who just looked like Stunna. Yes, this is exactly what our Stunna is besides being a boroughbred, an Amstaff, majestic, noble, loyal, well mannered and trained. Stunna is 10 year old and was a family dog all his life, always welcoming of strangers, great with kids, happy with his little female housemate and very loving to his family. He is described by his former owners as a "big fluff" sleeping in their bed, under the cover. I have been so impressed by Stunna's looks, his perfect manners, the way he sits right away, his excellent leash manners, his sociability and friendliness with people and dogs alike. Stunna has been beautifully cared for and raised to be a well rounded pet who will be the joy and pride of a new owner or family. Come and meet our gem, Stunna at the Manhattan Care Center! He is the friend you have been dreaming of! Volunteer Georgia Richmond writes: Stunna is a lovely older gent, a happy explorer in the park and a fun friend in the yard. He's strikingly handsome and very smart, independent but social too. Join the Stunna fan club today! Manhattan ACC Dog Volunteers: Dedicated to The Ones We Love Facebook-Page writes: There's no bigger joy than welcoming a senior into your home, one who was surrendered due to housing issues, lived with young kids and a small dog, is house broken, good on leash, lively, friendly, well mannered and has been great in playgroup with both males and females. Seriously, what's not to love about Sir Stunna! VIDEO: Stunning Stunna <3 https://youtu.be/m53Bg1XvIc4 Stunna ID# 46610 Manhattan Animal Care Center 10 yrs old, 51.8 lbs Brown Male Seize: Large Owner Surrender Reason: Landlord Issues Intake Date: 11-06-2018 SHELTER ASSESSMENT ~ EXPERIENCED HOME OWNER NOTES Basic Information: Stunna is a 10 year old male unaltered brown and white large mixed breed dog. Previous owner got Stunna from a friend about 8 years ago. She has had Stunna for 8 years and surrendered him over to ACC because of her living situation. Previously lived with: 2 adults, 1 dog How is this dog around strangers? Around strangers, Stunna is friendly and outgoing. He will greet strangers with a wagging tail and happy "smile" How is this dog around children? Stunna has been around 2 children between the ages of 5 months and 2 years old. He is friendly, respectful and plays gently with these children. How is this dog around other dogs? Stunna lived with a small female dog. He was playful and respectful of this dog. How is this dog around cats? Stunna has not been around cats. His behaviour is unkonwn Resource guarding: Stunna is not bothered if his food bowls/toys/treats are touched while he is utilizing them. He will bark if someone unfamiliar approaches the owner or the household. Bite history: Stunna has not bitten another animal or person before. Housetrained: Yes Energy level/descriptors: Very high, friendly, affectionate, playful, excitable Other Notes: Stunna enjoys baths and loves to be scrubbed. He enjoys being brushed and groomed. He has not received a nail trimming from his owners because his nails are filed down when he goes on walks. He enjoys being held and isnt bothered if he is restrained. Has this dog ever had any medical issues? No Medical Notes Stunna saw a vet last year and has no medical concerns or injuries that were reported at intake. For a New Family to Know Stunna is a Very high energy , friendly, affectionate, playful and excitable dog. He loves to cuddle in his owners bed and sleep under the covers. Previous owner explained him as a big fluff. Stunna loves to play with toys of all kinds and his favorite activity is tug of war. He is very housetrained and will rarely have accidents. He was taken on 4 walks a day. He knows commands such as sit stay and come. He eats dry food only and is given wet food as a treat. BEHAVIOR NOTES Upon Intake: Upon intake, Stunna had a loose wiggly body. He was panting and licking the air. He allowed to be collared, pet and placed inside of a kennel. Allowed all handling. Means of surrender (length of time in previous home): Owner Surrender (In home for 8 years) Previously lived with: Adults and a dog Behavior toward strangers: Friendly Behavior toward children: Friendly, respectful, and gently playful Behavior toward dogs: Playful and respectful Resource guarding: None reported Bite history: None reported Housetrained: Yes Energy level/descriptors: Stunna is described as friendly, affectionate, playful, and excitable with a very high level of activity. SAFER SCORES: Date of assessment: 7-Nov-2018 Look: 1. Dog's eyes are averted, with tail wagging and ears back. Allows head to be held loosely in Assessor's cupped hands. Sensitivity: 1. Dog leans into the Assessor, eyes soft or squinty, soft and loose body, open mouth. Tag: 1. Dog follows at the end of the leash, body soft. Paw squeeze 1: 1. Dog gently pulls back his/her paw. Paw squeeze 2: 1. Dog gently pulls back his/her paw. Flank squeeze 1: Item not conducted Flank squeeze 2: Item not conducted Toy: 1. Minimal interest in toy, dog may smell or lick, then turns away. Summary: Stunna approached the assessor with a soft body. He was social during the assessment, allowed all handling, and displayed no concerning behaviors. Summary (1): 11/7: When introduced off leash to female dogs, Stunna greets politely. Summary (2): 11/8: Stunna greets politely. Summary (3): 11/9: Stunna greets a group of female dogs politely. When one jumps up on the handler for attention he rushes over with stiff body. Summary (4): 11/10: Stunna greets male and female dogs politely and engages in brief play with a select male dog. Date of intake: 6-Nov-2018 Summary: Loose body, allowed handling ENERGY LEVEL: Stunna is described as having a very high level of activity. We recommend long-lasting chews, food puzzles, and hide-and-seek games, in additional to physical exercise, to positively direct his energy and enthusiasm. BEHAVIOR DETERMINATION: EXPERIENCE (suitable for an adopter with some previous dog experience, especially with the behaviors outlined below) Potential challenges: Handling/touch sensitivity Potential challenges comments: Handling/touch sensitivity: During his medical examination, Stunna displayed defensive behavior when restrained, growling, snapping, and thrashing. He appears uncomfortable with medical restraint. While this behavior was not reported in his previous home and has not been seen in the shelter other than during his medical exam, we cannot be certain if it will appear in other contexts outside of a medical setting. Future adopters should be aware of this behavior and note that Stunna may need to be muzzled or possibly sedated for veterinary exams. MEDICAL EXAM NOTES 10-Nov-2018 Spay-Neuter Waiver Documentation [Spay/Neuter Waiver - Age] It is the policy of ACC not to perform surgery on any animal over the age of 8-10 years due to the higher risks incurred in a shelter setting. The veterinarian is hereby issuing a permanent spay/neuter waiver, from the spay/neuter requirements of the City of NY due to the estimated age of this animal. ACC does recommend you consult with your veterinarian to determine if surgical sterilization is appropriate. 10-Nov-2018 DVM Intake Exam Estimated age: 10y Microchip noted on Intake? no Microchip Number (If Applicable): History : owner surrender Subjective: BARH, good appetite, normal defecations Observed Behavior - Needed to be muzzled, will charge and snap when held Evidence of Cruelty seen - no Evidence of Trauma seen - no Objective P = wnl R = wnl BCS 5/9 EENT: Eyes clear, ears cropped, mild cerumenous debris, no nasal or ocular discharge noted Oral Exam: incisors appear normal, could not see rest due to muzzle PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful, no masses palpated U/G: male intact, soft and symmetric testicles, no leakage and discharge MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: visually normal Assessment Apparently healthy Prognosis: excellent Plan: medically cleared refer to behavior SURGERY: Permanent waiver due to age *** TO FOSTER OR ADOPT *** ASPEN IS RESCUE ONLY. You must fill out applications with New Hope Rescues to foster or adopt him. He cannot be reserved online at the ACC ARL, nor can he be direct adopted at the shelter. PLEASE HURRY AND MESSAGE OUR PAGE FOR ASSISTANCE! HOW TO RESERVE A “TO BE KILLED” DOG ONLINE (only for those who can get to the shelter IN PERSON to complete the adoption process, and only for the dogs on the list NOT marked New Hope Rescue Only). Follow our Step by Step directions below! *PLEASE NOTE – YOU MUST USE A PC OR TABLET – PHONE RESERVES WILL NOT WORK! ** STEP 1: CLICK ON THIS RESERVE LINK: https://newhope.shelterbuddy.com/Animal/List Step 2: Go to the red menu button on the top right corner, click register and fill in your info. Step 3: Go to your email and verify account \ Step 4: Go back to the website, click the menu button and view available dogs Step 5: Scroll to the animal you are interested and click reserve STEP 6 ( MOST IMPORTANT STEP ): GO TO THE MENU AGAIN AND VIEW YOUR CART. THE ANIMAL SHOULD NOW BE IN YOUR CART! Step 7: Fill in your credit card info and complete transaction HOW TO FOSTER OR ADOPT IF YOU *CANNOT* GET TO THE SHELTER IN PERSON, OR IF THE DOG IS NEW HOPE RESCUE ONLY! You must live within 3 – 4 hours of NY, NJ, PA, CT, RI, DE, MD, MA, NH, VT, ME or Norther VA. Please PM our page for assistance. You will need to fill out applications with a New Hope Rescue Partner to foster or adopt a dog on the To Be Killed list, including those labelled Rescue Only. Hurry please, time is short, and the Rescues need time to process the applications.

[vandykecarolpdrf7]

Ketogenic Diet and Brain Cancer

Brain cancers accounts for 1.8% of all cancers worldwide (1). The number of new diagnoses made annually is 2 to 3 per 100,000 people in the US and Europe. Brain and other CNS tumors are the 11th most common cancer in the UK, accounting for 3% of all new cases (2).

Types of Brain Cancers

Primary brain tumors are a varied group of both benign and malignant tumors. There are over 120 types of brain and central nervous system cancers. Some tumors are often given a grade to signify the rate of growth (3).

Grade I is classed as the least malignant with grade IV being classed as the most malignant. Glioblastoma Multiforme (GBM) is the most aggressive type of brain tumor. The average lifespan of patients diagnosed with GBM is between 12-18 months, with less than 10% surviving at 5 years. The survival for low-grade gliomas ranges from 7 to 14 years (4).

Standard Treatment Approaches

The treatment of brain cancers generally involves a multifactorial approach of surgery followed by chemotherapy with or without radiation therapy.

Conventional treatment options for GBM are more regarded as palliative and rarely curative due to their aggressive nature. Likewise, complete surgical resection is often impossible due to GBM’s ability to infiltrate normal brain tissue. Due to this, other types of treatments are being looked at to help with the overall prognosis of these types of cancers.

Proposed Mechanism of the Ketogenic Diet in Cancer

The way in which cancer cells work in the body are very different to that of normal cells. Namely, cancer cells have been shown to exhibit an altered metabolism. Compared to normal cells, cancer cells appear to have a greater glucose uptake, even when oxygen is present. Certain tumors function and thrive purely on glucose.

Image source: Role of ketogenic metabolic therapy in malignant glioma: A systematic review

The “Warburg Effect”

This phenomenon was first coined by a biochemist known as Otto Warburg. He hypothesised and proposed the theory that cancer was a metabolic rather than a genetic problem (5).

Whilst it sparked criticism then, it has generated new interest with it being coined “The Warburg Effect”. Oncologists can use position emission tomography (PET) scans to locate glucose dependent cancers. These scans allow them to detect where the highest amounts of glucose are being used. Further to this, cancer cells exhibit alterations in mitochondrial metabolism due to increased oxidative stress (6).

Mechanisms of The Ketogenic Diet in Primary Brain Cancers

It has been proposed that the ketogenic diet may be a useful tool in exploiting the defects in tumor metabolism, including that of the Warburg Effect.

Both the ketogenic diet and calorie restriction are believed to be the only therapeutic approaches that simultaneously target several of the hallmarks of cancer including glucose uptake, angiogenesis and inflammation (7).

One of the observations with the Warburg Effect, is that the cells not only thrive on glucose, they also lack metabolic flexibility. Unlike normal cells that can switch between using that of glucose and ketone bodies, cancer cells can only use glucose for energy.

By reducing the glucose availability to cancer cells and providing ketone bodies for the energy to normal cells, the ketogenic diet could be used as a therapeutic option, especially in highly glucose dependent cancers such as GBM’s.

The Ketogenic is Working Beyond Just Glucose Levels

However, like with the data we have for its use in epilepsy, the action of the ketogenic diet and its anti-tumor effects are likely to extend beyond just the lowering of blood glucose.

The ketogenic diet not only lowers glucose but also insulin levels in the body. Insulin signalling molecules (including IGF-1, IGF-1R and C-Peptide) and pathways (akt/mTOR and Ras/MAPK) have all been linked to increase cancer risk and promotes the development of cancer cells (8).

Ketone bodies have been shown to be toxic to cancer cells whilst the cells also showing a decreased level of key ketolytic enzymes (9).

Ketone bodies themselves are active signalling metabolites and have demonstrated neuroprotective properties in other brain disorders such as Alzheimer’s Disease and Parkinson’s Disease (10).

As such, another mechanism for the ketogenic diet working within brain cancer is the ability of the ketone bodies to enhance the protection of healthy central nervous system (CNS) from cancer growth (11).

The Human Evidence for the Ketogenic Diet in Primary Brain Cancers

Much of the evidence that we have right now for the ketogenic diet in brain cancer is that of animal and cell culture data. However, there are now small retrospective case studies that have been looked at in humans, with some pre-clinical work now under way.

A recent systematic review (12) analysed all the current evidence on the use of the Ketogenic Diet in brain cancers.

In it they conclude that the literature available and preliminary results from ongoing trials, suggest the safety and feasibility of the ketogenic diet in GBM’s.

They do highlight that the clinical application i.e. the amount of evidence we have in humans, is limited and therefore should be interpreted with caution.

Study 1

The first ever trial looking at the ketogenic diet in brain cancer was carried out in 1995 (13). The study placed 2 young girls on an MCT ketogenic diet (where above 50% of the calories come from MCTs) and followed them for a total of 8 weeks. PET scans revealed a 21.8% average decrease in glucose uptake at the tumor site in both patients.

Study 2

A case report of a 65 year old woman diagnosed with GBM describes her experience of following a classical 4:1 Ketogenic Diet (fat/ protein + carbohydrates) with calorie restriction (600 kcal per day) (14) . She followed this dietary approach for 14 days and then started radiation and chemotherapy treatment. At 2 months, no evidence of either tumor nor associated oedema was apparent and PET scans revealed no recurrent disease.

Study 3

A retrospective study looked at 53 patients with high grade GBM’s being treated with chemoradiotherapy and adjuvant chemotherapy (15). Of the patients, 6 underwent a ketogenic diet during their standard treatment. The diet appeared to be well tolerated and safe, with 4 patients still alive at 14 months follow up.

Study 4

A pilot study from Germany looked at the feasibility of the ketogenic diet in 20 patients with recurrent GBM (16). In this study patients could eat up to 60 grams of carbohydrates per day and there was no restriction on calorie amount. The patients were followed up at 6-8 week intervals. The study could show that the ketogenic diet was safe and relatively well tolerated. Three patients dropped out as they found it too difficult to stick with the diet and only 12 of the patients left could reach a ketogenic state. No severe toxicity or serious diet-related adverse events were identified though.

What Ketogenic Approach Should be Followed?

Since the studies that we have are limited in humans, it means the optimal ketogenic diet to follow for maximal therapeutic benefit is still not known.

The Classical Ketogenic Diet

Many of the mice and cell culture studies have used a classical 4:1 Ketogenic Diet (17, 18). As we know though, this diet for adults to follow can be difficult to achieve and importantly maintain. Likewise, it can bring about some adverse reactions and so proper clinical monitoring is required.

The Modified Atkins Approach

A study from the John Hopkins Adult Epilepsy Diet Centre, looked at a group of adults who had been following the Modified Atkins Approach (19). This approach restricts carbohydrate intake to 20 grams per day with no restriction on calorie or fat content.

The centre identified 8 patients following the dietary approach of whom 7 remained on the diet when they were followed up at 13 months. Overall the diet appeared safe and well tolerated with around 50% of the adults reporting a reduction in the seizures they were experiencing due to their tumors.

The Modified Atkins Approach Combined with Intermittent Fasting

One proposed combination therapy is that of the MAD and intermittent fasting. Given the benefits that appears to arise from extended periods of fasting in cancer risk (20) and the difficulties of following the classical ketogenic diet; following the Modified Atkins Approach with intermittent fasting may offer superior therapeutic potential.

The Ketogenic Diet in Combination with Standard Therapies

Whilst the ketogenic diet may appear to have strong therapeutic potentials for the use in cancer treatment, most of the studies shows this in combination with standard care.

Predominantly all the data presented in this article utilised the ketogenic diet along with other treatment options.

One benefit that appears to be occurring with the ketogenic diet and that of standard care is the diet can help mitigate some of the side effects normally caused. Whilst also helping to enhance the anti-tumor effects of radiation and chemotherapy (21, 22).

Other Possible Co-strategies and Novel Approaches

As well as the ketogenic diet being studied alongside that of standard care, there are other treatment options now being looked at in combination.

Hyperbaric Oxygen Therapy

Due to the nature of rapid growth with cancer cells, tumors quickly exhaust the oxygen supply from the blood vessel. This creates a state known as hypoxia.

Hyperbaric Oxygen Therapy (HBO2T) saturates tumors with oxygen again and can help to reverse this hypoxia.

Whilst HBO2T alone has not been shown to offer great improvements in cancer development, combining it with the ketogenic diet appears to produce significant anti-cancer effects in animal models (23).

Exogenous Ketones

Another specific area of interest is the use of ketone ester supplementation. Over the past few years there have been several companies that have been developing ketone esters and salts to artificially raise ketone levels in the body.

It has been proposed as a potential therapy option within cancer as this population group are known to have difficulties with eating especially when going through active treatment. Being able to artificially raise ketone levels without having to rely solely on diet may therefore be a novel approach to get the body into ketosis.

Administration of ketone esters in animals have shown anticancer effects, independent of glucose levels (24). Likewise, the use of the ketogenic diet, HBO2T and ketone supplementation all in combination has shown a more powerful effect on cancer cell death and overall survival rates than when used individually (25).

Take-Home Message

Whilst the animal and cell data as well as preliminary clinical data appear to show the ketogenic diet offering a therapeutic potential in brain cancers, this needs to be interpreted with much caution.

Firstly, most of the studies that have been done are within animal models. The diet administered to them have been of the most strict, classical ketogenic diet form and so adherence may not be as good in adults if this is the diet that needs to be followed. There is a small amount of data in individuals following the Modified Atkins Diet which may offer better adherence rates but perhaps not be as effective.

Likewise, much of the data we have has also administered the ketogenic diet alongside calorie restriction. This means that as well as following ketogenic principles, a calorie restriction of 600 kcal/day has been put in place. Again, this has mostly been looked at in animals so translation to humans may not be achievable for all.

Cancer is an extremely complex disease. We still do not fully understand all the mechanisms happening with the ketogenic diet within cancer cells. Whilst the theory of the Warburg Effect appears to be gaining traction, we cannot say that this is the only reason for the ketogenic diet having an impact; needless to say like with cancer, it is and will be much more complex than this.

Perhaps the major point that also needs to be emphasised with all of this though is that the ketogenic diet should not be a standalone treatment. To date, most of the work, especially the human data we have, has all been done in combination with standard care. Whilst the ketogenic diet may appear to be a useful tool, it is just that, a tool.

Until there are more robust, clinical trials carried out, we cannot say that it offers a cure nor should it just be used on its own. The other novel therapies that are being studied are also at the very early stages. Much more needs to be understood about their long-term use and combination with the diet before giving a definitive answer on their safety and efficacy in humans.

Currently there are 10 trials listed at Clinicaltrials.gov that are looking at GBMs and the ketogenic diet within humans (26). This will allow the development of more robust data to help answer some of the pressing questions that remain within this topic.

In summary, the ketogenic diet does appear to be useful adjuvant to treatment for brain cancer. However much more clinical work and human studies are still needed in order to fully understand it’s mechanisms, long-term safety and overall efficacy.

http://ift.tt/2utUPif

[healthcarebiz]

SIR-Spheres(R) Y-90 Resin Microspheres Substantially Improves Quality of Survival in Primary Liver Cancer, New Study Against Standard Treatment Shows

AMSTERDAM, April 24, 2017 /PRNewswire/ --

459-patient SARAH Study shows that local treatments of advanced or inoperable Hepatocellular Cancer (HCC) with SIR-Spheres Y-90 resin microspheres did not lead to a planned superiority difference in overall survival compared to daily standard-of-care systemic therapy with sorafenib, yet had significantly reduced side effects and better Quality of Life 

Patients with advanced or inoperable Hepatocellular Carcinoma (HCC) who usually received one or two treatments with liver-directed SIR-Spheres Y-90 resin microspheres in the 459-patient French SARAH study had similar survival compared to patients who received standard twice-daily systemic treatment with sorafenib, but with less than half the number and significantly fewer severe treatment-related adverse effects and significantly better Quality of Life, according to data presented here at The International Liver Congress™ 2017.[1]

The results, which could impact the treatment of tens of thousands of liver cancer patients annually, were announced by the principal investigator of the SARAH study, Professor Valerie Vilgrain MD, PhD, Department of Radiology, Beaujon Hospital, Assistance Publique - Hopitaux de Paris (AP-HP) and Universite Paris Diderot, Sorbonne Paris Cité, France.

"Neither sorafenib nor SIR-Spheres Y-90 resin microspheres produced a statistically significant difference in Overall Survival (OS) of the patients we studied," said Prof. Vilgrain.  "Despite 26.6% of patients in the SIRT arm not receiving SIR-Spheres per protocol, the primary endpoint of Overall Survival by intention-to-treat [ITT] was not significantly different (median 8.0 vs. 9.9 months; p=0.18). Moreover, if we look at the patients who received SIR-Spheres or sorafenib according to the SARAH protocol, median OS was identical (9.9 vs. 9.9 months; p=0.92)."

"In terms of what matters for patients, the findings from this first large head-to-head comparison of liver-directed Selective Internal Radiation Therapy (SIRT) and systemic chemotherapy with sorafenib also show clearly that liver-directed procedures with SIR-Spheres result in a significantly better tolerance of treatment and quality of life," Prof. Vilgrain stated.  "I believe this consideration should be a critical factor in selecting first-line treatment for this patient population in the future."

The difference in the frequency and severity of side effects of patients treated with SIR-Spheres Y-90 resin microspheres versus sorafenib was striking. Significantly fewer patients treated with SIR-Spheres Y-90 resin microspheres had any treatment-related side effects at all (76.5% vs. 94.0% for sorafenib; p<0.001), and these were also less severe (≥ grade 3; 40.7% vs. 63.0%, respectively; p<0.001). Moreover, those patients treated with SIR-Spheres Y-90 resin microspheres who reported treatment-related side effects experienced a median of only 5 such events over the course of the SARAH study, compared to a median of 10 events in those who received sorafenib (p<0.001).

General treatment-related symptoms such as fatigue (42% vs. 65%; p<0.001), abdominal pain (20% vs. 29%; p=0.032), nausea or vomiting (12% vs. 23%; p=0.001) and infection (4% vs. 11%; p=0.007) were also significantly less frequently reported and less severe for patients receiving SIR-Spheres Y-90 resin microspheres, compared to sorafenib.

Fewer patients receiving SIR-Spheres Y-90 resin microspheres experienced treatment-related diarrhoea (13% vs. 68% for sorafenib; p<0.001), hand-foot skin reaction (0.4% vs. 21%; p<0.001), anorexia (13% vs. 32%; p<0.001), weight loss (6% vs. 21%; p<0.001) and alopecia (0% vs. 16%; p<0.001), as well as infections (4% vs. 11%; p=0.007), hypertension (3% vs. 13%; p<0.001) and non-gastrointestinal haemorrhage (3% vs. 10%; p=0.002).

There were few potential SIRT-associated treatment-related complications and, importantly, no radioembolization-induced liver disease (radiation hepatitis) experienced. There were no significant increases for SIR-Spheres Y-90 resin microspheres in gastrointestinal (GI) ulceration (2% vs. 0.5% for sorafenib; p=0.37) including one case of radiation-induced GI ulcer, ascites (12% vs. 11%; p=0.57), hyperbilirubinemia (12% vs. 13%; p=0.86) and only one case of radiation pneumonitis (0.4% vs. 0; p=0.46).

The results of Quality of Life (QoL) surveys filled out by SARAH participants at three month intervals after their initial treatment underscored the benefit of SIR-Spheres Y-90 resin microspheres. "Based on their responses to the Global Health Status questions in the European Organisation for Research and Treatment of Cancer [EORTC] QLQ-C30 questionnaire, patients treated with SIR-Spheres maintained their health status over the duration of the SARAH study, whereas patients receiving sorafenib reported a significant and sustained decline in QoL (group effect: p=0.005; time effect: p<0.001; between group difference increase over time: p=0.045)," Prof. Vilgrain said.

"In addition," she noted, "we found that the tumours of patients treated with SIR-Spheres had a higher objective response (19.0% vs. 11.6%; p=0.042) than was seen with sorafenib, and experienced a significantly reduced risk of their cancer progressing in the liver, which is the main cause of death from this disease."

Background of the SARAH Study 

"Patients with HCC who are not eligible for liver transplant, surgery or ablation to treat their tumours in place face a very bleak prognosis of one or two years of life with increasing debilitation and pain," Prof. Vilgrain said.  "In many cases, the patient's HCC is already so advanced that the main treatment option available is sorafenib. In other cases, we are able to treat patients with intermediate-stage disease initially with several courses of chemotherapy infused directly into their livers, which is called transarterial chemoembolisation, or TACE, but this approach may fail."

"For patients with advanced HCC or those failing TACE, we have for the past ten years relied upon oral systemic treatment with sorafenib, which was shown to extend survival compared to placebo, but also causes many side effects that can compromise patients' quality of life.  That is why we decided to see if treatment with a newer form of liver-directed therapy, selective internal radiotherapy, or SIRT, with SIR-Spheres could represent a better alternative.  Our decision to initiate the SARAH study was based on smaller previous studies and retrospective analyses, which suggested that SIR-Spheres could be at least as effective and was well tolerated by HCC patients," she stated.  

The randomized, controlled, open-labelled SARAH (SorAfenib versus Radioembolization in Advanced Hepatocellular carcinoma) study directly compared the efficacy of selective internal radiation therapy (SIRT, or radioembolisation) using yttrium-90 [Y-90] resin microspheres (SIR-Spheres Y-90 resin microspheres, Sirtex Medical Limited, Sydney, Australia) versus sorafenib (Nexavar®, Bayer HealthCare Pharmaceuticals, Berlin, Germany).  

SARAH was launched in December 2011 and concluded enrolment in February 2015.

With 459 patients treated in 25 clinical centres across France, SARAH is the largest randomized study ever to compare selective internal radiation therapy - or any liver-directed therapy - against the standard-of-care systemic therapy in the treatment of primary liver cancer.  Almost 70% of the patients in the SARAH study had advanced HCC (Barcelona Clinic Liver Cancer stage C), with portal vein thrombosis and no extrahepatic spread. Most of the other patients had failed two cycles of TACE.

Results of SIRveNIB, a parallel study in more than 360 Asia Pacific HCC patients will be presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago on 4 June 2017.

What is Hepatocellular Carcinoma (HCC)? 

HCC patients represent 90% of all people diagnosed with primary liver cancer, which is the sixth most common cancer in the world and the second leading cause of cancer-related death.  HCC affects mainly patients with cirrhosis from any cause, including viral hepatitis, alcohol misuse, and fatty liver disease, and results in more than 670,000 deaths globally each year.[2] Among people at risk of HCC, incidence of the disease increases progressively with advancing age, reaching a peak at around 70 years.[3]  

Overall, one-third of patients with liver cirrhosis will develop HCC during their lifetime.[4]

Worldwide, approximately 54% of HCC cases can be attributed to HBV infection (affecting 400 million people) while 31% can be attributed to HCV infection (affecting 170 million people).[3]

In Africa and East Asia, the largest attributable fraction is due to HBV infection (60%), while in the developed Western world, chronic HCV infection appears to be the major risk factor.[5],[6]

In addition to these causes, it is now thought that up to one in eight (12.8%) of non-alcoholic steatohepatitis (NASH) patients with cirrhosis will progress to HCC.[7] NASH - which is widely considered to be triggered by type II diabetes, insulin resistance, obesity, hyperlipidaemia and hypertension - has become the number one cause of liver disease in Western countries.  Progression of NASH dramatically increases the risks of cirrhosis, liver failure, and HCC.  This is thought to be related to the worldwide epidemic of diabetes and obesity.[8]

HCC occurs more often in men than women, except in Africa, where more women are affected.[2]

What is SIRT with SIR-Spheres Y-90 resin microspheres? 

SIRT with SIR-Spheres Y-90 resin microspheres is an approved treatment for inoperable liver tumours. It is a minimally-invasive treatment that delivers high doses of high-energy beta radiation directly to the tumours.  SIRT is administered to patients by interventional radiologists, who infuse millions of radioactive resin microspheres (diameter between 20-60 microns) via a catheter into the liver arteries that supply blood to the tumours. By using the tumours' blood supply, the microspheres selectively target liver tumours with a dose of radiation that is up to 40 times higher than conventional radiotherapy, while sparing healthy tissue.

SIR-Spheres Y-90 resin microspheres are approved for use in Argentina, Australia, Brazil, the European Union (CE Mark), Switzerland, Turkey, and several countries in Asia for the treatment of unresectable liver tumours. In the US, SIR-Spheres Y-90 resin microspheres have a Pre-Market Approval (PMA) from the FDA and are indicated for the treatment of unresectable metastatic liver tumours from primary colorectal cancer with adjuvant intra-hepatic artery chemotherapy (IHAC) of FUDR (floxuridine).

References: 

Vilgrain V et al.  The International Liver Congress™ 2017 - 52nd annual meeting of the European Association for the Study of the Liver, J Hepatol 2017; 66 (Suppl 1): Abs. GS-012.

Extrapolated from Ferlay J et al.  Globocan 2012. v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr, accessed on 14/April/2017.

EASL-EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma.  J Hepatol 2012; 56: 908-43.

Sangiovanni A et al.  Hepatology 2006; 43: 1303-10.

Di Bisceglie AM.  Hepatology 2009; 49(Suppl 5): S56-60.

Davis GL et al.  Proc (Bayl Univ Med Cent) 2008; 21: 266-80

White DL et al.  Clin Gastroenterol Hepatol 2012; 10: 1342-59.

World Gastroenterology Organisation Global Guidelines: Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis, 2012.

SIR-Spheres® is a Registered Trademark of Sirtex SIR-Spheres Pty Ltd.

562-EUA-0417

Read this news on PR Newswire Asia website: SIR-Spheres(R) Y-90 Resin Microspheres Substantially Improves Quality of Survival in Primary Liver Cancer, New Study Against Standard Treatment Shows

[catherineraephotography]

Surivor Saturday w/Camille Goff - Maryland Portrait Photographer

I often am asked, "What led you to featuring cancer survivors?"  The answer is simple; everyone has a story and everyone should share their story to help the next person who they might not even know!  Just because an individual goes through cancer doesn't define them and I hope that this experience gives a little beauty back to the person because cancer wears a person down in so many ways.  This week our Survivor is Camille a breast cancer survivor and here is her story:

1. When and what type of cancer were you diagnosed with?

I was diagnosed twice with right breast cancer after I felt a palpable lump during self breast examinations both times.  The first time was in June 2004 at age 26 years old (one month before my 27th birthday) and the second diagnosis recently at age 38 in December 2015 (about a week before Christmas).  I was diagnosed with Triple Negative Breast Cancer both times in Stage 1, but with the most recent breast cancer I learned that the cells also have a “Grade” and my pathology report showed that my Grade was a 3, which meant that the cells in my tumor were poorly differentiated and more aggressive this time around.  A Triple Negative Breast Cancer diagnosis also meant that I had fewer options for treatment and could not be treated with hormone therapy such as Tamoxifen because it would not respond to that type of treatment.  I don’t have any family history of “breast” cancer although other types of cancer does run in my family.  I did genetic testing in 2004 BRACA 1 and 2 to see if I carried a gene mutation that could be passed on to my children.  I have two children - a 19 year old daughter and a 11 year old son. My daughter was 8 years old at the time of my first cancer diagnosis and my son wasn’t born yet (he was born a year later in 2005). The genetic testing came back negative.  I also did genetic testing after my recent diagnosis in January 2016.  When I met with the genetic counselor, she told me that there were more test now then back when I had the previous testing in 2004 to check for various gene mutations that they didn’t know about back then.  All the test came back negative, which was a relief for me but still didn’t answer where did the cancer came from.  I decided to go with an entirely different medical care team with the second diagnosis which consisted of an oncologist, breast surgeon, plastic surgeon, and my primary care physician.  Every year after I had my first breast cancer diagnosis, I had my mammograms and was clear each time with negative findings for any malignancy.  Around 2010, when I went to get my annual mammogram the radiologist started seeing areas that they wanted to further evaluate and biopsy in both breast, but the findings were all benign (no cancer) until December 2015 when the cancer came back.  Each year after 2010 was a very nerve wrecking experience when I went for my annual mammogram screenings.  I opted to have a double mastectomy with nipple sparring breast reconstruction after my second diagnosis.  I had made up my mind that I was going to do whatever I could to lessen the chances of a recurrence so I could live as long as possible.  I met with my oncologist and nurse and we discussed my treatment plan.  It was strongly suggested by my oncologist that I do chemotherapy this time around, which I dreaded (I will terrified of chemotherapy) but again hoped that maximum treatment would give maximum results.  My oncologist during the first diagnosis felt that chemotherapy would not make too much of a difference as apart of my treatment plan due to the size of the tumor, clean margins and no lymph node activity. I was also younger and wanted to have another child. The chemotherapy drug that was suggested could push you into early menopause and cause infertility. I had a strong survival prognosis with my first cancer diagnosis. I went 11 years without a recurrence. During this second diagnosis my treatment plan included the chemotherapy drug - Adriamycin (also known as the “red devil”), Cytoxan and Taxol.  This type of chemotherapy is harsh and causes alot of side effects, but my oncologist prepared me as much as possible with anti-nausea meds, nutrition plans, and other helpful resources. I read as much as I could to cope with all the symptoms and physical changes, but to actually go through it was another story.  I lost every strand of hair on my head and body.  My hair started coming out a lot after my second chemotherapy treatment. I tried to have some control over the situation and asked my husband to shave my head on April 20, 2016. I will never forget that day!  I actually started chemotherapy on March 31st, almost a month earlier.  My plastic surgeon had inserted the tissue expanders during my double mastectomy. The tissue expanders were hard and uncomfortable but their purpose is to stretch out the muscle in preparation for the breast implants. I had several complications while getting chemotherapy throughout my entire treatment which resulted in a total of 5 surgeries from Feb - Dec 2016.  To make a long story short - the previously radiated skin on the right breast from my first breast cancer would not heal from my original double mastectomy surgery in February 2016. The surgeon tried all kinds of ways to get it to heal but the skin was so damaged that the wound underneath my breast just would not heal.  I had to get the right tissue expander and my right nipple removed in May 2016. My surgeon and I discussed me having a latissimus dorsal flap procedure. He wanted to basically take muscle from my back to reconstruct my right breast, but suggested that we wait until I was done with chemotherapy for that procedure. He also had to insert a new tissue expander on the right side after my chemotherapy was completed.  I completed my entire chemotherapy treatment plan on August 18, 2016 surrounded by the infusion center staff, my husband, and my mom. I rang that bell and got out of there as quickly as I could! It was such a relief. What a long journey, but I was finally done for real after several delays due to complications and my treatment plan had been extended at least 2 or 3 times.  It had gotten to the point that I didn’t want to discuss what I thought would be my last actual date to be finished because my oncologist had to change my treatment plan due to all the issues that occured during treatment.   I really had a tough time, but I made it to the end. I experinced so many side effects that included things such as a bladder reaction - frequency and urinary spasms, intense itching, skin peeling, fingernail discoloration/nail loss, neuropathy in my hands and feet, excessive weight loss - I lost around 24 pounds and really felt grateful that part was finally over and I could begin to live again.  I could finally look forward to building myself back up physically and mentally.  I was off from work for about 6 months and was looking forward to getting back to my “norm” again.

2. Who helped you get through your treatments?

My husband and my mom helped me get through my treatment.  They were a HUGE support system for me. My mom bought vegetables, fruits, and whatever else she thought would be helpful to almost every infusion appointment.  My husband cooked every meal and took care of everything at home.  I never had to go to a doctor’s appointment or chemotherapy treatment alone. They sat with me during EVERY treatment no matter how irritated or unpleasant my attitude was on some days -they were there. I also got support in various ways from other family members and a few close friends and co-workers.  I got text, phone calls, cards, flowers, meals delivered, and gifts which reminded me that I was being thought of almost daily or at least weekly and I wasn't alone in my fight to battle cancer.  I am a very independent and a private person that would have probably tried to do everything alone but I am so glad that I accepted all the support that I received.  It was overwhelming at times, but so appreciated.  I am and I will always be very grateful.  I even got a surprise at my final chemotherapy infusion from a friend that I haven’t seen in years.  She was one of my closest childhood friends. I've known her since elementary school.  We hugged and cried - that moment was so special and priceless in the middle of waiting room of the infusion center.

3. When were you given the all clear?

I was actually deemed cancer free when I had my double mastectomy on February 16, 2016. That was the big surgery where the cancer was removed.  I can’t believe that it’s been almost a year already.  I plan to set the tone with this 1st anniversary and do something special for myself like this Survivor photoshoot every year moving forward. Enjoy time with my family - maybe we’ll go out to a nice quiet dinner that evening.  I can really celebrate on my birthday this summer in July that I made it to 40 and pray that God blesses me with many more. I am planning either a big party or trip.

4. Do you work with any charitites or have one of your own?

I am not affiliated in any special charities at this time.  I hope to get involved and mentor other survivors in the near future.  I have done breast cancer walks and given donations to various charities in the past.

5.  What would you like to tell someone who might have been just diagnosed?

I would tell anyone that has just been diagnosed that they will get through it all. To always Have Faith, Believe, and have Hope - Do whatever to keep yourself strong spiritually and mentally because the treatment can drain you in every way.  Try to do things to make yourself feel better, towards the middle of treatment, I learned that if I had the strength to dress up nice ...I felt better (Look good, Feel Good!)  I would also say - Never give up and keep fighting until you can’t fight anymore!  Be your own advocate when it comes to your me

[bloojayoolie]

9/11, Being Alone, and Apparently: 41134-9 years old, 59 lbs Older Fella dumped due to NO TIME- Handsome, sweet, a little nervous, housetrained, well behaved when home alone, kid friendly good w/ 8 yr old female dog he lived with **** TO BE KILLED - 11/1/2018 **** NINE YEAR OLD REX DUMPED DUE TO NO TIME :'( Who better to introduce a deserving doggie than himself? After viewing his happy photos, its hard to imagine him any other way, so without further ado, here's a heartfelt intro from Rex. "Hello, my name is Rex, all my photos capture my smile. I hope to one day share my smile with a new family. I've had a home all my life, and now 9 years later, I find myself alone in a very sad, strange, and scary place. I heard conflicting remarks about my bio. Some say I'm friendly, allowing handling and social, other remarks are less than ideal. I'm trying my best in this unfamiliar scenario, and sometimes I am afraid of what might happen. I'm starting to think I may never leave here, and I'm scared. I always thought I was a great catch, but recently heard someone describe be as a senior brown dog, and it didn't sound promising. I wish they could get to know me, because I still love to act and play the way I did years ago, and I was always called cute. I am loyal, sincere and affectionate with my loved ones. I don't want my life to end this way, but if it does I hope you all see the real me. The people here say I have a slim chance of getting a foster or adopter since there are so many other doggies in need. Maybe someone loves older souls, and would love my company? Please spread the word about me, I am a good boy." REX@BROOKLYN ACC Hello, my name is Rex My animal id is #41134 I am a male brown brindle dog at the Brooklyn Animal Care Center The shelter thinks I am about 9 years old, 59 lbs Came into shelter as owner surrender Oct. 28, 2018 Reason Stated: NO TIME FOR ANIMAL Rex is rescue only Rex was placed at risk due to behavioral concerns; he has not acclimated well to the shelter environment and is reflecting on his behavior. Rex remains fearful and uncomfortable in the care center. While he has allowed some handling from select handlers, he continues to remain uncomfortable with direct touch and some forms of approach, escalating to growling and snapping. We believe Rex may be best set up to succeed if placed with an experienced rescue partner who may allow him to decompress and acclimate to a new home environment at this own pace. Rex is geriatric. My medical notes are... Weight: 59.7 lbs Vet Notes 13/09/2018 DVM Intake Exam Estimated age: 9 years Microchip noted on Intake? positive 981020015672030 History : o/s, now RTO Subjective: BARH Observed Behavior - Tense nervous, and had to be muzzled for exam Evidence of Cruelty seen - no Evidence of Trauma seen - no Objective P = wnl R = eupneic BCS 6/9 EENT: Eyes have nuclear sclerosis ou, ears clean, no nasal discharge noted Oral Exam: muzzled H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: tense U/G: MI, 2 testicles descended MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: mentation appropriate - no signs of neurologic abnormalities Assessment:Apparently healthy-geriatric Plan: Continue to monitor while at BACC Prognosis: Excellent SURGERY: permanent waiver due to age 30/10/2018 DVM Intake Exam Estimated age: 9 years Microchip noted on Intake? positive 981020015672030 History : o/s (was here before Sept 2018) Subjective: BARH Observed Behavior - Tense nervous, whale eyes, tried to snap and whipped head around. Muzzled for exam and was growling and alligator rolling. Evidence of Cruelty seen - no Evidence of Trauma seen - no Objective P = wnl R = eupneic BCS 6/9 EENT: Eyes have nuclear sclerosis ou, ears clean, mild serous nasal discharge noted Oral Exam: muzzled H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: tense, unable to deeply palpate but no obvious abnormalities noted U/G: MI, 2 testicles descended MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: mentation appropriate - no signs of neurologic abnormalities Assessment:Apparently healthy-geriatric Plan: Continue to monitor while at BACC Prognosis: Excellent SURGERY: permanent waiver due to age Details on my behavior are... Behavior Condition: 4. Orange Behavior History Behavior Assessment Behavior during intake: Rex had a soft body, tail high when counselor approached him. Counselor was able to scan for a microchip, collar and take a picture without any issues. Date of Intake: 10/28/2018 Basic Information:: Rex is a 9 years old unneutered male. Rex does not have any previous or current medical issues that the owner is aware of. Owner had Rex since he was 3 months old but had to surrender due to leaving the country. Previously lived with:: 1 adult How is this dog around strangers?: When a stranger would come to the owners home, Rex was friendly and outgoing How is this dog around children?: Owner stated that Rex has not been around any children so behavior is unknown How is this dog around other dogs?: Rex previously lived with a 8 year old spayed female. Around her he is relaxed and affectionate and will play in a gentle way. When Rex is being walked outside and sees other dogs,he will lunge towards them while hard barking. How is this dog around cats?: Rex will chase after cats when he sees them outside Resource guarding:: Rex is not bothered when owner would take away Rex's food, treats or toys Bite history:: Rex does not have a bite history Housetrained:: Yes Energy level/descriptors:: Very High Other Notes:: Rex is not bothered when the owner would hold him/restrain him, being pushed off furniture being disturbed while sleeping, being given a bath, having his nails trimmed, having his coat brushed or when unfamiliar people would approach the owner or the owners home Has this dog ever had any medical issues?: No Medical Notes: Rex does not have any known medical concerns For a New Family to Know: Rex is described as a friendly, affectionate and playful. He has a very high activity level and likes to play with balls, chew toys and ropes. In the home, he liked to be in the same room as the owner. Rex was fed both wet and dry food brand Alpo and Pedigree. He was kept mostly indoors and is house trained. When left alone in the home, he was well behaved. Rex is crate trained and would be behaved in a crate when left for up to 4 hours. IF he if left longer, he will bark. He knows the cues sit, come and stay. For exercise, Rex was taken running and jogging. When on leash, Rex pulls very hard. Owner has walked him off leash before and stated that he will wander around at first but come back when his name was called. Date of intake:: 9/10/2018 Spay/Neuter status:: No Means of surrender (length of time in previous home):: Owner surrender Previously lived with:: 1 Adult and another dog Behavior toward strangers:: Friendly and outgoing Behavior toward children:: Relaxed and affectionate Behavior toward dogs:: Relaxed and affectionate but with unfamiliar dogs, she will bark and lunge. Behavior toward cats:: Unknown Resource guarding:: None reported Bite history:: None reported Housetrained:: Yes Energy level/descriptors:: The owner describes Rex as friendly, affectionate and playful with a high activity level. Other Notes:: Owner surrender, 2nd stay in the care center, 10/28/2018 Previously lived with: 1 adult, 1 dog Behavior towards strangers: Friendly, outgoing Behavior towards children: Unknown Behavior towards dogs: Relaxed, gentle with resident dogs though lunges and barks at other dogs on leash Behavior towards cats: Chases cats he sees outside Resource guarding: None reported Bite history: None reported House-trained: Yes Energy level/descriptors: Friendly, affectionate, playful with a high energy level Date of assessment:: 9/13/2018 Look:: 5. Dog freezes and/or growls or tries to bite. Toy:: 1. No interest. Summary:: Rex came into the assessment room calm and quiet, when attempting to coax him and pet him he was a bit tense and uncomfortable. The assessor began to start his evaluation with look item and that's when he became stiff and growled. Rex continue to remain tense with displaying whale eyes towards both handlers. Summary (1):: According to Rex's previous owner, Rex was social with the other resident dig but would lunged and snapped at unfamiliar dogs. 9/11: Due to Rex's behavior at home, a muzzle was placed on him before being introduced to the novel female. He was mostly occupied with the muzzle, and did not greet the helper dog. He quickly pulled the muzzle off so both dogs were separated. 9/12: Another attempt was made to muzzle Rex, but during the handling portion he growled and snapped at the handlers. Date of intake:: 10/29/2018 Summary:: Soft bodied, allowed all handling Date of initial:: 9/13/2018 Summary:: Tense, nervous, had to be muzzled for exam. ENERGY LEVEL:: Rex displays a medium activity level in the care center. BEHAVIOR DETERMINATION:: NEW HOPE ONLY Behavior Asilomar: TM - Treatable-Manageable Recommendations:: No children (under 13),No cats,Place with a New Hope partner Recommendations comments:: No children: Due to how uncomfortable Rex is currently with touch and novel stimuli, we feel that an adult-only home would be most beneficial at this time. No cats: In his previous home, Rex is reported to chase cats, for these reason we feel that a home without cat would be most appropriate at this time. Place with a New Hope partner: While his previous owner describes him as a friendly and outgoing dog, Rex remains fearful and uncomfortable in the care center. While he has allowed some handling from select handlers, he continues to remain uncomfortable with direct touch and some forms of approach, escalating to growling and snapping. We believe Rex may be best set up to succeed if placed with an experienced rescue partner who may allow him to decompress and acclimate to a new home environment at this own pace. Force-free, reward-based training is advised when introducing or exposing Rex to new and unfamiliar situations. Potential challenges: : Fearful/potential for defensive aggression Potential challenges comments:: Fearful/potential for defensive aggression: Rex gives clear warnings when he is uncomfortable and does seem to choose to avoid or retreat when given the opportunity, but if prevented from moving away there is a potential to escalate to higher-level warning behaviors and possible fear-based aggression. It is important to move slowly with Rex, to build positive associations (treats/toys/praise), and to allow Rex to initiate interactions with new people. He should never be forced to greet or to interact if he is not comfortable and soliciting attention. REX IS RESCUE ONLY…..TO SAVE THIS PUP YOU MUST FILL OUT APPLICATIONS WITH AT LEAST 3 NEW HOPE RESCUES. PLEASE HURRY!!! IF YOU CAN FOSTER OR ADOPT THIS PUP, PLEASE PM OUR PAGE FOR ASSISTANCE. WE CAN PROVIDE YOU WITH LINKS TO APPLICATIONS WITH NEW HOPE RESCUES WHO ARE CURRENTLY PULLING FROM THE NYC ACC. PLEASE SHARE THIS DOG FOR A HOME TO SAVE HIS LIFE.