Dramatic play vet clinic free printables
Being a woman was not easier
2023.06.04 19:06 ThisDudeisNotWell Being a woman was not easier
I tried to post this and uses the wrong flair. Sorry mods, dyslexia. Misread the rules on discussion posts.
On a different post I was asked as a trans guy (ftm, assigned female at birth and medically transitioned into a man) if being a woman was easier.
No gents, sorry. It wasn't.
I don't think my experience is really one-to-one comparable to being a cis man. I don't think being a man is actually that dramatically easier than being a woman in terms of the social conditioning. I'm also not a very masculine man to be honest, and that does affect my experience of manhood also. Other trans men who are more traditionally masculine, anecdotally, do say they are treated better however.
The core I think of what cis men who ask me questions like this are trying to get at though is whether or not people were generally nicer, more gentle in the way they treated me when I was living as a woman. Mostly because they see women getting approached with romantic prospects instead of having to seek them out and wish that would happen to them. And the answer is no.
From a very young age you become very aware as a woman that men will be "nice" in a very conditional way that really ends up being more threatening than anything. You have to play a kind of 5D chess where you have to communicate that you are not DTF and rebuff unwanted advances without inciting him into violance. Straight men will interpret politeness as signs of interest sometimes, so you have to be just rude enough to show him you're not interested while not so rude he'll attack you. Or if you're tried be extremely rude and prepare yourself for a fight, which I ended up doing once or twice while drunk knowing full well I was going to get hurt.
I have nothing against straight cis men shooting their shot in social situations where it was appropriate. I, as someone who was also at a bar to pick up chicks, tried to show men who approached me as much respect as I could. As an example, I never let a guy buy me a drink just to get free booze, and I bought some dudes who already bought drinks before coming over to talk to me a drink back to so he'd break even. Many men were respectful and kind to me, I don't want to paint them all as assholes, but maybe even 10% even refusing to let a dude buy me a beer he took as some kind of insult. Even my experience as a woman is not representative though, because I was willing to be more confrontational and willing to risk getting beat up way more than most women I know are.
And that's just in social situations where getting hit on was appropriate. I have a collection of creepy love letters men had handed me at my old shitty fast food till job, most of them graphic, two of them containing death threats. I (stupidly, without thinking it through) stopped to try and help a guy vomiting on the street while walking home at night, and he ended up texting his buddies (who were just a block or two away) to come and help him try to physically force me into his car to "take me to a party at his house" while calling me "the woman he wants to marry." A dude followed me home screaming at me the whole way after he mistook me for the call girl he ordered, I guess, and I had to duck into a convenient store until the police showed so he wouldn't know what building I lived in. A drunk old man straight up tried to grab my tits on the train then said "beat the living daylights out of me if I was his daughter" infront of a crowded car of bystanders. Because I reflexively beat his hand away from my chest. That's just some of the serious stuff, none of the casual harassment of some dickweed trying to flirt with me while in the line at the fucking grocery store or whatever and getting mad that I'm just ignoring him.
A popular trans woman YouTuber I'm worried might trigger some people if I say her channel name described the constant barage of male attention you get as a woman as the "firing squad of dicks" where as being a man feels like radio silence sometimes when looking for a romantic connection. I feel this is a pretty accurate way of describing it. Personally, not having to face that "firing squad of dicks" anymore feels like a massive relief. My perspective is biased as someone who doesn't struggle with flirting and dating and has gotten used to being the one that makes the first move, but to me it's a huge relief.
If I'm wearing a medical mask and my beard and mustache are covered I still get mistaken for a women sometimes. And to be frank, as much as it sucks to be misgendered, it sucks way more getting fucking catcalled again. In that kind of death by a thousand cuts kind of way. Because as much as I'd love to scream shit back at every asshat who does that shit both now and before I transitioned, I probably wouldn't have a face left to break at that point if I did.
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2023.06.04 19:01 xDINOxNUGGETSx [NA] [EUR] [PC] 🌎 =UWS= United We Stand ~ Non-Toxic Adults DISCORD
Region: NA / EUR Age: 18+ (majority in the community though are 30+)Discord: https://discord.gg/VznjUrRSuc
Description: We are a community who strive to build an environment catered for older gamers in COD who just want to kick back after work, play games stamped with some great memories. Created in 2003, Adults choose to play with us because we provide one of the most honest, lax gaming communities for non-toxic Adults who want a home that won't have kids or teens barking orders at them, and drama free staff. No other community displays their Paypal info to prove 100% of their donations go towards the community. What we offer:
💠 Good Sportsmanship and will (no rages or blames for mistakes)
💠 Friendly, active, and generous members teaching new players while assisting the vets
💠 Never get kicked from community regardless of life activity (life comes first with us)
💠 We host charity events for groups like Doctors without Boarders and the Red Cross
💠 Players on 24/7 there's always someone on to group up with so you never play alone
💠 Non-abusive Staff that deal with any problematic players or situations in a fair manner
💠 A L3 Boosted Discord where you can Stream 1080p 60fps FREE for better tactical communication
💠 Channel Creation - Make your channel, lock/limit it and set it how you want to play with friends
Other Games We Play: Battlefield, Star Citizen, EFT, Division 2, Apex, D&D & many more Survival/FPS games
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2023.06.04 18:51 veilsofrealitydotcom If Blizzard just hired some top poe strmrs as consultants game=good
Don't get me wrong, all the poe streamers I watch know that not every game needs to be PoE and having a more user friendly and casual alternative is a good thing.
I think the streamers would even rather work for free than leave d4 in its current state. The reviews I've heard from streamers I watch are 5/10 6/10 6/10. They all agree the game has a good base but given Blizzard's past design decisions I personally don't see the experience changing dramatically as they've had 10 years to improve d3 and 10 years to make this game and there is very little innovation.
I know there is a disagreement about whether some features are pros or cons so I wont list my opinions but I think top streamers have good instincts and analysis about what makes a game engaging/immersive/long-lived.
Blizzard is thinking primarily from a "how much money can we squeeze with as little investment as possible mindset". This is evidenced in one example by the half-assed hc race where some people could pay $30 extra to get 4 day head start. I get that games are more expensive now I am just talking about the willingness to allow paid advantage in a competitive game.
I think Blizzard's reputation as being greedy and lazy is the main reason it generates so much hate, not because people want you to only be able to like one game. And this is why I think bringing in consultants who actually play games for a living and are not just thinking about monetization could actually make the game more money over time.
PoE is free and I've dumped wayyyyyy more money happily than I would give to Blizzard. If hardcore players had an incentive to stick around you make more money from MTX.
I just don't get their one and done, thanks got your money, half-assed seasons(they did it before and you still paid for this so why change?) model.
Lastly, streams or forums where you are not allowed to talk about the disappointments of the game will give people wrong impression which will make them even more toxic as a review source. Its better for people to know what they are getting into so they can only blame themselves like is the case for me if I buy this.
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2023.06.04 18:09 i_know_nothing123 Astrology observations pt 44
DISCLAIMER- Placements will not play out the same way for everyone and having challenging placements + aspects does not mean that you are a bad person or that you will have a bad life. Take what resonates and leave what doesn’t
-Juno in the 12th house may indicate getting married in secret/eloping (12th house—escapism, both literally and figuratively)
-possible job prospects for people with the 6th or 10th house cusp in scorpio is not limited to detective work, psychology and the occult, they can take on careers involving reproductive health (like urology, gynecology, working in an STD testing clinic, etc)
-the health branch for someone with the 6th or 10th house cusp in Capricorn or Aries includes dentistry (Capricorn rules the bones including the teeth and Aries rules the head/face).
-Juno in the 3rd house can indicate that you will meet your future spouse on a messaging app (dating or not), while you are out on a short trip, or through a sibling. I can also see that happening through a “dialing the wrong number” situation
-another way a harsh venus-Neptune aspect can manifest (aside from not seeing red flags until it is too late) is getting into a lot of unrequited love situations and the effects are more painful if Chiron is also aspected
-Jupiter in the 3rd house or aspected with mercury can manifest literally via talking too much or sending your brain into overdrive by overthinking.
-people with 6th and 12th house stelliums (or the moon in any of those 2 houses) usually love animals and are most likely to have had quite a few pets throughout their lives
-Saturn in the 11th house can indicate having friends that are older than you or that you connect with older folks better than people around your age
-the type of envious people 8th and 12th house stellium natives tend to attract are the type that envy them but still want to stay in close proximity to stay in the loop of what is going on in their lives, like a monitoring spirit
-people with pluto and/or Uranus in the 4th house experience the most dramatic family dynamic or living arrangement changes, whether it’s divorce, abandonment, folks moving in and out of their homes or something else
Ps- I’m open for readings, book one if you’re interested
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2023.06.04 16:46 thisgingercake Lack of sleep and PTSD: What you need to know now. - Cereset
Lack of sleep and PTSD: What you need to know now.
There is an unmistakable relationship between how well you sleep and the symptoms experienced with PTSD.
Nearly 1 in 10 U.S. adults will be diagnosed with symptoms of PTSD at some point in their life, with woman twice as likely as men. If you’ve experienced a traumatic event and are also having trouble sleeping, you may be suffering from the debilitating effects of PTSD.
PTSD and sleep: What the research tells us. Research has demonstrated many connections between restful sleep and PTSD. If you have been diagnosed with PTSD, it’s more than likely you will have sleep issues. Achieving restful sleep again can alleviate PTSD symptoms. We now also know that too little sleep can actually make PTSD symptoms worse. One sure way to determine the effectiveness of any therapy you may be receiving for PTSD is how quickly treatments restore restful sleep or how much your sleep quality has improved since beginning therapy. Even for those without a PTSD diagnoses, restful sleep can help guard against the impact of traumatic life events we may face. Treating sleep complaints as a primary symptom rather than a secondary one will dramatically improve the outcomes for all PTSD sufferers.
You can’t heal if you can’t sleep.
Cereset® can help! Trauma adversely affects brain balance. Sometimes it happens quickly, other times it may take years. The brain is the organ of central command, it drives everything. When it becomes unbalanced due to extreme stress, an individual can experience symptoms associated with PTSD. If the brain is not reorganized, it becomes an impediment to restful sleep. Cereset relaxes the brain, allowing it to restore its own normal balance to help alleviate symptoms of PTSD.
During the Cereset session process, restful sleep is typically achieved in 3 weeks, with many experiencing it in just 3 days. Cereset Research® has an incredible track record of successes relieving people from the debilitating effects of PTSD. Clinical trials conducted with civilians, the military and first responders have demonstrated the benefits of Cereset conclusively. left-side brain dominance numbs us, so we don’t “feel” a situation as much, slowing the brain’s response – the freeze response right-side brain dominance, stimulates us to fight or run from a stressful situation – the fight-or-flight response
The Cereset solution.
Relax. Rebalance. Reset.
The Cereset® Experience is a non-invasive process using brain initiated sound to relax the brain and allow it to reset and free itself. A rebalanced brain helps you experience more restful sleep, providing relief from the symptoms of PTSD. High resolution brain sensors placed on the scalp record precise real-time brain rhythms. Cereset’s proprietary algorithms translate those brain rhythms into engineered tones that create your own unique BrainEcho®. You’ll hear that echo through a pair of ear buds. Your brain in effect sees its own reflection enabling it to fully relax and reset itself to its natural balance. During the Cereset process, restful sleep is typically achieved in 3 weeks, with many experiencing it in just 3 days.
Schedule an introduction to Cereset with your nearest client center
This 50 minute baseline evaluation includes an orientation with your personal Tech Coach, a baseline brain observation to assess your brain’s ability to manage stress, your very own Personal Brain Index
® and a recommended plan of action. Please check with your local client center for special pricing on this offer.
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2023.06.04 16:27 DefaultLayoutIsAwful Toys and advice for dog in recovery?
My dog recently had cruciate ligament repair surgery and the vet recommended 6-8 weeks of crate rest and even bathroom is to be on a leash. We got various things to try and make the recovery period as comfortable as possible, but he's a lab-collie and he's going berserk not having freedom to roam the house and garden. It's only day 2. He was already getting frustrated prior to the surgery with the limited walks - walks before the injury were 1.5/2 hours. I've tried distracting him with things like a shuffle mat for feeding and dog peanut butter on a lick mat. They worked for a while, but I don't want to be giving him food all day to keep him occupied, especially while he's not getting much exercise. He's not interested in his toys that he was before (mostly soft toys/balls/treat stuff) and even petting only goes so far before he wants to get out and go for a walk. I've tried moving the crate around to give him different scenery to look at, but it's large and moving it between rooms requires folding it up (I might try switching the rooms every few days). They're all brief distractions, but his nature is wanting to see and be everywhere all at once. He's doing a lot of whining. It stops the instance he thinks we're going to do something, so I assume it's purely from boredom, because once he realises it's not a walk or free roam of the house, he start crying again until he tries himself out. When he does settle down, he's not too bad, but after every meal, there's an hour or two of this. I can't imagine it's good for his recovery and, if I can briefly be selfish, I'm getting a headache.
Are there any toys that would be suitable for this case? Things to break up the day for him. I'm really wary this early on doing something that might overtax him. Any other advice is welcome as well. I did see some comments about sedatives, but I'd prefer not to go that route unless absolutely necessary. He does love to play, it's just his idea of play is going at 100% and making you chase after him. I also saw some people recommend teaching him a new trick. Any suggestions?
He's on a medication and a painkiller (given by the vet). He's in the same room as me except for at night. During the day he's got an inflatable collar, but cone at night as extra precaution to ensure he can't get at the leg. The crate has his bed in it and he can sprawl out the length of it. I tried seeing if he might prefer lying on the wooden floor in case the bed was too warm, but he was frustrated either way from not being able to wander.
Thanks for any help.
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2023.06.04 15:47 rythmica D20 Fan Roleplaying Group Looking for 2 More Players
Greetings! We’re a group of 4 Dimension 20 fans. We all met on this subreddit, and since we’re firm believers that D20 people are the best people, we’re here looking for two more heroes to join us on a new adventure. We play together online using zoom and roll20.
We’re a fun, open group who believes honest communication is the key to successful relationships. Newbies to d&d or role playing are welcome and encouraged, but we definitely need someone who is at least 18 years old.
A few potential deal breakers:
- We are LGBTQ+ inclusive, and otherwise intolerant of bigotry or hate.
- While we enjoy dramatic storytelling with high highs and low lows, we’re not looking for anything extreme, edgy, or overly controversial.
- We like an even ratio of roleplay to combat, but what matters most is the overall story. Combat should support the narrative, not the other way around.
- When it comes to roleplay, we really value being able to see the person you're interacting with. For that reason, while we respect people's privacy / social anxiety, the best fit for our group will be someone that doesn't mind joining us on zoom with a camera.
- We're insistent upon finding someone who can reliably commit to our timeslot, which is 7:00PM EST to 10:00ishPM EST every Friday. This is a huge sticking point - please don't respond if you have any potential conflicts with this timeslot.
We would like a chance to meet with you before we decide to go forward, and we’d love to give you a chance to ask us any questions you have, as well as to just feel out the vibe on both sides. We’re hoping to schedule 15-30 minute zoom calls with any interested parties, starting tonight, but if you can't make it until later this week, that's fine.
Feel free to send me a direct message with the following info:
- Name and preferred pronouns
- Are you above 18?
- What are some of your favorite nerdy interests? Books, games, movies, whatever - just tell us what your interested in.
- Favorite D20 moment?
Thanks! We look forward to meeting you.
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2023.06.04 14:34 Dirtclodkoolaid AMA RESOLUTION 235
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AMA RESOLUTION 235 November 2018 INAPPROPRIATE USE OF CDC Guidelines FOR PRESCRIBING OPIOIDS (Entire Document)
“Resolution 235 asks that our AMA applaud the CDC for its efforts to prevent the incidence of new cases of opioid misuse, addiction, and overdose deaths; and be it further, that no entity should use MME thresholds as anything more than guidance and that MME thresholds should not be used to completely prohibit the prescribing of, or the filling of prescriptions for, medications used in oncology care, palliative medicine care, and addiction medicine care: and be it further, that our AMA communicate with the nation’s largest pharmacy chains and pharmacy benefit managers to recommend that they cease and desist with writing threatening letters to physicians and cease and desist with presenting policies, procedures and directives to retail pharmacists that include a blanket proscription against filling prescriptions for opioids that exceed certain numerical thresholds without taking into account the diagnosis and previous response to treatment for a patient and any clinical nuances that would support such prescribing as falling within standards of good quality patient care; and be it further, that AMA Policy opposing the legislating of numerical limits on medication dosage, duration of therapy, numbers of pills/tablets, etc., be reaffirmed; and be it further, that physicians should not be subject to professional discipline or loss of board certification or loss of clinical privileges simply for prescribing opioids at a quantitative level that exceeds the MME thresholds found in the CDC Guidelines; and be it further, that our AMA encourage the Federation of State Medical Boards and its member boards, medical specialty societies, and other entities to develop improved guidance on management of pain and management of potential withdrawal syndromes and other aspects of patient care for “legacy patients” who may have been treated for extended periods of time with high-dose opioid therapy for chronic non-malignant pain.
RESOLVED, that our American Medical Association (AMA) applaud the Centers for Disease Control and Prevention (CDC) for its efforts to prevent the incidence of new cases of opioid misuse, addiction, and overdose deaths
RESOLVED, that our AMA actively continue to communicate and engage with the nation’s largest pharmacy chains, pharmacy benefit managers, National Association of Insurance Commissioners, Federation of State Medical Boards, and National Association of Boards of Pharmacy in opposition to communications being sent to physicians that include a blanket proscription against filing prescriptions for opioids that exceed numerical thresholds without taking into account the diagnosis and previous response to treatment for a patient and any clinical nuances that would support such prescribing as falling within standards of good quality patient care.
RESOLVED, that our AMA affirms that some patients with acute or chronic pain can benefit from taking opioid pain medications at doses greater than generally recommended in the CDC Guideline for Prescribing Opioids for Chronic Pain and that such care may be medically necessary and appropriate, and be it further
RESOLVED, that our AMA advocate against misapplication of the CDC Guideline for Prescribing Opioids by pharmacists, health insurers, pharmacy benefit managers, legislatures, and governmental and private regulatory bodies in ways that prevent or limit patients’ medical access to opioid analgesia, and be it further
RESOLVED, that our AMA advocate that no entity should use MME (morphine milligram equivalents) thresholds as anything more than guidance, and physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME thresholds found in the CDC Guideline for Prescribing Opioids.””
Pain Management Best Practices Inter-Agency Task Force - Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations Official Health and Human Services Department Released December 2018
“The Comprehensive Addiction and Recovery Act (CARA) of 2016 led to the creation of the Pain Management Best Practices Inter-Agency Task Force (Task Force), whose mission is to determine whether gaps in or inconsistencies between best practices for acute and chronic pain management exist and to propose updates and recommendations to those best practices. The Task Force consists of 29 experts who have significant experience across the disciplines of pain management, patient advocacy, substance use disorders, mental health, and minority health.”
In addition to identifying approximately 60 gaps in clinical best practices and the current treatment of pain in the United States, HHS PMTF provided recommendations for each of these major areas of concern. In alignment with their original charter, the PMTF will submit these recommendations to Congress to become our ‘National Pain Policy’. The 60+ gaps and inconsistencies with their recommendations will serve to fill gaps in pain treatment at both the state and federal level; and the overwhelming consensus was that the treatment of pain should be multimodal and completely individualized based on the individual patient. The heart of each recommendation in each section was a resounding call for individualization for each patient, in regards to both non-pharmacological and pharmacological modalities; including individualizations in both opioid and non-opioid pharmacological treatments.
While each of the gap+recommendation sections of what is poised to become our national pain policy is extremely important, one that stands out the most (in regards to opioid prescribing) is the Stigma section. Contained in this section is one of the core statements that shows our Health and Human Services agency - the one that should have always been looked to and followed - knew the true depth of the relationship (or lack of) between the overdose crisis and compassionate prescribing to patients with painful conditions:
“The national crisis of illicit drug use, with overdose deaths, is confused with appropriate therapy for patients who are being treated for pain. This confusion has created a stigma that contributes to raise barriers to proper access to care.”
The recommendation that follows - “Identify strategies to reduce stigma in opioid use so that it is never a barrier to patients receiving appropriate treatment, with all cautions and considerations for the management of their chronic pain conditions” - illustrates an acknowledgment by the top health agency of the federal government that the current national narrative conflating and confusing compassionate treatment of pain with illicit drug use, addiction, and overdose death is incorrect and only serving to harm patients.
Since March of 2016 when the CDC Guidelines were released, advocates, patients, clinicians, stakeholders, and others, have began pointing out limitations and unintended consequences as they emerged. In order to address the unintended consequences emerging from the CDC Guidelines, this task force was also charged with review of these guidelines; from expert selection, evidence selection, creation, and continuing to current misapplication in order to provide recommendations to begin to remedy these issues.
“A commentary by Busse et al. identified several limitations to the CDC guideline related to expert selection, evidence inclusion criteria, method of evidence quality grading, support of recommendations with low-quality evidence, and instances of vague recommendations. In addition, the CDC used the criterion of a lack of clinical trials with a duration of one year or longer as lack of evidence for the clinical effectiveness of opioids, whereas Tayeb et al. found that that was true for all common medication and behavioral therapy studies.
Interpretation of the guideline, in addition to some gaps in the guideline, have led to unintended consequences, some of which are the result of misapplication or misinterpretation of the CDC guideline.
However, at least 28 states have enacted legislation related to opioid prescription limits, and many states and organizations have implemented the guideline without recognizing that the intended audience was PCPs; have used legislation for what should be medical decision making by healthcare professionals; and have applied them to all physicians, dentists, NPs, and PAs, including pain specialists.441–444 Some stakeholders have interpreted the guideline as intended to broadly reduce the amount of opioids prescribed for treating pain; some experts have noted that the guideline emphasizes the risk of opioids while minimizing the benefit of this medication class when properly managed.”
“The CDC guideline was not intended to be model legislation for state legislators to enact”
“In essence, clinicians should be able to use their clinical judgment to determine opioid duration for their patients” https://www.hhs.gov/ash/advisory-committees/pain/reports/2018-12-draft-report-on-updates-gaps-inconsistencies-recommendations/index.html
HHS Review of 2016 CDC Guidelines for responsible opioid prescribing
The Pain Management Task Force addressed 8 areas that are in need of update or expansion with recommendations to begin remediation for each problem area:
Lack of high-quality data exists for duration of effectiveness of opioids for chronic pain; this has been interpreted as a lack of benefit Conduct studies Focus on patient variability and response for effectiveness of opioids; use real-world applicable trials
Absence of criteria for identifying patients for whom opioids make up significant part of their pain treatment Conduct clinical trials and/or reviews to identify sub-populations of patients where long-term opioid treatment is appropriate
Wide variation in factors that affect optimal dose of opioids Consider patient variables for opioid therapy: Respiratory compromise Patient metabolic variables Differences in opioid medications/plasma concentrations Preform comprehensive initial assessment it’s understanding of need for comprehensive reevaluations to adjust dose Give careful considerations to patients on opioid pain regimen with additional risk factors for OUD
Specific guidelines for opioid tapering and escalation need to be further clarified A thorough assessment of risk-benefit ratio should occur whenever tapering or escalation of dose This should include collaboration with patient whenever possible Develop taper or dose escalation guidelines for sub-populations that include consideration of their comorbidities When benefit outweighs the risk, consider maintaining therapy for stable patients on long term opioid therapy
Causes of worsening pain are not often recognized or considered. Non-tolerance related factors: surgery, flares, increased physical demands, or emotional distress Avoid increase in dose for stable patient (2+ month stable dose) until patient is re-evaluated for underlying cause of elevated pain or possible OUD risk Considerations to avoid dose escalation include: Opioid rotation Non-opioid medication Interventional strategies Cognitive behavior strategies Complementary and integrative health approaches Physical therapy
In patients with chronic pain AND anxiety or spasticity, benzodiazepine co-prescribed with opioids still have clinical value; although the risk of overdose is well established When clinically indicated, co-prescription should be managed by specialist who have knowledge, training, and experience with co-prescribing. When co-prescribed for anxiety or SUD collaboration with mental health should be considered Develop clinical practice guidelines focused on tapering for co-prescription of benzodiazepines and opioids
The risk-benefit balance varies for individual patients. Doses >90MME may be favorable for some where doses <90MME may be for other patients due to individual patient factors. Variability in effectiveness and safety between high and low doses of opioids are not clearly defined. Clinicians should use caution with higher doses in general Using carefully monitored trial with frequent monitoring with each dose adjustment and regular risk reassessment, physicians should individualize doses, using lowest effective opioid dose that balances benefit, risk, and adverse reactions Many factors influence benefits and risk, therefore, guidance of dose should not be applied as strict limits. Use established and measurable goals: Functionality ADL Quality of Life
Duration of pain following acute and severely painful event is widely variable Appropriate duration is best considered within guidelines, but is ultimately determined by treating clinician. CDC recommendation for duration should be emphasized as guidance only with individualized patient care as the goal Develop acute pain management guidelines for common surgical procedures and traumas To address variability and provide easy solution, consideration should be given to partial refill system
Human Rights Watch December 2018 (Excerpt from 109 page report)
“If harms to chronic pain patients are an unintended consequence of policies to reduce inappropriate prescribing, the government should seek to immediately minimize and measure the negative impacts of these policies. Any response should avoid further stigmatizing chronic pain patients, who are increasingly associated with — and sometimes blamed for — the overdose crisis and characterized as “drug seekers,” rather than people with serious health problems that require treatment.
Top government officials, including the President, have said the country should aim for drastic cutbacks in prescribing. State legislatures encourage restrictions on prescribing through new legislation or regulations. The Drug Enforcement Administration (DEA) has investigated medical practitioners accused of overprescribing or fraudulent practice. State health agencies and insurance companies routinely warn physicians who prescribe more opioids than their peers and encourage them to reduce prescribing. Private insurance companies have imposed additional requirements for covering opioids, some state Medicaid programs have mandated tapering to lower doses for patients, and pharmacy chains are actively trying to reduce the volumes of opioids they dispense.
The medical community at large recognized that certain key steps were necessary to tackle the overdose crisis: identifying and cracking down on “pill mills” and reducing the use of opioids for less severe pain, particularly for children and adolescents. However, the urgency to tackle the overdose crisis has put pressure on physicians in other potentially negative ways: our interviews with dozens of physicians found that the atmosphere around prescribing for chronic pain had become so fraught that physicians felt they must avoid opioid analgesics even in cases when it contradicted their view of what would provide the best care for their patients. In some cases, this desire to cut back on opioid prescribing translated to doctors tapering patients off their medications without patient consent, while in others it meant that physicians would no longer accept patients who had a history of needing high-dose opioids.
The consequences to patients, according to Human Rights Watch research, have been catastrophic.”
Opioid Prescribing Workgroup December 2018
This is material from the Board of Scientific Counselors in regards to their December 12, 2018 meeting that culminated the works of a project titled the “Opioid Prescribing Estimates Project.” This project is a descriptive study that is examining opioid prescribing patterns at a population level. Pain management is a very individualized process that belongs with the patient and provider. The Workgroup reviewed work done by CDC and provided additional recommendations.
SUMMARY There were several recurrent themes throughout the sessions.
Repeated concern was voiced from many Workgroup members that the CDC may not be able to prevent conclusions from this research (i.e. the benchmarks, developed from limited data) from being used by states or payors or clinical care systems to constrain clinical care or as pay-for- performance standards – i.e. interpreted as “guidelines”. This issue was raised by several members on each of the four calls, raising the possibility that providers or clinical systems could thus be incentivized against caring for patients requiring above average amounts of opioid medication.
Risk for misuse of the analysis. Several members expressed concerns that this analysis could be interpreted as guidance by regulators, health plans, or clinical care systems. Even though the CDC does not plan to issue this as a guideline, but instead as research, payors and clinical care systems searching for ways to reign in opioid prescribing may utilize CDC “benchmarks” to establish pay-for-performance or other means to limit opioid prescribing. Such uses of this work could have the unintended effect of incentivizing providers against caring for patients reliant upon opioids.
…It was also noted that, in order to obtain sufficient granularity to establish the need for, dosage, and duration of opioid therapy, it would be necessary to have much more extensive electronic medical record data. In addition, pain and functional outcomes are absent from the dataset, but were felt to be important when considering risk and benefit of opioids.
...Tapering: Concerns about benchmarks and the implications for tapering were voiced. If tapering occurs, guidance was felt to be needed regarding how, when, in whom tapering should occur. This issue was felt to be particularly challenging for patients on chronic opioids (i.e. “legacy” patients). In addition, the importance of measuring risk and benefit of tapering was noted. Not all high-dose patient populations benefit from tapering.
General comments. Workgroup members noted that most patients prescribed opioids do not experience adverse events, including use disorder. Many suggested that further discussion of opioids with patients prior to surgery was important, with an emphasis on expectations and duration of treatment. A member suggested that take-back programs would be more effective than prescribing restrictions.
Procedure-related care. Members noted that patient factors may drive opioid need more than characteristics of a procedure.
Patient-level factors. Members noted that opioid-experienced patients should be considered differently from opioid-inexperienced patients, due to tolerance.
It was noted that anything coming out of the CDC might be considered as guidelines and that this misinterpretation can be difficult to counter. There was extensive discussion of the 50 and 90 MME levels included in the CDC Guidelines. It was recommended that the CDC look into the adverse effects of opioid tapering and discontinuation, such as illicit opioid use, acute care utilization, dropping out of care, and suicide. It was also noted that there are major gaps in guidelines for legacy patients, patients with multiple diagnoses, pediatric and geriatric patients, and patients transitioning to lower doses.
There were concerns that insufficient clinical data will be available from the dataset to appropriately consider the individual-level factors that weigh into determination of opioid therapy. The data would also fail to account for the shared decision-making process involved in opioid prescribing for chronic pain conditions, which may be dependent on primary care providers as well as ancillary care providers (e.g. physical therapists, psychologists, etc).
Patient-level factors. Members repeatedly noted that opioid-experienced patients should be considered differently from opioid-experienced patients, due to tolerance.
Members noted that the current CDC guidelines have been used by states, insurance companies, and some clinical care systems in ways that were not intended by the CDC, resulting in cases of and the perception of patient abandonment. One option raised in this context was to exclude patients on high doses of opioids, as those individuals would be qualitatively different from others. A variant of this concern was about management of “legacy” patients who are inherited on high doses of opioids. Members voiced concerns that results of this work has caused harm to patients currently reliant upon opioids prescribed by their providers.
Acute Non-Surgical Pain
Patient-level factors. Members felt that opioid naïve versus experienced patients might again be considered separately, as opioid requirements among those experienced could vary widely.
...Guidelines were also noted to be often based on consensus, which may be incorrect.
Cancer-Related and Palliative Care Pain
It was noted that the CDC guidelines have been misinterpreted to create a limit to the dose of opioids that can be provided to people at all stages of cancer and its treatment. It was also noted that the cancer field is rapidly evolving, with immunotherapy, CAR-T, and other novel treatments that affect response rates and limit our ability to rely upon historical data in establishing opioid prescribing benchmarks.
Concern that data would not be able to identify all of the conditions responsible for pain in a patient with a history of cancer (e.g. people who survive cancer but with severe residual pain). Further, it was noted that certain complications of cancer and cancer treatment may require the least restrictive long-term therapy with opioids.
The definition of palliative care was also complicated and it was suggested that this include patients with life-limiting conditions.
Overall, it was felt that in patients who may not have long to live, and/or for whom returning to work is not a possibility, higher doses of opioids may be warranted. https://www.cdc.gov/injury/pdfs/bsc/NCIPC_BSC_OpioidPrescribingEstimatesWorkgroupReport_December-12_2018-508.pdf
CDC Scientists Anonymous ‘Spider Letter’ to CDC
Carmen S. Villar, MSW Chief of Staff Office of the Director MS D14 Centers for Disease Control and Prevention (CDC) 1600 Clifton Road Atlanta, Georgia 30329-4027
August 29, 2016
Dear Ms. Villar:
We are a group of scientists at CDC that are very concerned about the current state of ethics at our agency. It appears that our mission is being influenced and shaped by outside parties and rogue interests. It seems that our mission and Congressional intent for our agency is being circumvented by some of our leaders. What concerns us most, is that it is becoming the norm and not the rare exception. Some senior management officials at CDC are clearly aware and even condone these behaviors. Others see it and turn the other way. Some staff are intimidated and pressed to do things they know are not right. We have representatives from across the agency that witness this unacceptable behavior. It occurs at all levels and in all of our respective units. These questionable and unethical practices threaten to undermine our credibility and reputation as a trusted leader in public health. We would like to see high ethical standards and thoughtful, responsible management restored at CDC. We are asking that you do your part to help clean up this house!
It is puzzling to read about transgressions in national media outlets like USA Today, The Huffington Post and The Hill. It is equally puzzling that nothing has changed here at CDC as a result. It’s business as usual. The litany of issues detailed over the summer are of particular concern:
Recently, the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) has been implicated in a “cover up” of inaccurate screening data for the Wise Woman (WW) Program. There was a coordinated effort by that Center to “bury” the fact that screening numbers for the WW program were misrepresented in documents sent to Congress; screening numbers for 2014 and 2015 did not meet expectations despite a multimillion dollar investment; and definitions were changed and data “cooked” to make the results look better than they were. Data were clearly manipulated in irregular ways. An “internal review” that involved staff across CDC occurred and its findings were essentially suppressed so media and/or Congressional staff would not become aware of the problems. Now that both the media and Congresswoman DeLauro are aware of these issues, CDC staff have gone out of their way to delay FOIAs and obstruct any inquiry. Shouldn’t NCCDPHP come clean and stop playing games? Would the ethical thing be to answer the questions fully and honestly. The public should know the true results of what they paid for, shouldn’t they?
Another troubling issue at the NCCDPHP are the adventures of Drs. Barbara Bowman and Michael Pratt (also detailed in national media outlets). Both seemed to have irregular (if not questionable) relationships with CocaCola and ILSI representatives. Neither of these relationships were necessary (or appropriate) to uphold our mission. Neither organization added any value to the good work and science already underway at CDC. In fact, these ties have now called into question and undermined CDC’s work. A cloud has been cast over the ethical and excellent work of scientists due to this wanton behavior. Was cultivating these relationships worth dragging CDC through the mud? Did Drs. Bowman and Pratt have permission to pursue these relationships from their supervisor Dr. Ursula Bauer? Did they seek and receive approval of these outside activities? CDC has a process by which such things should be vetted and reported in an ethics review, tracking and approval system (EPATS). Furthermore, did they disclose these conflicts of interest on their yearly OGE 450 filing. Is there an approved HHS 520, HHS 521 or “Request for Official Duty Activities Involving an Outside Organization” approved by Dr. Bauer or her Deputy Director Ms. Dana Shelton? An August 28, 2016 item in The Hill details these issues and others related to Dr. Pratt.
It appears to us that something very strange is going on with Dr. Pratt. He is an active duty Commissioned Corps Officer in the USPHS, yet he was “assigned to” Emory University for a quite some time. How and under what authority was this done? Did Emory University pay his salary under the terms of an IPA? Did he seek and receive an outside activity approval through EPATS and work at Emory on Annual Leave? Formal supervisor endorsement and approval (from Dr. Bauer or Ms. Shelton) is required whether done as an official duty or outside activity.
If deemed official, did he file a “Request for Official Duty Activities Involving an Outside Organization” in EPATS? Apparently Dr. Pratt’s position at Emory University has ended and he has accepted another position at the University of California San Diego? Again, how is this possible while he is still an active duty USPHS Officer. Did he retire and leave government service? Is UCSD paying for his time via an IPA? Does he have an outside activity approval to do this? Will this be done during duty hours? It is rumored that Dr. Pratt will occupy this position while on Annual Leave? Really? Will Dr. Pratt be spending time in Atlanta when not on Annual Leave? Will he make an appearance at NCCDPHP (where he hasn’t been seen for months). Most staff do not enjoy such unique positions supported and approved by a Center Director (Dr. Bauer). Dr. Pratt has scored a sweet deal (not available to most other scientists at CDC). Concerns about these two positions and others were recently described in The Huffington Post and The Hill. His behavior and that of management surrounding this is very troubling.
Finally, most of the scientists at CDC operate with the utmost integrity and ethics. However, this “climate of disregard” puts many of us in difficult positions. We are often directed to do things we know are not right. For example, Congress has made it very clear that domestic funding for NCCDPHP (and other CIOs) should be used for domestic work and that the bulk of NCCDPHP funding should be allocated to program (not research). If this is the case, why then is NCCDPHP taking domestic staff resources away from domestic priorities to work on global health issues? Why in FY17 is NCCDPHP diverting money away from program priorities that directly benefit the public to support an expensive research FOA that may not yield anything that benefits the public? These actions do not serve the public well. Why is nothing being done to address these problems? Why has the CDC OD turned a blind eye to these things. The lack of respect for science and scientists that support CDC’s legacy is astonishing.
Please do the right thing. Please be an agent of change.
CDC Spider (CDC Scientists Preserving Integrity, Diligence and Ethics in Research) https://usrtk.org/wp-content/uploads/2016/10/CDC_SPIDER_Letter-1.pdf
January 13, 2016
Thomas Frieden, MD, MPH Director Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30329-4027
Re: Docket No. CDC-2015-0112; Proposed 2016 Guideline for Prescribing Opioids for Chronic Pain
Dear Dr. Frieden:
There is no question that there is an opioid misuse epidemic and that efforts need to be made to control it. The Centers for Disease Control and Prevention (CDC) is applauded for its steps to undertake this lofty effort. However, based on the American Academy of Family Physicians’ (AAFP’s) review of the guideline, it is apparent that the presented recommendations are not graded at a level consistent with currently available evidence. The AAFP certainly wants to promote safe and appropriate prescribing of opioids; however, we recommend that the CDC still adhere to the rigorous standards for reliable and trustworthy guidelines set forth by the Institute of Medicine (IOM). The AAFP believes that giving a strong recommendation derived from generalizations based on consensus expert opinion does not adhere to evidence-based standards for developing clinical guideline recommendations.
The AAFP’s specific concerns with the CDC’s methodology, evidence base, and recommendations are outlined below.
Methodology and Evidence Base
All of the recommendations are based on low or very low quality evidence, yet all but one are Category A (or strong) recommendations. The guideline states that in the GRADE methodology "a particular quality of evidence does not necessarily imply a particular strength of recommendation." While this is true, it applies when benefits significantly outweigh harms (or vice versa). When there is insufficient evidence to determine the benefits and harms of a recommendation, that determination should not be made.
When evaluating the benefits of opioids, the evidence review only included studies with outcomes of at least one year. However, studies with shorter intervals were allowed for analysis of the benefits of nonopioid treatments. The guideline states that no evidence shows long-term benefit of opioid use (because there are few studies), yet the guideline reports "extensive evidence" of potential harms, even though these studies were of low quality. The accompanying text also states "extensive evidence" of the benefits of non-opioid treatments, yet this evidence was from shorter term studies, was part of the contextual review rather than the clinical systematic review, and did not compare non- opioid treatments to opioids.
The patient voice and preferences were not explicitly included in the guideline. This raises concerns about the patient-centeredness of the guideline. https://www.aafp.org/dam/AAFP/documents/advocacy/prevention/risk/LT-CDC-OpioidGuideline011516.pdf
The Myth of Morphine Equivalent Daily Dosage Medscape Neuro Perspective
For far too many years, pain researchers and clinicians have relied on the concept of the morphine equivalent daily dosage (MEDD), or some variant of it, as a means of comparing the "relative corresponding quantity" of the numerous opioid molecules that are important tools in the treatment of chronic pain.
...And, most unfortunately, opioid prescribing guideline committees have relied on this concept as a means of placing (usually arbitrary) limits on the levels of opioids that a physician or other clinician should be allowed to prescribe. Although these guidelines typically bill themselves as "voluntary," their chilling effect on prescribers and adaptation into state laws makes calling them "voluntary" disingenuous.
Although some scientists and clinicians have been questioning the conceptual validity of MEDD for several years, a recent study has indicated that the concept is unequivocally flawed—thereby invalidating its use empirically and as a tool in prescribing guideline development.
The authors used survey data from pharmacists, physicians, nurse practitioners, and physician assistants to estimate daily morphine equivalents and found great inconsistency in their conversions of hydrocodone, fentanyl transdermal patches, methadone, oxycodone, and hydromorphone—illustrating the potential for dramatic underdosing or, in other cases, fatal overdosing.
Patients with chronic pain (particularly that of noncancer origin) who are reliant on opioid analgesia are already sufficiently stigmatized and marginalized to allow this type of practice to continue to be the norm.
Although the use of MEDD in research and, to a greater extent, in practice, is probably due to unawareness of its inaccuracy, we posit that the use of MEDD by recent opioid guideline committees (eg, the Washington State Opioid Guideline Committee and the Centers for Disease Control and Prevention Guideline Committee) in the drafting of their guidelines is based more heavily on disregarding available evidence rather than ignorance. Furthermore, their misconduct in doing so has been more pernicious than the use of MEDD by researchers and individual clinicians, because these guidelines widely affect society as a whole as well as individual patients with persistent pain syndromes. We opine that these committees are strongly dominated by the antiopioid community, whose agenda is to essentially restrict opioid access—irrespective of the lack of data indicating that opioids cannot be a useful tool in the comprehensive treatment of carefully selected and closely monitored patients with chronic pain.
Above 100% extracted from: Medscape Journal Brief https://www.medscape.com/viewarticle/863477_2
Actual Study https://www.dovepress.com/the-medd-myth-the-impact-of-pseudoscience-on-pain-research-and-prescri-peer-reviewed-article-JPR
Are Non-Opioid Medications Superior in Treatment of Pain than Opioid Pain Medicine? Ice Cream Flavor Analogy...
In the Oxford University Press, a November 2018 scientific white paper was released that examined the quality of one of the primary studies that have been used to justify the urgent call to drastically reduce opioid pain medication prescribing while claiming that patients are not being harmed in the process.
The study is commonly referred to as ‘the Krebs study’. “The authors concluded that treatment with opioids was not superior to treatment with non opioid medications for improving pain-related function over 12 months.”
Here is an excerpt from the first paragraph of the design section (usually behind a paywall) from the Krebs study that gives the first hint of the bias that led to them to ‘prove’ that opioids were not effective for chronic pain:
“The study was intended to assess long-term outcomes of opioids compared with non opioid medications for chronic pain. The patient selection, though, specifically excluded patients on long-term opioid therapy.”
Here is an analogy given in the Oxford Journal white paper to illustrate how the study design was compromised:
If I want to do a randomized control study about ice cream flavor preferences (choices being: vanilla, chocolate, or no preference), the results could be manipulated as follows based on these scenarios:
Scenario A: If a study was done that included only current ice-cream consumers, the outcome would certainly be vanilla or chocolate, because of course they have tried it and know which they like.
Scenario B: If a study was done that included all consumers of all food, then it can change the outcome. If the majority of study participants do not even eat ice-cream, than the result would certainly be ‘no preference’. If the majority do eat ice-cream it would likely be ‘chocolate’. Although this study is wider based, it still does not reflect real world findings.
Scenario C: In an even more extreme example, if this same study is conducted excluding anyone who has ever ate ice-cream at all, then the conclusion will again be ‘no preference’ and the entire study/original question becomes so ludicrous that there is no useful information to be extracted from this study and one would logically question why this type of study would even be conducted (although we know the answer to that)
Scenario C above is how the study that has been used to shift the attitudes towards the treatment of pain in our nation's medical community was designed. “One has to look deep into the study to find that they began with 9403 possible patients and excluded 3836 of them just because they had opioids in their EMR. In the JAMA article, they do not state these obvious biases and instead begin the explanation of participants stating they started with 4485 patients and excluded 224 who were opioid or benzo users.” That is the tip of the iceberg to how it is extremely misleading. The Oxford white paper goes into further detail of the studies “many flaws and biases (including the narrow focus on conditions that are historically known to respond poorly to opioid medication management of pain)”, but the study design and participant selection criteria is enough to discredit this entire body of work. Based on study design alone, regardless of what happened next, the result would be that opioids are no more effective than NSAIDs and other non-opioid alternatives.
The DEA Is Fostering a Bounty Hunter Culture in its Drug Diversion Investigators
A Good Man Speaks Truth to Power January 2019
Because I write and speak widely on public health issues and the so-called “opioid crisis”, people frequently send me references to others’ work. One of the more startling articles I’ve seen lately was published November 20, 2018 in Pharmacy Times. It is titled “Should We Believe Patients With Pain?”. The unlikely author is Commander John Burke, “a 40-year veteran of law enforcement, the past president of the National Association of Drug Diversion Investigators, and the president and cofounder of the International Health Facility Diversion Association.”
The last paragraph of Commander Burke’s article is worth repeating here.
“Let’s get back to dealing with each person claiming to be in legitimate pain and believe them until we have solid evidence that they are scamming the system. If they are, then let’s pursue them through vigorous prosecution, but let’s not punish the majority of people receiving opioids who are legitimate patients with pain.”
This seems a remarkable insight from anyone in law enforcement — especially from one who has expressed this view in both Pain News Network, and Dr Lynn Webster’s video “The Painful Truth”. Recognizing Commander Burke’s unique perspective, I followed up by phone to ask several related questions. He has granted permission to publish my paraphrases of his answers here.
“Are there any available source documents which establish widely accepted standards for what comprises “over-prescription?” as viewed by diversion investigators?” Burke’s answer was a resounding “NO”. Each State and Federal Agency that investigates doctors for potentially illegal or inappropriate opioid prescribing is pretty much making up their own standards as they go. Some make reference to the 2016 CDC Guidelines, but others do not.
- “Thousands of individual doctors have left pain management practice in recent years due to fears they may be investigated, sanctioned, and lose their licenses if they continue to treat patients with opioid pain relievers.. Are DEA and State authorities really pursuing the worst “bad actors”, or is something else going on?
Burke’s answer: “Regulatory policy varies greatly between jurisdictions. But a hidden factor may be contributing significantly to the aggressiveness of Federal investigators. Federal Agencies may grant financial bonuses to their in-house diversion investigators, based on the volume of fines collected from doctors, nurse practitioners, PAs and others whom they investigate.
"No law enforcement agency at any level should be rewarded with monetary gain and/or promotion due to their work efforts or successes. This practice has always worried me with Federal investigators and is unheard of at the local or state levels of enforcement.”
Commander Burke’s revelation hit me like a thunder-clap. It would explain many of the complaints I have heard from doctors who have been “investigated” or prosecuted. It’s a well known principle that when we subsidize a behavior, we get more of it. Financial rewards to investigators must inevitably foster a “bounty hunter” mentality in some. It seems at least plausible that such bonuses might lead DEA regulators to focus on “low hanging fruit” among doctors who may not be able to defend themselves without being ruined financially. The practice is at the very least unethical. Arguably it can be corrupting.
I also inquired concerning a third issue:
- I read complaints from doctors that they have been pursued on trumped-up grounds, coerced and denied appropriate legal defense by confiscation of their assets – which are then added to Agency funds for further actions against other doctors. Investigations are also commonly announced prominently, even before indictments are obtained – a step that seems calculated to destroy the doctor’s practice, regardless of legal outcomes. Some reports indicate that DEA or State authorities have threatened employees with prosecution if they do not confirm improper practices by the doctor. Do you believe such practices are common?”
Burke’s answer: “I hear the same reports you do – and the irony is that such tactics are unnecessary. Lacking an accepted standard for over-prescribing, the gross volume of a doctor’s prescriptions or the dose levels prescribed to their patients can be poor indicators of professional misbehavior. Investigators should instead be looking into the totality of the case, which can include patient reports of poor doctor oversight, overdose-related hospital admissions, and patterns of overdose related deaths that may be linked to a “cocktail” of illicit prescribing. Especially important can be information gleaned from confidential informants – with independent verification – prior patients, and pharmacy information.”
No formal legal prosecution should ever proceed from the testimony of only one witness — even one as well informed as Commander John Burke. But it seems to me that it is high time for the US Senate Judiciary Committee to invite the testimony of others in open public hearings, concerning the practice of possible bounty hunting among Federal investigators.
C50 Patient, Civil Rights Attorney, Maine Department of Health, and Maine Legislature Collaborative Enacted Definition of Palliative Care
One suggestion that our organization would like to make is altering the definition of “palliative care” in such a manner that it can include high-impact or intractable patients; those who are not dying this year, but our lives have been shattered and/or shortened by our diseases and for whom Quality of Life should be the focus. Many of our conditions may not SIGNIFICANTLY shorten my life, therefore I could legitimately be facing 30-40 years of severe pain with little relief; that is no way to live and therefore the concern is a rapidly increasing suicide rate.
This is a definition that one of our coalition members with a civil rights attorney and the Maine Department of Health agreed upon and legislators enacted into statues in Maine. This was in response to a 100mme restriction. This attorney had prepared a lawsuit based on the Americans with Disability Act that the Department of Health in Maine agreed was valid; litigation was never the goal, it was always patient-centered care.
A. "Palliative care" means patient-centered and family-focused medical care that optimizes quality of life by anticipating, preventing and treating suffering caused by a medical illness or a physical injury or condition that substantially affects a patient's quality of life, including, but not limited to, addressing physical, emotional, social and spiritual needs; facilitating patient autonomy and choice of care; providing access to information; discussing the patient's goals for treatment and treatment options, including, when appropriate, hospice care; and managing pain and symptoms comprehensively. Palliative care does not always include a requirement for hospice care or attention to spiritual needs. B. "Serious illness" means a medical illness or physical injury or condition that substantially affects quality of life for more than a short period of time. "Serious illness" includes, but is not limited to, Alzheimer's disease and related dementias, lung disease, cancer, heart, renal or liver failure and chronic, unremitting or intractable pain such as neuropathic pain.
Here is the link to the most recent update, including these definitions within the entire statute: https://legislature.maine.gov/statutes/22/title22sec1726.html?fbclid=IwAR0dhlwEh56VgZI9HYczdjdyYoJGpMdA9TuuJLlQrO3AsSljIZZG0RICFZc
January 23, 2019
The Board of Pharmacy has had an influx of communication concerning patients not able to get controlled substance prescriptions filled for various reasons, even when signs of forgery or fraudulence were not presented. As a result of the increased “refusals to fill,” the board is issuing the following guidance and reminders regarding the practice of pharmacy and dispensing of controlled substances:
- Pharmacists must use reasonable knowledge, skill, and professional judgment when evaluating whether to fill a prescription. Extreme caution should be used when deciding not to fill a prescription. A patient who suddenly discontinues a chronic medication may experience negative health consequences;
- Part of being a licensed healthcare professional is that you put the patient first. This means that if a pharmacist has any concern regarding a prescription, they should attempt to have a professional conversation with the practitioner to resolve those concerns and not simply refuse the prescription. Being a healthcare professional also means that you use your medication expertise during that dialogue in offering advice on potential alternatives, changes in the prescription strength, directions etc. Simply refusing to fill a prescription without trying to resolve the concern may call into question the knowledge, skill or judgment of the pharmacist and may be deemed unprofessional conduct;
- Controlled substance prescriptions are not a “bartering” mechanism. In other words, a pharmacist should not tell a patient that they have refused to fill a prescription and then explain that if they go to a pain specialist to get the same prescription then they will reconsider filling it. Again, this may call into question the knowledge, skill or judgment of the pharmacist;
- Yes, there is an opioid crisis. However, this should in no way alter our professional approach to treatment of patients in end-of-life or palliative care situations. Again, the fundamentals of using our professional judgment, skill and knowledge of treatments plays an integral role in who we are as professionals. Refusing to fill prescriptions for these patients without a solid medical reason may call into question whether the pharmacist is informed of current professional practice in the treatment of these medical cases.
- If a prescription is refused, there should be sound professional reasons for doing so. Each patient is a unique medical case and should be treated independently as such. Making blanket decisions regarding dispensing of controlled substances may call into question the motivation of the pharmacist and how they are using their knowledge, skill or judgment to best serve the public.
As a professional reminder, failing to practice pharmacy using reasonable knowledge, skill, competence, and safety for the public may result in disciplinary actions under Alaska statute and regulation. These laws are:
AS 08.80.261 DISCIPLINARY ACTIONS
(a)The board may deny a license to an applicant or, after a hearing, impose a disciplinary sanction authorized under AS 08.01.075 on a person licensed under this chapter when the board finds that the applicant or licensee, as applicable, …
(7) is incapable of engaging in the practice of pharmacy with reasonable skill, competence, and safety for the public because of
(A) professional incompetence; (B) failure to keep informed of or use current professional theories or practices; or (E) other factors determined by the board;
(14) engaged in unprofessional conduct, as defined in regulations of the board.
12 AAC 52.920 DISCIPLINARY GUIDELINES
(a) In addition to acts specified in AS 08.80 or elsewhere in this chapter, each of the following constitutes engaging in unprofessional conduct and is a basis for the imposition of disciplinary sanctions under AS 08.01.075; …
(15) failing to use reasonable knowledge, skills, or judgment in the practice of pharmacy;
(b) The board will, in its discretion, revoke a license if the licensee …
(4) intentionally or negligently engages in conduct that results in a significant risk to the health or safety of a patient or injury to a patient; (5) is professionally incompetent if the incompetence results in a significant risk of injury to a patient.
(c) The board will, in its discretion, suspend a license for up to two years followed by probation of not less than two years if the licensee ...
(2) is professionally incompetent if the incompetence results in the public health, safety, or welfare being placed at risk.
We all acknowledge that Alaska is in the midst of an opioid crisis. While there are published guidelines and literature to assist all healthcare professionals in up to date approaches and recommendations for medical treatments per diagnosis, do not confuse guidelines with law; they are not the same thing.
Pharmacists have an obligation and responsibility under Title 21 Code of Federal Regulations 1306.04(a), and a pharmacist may use professional judgment to refuse filling a prescription. However, how an individual pharmacist approaches that particular situation is unique and can be complex. The Board of Pharmacy does not recommend refusing prescriptions without first trying to resolve your concerns with the prescribing practitioner as the primary member of the healthcare team. Patients may also serve as a basic source of information to understand some aspects of their treatment; do not rule them out in your dialogue.
If in doubt, we always recommend partnering with the prescribing practitioner. We are all licensed healthcare professionals and have a duty to use our knowledge, skill, and judgment to improve patient outcomes and keep them safe.
Professionally, Richard Holt, BS Pharm, PharmD, MBA Chair, Alaska Board of Pharmacy
FDA in Brief: FDA finalizes new policy to encourage widespread innovation and development of new buprenorphine treatments for opioid use disorder
February 6, 2018
Media Inquiries Michael Felberbaum 240-402-9548
“The opioid crisis has had a tragic impact on individuals, families, and communities throughout the country. We’re in urgent need of new and better treatment options for opioid use disorder. The guidance we’re finalizing today is one of the many steps we’re taking to help advance the development of new treatments for opioid use disorder, and promote novel formulations or delivery mechanisms of existing drugs to better tailor available medicines to individuals’ needs,” said FDA Commissioner Scott Gottlieb, M.D. “Our goal is to advance the development of new and better ways of treating opioid use disorder to help more Americans access successful treatments. Unfortunately, far too few people who are addicted to opioids are offered an adequate chance for treatment that uses medications. In part, this is because private insurance coverage for treatment with medications is often inadequate. Even among those who can access some sort of treatment, it’s often prohibitively difficult to access FDA-approved addiction medications. While states are adopting better coverage owing to new legislation and resources, among public insurance plans there are still a number of states that are not covering all three FDA-approved addiction medications. To support more widespread adoption of medication-assisted treatment, the FDA will also continue to take steps to address the unfortunate stigma that’s sometimes associated with use of these products. It’s part of the FDA’s public health mandate to promote appropriate use of therapies.
Misunderstanding around these products, even among some in the medical and addiction fields, enables stigma to attach to their use. These views can serve to keep patients who are seeking treatment from reaching their goal. That stigma reflects a perspective some have that a patient is still suffering from addiction even when they’re in full recovery, just because they require medication to treat their illness. This owes to a key misunderstanding of the difference between a physical dependence and an addiction. Because of the biology of the human body, everyone who uses a meaningful dose of opioids for a modest length of time develops a physical dependence. This means that there are withdrawal symptoms after the use stops.
A physical dependence to an opioid drug is very different than being addicted to such a medication. Addiction requires the continued use of opioids despite harmful consequences on someone’s life. Addiction involves a psychological preoccupation to obtain and use opioids above and beyond a physical dependence.
But someone who is physically dependent on opioids as a result of the treatment of pain but who is not craving the drugs is not addicted.
The same principle applies to replacement therapy used to treat opioid addiction. Someone who requires long-term treatment for opioid addiction with medications, including those that are partial or complete opioid agonists and can create a physical dependence, isn’t addicted to those medications. With the right treatments coupled to psychosocial support, recovery from opioid addiction is possible. The FDA remains committed to using all of our tools and authorities to help those currently addicted to opioids, while taking steps to prevent new cases of addiction.”
Above is the full statement, find full statement with options for study requests: https://www.fda.gov/NewsEvents/Newsroom/FDAInBrief/ucm630847.htm
Maryland’s co-prescribing new laws/ amendments regarding benzos and opioids
Chapter 215 AN ACT concerning Health Care Providers – Opioid and Benzodiazepine Prescriptions – Discussion of Information Benefits and Risks
FOR the purpose of requiring that certain patients be advised of the benefits and risks associated with the prescription of certain opioids, and benzodiazepines under certain circumstances, providing that a violation of this Act is grounds for disciplinary action by a certain health occupations board; and generally relating to advice regarding benefits and risks associated with opioids and benzodiazepines that are controlled dangerous substances.
Section 1–223 Article – Health Occupations Section 4–315(a)(35), 8–316(a)(36), 14–404(a)(43), and 16–311(a)(8) SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, That the Laws of Maryland read as follows: Article – Health Occupations (a) In this section, “controlled dangerous substance” has the meaning stated in § 5–101 of the Criminal Law Article.
Ch. 215 2018 LAWS OF MARYLAND (B) On treatment for pain, a health care provider, based on the clinical judgment of the health care provider, shall prescribe: (1) The lowest effective dose of an opioid; and (2)A quantity that is no greater than the quantity needed for the expected duration of pain severe enough to require an opioid that is a controlled dangerous substance unless the opioid is prescribed to treat: (a.) A substance–related disorder; (b.) Pain associated with a cancer diagnosis; (c.) Pain experienced while the patient is receiving end–of–life, hospice, or palliative care services; or (d.) Chronic pain
(C.) The dosage, quantity, and duration of an opioid prescribed under [subsection (b)] of this [section] shall be based on an evidence–based clinical guideline for prescribing controlled dangerous substances that is appropriate for: (1.) The health care service delivery setting for the patient; (2.) The type of health care services required by the patient; (3.) and The age and health status of the patient.
(D) (1) WHEN A PATIENT IS PRESCRIBED AN OPIOID UNDER SUBSECTION (B) OF THIS SECTION, THE PATIENT SHALL BE ADVISED OF THE BENEFITS AND RISKS ASSOCIATED WITH THE OPIOID.
(2) WHEN A PATIENT IS CO–PRESCRIBED A BENZODIAZEPINE WITH AN OPIOID THAT IS PRESCRIBED UNDER SUBSECTION (B) OF THIS SECTION, THE PATIENT SHALL BE ADVISED OF THE BENEFITS AND RISKS ASSOCIATED WITH THE BENZODIAZEPINE AND THE CO–PRESCRIPTION OF THE BENZODIAZEPINE. (E) A violation of [subsection (b) OR (D) of] this section is grounds for disciplinary action by the health occupations board that regulates the health care provider who commits the violation.
4-315 (a) Subject to the hearing provisions of § 4–318 of this subtitle, the Board may deny a general license to practice dentistry, a limited license to practice dentistry, or a teacher’s license to practice dentistry to any applicant, reprimand any licensed dentist, place any licensed dentist on probation, or suspend or revoke the license of any licensed dentist, if the applicant or licensee: (35) Fails to comply with § 1–223 of this article.
8–316. (a) Subject to the hearing provisions of § 8–317 of this subtitle, the Board may deny a license or grant a license, including a license subject to a reprimand, probation, or suspension, to any applicant, reprimand any licensee, place any licensee on probation, or suspend or revoke the license of a licensee if the applicant or licensee: (36) Fails to comply with § 1–223 of this article.
14–404. (a) Subject to the hearing provisions of § 14–405 of this subtitle, a disciplinary panel, on the affirmative vote of a majority of the quorum of the disciplinary panel, may reprimand any licensee, place any licensee on probation, or suspend or revoke a license if the licensee: (43) Fails to comply with § 1–223 of this article.
16–311. (a) Subject to the hearing provisions of § 16–313 of this subtitle, the Board, on the affirmative vote of a majority of its members then serving, may deny a license or a limited license to any applicant, reprimand any licensee or holder of a limited license, impose an administrative monetary penalty not exceeding $50,000 on any licensee or holder of a limited license, place any licensee or holder of a limited license on probation, or suspend or revoke a license or a limited license if the applicant, licensee, or holder:
(8) Prescribes or distributes a controlled dangerous substance to any other person in violation of the law, including in violation of § 1–223 of this article;
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect October 1, 2018.
Approved by the Governor, April 24, 2018.
2023.06.04 14:03 baume777 An alternative interpretation of OMORI's plot
I am actually expecting a lot backlash for this since the majority of the fandom loves the twist lol
Part I: Characters
Sunny is the main characters, we spend a good portion of the game exploring his dreams, and even the real world is explored through his perspective.
Sunny tends to dissociate, even before Maris death, as is evident by the excerpt found in the lost library:
"This year, ☐ was lucky enough to get assigned to a desk next to the small window."
"Every day during class, ☐ would gaze listlessly through the opening... at the shadows of the trees, the clouds creeping overhead."
"His mind drifted elsewhere... into his own worlds, his own stories, his own adventures."
"He had a habit of doing this.It was easy for him to get lost."
"Today was the same as any other. ☐ stared vacantly out the small window as the clouds passed one by one."
"Suddenly, a hand playfully slaps his back, snapping him out of his reverie. ☐ looks away from the opening."
"☐☐☐ smiles. He motions that class is over and that it's finally time for lunch. It's pizza day today, and theyneed to bolt to the cafeteria before it's all gone."
"☐'s stomach growls. He looks at the small window one last time."
"He would have to continue his adventure another day."
The dissociative tendencies are very clear, described as his mind being elsewhere.
However, the excerpt also shows off another key-trait: Imagination.
Sunny has extraordinately vivid imagination, as displayed by the entirety of Head Space, as well as his liking of imagining himself and his friends going on adventures, even in the real world, as well as both before and Maris death.
The situation described by the Lost Library is pretty much identical with the real world event involving fighting the recycultists.
One more important, but less dicussed point, is his excellent memory. Sunny can recall the correct order of Basils photographs without failure, even after 4 years of staying inside.
And speaking of the album, he can also accurately recreate their content in Head Space, shown by the HS version containing pretty much the exact same content as the real one, just with the aesthetics adjusted to Head Space. Furthermore, the scribbled out version found in Black Space are 100% identical with the reeal ones, just blacked out with marker.
Considering this, I'd say good memory is an understatement.
I'd go as far as attributing him with Photographic Memory.
But despite this, Sunny forgot something, 4 years ago he repressed something.
And he is aware of this. Dialogue from various HS characters allude to this, and urge him to try and remember:
The truth that you've locked away... You must find it no matter what.
You have to... for the both of us.
Even if you hide something, it will always be there.
Bullet points for Sunny: Prone to dissociation; extremely vivid imagination; amazing memory; knows he forgot something and believes he can recover it
Basil is a very controversial character, receiving a lot of hate, but also a lot of love.
Basil-haters often attribute him with traits such as 'obsessive' or 'manipulative', even though none of these are accurate on closer inspection.
I'll just list of a few of his traits, which will be highly relevant for the crux of this theory, though just indirectly.
- Basil has abandonment-issues. These are repeatedly displyed by franctic pleas for someone to not leave him.
- Basils view of other characters are mostly based on idealization. It is seen through assgining flowers with highly positive meanings to his friends, while ignoring any negatives they might hold.
Furthermore, this behaviour is very prominent in his complete refusal to accept what Sunny had done.
- Basil is also deeply troubled, with latent suicidal ideation and tendencies. The by and large biggest red flag is encountered on '3 Days left', where he says this to Sunny...
It's nice to see that you're still around...even if it's only for a little while.
Here. Take my PHOTO ALBUM... I want you to have it.
...Basil acts like he is saying goodbye to Sunny, and hands off his most precious sentimental belonging...
...Despite not even knowing that Sunny is moving away.
- Basil is highly emotional. He displays extreme emotional reactions when put under pressure or faced with emotional hurt.
The previously mentioned instance of learning of Sunny moves triggers him to run to the bathroom, where he has a mental breakdown.
Judging by dialogue like...
BASIL's been going to the bathroom a lot lately. I hope it's not my food...
And when we got to his room, I tried to talk to him... but he said he had to go to the bathroom and ran off.
...this seems to be his go-to coping-mechanism to deal with stress, and doesn't even seem to be limited to interactions with Sunny.
Furthermore, at the lake-scene, Basil hysterically screams for help, despite the hooligans actively attempting to calm him down, not at all acting hostile towards him.
- Although rare, there is at least one instance of him acting extremely angry, particularily the scene before his boss-fight, and he seems to have huge trouble to contain his anger, actually having to resort to delusional behaviour to quell it.
- Basil displays severe dissociative and psychotic (hallucinations and delusions) symptoms. The dissociation in particular is shown in what appears to be fuzzy memory:
A lot has happened since these pictures were taken.Sometimes, it feels like it was all a bad dream.
It's hard to remember now, but... I think... at the time...I took photos of what I was most afraid to lose.
Additionally, certain dialogue alludes to severe psychological issues being present prior to joining the friend-group: Processing img s4afsed5ef3b1...
From the points listed above, the only one I consider to be debatable is the anger-issue. However, the other 5 traits are genuine canon. Processing img q8mx1difef3b1...
Great, so now we have established for Basil to canonically suffer from Borderline Personality Disorder.
II.a Sunnys case
Does Basil have his own White Space and Black Space?
The idea of the White Space is based on the ability of some people to completely isolate themselves when a traumatic happens. They isolate their mind and travel through the White Space to relieve their memories. From my personal experience, not everyone it able to do it. If Basil would have had his own White Space it would've been full of disturbing imagery, and, unlike Sunny's, it wouldn't be static but really dynamic with a lot of fast changes. Therefore I don't think Basil would be able to escape his own mind like Sunny does. And that's why his problems manifest in the real world. After all, something exists because of Basil’s idea that it exists in the first place.
Source: OMOCAT interview from Cydonia streaming translated in english : OMORI (reddit.com)
Pay close attention to the part that I highlighted.
OMOCAT openly states that Something exists for the simple reason that Basils believes it to exist to begin with. But if Somethings existence is based on Basils belief, then this raises the question why Sunny can see it, too.
I believe that this cutscene is the answer:
Processing gif 5q8azvo6jf3b1...
It seems to me that Sunny only began to be haunted by his Something due to this conversation, in which Basil asks Sunny to remember Something while simultaniously already suggesting what Sunny is supposed to remember.
Essentially, Sunny sees Something because of Basils suggestion of it existing to begin with.
This sets an interesting precedent of Basil unintentionally influencing Sunnys psyche by merely asking a suggestive question.
Another thing to note that this is just a short snippet of this conversation, and that there are more black-and-white cutscenes that display different parts of this particular encounter.
Another one is this:
Processing gif 83ofu1h8sf3b1...
This is clearly the first creation of White Space, right?
You see, there are certain special characters explaining the lore of Head Space, one of them being Daddy Longlegs.
He actually has dialogue explaining the creation of Head Space:
You have reached the end of the LOST FOREST... but the beginning of the truth.
I will tell you a story that has been lost through time... a story about the creation of this reality.
In the beginning, there only existed two... the DREAMER and his room.
The DREAMER grew weary of his room and created a door that led to many different worlds.
Walking the path as a visitor to these worlds, the DREAMER would come and go as he pleased.
Slips and falls, tumbles and drops... the DREAMER's curiosity and clumsy exploration eventually led him to a certain world.
One not like the others... one painted with chaos and bathed in darkness.
The DREAMER slowly became filled with dread. Quiet as they may have been, words of malice quietly crept into his mind. Whispering lies, secrets, and truths.
The 'DREAMER and his room...'
clearly refers to Sunnys White Space.
Meanwhile, the world 'painted with chaos and bathed in darkness'
very clearly refers to Black Space.
This means, according to Daddy Longlegs, that White Space existed way before Black Space. Furthermore, he states that only after Sunnys first encounter with Black Space did he 'slowly became filled with dread'
, which seems to imply that Sunnys most severe issues started at a later point in time than the creation of White Space.
Now, since White Space already existed prior to Black Space, this creates a problem:
As stated by OMOCAT, White Space exists to provide relief of memory - meaning that Sunny had already repressed memories at this point.
However, if we assume the cause of supression to be 'the truth' about Maris death, both Something and Black Space, and the Black Lightbulb should have already been a thing from the very beginning.
However, this is not the case. The black door as well as the lightbulb make their first appearence in this cutscene.
What this implies to me is that, just like Something, Black Space was created due to suggestions Basil made in this conversation, and subsequently the Black Lightbulb was created to supress Black Space.
In fact, Black Space can be further linked to being the product an external source: Processing img sjtem9akhg3b1...
White Egret Orchids, at least in this game, represemt the phrase: 'My thoughts will follow you into your dreams.'
Furthemore, Black Space in general is strongly linked to Basil, both due to the overwhelming presence of Stranger as well the fact that it is always Basil that will find the path to 'the truth'.
This entire dynamic is very interesting.
Appearantly, there was a period of time in which Sunny was completely free
of the influence of both Black Space,'the truth' it contains, and Something.
This might sound crazy, but this seems to imply that all three of Black Space, 'the truth' and Something can be traced back to this conversation, but not any further.
This becomes even clearer when you line up the three cut-scenes in the order they appear in the game:
Processing video aed5qnn9ov3b1...
The implication here is that this conversation is what triggered Sunnys Hikkikomori-lifestyle and caused a sharp shift in Sunnys behaviour.
This may be hard to accept, but what is being implied here is that this is the starting point of Sunnys 4 years of agony.
This is extremely weird, since 'the truth' about Maris death is supposed to be the source of his suffering, yet it started only about a few months after her death.
Why did Sunny only become haunted by 'the truth' after this point?
It can't be explained by repression either since a) the Black Lightbulb is required to repress it and b) the Black Lightbulb is what caused his Hikkikomorism to begin with, yet Sunny is stated to have gone to school up until this point and was actually willing to let others reach out to him.
This is a stark contrast to his behaviour after this conversation.
answer that makes sense is the following: 'The truth' simply didn't exist
up until this point, not even in a repressed form.
This scene depicts the literal creation
of 'the truth'.
'The truth' in it's entirety is an idea that Basil put into Sunnys head.
A hanging black light bulb... the repression of an idea.
It is openly stated that the Black Lightbulb is not the repression of a memory - that is White Spaces purpose - but in fact the repression of an idea.
Additionally, there actually is dialogue hinting at the replacement and subsequent repression of memories:
BLANK Your memories are not free. To gain a memory, another must be shrouded. And yet... All memories will eventually fade.
What I propose is the following: Basil wanted to talk to Sunny about 'the truth'. Now, the problem is that Sunny had already repressed the memories of Maris true death - suicide.
So, when Basil realizes that Sunny doesn't remember... he fills him in, similar to how he recounts the events of Maris death prior to his boss fight.
This is also the reason for the photo at the treehouse: Since Basil believes that Sunny had already 'forgotten' the truth at least once before, he decides to leave him a physical reminder - a photo and the key to the toy-chest.
This is supported by the 'Don't forget... it's in the toy-chest'-message - there is no reason to write a message urging Sunny not to forget about it unless Basil has a reason to believe Sunny might forget about it to begin with.
Now, Sunnys got a huge problem - since he already had repressed his memory at this point he had no way of falsifying Basils account. And since he trusts Basil, he makes the wrong choice and believes him.
Subsequently, this triggers the creation of both Something and Black Space.
Quiet as they may have been, words of malice quietly crept into his mind. Whispering lies, secrets, and truths.
This is referring to Basils words during this conversation.
Even though Sunny tried to repress them, the only thing he achieved is pushing them to his subconscious - where they then rampaged rampaged and grew in strength over the next 4 years.
In essence, this constitutes a case of both False Memories
and Shared Delusional Disorder
And it makes sense. You remember the characterization of Sunny at the beginning of this post?
Well, check this out:
Greater creative imagination and dissociation are known to relate to false memory formation. Creative imagination may lead to vivid details of imagined events. High dissociation may be associated with habitual use of lax response criteria for source decisions due to frequent interruption of attention or consciousness. Social desirability and false memory have also been examined. Social desirability effects may depend on the level of perceived social pressure.
Individuals who feel under greater social pressure may be more likely to acquiesce. Perceived pressure from an authority figure may lower individuals' criteria for accepting a false event as true. The new individual difference factors include preexisting beliefs about memory, self-evaluation of one's own memory abilities, trauma symptoms, and attachment styles. Regarding the first of these, metamemory beliefs about the malleability of memory, the nature of trauma memory, and the recoverability of lost memory may influence willingness to accept vague impressions or fragmentary images as recovered memories and thus, might affect the likelihood of accepting false memory. For example, if someone believes that memory once encoded is permanent, and that visualization is an effective way to recover memories, the individual may endorse more liberal criteria for accepting a mental image as true memory. Also, individuals who report themselves as having better everyday memories may feel more compelled to come up with a memory when asked to do so. This may lead to more liberal criteria, making these individuals more susceptible to false memory.
There is some research that shows individual differences in false memory susceptibility are not always large (even on variables that have previously shown differences—such as creative imagination or dissociation), that there appears to be no false memory trait, and that even those who have highly superior memory are susceptible to false memories.
How convenient. This is literally Sunny. Sunny displays all of these traits. Sunny is morbidly predispositioned
to aquire False Memories, especially due to his great trust in Basil, his best friend.
Additionally, 'recovering repressed memories' is notorious for confabulating False Memories:
However, when memories are "recovered" after long periods of amnesia, particularly when extraordinary means were used to secure the recovery of memory, it is now widely (but not universally) accepted that the memories have a high likelihood of being false, i.e. "memories" of incidents that had not actually occurred.
And there actually are fairly strong hints that can be interpreted as Sunnys recovered memories being memories that were imagined at Basils suggestion:
Processing img 6whr115l7n3b1... Processing img 13x2utk98n3b1...
A basic, common yet effective technique to determine memories as either dreams or imagined events is to look for inconsistencies, either with reality or among the memories in question.
And there are several inconsistencies to be found in those photos.
The problem with this procedure though is that such inconsistencies can be dismissed as simple oversights on the developers side, meaning that this is 100% percent dependent on ones willingness to interpret them either as inconsistencies or a developers oversight.
But for the purpose of this theory I'll continue under the former assumption.
And these are the inconsistencies I found:
Processing img vdlj795han3b1...
Truth Photo: Only lower level has vine-pattern, no table bellow the window, hanging photos (Note: The table bellow the window is actually gone in RW present time, but in the past there was one.)
Real World: Both levels have vine-pattern, table beneath the window, photos are on a sideboard.
Processing img m6az3bavbn3b1... Processing img j1l9myucjn3b1...
Processing img 8vh1lqzcpn3b1...
Well... no. In reality, it is a sliding door:
Processing img 0otxujv6rn3b1...
Processing img lfq7am4wzs3b1...
Left photo: Left tree has no branch, right one has one on it's right side.
Right photo: Left tree has one branch on it's right side, right one has none.
Processing img aum9y3531t3b1...
Judging by the position of the sun in the photos, the incident is supposed to happen close to sundown.
However, this images shading implies nighttime.
Additionally, Aubrey mentions that Mari was found in the evening. And actually, the neighbours were home.
Or, at least Hero. Hero actually states that he was home in the afternoon of that day.
It is not unreasonable to say that if Hero was home, he would have somehow been alerted of what was hapenning: A crash, a scream, or simply looking out the window to see Sunny and Basil carry a dead Mari.
You know what have not been suspicious at all? Mari, walking across her own backyard towards the tree. Processing img y16y8reu2t3b1...
Processing img j93z2beq6t3b1...
Left: Mari faces away
Right: Suddenly, Mari does face towards
As you can see, there are quite a few inconsistencies that can be found in those photos.
II.b Basils Case
But up until this point, the only thing I've argued for is that Sunny memory is based on Basils account, and not that the incident in it's entire actually never happened to begin with.
Well, let us look at the following question: How realistic, or even feasably possible is 'the truth'?
The answer: Not at all.
You see... there is a standard procedure by authorities for suicide-cases.
One, the deceased has the to be officially pronounced dead - and for this, either a doctor or a paramedic is necessary.
The problem is that Mari supposedly fell down the stairs. There absolutely have to be
at least bruises. And, in fact, the notesheets that Mari carried while falling are noted to be blood-stained. There also was blood.
The paramedic would find unexplained physical trauma and blood. At this point, they would be required to notify investigative authorities and alert them to evidence of foul play.
Two, in cases of a suicide without a suicide-note, a standard-investigation is carried out, including an obducation.
This procedure is mandatory, and cannot be vetoed even by close relatives.
And even if the investigations would yield no results, this case is more likely to be considered an unsolved homicide rather than a suicide.
There's also the matter of physical feasability. Can Sunny and Basil even pull this off...?
There's 2 scenarios for this incident. Case I: Basil did it alone and Case II Sunny and Basil did it together.
Case I: Complete nonsense. Basil cannot pull this off.
He's 12 and Mari is 16 and significantly heavier. He's too weak.
The game actually comments on Basils strength, or more percisely his lack of exactly that:
BASIL ... OMORI... You're so heavy...
BASIL Come on... Up the stairs you go...
BASIL Phew... Thank goodness you're awake.
BASIL Are you hurt at all? I was trying to pull you toward this white light at the top of the staircase...
Key word being 'trying'.
This is the scene in question: Processing img vbf5agr23v3b1...
As you can see, Omori is still lying at the bottom of the stairs. This means Basil didn't even manage to drag him a single step upwards. Basil completely and utterly failed to even move another 12-yevar-old.
There is no way he can even remotely exert the force necessary to do that to Mari.
Case II: Sunny and Basil did it together.
I will concede that if they sling the rope around the branch, and then both of them at once oull at the rope, then they actually can get her to the necessary height.
The problem is the following though:
If they follow this procedure, they still have to fix the rope to the branch.
To do that, one of them has to let go of the rope, scale the tree and then tie the knot.
Now consider this: The setup essentially functions like a ⚖️:
Whatever is heavier at either end of the rope will remain on the ground.
Sunny and Basil together are heavier than Mari.
Either of them alone isn't.
As soon as either lets go of the rope, Mari will plummet, while the other 12-year-old will be lifted of the ground.
Another problem is scaling the tree. Sunny is afraid of heights, to the point that even the staircase is a serious obstacle.
Here's a visiualization of the necessary heights: Processing img fcjjnly56v3b1...
Height of the branch: ~ Maris height x 1.666
Height of the noose: ~ Maris height x 1.2
Lowballing Maris height to the average 1.60m will lead to the following results:
Height of the branch: ~ 2.65m
Height of the noose: 1.92m
You can see that 2.65m is pretty high up.
In Basils case, it is actually implied that he is a bad climber due to a fear of height as well:
It's been pretty busy with school lately, but we finally made time to get together and go to the park today. Here's KEL hanging his legs off a tree. He's such a good climber! I wish I was as fearless as him.
This already constitutes a huge problem.
The alternative option is that they first tie the rope to the branch, and only then put Maris head through the noose.
The problem is the height of the noose. They'd have to lift Maris head ~ 1.90m of the ground.
This is problematic, since Mari is dead and thus her body acts like a limp noodle. They'd have to lift her by the head to avoid her body or head slumping over, and this creates a problem of reach.
Mind you that this is a situation in which even an adult would struggle to lift a person of comparable stature to this height.
Can two 12-year-old-boys, who are in a clear state of shock pull this off?
I highly doubt that.
And if we are to assume the scrapped descriptions of the album as a basis, then the case is already clear:
It is impossible, since all problems regarding Case II apply even more glringly to Case I.
Now, that still leaves the question on why Basil genuinly believes in this False Memory.
Well, we have talked about Basil and BPD, haven't we?
Well take a look at this:
This paper presents an analysis of dream-reality confusion (DRC) in relation to the characteristics of borderline personality disorder (BPD), based on research findings and theoretical considerations. It is hypothesized that people with BPD are more likely to experience DRC compared to people in non-clinical population. Several variables related to this hypothesis were identified through a theoretical analysis of the scientific literature.
Sleep disturbances: problems with sleep are found in 15–95.5% of people with BPD, and unstable sleep and wake cycles, which occur in BPD, are linked to DRC.
Dissociation: nearly two-thirds of people with BPD experience dissociative symptoms and dissociative symptoms are correlated with a fantasy proneness; both dissociative symptoms and fantasy proneness are related to DRC .
Negative dream content: People with BPD have nightmares more often than other people; dreams that are more likely to be confused with reality tend to be more realistic and unpleasant, and are reflected in waking behavior.
Cognitive disturbances: Many BPD patients experience various cognitive disturbances, including problems with reality testing , which can foster DRC. Thin boundaries: People with thin boundaries are more prone to DRC than people with thick boundaries, and people with BPD tend to have thin boundaries .
The theoretical analysis on the basis of these findings suggests that people who suffer from BPD may be more susceptible to confusing dream content with actual waking events.
If you're interested in this thematic, here's
What this suggests is that people suffering from BPD are significantly more prone to DRC, which is an inability to differentiate between dreams and reality. On top of that, DRC is trongly linked to the concept of nightmares.
And Basil, in fact is hinted to suffer from this by his own dialogue:
Processing img kk3tofx0fv3b1...
A lot has happened since these pictures were taken.
Sometimes, it feels like it was all a bad dream.
Note that he specifically says 'since these pictures were taken'
- in the timeframe he describes, Maris death is included.
If it wasn't clear before what I was getting at with this, by now all the pieces should have fallen in place.
Yes, I am suggesting that the plot of OMORI is not some sort of murder-mystery, but instead a tragic tale about two boys who were completely ruined by a mental hell that exists exclussively in their heads.
Essentially, I am arguing that 'the truth' is a Red Herring, and that taking the obvious conclusion at face-value is a fallacy.
Here's a general outline for the backstory:
At the day of the recital, Mari commits suicide.
Sunny and Basil are the ones to find her. Both develop PTSD. Additionally, Basils BPD drastically worsens due to his trauma.
A few months pass. At an unspecified point during this time, Basil has a terrible nightmare influenced by his trauma, and due to BPD-related DRC mistakes it for a genuine memory.
He goes on to talk about 'the truth' to Sunny. Many reasons are possible: He just wants to comfort him, or maybe he did so in a desperate hope that Sunny would deny this memory to be true.
But Sunny has amnesia. And he is morbidly predispositioned to develop False Memories at other peoples suggestion. And since he has no way of debunking Basil recounting of that day, he accepts it as true.
Meanwhile, Basil had noticed Sunny to have 'forgotten' about 'the truth'. So, to ensure that Sunny does not do so again, he tapes the key to the back of one of his photos, and leaves the 'Don't forget'-message on it's back.
Basils influence on Sunnys vulnerable psyche has triggered the creation of Black Space (Note how the door to BS is located in a field of White Egret Orchid, which represent the phrase 'My thoughts will follow you into your dreams' Black Space is Basils suggestion following Sunny into his dreams).
In order to subdue it, he creates the Black Lightbulb, and starts to shut himself off completely.
4 years of silence follow, and in the meantime, 'the truth' rampages in Sunnys subconscious and grows in strength, as implied by both Stranger and Daddy Longlegs.
At the night of '3 Days Left', Sunny actively tries to remember 'the truth' and destroys the Black Lightbulb.
This causes the 'idea' that Basil unknowingly planted in Sunnys mind to resurface full-force.
What follows is a Sunny 'remembering' a False Memory, based on Basil account of the events. The photos are from Basils POV, in a book labeled 'Basils Memories', and are riddeled with inconsistencies and impossibilities.
Additionally, Basils claim of 'Something behind Sunny' having killed Mari is actually based on a truth: Since Something=Mari, this means 'Something killed Mari' is correct, just twisted beyond recognition.
I'd like to add that this theory also solves certain plot-issues rather nicely, and offers concrete conclusions rather than vague interpretations and shallow symbolism.
Specificall the key and photo in the treehouse, as well as the the meaning of the White Egret Orchid come to mind.
There is just one question left unanswered:
BASIL Aww, MARI... I wish I could be more like you! You always seem to have everything under control.
MARI That's not true at all! It just seems that way from the outside!
The implication here is that Mari has more going on than she lets on.
Additionally, she expresses a certain strong belief:
Everyone... I know it's tough right now, but we have to stay positive! We should all try to be like BASIL! Even when BASIL is upset, he always manages to smile.
She essentially says that one should suck it up and smile regardless.
This behaviour is dangerous.
If you actively try to cover up your problems up with toxic positivity, other people cannot offer help, and may result in those problems becoming worse and worse. This behaviour would explain why nobody saw it coming.
Mari is also a perfectionist.
Researchers have begun to investigate the role of perfectionism in various mental disorders such as depression, anxiety, eating disorders and personality disorders, as well as suicide. Each disorder is associated with varying levels of the three subscales on the Multidimensional Perfectionism Scale. For instance, socially prescribed perfectionism in young women has been associated with greater body-image dissatisfaction and avoidance of social situations that focus on weight and physical appearance.
Perfectionism is known to be a great contributor to both mental disorders and suicidal ideation.
I already have a specific disorder in mind, but more on that later.
Perfectionism is increasingly considered to be a risk factor for suicide. The tendency of perfectionists to have excessively high expectations of self and to be self-critical when their efforts do not meet the expectations they have established, combined with their tendency to present a public image of flawlessness increases their risk of suicidal ideation while decreasing the likelihood of seeking help when it is needed. Perfectionism is one of many suicide predictors that affect individuals negatively via pressure to fulfill other- or self-generated high expectations, feeling incapable of living up to them, and social disconnection.
This is pretty much the behaviour I have previously described.
In this context, it would make sense for Maris suicide to come out of nowhere due to a tendency to hide their problems and social disconnection.
Social disconnection is acually hinted at at least twice.
SUNNY giving MARI a big hug! MARI doesn't come home until late now because she's taking extra classes to prepare for college. Me and SUNNY have been hanging out a lot, but I'm sure he still misses her a lot.
According to Basil, Mari doesn't come home from school until very late. Furthermore, she appearantly barely gets to spend any time with Sunny, despite him being her brother and literally sleeping in the same room.
Subsequently, she probably gets little to no time to spend with the others either, including Hero.
This is further supported by the Black Space II area known as 'Mari is home':
Hey, OMORI... I think your sister is ignoring us. Maybe you should go talk to her.
We can't have a picnic without MARI!
MARI hasn't been home in a long time... She just needs some room to adjust.
According to Aubrey, Mari is ignoring them. This hints at increased social isolation on Maris side.
Heros wording also brings us to the next topic:
Adjustment Disorder is in essence very similar to depression, but caused by an accute psychologic stressor. The disorder usually disappears once the offending stressor is terminated and the person manages to 'adjust' to the situation. The type I am suggesting is essentially very similar to Burnout.
Adjustment Disorder poses a strong risk-factor for suicide, especially if it is in conjunction with perfectionism.
Mari was extremely stressed in the months leading up the recital:
Mine and MARI's school books. MARI has been coming home late because of cram school. She must be tired...
Maris parents are sending her to cram school, which causes Mari to come home very late.
It is reasonable to assume that the majority of her free-time, most notably the weekends, were probably consumed by practicing for the recital.
A table lamp. MARI has trouble sleeping, so she reads books before bed. I often turn off this light for her after she falls asleep.
It is openly stated that Mari has problems falling asleep. This serves to make mental exhaustion and depressive tendencies even worse.
The way I see it, Mari was under constant and extreme pressure in the time leading up to the recital. Her busy schedule impeded on her social life, and combined with a prefectionist tendency to try and keep up an image of flawlessness resulted in her problems to go unnoticed by the others.
The closer the recital came, the more the pressure on Mari increased. She wanted it to be perfect, but since only the weekends are left to practice, this severly limited her opportunities to practice.
However, Sunny hated the practicing, and he also hated Mari locking herself away on the piano for hours at a time.
This conflict caused an alienation between the two siblings.
All of those issues combined provide both a realistic and believable reason for Maris suicide as well as an explanation as to why nobody saw it coming.
All in all I'd say that this alternative interpretation of 'the truth' greatly increases Mari depth as a character based on actual in-game evidence.
That should be about everything. If you have any questions, feel free to ask in the comments.
What do you think about this theory?
While I certainly expect a lot skepticism, I think that at the very least I have proven that this is fairly substantiated, realistic, and narratively compelling alternative interpretation of OMORIs plot.
Before you ask, yes, I do headcanon this.
I particularily like the subtle hints, and howthe characters personality, relationships and backstory fall in place very conveniently.
A lot of little details on their own can be dismissed very easily, yet together they converge to a very powerful argument.
Essentially, I love that this interpretation re-defines 'the truth' as an ingenious Red Herring.
submitted by baume777
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2023.06.04 14:02 JuicyPeachGourl 30 F, looking for friends with similar interests
I’m not on Reddit too much but I feel like I could possibly find like minded people here. I enjoy things like cozy games (currently playing Wylde Flowers), writing (I used to write a lot of fan fiction but I’m currently trying to write a fantasy romance novel), and I’m really into fantasy/sci-fi/dramatic movies and shows. I’m an introvert with some social anxiety so it’s takes a lot of energy out of me to go out unless there’s a set plan in place, which is why I think an online friend would be great for me. Someone to bounce book ideas off of would be awesome too. I also love to read or listen to audiobooks.
Me, my husband (29), and my son (2), move around a lot because my husband is in the navy, which can make trying to start a friendship hard. A lot of the navy people we’ve met are cool, but the connection isn’t there.
I’d like to be completely honest and put all my cards on the table by saying I suffer from anxiety and depression (I suspect autism but I haven’t been diagnosed). I make it a point not to ask for help, though, which my past friends thought was a good quality even though I was suffering in silence. I’d like to be there for someone as equally as they are for me. Tbh, lighthearted conversations about similar interests and bonding in general really helps me work through a lot of the problems I deal with in my head.
I’m not looking for mom friends specifically, but if you also have any kids that’s great! If not, also great!
If you think we’d get along, feel free to message me. It would help me if we skipped over the whole “Hey! How are you?” thing and got into the nitty gritty of our interests right away. I crave human connection just like anyone else and I consider myself to be a safe person/judgement free zone. ❣️
Edit: I’m not looking for anything romantic or flirting. As I stated, I’m married. Happily.
submitted by JuicyPeachGourl
to friendship [link] [comments]
2023.06.04 13:54 sophieeestry 3 months without a cigarette, and 2 months no weed!! No nicotine gum, no patches - Here's what finally worked!
For upwards of almost 2 years, I smoked almost a half-pack to a full-pack per day. I tried to quit so many times and had the absolute worst experiences - trust me as someone with ADHD, severe depression, chronic anxiety and panic disorder, it wasn't easy. BUT
, I'm proud to say that my last cigarette was on March 10th at 10:20am, and I am nearly 3 months smoke free and I will never ever touch another one of these things again. I am repulsed by the it now and have been in complete control of my cravings.
Here's what finally worked for me, when I WANTED to finally quit:
- A trick that I would call "unhealthy/negative visualization". This is pretty dark but it finally helped snapped my brain out of the cycle. I repeated this process every time I got bad cravings early on:
- Pull up a the hospital heart monitor beep on YouTube. That consistent sound you'll hear in any hospital. The monotonous sound of a heart monitor beeping. Play it over speakers if you can.
- Lie down on the couch, or bed. Do not move, do not get up. Take shallow breaths. Lie here, do not move. Do not grab your phone. Lie here for as long as you can, and listen to the heart monitor's constant beeping. Close your eyes and vividly imagine yourself lying in a hospital bed, staring at the dull ceiling. Grab a plastic straw and breathe through that if you wanna make it feel more real. Imagine the tubes in your throat, horrific constant pain your chest or legs. Remind yourself: This is your life now, this is what you did to yourself. You did this because you kept smoking. Is it cancer? Is it lung disease? Did your lungs collapse? Did you get a severe blood clot? Regardless, you're stuck here now and you have to stay here until you die. How long? Who knows. Hate this? Keep sitting here and think about if this was your reality for hours. Days. Years even. Now you wanna go smoke even though you've stressed yourself out? Nope. You couldn't smoke anyway if you were in the hospital. Picture your loved ones staring down at you, their saddened and pity-stricken looks. Now they're walking away, you're here by yourself. You cannot move. Listen to that heart monitor. Beep. Beep. Beep. Fucking awful, isn't it? .
- Remind yourself that if you're going to smoke, this life can absolutely (and likely will) happen to you. Cancer is real and painful, people. I've lost loved ones to it. I've been on the opposite side of this and seen people I care about in constant pain to this day from cancer due to smoking. I never flipped that switch in my brain. Until I realized how shitty the rest of my life would be if I had to live in this reality, listening to that heart monitor over and over staring at a ceiling barely able to breathe until I eventually die. You have you tell your brain that this is where smoking will end up.
- Get up, beathe in, relax. Come back to reality. You're not there anymore. Cry a little if you have to. It sucks, but try to repeat this processes every time you get a craving. Or at the very least listen to that heart monitor every time you go out for a smoke. Remind yourself of what it would feel like to be back there...
Other (less dramatic) tips:
- Tapering down as you plan on quitting helps a ton, at least for me. Relapse is part of addiction, and you are not a failure as long as you keep trying!
- Remind yourself that quitting doesn't actually "help" your mental health or anxiety or stress or whatever. Your brain just "thinks" it does. You're not "quitting" cigarettes, you're giving up an unhealthy addiction made by evil companies that want to kill you. By going through a few weeks of pain, you are giving yourself the possibility of a much better quality of life.
- You have to really want to. You can't cheat it. You can't just "only smoke on the weekends" or "only at concerts" or "only when life gets less stressful, then I'll quit". You have to retrain your addiction-angry brain that's seeking that dopamine that you don't want it. Quitting is an all-or-nothing deal and it's so much more painful to quit when you rationalize continuing over and over. You don't want the cigarette, you just want the mental release and chemical rush you got from the first smoke. Or the memory you had. Neither of these are attainable, ever again.
- Cautiously, I can say that Wellbutrin helped with the cravings....However, in the long run that medication did more harm than good for me personally, be advised. Talk to a doctor or healthcare professional if you can.
- As lame and early 2000's as the website is, this old e-book by a retired quit-smoking coach helped me more than any article or routine or app: https://whyquit.com/joel/index-ebook.html Takes work to un-learn a lot of thinking patterns about smoking. I will say though, I hated Allan Carr's condescending book lol, fuck the "it's ez bro it's all about mindset you don't want one" bullshit. Quitting any addiction isn't fucking easy. It sucks ass, but you'll get through it if you are determined enough to.
- You can do this. I know it doesn't feel like it, but I promise you have the power within you to beat this addiction, no matter what you brain might tell you.
submitted by sophieeestry
to quittingsmoking [link] [comments]
2023.06.04 13:25 ViridiAve Some Opinions on the OT2 Character Themes
> disclaimer: these are the ramblings of someone who has not formally studied music or music theory and is just going off of the vibes that they got from listening to the character themes over and over. so uh please take these opinions like the opinions that they were meant to be
> also MASSIVE SPOILERS AHEAD
Ochette, the Hunter
> I love this theme. The first time I heard the samples on the Octopath website I fell in love instantly and was convinced that Ochette was going to be my starter just because of how EPIC it sounded. When the full version came out, my feelings on it being epic did not change one bit because it captures the spirit of going on a grand mission SO WELL, and the theme itself feels like it represents Toto'haha as a whole more than just Ochette, reminding us every time of the gravity of their situation. Of course I have maybe too many problems with her actual story but damn if it doesn't do a great job at being cinematic. You can just tell the dev team had so much fun making scenes with the scale of the Legendary Beasts in mind
> also I'm not the only one who hears a slight choir in the background right.
In Pursuit of Legends
> easily one of the best pre-battle themes in the game - the high wind instruments just send chills down my spine no matter what situation Ochette is put in, and when we hear it for the last time in Ochette 3 - oh BOY does it feel incredible. Speaking of Ochette 3
The Journey for Legends Ends
> Out of all the Journey Ends remixes Ochette's version of it is undoubtedly one of my favorites - easily cracks the top 3. In my first run of OT2, I saved Ochette 3 for last, and having it be against the fight against the Darkling?? The high wind instrument sounded like WAILING and I can't get over how fitting that is given everything that the Darkling had gone through until this moment. The whole island is at stake but our attention is all on the Darkling's suffering and honestly? That whole sequence made me forget about the problems I had with Ochette's story and got me to cry a bit because holy shit
Castti, the Apothecary
> I don't have too many strong feelings about Castti's theme, but I dearly appreciate how subdued and somber it sounds. It fits Castti's journey of finding her memories so well and I just generally have no complaints.
> HER LEITMOTIF HOWEVER - the theme used in every flashback sequence incorporates it so well that I cry every goddamn time that it's used. THIS IS THE THEME THAT HER CHAPTER 3 ENDED WITH. IT'S SO SAD AND LOST THAT IT JUST AKSJAKS WHAT DID NISHIKI INJECT INTO THIS THEME???
In Pursuit of Memories
> I love For Succor from the first game. Easily one of the most cinematic-sounding pre-battle themes. In Pursuit of Memories takes everything that made For Succor amazing and TURNS IT UP TO 11 AND WOW THOSE TRUMPETS ARE SENDING CHILLS UP MY SPINE. Castti's leitmotif messes up my brain a lot it's great
The Journey for Memories Ends
> As much as I wanted Castti's rendition of this song to crack the top 3 my god the renditions that DID just made me feel way more BUT HECK IF THIS DIDN'T MAKE ME FEEL A LOT OF THINGS
> Having her theme be up against Trousseau feels incredibly triumphant. Like she's being backed up by Eir's Apothecaries as she fights like Jesus they went SO HARD
Throne, the Thief
> I'm probably going to get a lot of flack for this but. I especially don't have strong feelings about Throne's theme. I like it enough, I'm a sucker for strings and I think it suits her well, but I feel like it blends too much into the rest of the soundtrack. It could be the instrument choice, it could be the chords? I promise I like the strings. I also love how it played in her ending. I feel nothing but happiness for Throne when I see her endcard I love it so much
In Pursuit of Freedom
> To be completely honest I have to strain my ears to actually hear Throne's motif in the pre-battle theme but I don't have a lot to say about it - definitely blends in too much with the violins.
The Journey for Freedom Ends
> OKAY THE LOW ELECTRIC GUITAR RIFFS IN THE BEGINNING OF THE RENDITION? GOD-TIER - FOR SOME REASON I ALWAYS PAY ATTENTION TO THOSE AND THEY'RE REALLY GOOD BUILDUP
> As for the rest of it it's fine I guess? Like I like hearing it and battling with it but I think the first time around I was way too confused with the bombshells that Claude dropped on us for me to properly appreciate the music
Osvald, the Scholar
> At first I thought this was a pretty generic somber theme that REALLY loves its cellos, but in my second playthrough I grew to appreciate it a lot more. Without changing a single note, Osvald's theme goes from somber to triumphant over the course of his story and it's kind of insane to me?? Like it fits way too well with the bittersweet ending that he has but has so much room for hope and somehow his character theme captures that so well??? Gods bless you Osvald
In Pursuit of Revenge
> Gotta say - I don't have a lot of feelings on this either. Other than to say that it's badass and imposing as all hell
The Journey for Revenge Ends
> OKAY I HONESTLY DID NOT THINK THAT THIS THEME COULD EVER FIT A FUCKING. DRAGON BALL KAMEHAMEHADOUKEN DUEL BETWEEN HIM AND HARVEY BUT THE ELECTRIC GUITAR MELODY PROVED ME SO WRONG. THIS THEME GOT ME REALLY HYPED UP
> Honestly the fact that I was maybe rooting for Osvald too hard to just kick Harvey's ass because he hurt Elena probably helped BUT STILL AWESOME THEME
Partitio, the Merchant
> God. The moment I heard the electric guitars I was already sold but then the SAX kicked in and it's like 'YO ALRIGHT WE'RE BALLING'
> this post really started out with me describing actual feelings. Don't worry we're still going to talk about feelings but I don't have much to say about Partitio's theme other than it's awesome and that people should play it in bars
In Pursuit of Happiness
> man this game is really giving me a great appreciation of the power of electric guitars. I see the appeal now. I especially see it in Partitio's leitmotif cuz man it really makes me want to end poverty. Unfortunately I don't have Partitio's business acumen OR his exuberance so I like. The most I can actually do is look into charity and volunteer work but this theme reminds me that that's good effort too
The Journey for Happiness Ends
> Gotta say? I don't have a lot of strong feelings about this rendition. Like I love Partitio and his story's ending to BITS but I think the fact that we're fighting a whole-ass steam-powered war train had the more staying power for me in this fight. Not that his theme was bad by any means because MAN that electric guitar solo goes bonkers
Agnea, the Dancer
> HANDS-DOWN MY FAVORITE OF ALL THE 8PATH2 CHARACTER THEMES - IT JUST SOUNDS AMAZING NO MATTER WHAT CONTEXT YOU PUT IT IN. I also love that it just ends up existing in-universe as full on diagetic noise for Agnea's encore at the end of her story? HELL I ALREADY SAID I'M A SUCKER FOR STRINGS BUT AGNEA'S THEME JUST SOUNDS SO HOMEY AND WHIMSICAL AND IT ACTUALLY MAKES ME REALLY WANT TO DANCE. AND I SUCK AT DANCING!
> Gil's piano version also just flat-out brings me to tears. God bless you Agnea motif. Why is it so good at being emotional. The evolution of this song throughout Agnea's journey just hits me on so many levels. Music and dance as a form of human expression and communication is fully on display with Agnea's story and her theme reflects that perfectly
In Pursuit of Hope
> how do I gush over Agnea's leitmotif even more without just repeating myself. it's just so good. it's so hype even if the situations themselves are relatively low-stakes. like she's just having a really intense talk with the manager of the theater and the battle theme goes HARDER THAN IT SHOULD
Song of Hope
> HONESTLY WHAT CAN I EVEN SAY ABOUT SONG OF HOPE THAT HASN'T ALREADY BEEN SAID. SONG OF HOPE BEING THE FINAL FORM OF AGNEA'S THEME LIKE IT'S A SUPER SAIYAN HAVING THEIR POWER LEVELS GO OVER 9000. THE FACT THAT IN-UNIVERSE IT'S ACTUALLY HER SINGING IT. THE FACT THAT THIS IS THE SONG THAT BEATS DOLCINAEA LUCIEL. THE FACT THAT THEY'RE BOTH SINGING IT ACTUALLY IT'S SO GOOD
> man I wish sometimes that whenever Agnea uses her EX Song of Hope we got like. a little jingle of her theme and her singing the lyrics. I love Song of Hope so much it's my second-favorite Journey Ends theme. Yes I know it technically doesn't qualify but come onnnn
Temenos, the Cleric
> okay now I'm REALLY going to get flack for this. I actually don't like Temenos's theme. There's specific reasons for this and most of them have to do with his story. It was already one of the character themes that I felt relatively neutral on when I first heard it, and my first impression was that 'mmmm okay. what's throne's theme sound like-'. The demo came out and gave us Chapter 1, and suddenly it makes sense why it sounds so funky - it represents his character from Chapter 1 so well! It tells us a lot about Temenos - that he's lackadaisical, full of doubt, and that there's more to him than meets the eye. It's true to his character as a detective who likes to mess with his assistant sometimes
> But then Stormhail happened, and it's like. The whimsical tones of his theme really didn't suit the tone of the rest of his story OR his character going forward. Crick's death has dramatically changed the feel of his story, and from that moment on it's pretty clear that Temenos is out for revenge more than he is out for truth - but his theme doesn't reflect that. In fact it feels like it's acting in defiance of the tone shift, feeling almost dismissive of the emotional plot points of his story. On a meta level I think it's interesting how it reflects Temenos's state of mind, sticking to his pursuit in order to avenge everybody he lost and keeping his emotions bottled up. Emotionally however it feels incredibly dissonant - especially when it plays over his endcard.
In Pursuit of Truth
> Honestly for how much flack I gave his character theme I have to give it to his leitmotif for being incorporated in incredibly interesting ways for his battle themes. I did NOT think that the Celestas?? Glockenspiels??? Whatever those brass instruments were - they were INTENSE
The Journey for Truth Ends
> Same words that I have for In Pursuit of Truth like oh my god I didn't think they could make his funky-sounding leitmotif sound so badass but they DID and it felt immensely satisfying to kick Kaldena's ass as the music played. Savor that satisfaction because my god the rest of his story arc does not have a lot of that
Hikari, the Warrior
> I'm partial to Eastern instruments and chord progression! Hikari's theme sounds incredibly regal and it tells us a lot about his character - he's noble, kind, and a great leader. It's a theme that's fit for a king and honestly what more can you ask for?
> also when the bridge plays with the peaceful tones of high wind instruments my heart is just. It is at ease. All is right in the world. tHEN IT'S BACK TO THE INTENSE PARTS WAHOO
In Pursuit of Kingship
> OKAY BEFORE THE GAME CAME OUT I WAS ONE OF THE PEOPLE WHO LISTENED TO THE LEAKED SOUNDTRACK OVER AND OVER BECAUSE OH MY GOD HIKARI'S LEITMOTIF GOES SO HARD - I literally SCREAMED when I first heard the leaked version and honestly through the choppy audio and the chunky part of the video - you all know the one - this theme was the one that convinced me that Octopath Traveler 2 was going to be something special. I screamed out loud to several people I knew that this? Seamless transition into Critical Clash II?? It sounded like Latin Honors.
The Journey for Kingship Ends
> So, picture me on my first run, intending to finish the second game this time in reverse OCTOPATH order, meaning I started with Hikari's final chapters. Sure I switched Temenos and Throne around for the order but that was fine, I'm in Ku, and we're about to finally kick Mugen's ass because I fucking hate Mugen. The chapter begins with Kazan literally summoning a sandstorm to open the gates of Ku. I am already so hyped. Then Clan Mei arrives. I am even more hyped. THEN WE FINALLY GET TO KICK RITSU'S ASS, AND HEY OCTOPATH 2, WHAT DO YOU MEAN THIS IS A BOSS RUSH??? I get to Mugen. I beat his first phase. I fight Hikari's intrusive thoughts and win. Mugen does some eldritch shit. AND THEN THIS FUCKING THEME KICKS IN AND I WAS JUST THROWN BACKWARDS INTO MY SEAT
> IN MY OPINION THIS IS THE BEST RENDITION OF THE JOURNEY ENDS REMIXES - THE MUSICAL PROGRESSION FROM THE FIGHT AGAINST RITSU, THEN A TASTE OF FOR THE DAWN WITH MUGEN'S FIRST PHASE, THEN CONQUERING THE SHADOW, AND THEN THIS - IT WAS SO GOOD?? AND IT SOUNDS SO TRIUMPHANT LIKE - HIKARI IS ON THE CUSP OF VICTORY AND PEACE IS AT HIS FINGERTIPS. KU WILL FINALLY SEE THE DAWN OF A NEW DAY. THAT IS WHAT THIS SOUNDS LIKE AND IT'S THE MOST AMAZING THING AND I LOVE IT
so yeah i'd love to hear you guys' thoughts on the character themes. feel free to disagree with my opinions! I welcome it!
submitted by ViridiAve
to octopathtraveler [link] [comments]
2023.06.04 13:11 Satan_likes_cattos Cat tail issues
Species: domestic short hair Age: 6 Sex: male neutered Weight 4.5-5kg History: he has never had issues with his tail but has been treated for an infection on his paw about two years ago. Location: UK
Woke up this morning to spooky (the cat) having a limp tail. It starts about 2 inches from the base of the tail. It looks inflamed and he has a grumble if we touch it. He struggles to lay down or sit but can still do so. He has toileted this morning and is also eating. He seems very much himself minus the sore tail.
The vets here charge a large amount to be seen on a weekend and I’m wondering if this is worth a vet visit tomorrow or if it’s an emergency?
He’s still jumping around and being his usual mischievous self but his tail looks very sad. It’s a bit puffy after the 2 inch mark. He was fine last night and we didn’t hear anything in the night. We’re wondering if it’s an injury sustained by playing with our other cat?
thanks in advance
submitted by Satan_likes_cattos
to AskVet [link] [comments]
2023.06.04 12:40 Astaritus Super Nate Adventure
| || | submitted by Astaritus to u/Astaritus [link] [comments]
Embark on a perilous journey to save the Kingdom of Starleon from the monsters that Lord Abbadon unleashed on the local lands! Save the beautiful princess who is imprisoned in the castle and dreams of freedom!
+ Availability: Free to play (From May 31, 2023)
+ Availability of achievements
+ Gamepad support
+ Multiple difficulty modes
+ 8-bit graphics
+ 8-bit soundtrack
+ Simple controls
+ Increasing difficulty level
+ "Glitch" mode
+ Cheat codes
Did not like:
- Lack of cloud saves
- Dramatic increase in difficulty level from world to world
- Lack of checkpoints in the level
- Lack of "codes" for completed levels
Retro platformer, in the best traditions of "Super Mario Bros."
Before us is a classic platformer that has retained all the advantages of retro games, familiar to many on Nintendo set-top boxes (NES / Dendy) in early childhood.
Pleasant visual style, flavored with midi melodies, simple two-button control - perfectly adapted for both keyboards and gamepads. Small levels, with a lot of collectibles. Opponents of different stripes that your hero can win, and those from whom he can die. Traps, boosters, trampolines and much more - that will not let players get bored, as well as "abandon" the passage.
The "Glitch" mode also makes the game interesting - which fills the level you pass with random blocks and opponents - creating the illusion of a bad port, or a cartridge glitch. But nevertheless - all such levels are quite passable, and the constant random generation after the death of the player makes this mode replayable.
The game is perfect for fans of complex platformers, as well as people who decide to get a little nostalgic.
2023.06.04 11:56 VioletNebula87 How can I make my senior cat happy?
My beautiful cat Hazel will be 12 this July and has been living with my parents since I moved overseas five years ago. I will be returning home and she’s now a much older cat than when I left. I recently lost a young Ragdoll to HCM and I regret working a lot and not spending enough time with her even though she was happy and lived a full life. I don’t want to feel any regret with Hazel so I’m determined to make her happy. She has changed quite a bit since she was under my care mostly because she has had chronic constipation issues, has had enemas and is on a few different meds. She is now terrified of the vet and any new people. She’s become very reserved. I think this is because of all the constipation issues she has had, multiple trips to the vet and maybe also just getting older? Her constipation has been under control for the past year or so. She is in good health otherwise. How can I spend time with her and make her happy? She doesn’t quite play or jump around like she used to. My family hasn’t noticed any dramatic behaviour changes by the way - I think I’m noticing it because I’ve been away.
submitted by VioletNebula87
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2023.06.04 10:55 EIEIOwoopwoop Onmyoji goes to college
I had a thought the other day about what each character would major in if they were in college and ig that spiraled into this post of more general "what they'd do in college" in no particular order. I don't have everyone here so feel free to agree, disagree, or add to the list ¯\_(ツ)_/¯
Seimei - polsci, either peace/conflict studies or international relations. active in discussions and is quite optimistic about how things will turn out - will make it his life's work to make sure things turn out good. enjoys literature and audits several literature classes. probably has a secret poetry tumblr
Kohaku - either seimei's dog(?) who has been snuck on campus or a history major
Hiromasa - music major, member of the archery team. probably has gone to competitions. composes some of his own works and often duets with ootengu
Kagura - too baby to go to college. here just to visit her older brother
Yao Bikuni - bioengineering, maybe biology. grad or phd student doing research on the functional immortality of planaria. prone to musings about the implications and ethics of making humans immortal
Enma - administrative and criminal law. will attend every mock trial and attempt to participate as much as possible. people who know her go to her to get her opinion/judgement on conflicts
Higanbana - entrepreneurship. has a startup that may or may not exist yet she is still somehow obtaining funding and backing for it. probably has her own cryptocurrency
Yorimitsu - mechanical engineering/electrical engineering or computer science with a focus on robotics and ai. sometimes makes some ethically questionable stuff but he's good at what he does so the board decides to let him cook. grad or phd student doing (again, questionable) research on human-computer systems
Yoto - social psychology/neuropsychology. originally was in computer science/computational sociology but then decided she was more interested in the human aspect of things. might pivot into neurology and surgery since she's got discipline and careful hands
Onikiri - software engineering with a potential focus in systems security? yorimitsu's long suffering RA, might claim that he's there to make sure yorimitsu doesn't break any laws. volunteers at dog shelters in his spare time
Shuten - physical fitness/kinesiology. president of his frat. likes to throw parties and drink a lot of alcohol, but surprisingly responsible (except when it comes to cleaning up, much to hoshiguma's despair). organises a lot of field day activities for the entire uni to attend. probably on the uni's sports team
Ibaraki - med student with a side of biomedical engineering. can't reattach a head using only magic, amirite? part of shuten's frat. he and shuten are in the boxing club or some other martial arts club and he keeps hounding shuten to spar with him. also probably on the uni's sports team
Ren - anthropology. chills on the quad to people watch. generally introverted, but likes to watch people interact with each other
Yamakaze - forensic science/forensic psychology. part of the "we love nature" club with ren , fuken, and hana
Fukengaku - earth science/environmental science, potentially zoology? that guy you see on a trip to the national park pointing out every single type of plant and animal while identifying them by scientific name
Miketsu - agriculture and sociology double major. has a green thumb and contributes a lot to gardening club. researching better farming methods, especially for organic produce
Arakawa - marine biology/environmental management. grad or phd student doing research on methods of sustaining ecosystems surrounding rivers that have been impacted by human activity. environmental activist.
Kingyo - zoology with a focus in ichthyology, maybe a minor in environmental policy. looks up to arakawa a lot and hangs around his research lab in hopes of learning more. maybe arakawa's RA
Otakemaru - archaeology/anthropology. loves going to dig sites and picking up all kinds of trinkets and relics to study. very proud of his finds and will send to his sister a picture of anything he finds that is remotely interesting
Suzuka Gozen - psychology, hoping to become a licensed clinical psychologist so she can provide her brother with the therapy he desperately needs (and maybe just about everyone else as well). loves helping people out so TAs a lot and has practically 24/7 office hours
Senhime - public administration. bio minor out of interest? working with yao bikuni on the immortality research as an RA. participates in MUN
Shiranui - dance. head of the uni dance troupe and organises performing arts festivals every now and then. probably already a member of a dance company and splits her time between working and going to college
Aoandon - creative writing/history/journalism. runs dnd games on the weekends and creates some of the best campaigns known to man, collabing with hana to make set pieces and figurines. probably livestreams the dnd campaigns
Hana - visual arts/art history/graphic design. her art is already out there in galleries. loves the natural world and will spend hours capturing the likeness of a field of water lilies. if she has time, works with the costume design department for theatre productions
Shokurei & Mishige - culinary arts
Enmusubi - sociology/relationship psychology. likely runs anonymous gossip twitter of the uni and/or the subreddit. she's super into organising events like valentines day or prom and will go all out with the decor and invitations
Ubume - education, child psychology professor. volunteers at a nearby kindergarten or preschool as teacher's assistant and babysits on the side. everyone loves her classes cuz she just got that nice vibe about her
Taisha - civil/criminal law. seems quite timid but in class says the most insane things about punishment of criminals and how a government should be run, professors are concerned. has likely shadowed an actual politician
Asura - also law, very outspoken about his beliefs and blunt when speaking. will openly debate taisha in the middle of class. seems to be in every class that taisha is in
Tsukuyomi - philosophy professor. heavy focus on determinism/fatalism. students can't tell if they're actually lecturing or joking half of the time. loves gossip and drama. has been guest dm on aoandon's dnd show
Kotodama - linguistics. conlangs in her spare time. people are wondering why such a young child is in college but she's just precocious ig. has a large emotional support dog called blot
Susanoo - public policy with a side of social work. audits a surprisingly wide range of subjects and does pretty well in all of them, all for the purpose of being able to tutor anyone who needs help. snuck ibuki into his dorm (has an instagram for ibuki). the cook of the dorm room
Susabi - polsci and philosophy (ethics) double major. has been TAing since he was a freshman and shows no sign of stopping. practically lives in the library. roommates with susanoo. has some kind of beef with tsukuyomi
Orochi - 100% drama/theatre (have you seen the way this guy talks and moves in the cgs?). has taken some ethics/philosophy classes so he can make dramatic speeches about the state of mankind or whatever. quotes shakespeare on the regular
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to Onmyoji [link] [comments]
2023.06.04 10:11 Yellow-Cream My kitten died this morning
I've never been a cat lover, but when a friend and I picked up a dirty sick kitten, I couldn't just leave him there. My family immediately fell in love to the kitten, my dog even started feeding him with her milk. We bought lots of vitamins, every day he ate well, slept and played. He was such a happy and clever boy. The only problem was that sometimes he wouldn't go to the toilet for days, but there was only one vet in my town who misdiagnosed my acquaintance's cat. Also, given how little money my family has, we couldn't go to the vet clinic anyway. That night he was full of energy, playing with the shoelaces I had left him, and then playing with the dog. He lay down on top of me and purred for a long time before he left. He rarely goes out at night, but I didn't think anything could have gone wrong. I didn't see him all morning and he missed his breakfast, but my mother reassured me by saying he was just sleeping somewhere. Because of the renovations, we have a bunch of stuff he can crawl into and sit there for hours, attacking from hiding places or just hiding toys in there. I reassured myself that he was just sleeping, but tried to look for him anyway. I found him under the bathtub, cold. He was lying there like he'd just gone to sleep, but his eyes were wide open and his mouth as well. It's still hard for me to comprehend what happened. Only tonight he was playing around, and now he's just a dead body. The worst part is that I wasn't there for him. I don't know why he went under the tub in the first place. What if he was in pain and trying to hide from that feeling in the dark? What if I could have helped him? Not knowing how he died caused so much pain. It's so unfair. He was only two months old, his whole life was just ahead of him, he had so much potential that he would never be able to fulfil. I just want him to hop on my bed again, carrying a toothbrush or shoelaces in his teeth, which he liked to play with more than cat toys. So we could play again, and then he lay down to sleep on my neck, purring loudly while I read.
I can't even bring myself to call him by his name most of the time. I can't associate his name with this body. Levi was full of energy, Levi loved to run and play, Levi could stand up for himself and was a perfectly healthy looking and behaving young kitten. I'm sorry the post is so big. I really don't know what to do or how to feel
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to Petloss [link] [comments]
2023.06.04 09:36 velodelia funny DIY Fanless PC Build in progress
I am trying to upload the whole thing as a text and pictures story and I hope it works. The Images & Video tab doesn't offer this format from what I see...
Straight out I would say this turned out so much different than I ever expected and also it has been taking days of work. All of which enjoyable, I love building stuff, but building a cooling system from scratch needs quite some precision work :)
This is one of my first post here, so I hope it all turns out well!
It all started when a friend gave me his old GPU - a strix gtx 970 4gb OC. And that cascaded in getting all other components. I should note that this is not the best option for a GPU in a fanless system, but it's what I got :) To be hones, it ran VERY quiet with original cooling, but... I disassembled it already , there is no going back haha.
CPU is a ryzen 5 3600
MB is mini ITX GIGABYTE B450I AORUS PRO Wi-Fi
BeQuiet pure power 11 500W . it has a fan, but have seen it spinning only a few times and it's inaudible
18gb ram, 1tb samsung nvma and so on, nothing special on this front, just needed some parts to make it run.
All temps are in Celsius! :)
At my work ( I repair clinical equipment) I got a hold of these beauties from a device in one laboratory.
I thought I would need only two of them and have the rest for another project - how wrong was I haha
My first idea was to directly press the cpu against a block of aluminum and the big heatsink.Unfortunately the 2 prototypes I tried, didn't transfer the head fast enough to the big headsing and the CPU would get hot really fast during a stress test.(I glued the nuts with fast glue and baking soda. It got so hard and strong that I had trouble removing it after that! haha )The first 2 tries looked like that:
At this point I was still under the disillusion, that this would be a quick job, done in a few hours. I lough at myself when I think back at how I imagined all this would go...Trying to build and cut everything on the fly, every whole was on the wrong spot, I kept on breaking drills and taps , while making holes and threads...After the first few uncecesfull attepmts I realised I need to take my time to work on every single piece of it slowly and measure everything better if I wanted to go anywhere with this.At this point I still didn't know if I would be able to cool the CPU, much less the GPU.The CPU is 65W and the GPU is twice as much and probably sucking even more power at max load.
Next I decided to use heat pipes, but instead of ordering some and figuring out how to attach them to the CPU die, I decided to repurpose an older cooler master CPU cooler I had around ( also a donation from a friend ) It was for an older intel CPU, so I had to create a mount for it for my AM4 platform :)
So I began and 2 hours later ...
Than 2 days later ...
I drilled holes for half of the pipes and stuck them inside the radiator, the other ones I bent and pressed against the face of the other radiator. At this point I am using two of them.Bending the heatpipes without a proper tool is a mess.I ended up using the neck of a bottle of wine.....I wouldn't go too deep in this topic hahahahTo my surprise it was working!!!! I managed to get to max 80C under stress. :)
At this point I was feeling a bit more optimistic and started working on the cooling for the gpu.This time I didn't even bother with trying to cool the gpu without headpipes, so I did the same as with the CPU - repurposed some heatpipes... or you could say - Destroyed a perfectly fine working cooling hehe -
At this point I was much more careful with the holes I drilled.I have a few jars with old bolts and nuts left from my grandfather - they hold everything in this project. Whenever I needed any size of anything, I found it in there. And everytime I was thankful to him! <3 Love you grandpop!
The first time I ran the Pc with the new GPU cooling, and started stress testing it - the computer turned off without a warning! It obviously overheated.I was a bit disappointed for a while, until I remembered the VRMs have just a small heatsink above them and no fan to blow air on it at the moment...So I cut two big sheets of 3mm aluminum and stuck them on the chips with a thermal pad.That did the trick , but they got around 95C while playing games.I had to address this.
Next I got more presents from a friend - a flat heatpipe from a laptop cooling and an old GPU cooling ( heatpipes and radiator)I should have made more photos of the creation, because it is so funny :) Nowhere near good looking.I put a 2mm copper plate on the vrm chips the laptop heatpipe, sandwiched with a sheet of aluminum plate. The flat heatpipe curves around the gpu body, goes to the other side and there I pressed the other end between another sheet of aluminum and the other gpu cooler.
https://preview.redd.it/ol6huhftey3b1.jpg?width=3468&format=pjpg&auto=webp&s=65cd952991757ed3d1a32ec8611f04e95c28867a https://preview.redd.it/3w9bckftey3b1.jpg?width=4624&format=pjpg&auto=webp&s=80441221b4d056aca2f3c00a8335e74780660fd7 https://preview.redd.it/dbl1ijftey3b1.jpg?width=3468&format=pjpg&auto=webp&s=95ba941aef99d548a76a4fd70fbb1a8416c82b5d
This did the trick - VRM are at 62C during gaming. That's fine for me. :)Holding one end with a zip tie... At this point I have no aestetic goals for the inside :D
Building everything together around the gpu is a step by step process in specific order so that everything comes together... I had to build and take everything apart or rework it in order to have access to all the bolds and nuts holding the whole thing together.
When I play Horizon : Forbbiden west, I get 50-60C CPU, 62 VRMs and around 90CI seem to remember that on the build before the vrm upgrade the gpu was not getting hotter than 85C... Will have to work on that more.
There is an original, thin black alu plate on the back side of the GPU that get really HOT. I can't seem to find anything directly touching to it, aside from one small chip ( don't know what its for) with a 2-3mm thick thermal pad on it. I am thinking of changing this thin back plate with a much wider and thicker one. I have some 3-4 mm sheets.That's one of the next steps, when I feel motivated, and after that I will start thinking about making a wooden box for the whole thing. I have a few Teak wood planks.And just for the sake of it am wandering if I should add one fan at the bottom of the box just in caseMaybe an Noctua nf-a12x15, turning at very low RPMs... will see about that :)
I don't know how heavy it is. It's still not in one piece and stays in place thanks to my oldschool sci-fi book collection :)
At the moment it looks like that and I LOVE it and the whole experience :
https://preview.redd.it/5zbi4q6zey3b1.jpg?width=4624&format=pjpg&auto=webp&s=168ef8b6001b215a77b59fc197b8d3ffa2c18263 https://preview.redd.it/mq34es6zey3b1.jpg?width=3468&format=pjpg&auto=webp&s=7aa61eb616310aaffc0376ca829ce7c745e1681a https://preview.redd.it/59swvp6zey3b1.jpg?width=4624&format=pjpg&auto=webp&s=dd109c427fc7fe504baabab22b932f3a7a7fe3f7
It's been 4 months now since I started and I work on the project whenever I have time.
I will add updates with any progress.I have some crazy ideas for the wooden box, to make it even heavier :D
Thanks for the patience of reading the whole thing :) You are free to make fun of the whole "creation" hahaha or add any advice.
submitted by velodelia
to PcBuild [link] [comments]
2023.06.04 08:32 WideAd8358 4 June 2023 (Kurt Tay) - Q&A (Part 4)
Many people have been asking me the same question including my wife. How is the SSS interview ?
Recently I went for the interview. They say have to wait for one week. Wait for 1 week then if have, they will call you. 31st May 2023 is the deadline. Even if they call you, you still have to go for second interview with the clients. So the clients will interview you. Then after that the clients will decide whether they will decide who will join as a security supervisor. I wasn't called up. My wife just called me up regarding the full time job. Actually for me, I don't mind working Adhoc jobs. But the problem is because we want to apply for the BTO loan. If Adhoc job no CPF or very very low CPF, it will be hard to get the loan. So you see, my wife just now ask me, I have been thinking. Its either I go and look for other agencies for a SSS full time job which I know its quite hard to get nowadays. Or I might change career to be a debt collector. I think its a job which I quite OK with it, which I actually quite interested. Because the job is not so hard. The job got a group of people accompany you to go to the house address to collect debt. So the job OK. If one person go, a bit jialat. You see TV right? Usually a group of people and some more its legalized. Not like those illegal ah long. Put the pig head. Got risk kenna arrested by police. Then police send you to jail to meet DeeKosh inside the jail. But this one is legalized one. Got license one. I will either go for the debt collector or SSS job. But actually I quite fine with the Adhoc job but the problem is the CPF thing. You say that on 24th May 2023 is your first time being fist fuck during BDSM but its not your first time being anal fucked so there's no blood. Can you tell good fans when you have been anal fucked ?
This question let me think how to answer you. I cannot remember when is the first time I kenna anal fucked. But I know its been a long long long long time ago. I cannot remember which year which date which month. All I know that its not the first time I kenna anal fucked. That is why when I go find BDSM mistress and whether the BDSM mistress use the dildo to fuck my ass or finger my asshole or use the fist to fist fuck my asshole, got no problem come out because its not a virgin hole. You ask me when ? Seriously I cannot remember which year what month which date because my memory not so good but confirm its not the first time. When I have been anal fucked, the date, I really cannot remember. Not I purposely don't want to tell you. I can't remember the date but its been many many years ago. If I not wrong should be more than 10 years ago but which year which date which month, unfortunatelly, I really forget. If the fist stuck in your asshole, cannot take out. How ?
This is a very silly question. If the fist can go inside the anal hole ? Of course the fist can come out lah. What kind of question is this ? If the fist cannot come out of the anal hole. In the first place, the fist will not be able to go inside the anal hole. If the fist can go inside the anal hole means the fist confirm won't get stuck inside the anal hole, the fist confirm can come out one. So this is a common logic right ? If the fist go inside. In in out out. Confirm can in in out out one. No such things as go inside cannot come out. No such things. This is simple common knowledge. Simple common sense. If one day Kurt do BDSM as a dog until the kukujiao accidentally cut off, will he go to the vet or the hospital ?
This is a very very funny question. Even if I go do BDSM as a dog, I am still not 100% dog. Its 50% dog 50% human. Half human half dog. So of course if accident happen, of course go to hospital. How can go to the vet ? As long as you are not 100% dog, you only 50% dog then you go to human hospital and not the vet. You should ask your owner, do anything like cut kukujiao, maybe will get forgiveness.
Answer is No. How can I accept cut kukujiao as punishment so that I can get forgiveness from Goddess Mistress Luna ? Of course cannot. If kukujiao cut off, honggan already. How to have two more kids ? How to have sex with my wife ? No kukujiao means I eunuch. Gong gong. Like that jialat already because a guy must have kukujiao. If the kukujiao cut off means I honggan already. Then I also don't know the pee come out from where. Women no kukujiao, the urine come out from vagina. If men cut off the kukujiao, no vagina then the urine come out from where also dunno. So of course cannot cut off kukujia. What kind of question is this ? Since you can autocum, why you cannot auto humilate ?
You see, you can go and watch porn then you see very very excited then you own self autocum or whatever. But the feeling is not there. The feeling is not shiok. Its different. I can go and watch the fendom porn video. Watch the BDSM mistress punish the male slaves then you see excited then you autocum. But the feeling of watching and ownself experience is totally different. Its not the same. How can you say watch porn then ownself autocum ? Its not the same OK. When you ownself real life experience, the feeling is different. You cannot experience that by just watching the porn. When the fist enters your ass, were you very proud ? Do you think it is an achievement because not a lot of people can fit a fist in their ass ?
Answer of course is Yes. This is a very very proud achievement. In fact, you are right that not many men, the fist can go inside the anal hole. Not say don't have lah. have. You go and see Twitter account. Actually got quite a lot of slaves, the fist can go inside but of course not many. But I got to say of course this is a proud achievement. Last time Mistress Luna post your buttocks photo on her Twitter. You won't feel xia suay meh ?
Answer is No. Why will I feel xia suay ? You see last time I go and approach Mistress Luna. In fact she never go and post my photo. I go and ask why ? I want to be humilated by her. I keep on asking her. After our third session, please post the photo and video of her kenna punish by her, post on the Twitter. Because I like it. When I see, it will make me feel high. So you see, when you kenna punish by her and then she post your buttocks or kukujiao or whatever photo or video, this is a something that is very very proud achievement. Thats right. Sometime you feel very proud. This is very very proud achievement. Why should I feel sia suay? There's nothing to be sia suay of. In fact, its a very very proud achievement. Like something you got the scholarship or whatever then you win the Olympics whatever. This is such a proud achievement. Where got sia suay ? The feelings is exactly the same when you win the Olympics. If Kim want to be a BDSM mistress, will you support her ?
Answer is Yes. This is not a joke. I seriously meant everything I say. If my wife say she want to become full time BDSM mistress just like Mistress Luna, I will fully fully support my wife. Because she is earning money and she can enjoy punishing the slaves. There's nothing to lose. If my wife say she want to become a slave, of course the answer is No. If my wife want to become a BDSM mistress then its Ok with me. That's fine with me. Because my wife she can fist fuck the slaves. No problem. My wife can finger fuck the slaves. Also no problem to me. My wife can even wear the dildo to fuck the slaves the anal hole. In in out out. You see why I don't mind. Because dildo is just a toy. My wife wearing a toy to fuck the slaves, its the slaves who got disadvantage. Btw, BDSM session, the slavess are not allowed to touch the BDSM mistress. So my wife will not kenna touch by them because she is a mistress. So she got nothing to lose and everything to gain. And to me, if my wife fist fuck the slave, its Ok, there nothing wrong. Lets say if other men fuck my wife, this confirm cannot. If my wife wear the dildo to fuck the slave the ass, this to me is OK. I okay with my wife to become BDSM mistress. The slave can kenna punish by my wife. Kenna cane. This is fine with me. I okay with that. The only thing I cannot accept is. I engage 3 BDSM mistresses before and I want to drink their urine. Almost all 3 BDSM mistresses, I seen their vagina before. Because I want to be a human toilet so I lie down. The BDSM mistresses they on top. They take off their underwear then I can see their vagina so they can urine on my mouth. For this thing, I not so OK with my wife to do that. Only this thing. Because I don't want other men to see my wife vagina. So this one I not so OK. Other punishments that is actually OK with me. Only the urine part. If the slaves want to drink the urine part, OK but they cannot see. Then my wife urine on the bowl and then let the slaves drink the urine but cannot directly from the vagina then urine. Because like that, the slaves can see my wife vagina. For this part answer cannot. The rest OK. No problem. You like Mistress Luna's tattoos is it ?
Actually I prefer women with no tattoos. The first time I see Mistress Luna. Wah. So many tattoos. But tattoos nevermind. Tattoo the thing no problem. The thing she is beautiful chiobu. That is the most important thing. So if she is beautiful chiobu. Even if she got tattoos, that doesn't matter. And I say many times before on my Telegram chat group, I like the way she punish me. I like the way she humilate me. I like the way she torture me. Because when she torture me, she show with no mercy. Thats why I like it. Not because after you cane me right then I scream in pain then you start to cane us very soft or whatever or you stop canning. No. Even though I very very painful. Don't care. Just continue cane. Cane as hard as you can. Don't show mercy to me. That's what I like about her. Because the way she torture me. I very very like. Is it because you stress earning money to feed whole family That is why you go and find BDSM mistresses ?
Stress whole family. Thats why I find BDSM mistresses ? Answer is No. I don't think that is the case mah. I told you before already. Its because of Loh Jia Hung. After I lost the fight to him, I suffered brain damage. That is why I go and find BDSM mistresses. Not because I feel stress to feed my whole family. That is not the real reason. The real reason is because of Loh Jia Hung. Because he made me feel low self esteem. He made me got depression. After I low self esteem, I got depression. That's why I go and find BDSM mistresses to ask them to torture me. Why haven't you ended friendship with Wen Loong yet even after all he has done to you ? and all the bad influence he has on you. Why do you still keep him as a friend ? I will argue that he has done things worse than any haters. Would a good fan make you lose your vessel job ? Would a good fan kick you in the stomach and constantly talk shit about you ?
First of all, I add him in my chat group doesnt mean I treat him as a friend. You misunderstand. I felt he is rather entertaining. Got people say he is irritating. But I felt he rather entertaining on my chat group. Sometimes my chat group can be quite quiet. He is quite entertaining. I don't really treat him as a friend anymore. I just add him for fun. For fun only. Not because I treat him as a friend. I never go out with him anymore. Vessel job, I got ask him. He say he is not the one who sabotage me. He admit he got talk to OE Harvey to scold OE Harvey that time December. That time I still working for vessel job after he scold OE Harvey. Few months later I was being fired. All OE Harvey tell me is because of some videos. But never tell me what is the video. I ask Wen Loong is it because he sabotage me. He tell me he is not the one. He tell me he never go and send any videos to Harvey whatever. But December, he admit he go and scold Harvey but it didn't affect my vessel job. I never treat him as good friend anymore. You really misunderstand. I just felt that he provided some entertainment on my telegram chat group. Sometimes I work, I eat the popcorn and can watch free show. Not because I treat him as a fan. You can imagine. Can eat popcorn. Like watching a movie for free. So many entertainment provided by this guy. Are you a pretty boy ?
I know I am a handsome man. But I am not sure I am a pretty boy. Because I am a 帅哥偶像。本土天王。帅哥偶像. Handsome Yes. Pretty boy I don't quite understand the definition. If new mistress punish you look toilet bowl how ? She already clean it.
First of all. No need to clean toilet bowl. The toilet bowl can have urine stain. If the BDSM mistress want to punish me lick the toilet bowl also can. Yes. Yes. Yes I think this will be a very very great humiliation that will make me feel very very high. This is a great punishment. Likely I will enjoy. So no need clean one. Dirty also can. Are you scared of drawing blood at clinic or hospital ? You can tahan the pain ?
That one should be OK. I try before. I can't remember for what reason but its not painful. Because when they draw blood, they put the needle, only when they poke, its a bit pain but then overall its not so painful.
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to kurt_tay [link] [comments]
2023.06.04 07:55 alevel19magikarp Is mental health a luxury/privilege for the well off?
With increase in mental health awareness + increase in economic inequality we need a GP discussion about this! Me poor so will give the supporting points. Feel free to evaluate my points and give opposing points!
In the Maslow pyramid the physical needs (like food/shelter) are the most basic. Good mental health is only possible if basic needs are met. Poor people/families struggle to meet basic needs so lack time/energy to work on their mental health. Struggle to meet basic needs causes stress/anxiety (poor mental health) and is also linked with social problems (like broken families and crime) that cause poor mental health. Of course rich people can also have broken families or commit crime but point is they can care for their mental health because their basic needs are met.
Fees for mental health service/treatment are very high because demand is far more than supply. Got gahmen + community schemes to make physical health medical service/treatment cheaper (like Medisave/Medishield or charity TCM clinics) but limited similar schemes for mental health. So even if poor people want mental health service/treatment they cannot afford it and kena higher opportunity cost especially risk of losing their job. Unlike rich people with savings who can take sabbathicals and easily tahan if insurance kena rejected or higher preniums.
Last time poor people who can meet basic needs can lead simple happy life (good mental health) but now much harder as society becoming more complex with new challenges. Growing up in HDB I like to stroke community cats + play football with other children + celebrate festivals with neighbours which all improve my mental health. Now me + family + neighbours got longer school/work hours while everything goes digital (especially with pandemic). Pandemic/inflation = new challenges to meeting our basic needs and we struggle to preserve our way of life in a more liberal society. In other countries climate change damages crops and destroys livelihood of farmers.
The pandemic increase awareness about mental health but most mental health activitism is from well off people so most of the mental health coverage/discussion is focused on mental health issues of well off (at least middle class) people. For example academic stress from too much tuition/enrichment (which poor people cannot afford) + LGBT issues + pressure from Western/social media. In contrast mental health issues of poor people (like stress/anxiety from struggling to meet basic needs + loss of way of life + kena elitism/abuse from the more well off) are neglected.
EDIT: Thanks for all the points (and some evidence/feedback)! Feel free to disagree with me as long as no personal insults. I'm learning a lot from this discussion so keep it going!
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2023.06.04 06:19 TheSleepyVin [RANT AND STORY] A boy who wasn't love by all living things.
These few days I been ranting, I hope nobody will bash me with words. It's okay to read my rant just don't push me down further as I don't even know how to lead in life with a smile, My heart feels so stigmatized, tight and heavy. Being born shortly after by my biological mom, some unverified reason happen between my mom and dad leads to divorce. I was very young back then, probably 3-5 years old and I can't talk as I have not yet learn how to, suddenly as this point of time writing this post, I can't believe how much time has passed, the last time I was a child, I felt small, my hands, legs, and there are less things I know about the world, I wasn't so upset or so depressed, but something wasn't feeling right, that love and emptiness I felt, even though I can't describe how it feels back then but subconsciously I miss my mom so much, I have only a memory left of my mom that before she abandoned me, my dad bring me to visit my mom once in awhile, ok very attached to my mom and would hug her everytime I see her. Even though like I said I can't speak, I enjoyed spending the short time with her at her house with my grand mother, I can no longer remember their faces, I know my mom was a very pretty lady wnd petite lady though she was short. She would buy DVDs something that genz won't understand, of Pokemon and digimon animes but back then I don't know it's an anime _(..)/ I could sit at the bedroom on the bed watching peacefully, I don't know what the story in Pokemon and digimon was about back then but the memory remains there till as I grow up with understanding of Pokemon I know what was the thing of memory I had. The two things I remembered was that Bulbasaur refused to evolve even though his species has all evolve, despite Venusaur wanted him to do so, he was so attached to its trainer and that love force him to remain the same which I do not know why maybe the fear to be no longer the same identity? The another was whereby ash, misty, Brock was put into sleep by Gengar and they saw a giant gengar and Alakazam was fighting, but when they touch Gengar or it ate them they fell into his stomach not dead as of they're inside a giant jar, I also remember my grandma bring me to her work place which was primary school but everytime it was emlty, filled with no students maybe because it's weekend? I don't know but when I was with her, I would just run around the canteen while my grandma cleans the canteen, it was so nostalgic, life was so simple back then. I don't need to care anything else.. it was a very simple and sacred love I had from then, but looking backwards, it was a just call before the storm. Everything bad starts happened, before I notice I no longer able to see my mom and grandma again, I was sent to different of my mom I think from my dad but it was just a short time, and I was constantly move from one place to another, but of course the reason was because nobody want to for free especially without money, fast forward that my dad married another woman, and that was really the nightmare that soon to begin, although when I was told to call her mom, it will never ever replace the love I had for my biological mom even though her love for me and the time spending her was short. As I was growing I will always ask my dad where's my mom and he know I was referring to my biological mom as I was very attached to her. I miss her and I know she will never come back but a child I do not know why and I just only kept missing her. That woman that my dad marries brought me to her family, they are a very traditional kind of mindset family and sort of rich, well selling fishball noodles till able to demolish and rebuild terrace house ya over the last few years and I was living there since then till I'm 12 years old. Moving to my dad's house was the hell period and start of the nightmare, always constantly I get beaten up by canning all over my leg and body, forcing to stand for 2 hours because I was too stupid unable study well. I remembered now suddenly that I was force to keep memorize English words for 2 hours sometimes and while crying and standing I had to repeat the words that I am learning for, spelling test often has in school that's why*
Fast forward to secondary school a new school for me, at age of 13/14, lost my previous friends as they went other schools because I wasn't staying at the woman's family house anymore which was nearer to my previous school. Orientation of the school day which is first day, my days of being bullied starts, was bullied by my group of Malay classmates, and I got angry but I cried while angry that is why the bullying continues for 3-4 years, each time I angry, I'll cry at the same time even when I'm angry. There was once my entire school books in my school bag was thrown into the dustbin according to the teachers and couldn't be found. It will be funny, like who even bring entire year of school books? Yup that's me, that woman wanted me to bring and I hate to bring or put it in my bag. I wanted to make friends with my classmates, even those female classmates but I do not know how, like 13 years old kids nowadays knows how to use iphone and I don't even know how to say: May I be your friend, because this doesn't exist in my brain, which I do not know how to even say or what's sentence so the only way to get their attention was by running around in class, and running to slam myself into the wall, pulling girls hairs to get their attention, it's kind of childish, but what to do? I literally don't even know how basic gestures works. Another reasons why I can't express myself properly was also because of my ADHD symptoms and back then I was very very hyperactive! for my school life, can't go anywhere after school and only home and I only can study at home, there's nothing for me to play and it was very bored as I can't sit still, it feels like a prison especially when holiday comes because I can never go out to play. Although I dislike that woman but I like her mother, she's the only one who will pamper me, and often I go back with her to that family house when I was at the hakwer centre, well they're selling fishball noodles that's why. Always when I wanted those toys from capsule machine, which cost a dollar, she gave me but when that woman knows I always get scolded for asking people to buy for me things. My classmates sometimes ask me why does my legs are full of blackmarks but I was scared, I do not dare to tell them that it was because that woman canes me almost everyday. Something causes my parents to talk to my school counselor because of me getting bullied in school everyday and that was a huge alarm as when I get bullied I would scream to the extend almost the whole school would heard and teachers has to come out of the office to look what's happening, my school counselor advise my dad to bring me to see a psychologist I think which is at child guidance clinic and also a time table where by I can go out 2-3 days, but when I was late on of the days when I called that woman, as my dad was busy driving taxi. She threatened me in Chinese that when I go home I will know what happened, terrified of that I dare not go home and had to sleep outside my classmates house which is at the stairs for 1 night, that woman made a police report not because of me lost but because I didn't return home to get beaten by her. Police didn't understand me either and there's no child protection law back then so I only can constantly get more beatings, as mentioned for going to child guidances, I was given to do IQ test but, of course they didn't tell me and till now I don't even know how high is my IQ level but more importantly my dad and that woman just wanted that medicine as they thought it will call me down even after getting beaten, everytime I get beaten and my anger and fear reach broke I will cried and lost control of myself and when one day I decided not to eat anymore they stop bringing me to see doctor because it can no longer control me. I was given only $4 a day, but my classmate who pity me will bring me out after school to lan cafe to play computer with my other classmates, a group of 5 including me. My dad and that women eventually found out and also knows that my school has a system of giving food coupons and that made that woman make her next move by reducing my pocket money to $2. I forgot to mention too, with my medical condition I was unstable in my mind and emotions but they seems to have a habit of further scolding, beating, and agitating me further and alot of times I only can cry in fear against them in the house as there's no other adults there to protect me. This fear letched on to me and made me very very negative, lonely, till today. Alot of times I wanted to find ways to (sui side, wrote in this way to avoid using sensitive words) there was once in army (19 years old) I went and bought a box of Panadols and swallowed 15 -18 tablets but I somehow knew it wasn't enough or deadly to end my life, ended up me seeing medical doctor at the airbase I was in and went to hospital to have IV drip to also flush out the paracetamol, ever since them I no longer able to take Panadol or tablets with similar taste and size due to allergic or the the featrauma of my body subconscious.
At the end of the day, during my entire growing stage life from child to adult, my brain devloped twice as slow than everyone my age and even till today there are some things I may not understand which sounds complicated to me or I'll never understand. I didn't have a normal love life either having girls comes up to me telling me they like me or me confessing to girls I like because I don't even know what's like and love, there was a girl I like and everytime she saw me she would wave to me, she's from a different class as she's smart, probably express or normal acad and is a sort of student council, a contemporary dancer in her cca, I subconsciously like her back then not know that. I always envy others when I walker pass those children with their parents who bring them out or when I sees them so happy playing or interacting with each other. I could only ask my self in my heart, why am I so different and why I couldn't have what normal people haves. Things that are worse is when I see baby or young child cries, my heart start to beat fast and I start to become Abit distracted and uncomfortable, maybe emotional because of the trauma I got child abused. I always sees many girls confessing to my classmate and his younger brother, envy that why so many girls like them, like felt they're so cool enough for girls to approach them be it irl, or online through Facebook. I guess the most depressing and unpleasant moments was I constantly sees girls going to their house to get **** by my classmate's brother, and I knew those girls like them but to him it's just flings, I felt so engioue everything in my life I'm opposite of what normal humans are, and all these experience and memories letch on to me till today made me unable to express or communicate well with people, I feel very lonely, especially after whek my ex classmate and his family treated me so badly, as I was degraded for not working, and saying my medical condition is nothing compared to people with autism and disability like having no hands and no legs, I was also compared to Michael Phelps through my ex-classmate brother, when I have no money I was treated badly and look down on, especially when they buy food for me and then proceed to say those stuffs towards me but when I have money they became so friendly, they made me left my dad's house which give my dad to tell me not to go back his house anymore as he was planning to "sell his house to buy a smaller house" due to debts. My classmate doesn't bother how I felt or my situation, because they lost job during covid period so asking me to rent there would help them have some cash, fast forward to 1 year ago I was rushed by them to get out of their house we one or their siblings coming back from oversea with his wife. I have no one else so I have to apply for a shelter from social workers, and when that extend from November to December till today they demand me to pay $300 when they knew I have no money even when I'm planning to study. Last few weeks because if that I started crying and got very uncontrollably depressed, I realisi that one of the reason because of them that made me depress and affect my behavior and life was because of them. My dad doesn't talk to me for 2 years and suddenly he message me to wish my birthday wish last year but realized he wanted to borrow money from me. Many people told me just let go off the past but how many actually knows that it's easier said than done, basically like a heavy chain are anchoring to me. Nobody knows how it feels to be alone in this entire world, having no one to be there with you be it, the time where I'm happy, sad, having surgery, suffering and crying alone. Even though I can't end my life because of fear and lack of beavery, I'm living a life of monochrome just to wait for me one day to leave this world be it old, sickness, or accident. I really hope one day I will be free from this anchors of pain, fear and grief.
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2023.06.04 05:46 ProposalEcstatic3944 Sweet Dog Needs new Home Grand Bay, Alabama
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Original post below from rescuer Regina.
Hi, this is a very hard post for me to write because I have been fostering this sweet girl for some time now. I can't even remember for certain because my children and I have been through so much the past ten years. The exact date, even year, is hard to recall. But it was around 2018 or 19 that I discovered this beautiful lady being abused and neglected by her owner in my neighborhood. She was chained to a small deck with no shelter, and I never saw any food or water as I walked by daily. Her owner even tried to run over her with a car, stating she just didn't like her as the reason. She was so skinny and malnourished, and she still has a scar on her throat where she broke free of the cable tied around it. After my very nasty separation from my kids' father, and the death of my own, I moved in with my mother. She knew I was rescuing dogs, and she forbid me to bring any to her home. Rescuing was something I couldn't just turn off though. My heart went out to the masses of neglected, abandoned and abused dogs out there. I never registered formally with a rescue organization because, as previously stated, my mother had forbidden it. But they seemed to find me. Wandering into my yard, one even flew out of a truck that flipped three times on the interstate while I was shopping for campers, which I hoped to make a temporary home of for my kids and me. My home was uninhabitable for us. But when there was no other choice, rescue intakes closed, and a dog either had to continue being abused and neglected or face euthanasia, it worked as a safe place for them. My neighbor allowed me to run an extension cord for heat or air-conditioning, and I went over three times a day to feed and walk them. One day, as I was over tending to another foster, this girl came over for probably the fourth time, bleeding, again, from her neck, and overjoyed to see me as I always gave her pets and treats. Something she never got from her owners. I kept hearing my mother's voice saying "do not bring anymore dogs here!" In the back of my mind. But I couldn't continue to ignore that she needed me. The county wouldn't even come out to do a well check bc she had no history of aggression. I managed to talk the owners into surrendering her to me, as I had spoken with a lady that said she would happily take her if I was able to get her. However, once I met her, I found that she also planned to keep her chained, and was unable to handle her anyway. She was disabled and could barely walk. This girl, having so much boundless energy, would surely be too much for her to handle. She also could barely afford to feed herself, let alone provide vetting and food for this bottomless "pit".😅 So sadly I had to decline this adoption. She stayed at my old home for about a year, until I insisted she had to come home with me to my mom's. She wasn't happy, but she knew county was out of the question as they are still a kill shelter. I have attempted to adopt her out a few times since then. One inquiry turned out to be from a dog fighter. They thought I didn't know. Anyway, Big NO! I drove about four hours away to meet a lady who, unfortunately was hoarding pitties in a small hotel room, and was incidentally giving birth to a new baby when I arrived. My instincts told me this was a very risky situation. Another interested party had a trial for one night. I told this person this dog must have a fence or be leash walked, as she is reactive to small animals. He agreed, but waited til I left to try his luck with letting her free roam in a highly populated area in the city. So I went to get her back, knowing this couldn't possibly end well. It seemed she might end up staying, as I was absolutely mentally exhausted from all the failed attempts, and from being cursed at by several others who failed to pass adoption criteria, which included vet checks, character references, evidence of ability to provide adequate care and safe environment. I have taken some time off from trying to adopt her out. Keeping her just seemed easier and safer than continuing to try to adopt her out. It seemed so unlikely that I would find a suitable adopter anyway, with so many desperately needing help. But recently, my health has gone downhill. I have been managing, but having been diagnosed with spinal stenosis and pancreatitis, along with being a full time mom, and caring for my mother, whose health has also declined drastically, it's becoming increasingly more difficult for me to keep up with the demands of caring for her. I've been tired before, and experienced burn out. But this is something entirely different. For the first time, I'm seriously afraid that the day is coming soon that I might not be able to tend to her. I am having more and more trouble walking. And she has so much energy, she desperately needs to be walked and played daily with to keep anxiety at bay. She is such a sweet girl, and has responded well to training. She is in good health, and the thought of her ever going to the county kill shelter terrifies me. But I fear that one day in the near future, I may have no other choice. As I said, I am managing. It is painful many days, and some days I am literally going on autopilot with no regard to my condition. I will continue to do my best to care for her as long as she needs me. But have decided that, in order to avoid the possibility of having to send her to a shelter where she will most likely be euthanized, I need to put forth my best effort to find her a loving home. She is spayed, and as mentioned previously, has had some training. She responds well to cues when I am able to consistently work with her. She loves to snuggle and give hugs. She even likes to dance with her paws around my waist. She loves kids too, but should be supervised as she does get excited and jump up for a hug. She loves to do zoomies too, and at times will forget herself and crash into her person. Very manageable, tho, by a strong healthy person. Regular walks and engagement help with this anxiety induced burst of energy tremendously. She has been sleeping in an air conditioned kennel, with lots of room in a large fenced yard to roam. But what she truly wants is daily walks and playing, and to be inside snuggling with her person. If you have experience with pit babies such as this, have no small animals, and can and will give this sweet girl the life she deserves, please message me. Please be prepared to offer vet references so that I can ensure that she is going to a responsible person. I am ok with self care such as holistic care and self administered parvo vaccines. But I would need to contact your vet to know that she will be vaccinated for rabies and that you are a responsible and loving pet owner. Also, you and your family must be able to keep her environment calm and without chaos as it is a trigger for her anxiety. I know it sounds silly, but I would also need to know that she chooses to go/stay with you to ensure that she will be happy with this transition. Preferably someone nearby, or I am willing to travel and spend a couple days letting you get to know her if you are willing to allow me to see where she will live. I don't care if you're not a great housekeeper. Or if you live in an apartment so long as you have time to walk her. I will not let her go somewhere she is not happy tho, or at risk of encountering and harming another pet. My ultimate goal is to get better. To possibly have surgery for my back, followed by physical therapy to regain strength, to control pancreatic flare ups through diet modification. And assuming I am able to make a significant recovery, I hope to get even more serious about rescue and go on to save many more lives through training and education. I am actually hoping to be able to attend school for training, become certified at a behavioral specialist, and, at some point, provide training to shelter dogs to increase adoptability, as well as to aide in their success post adoption. For those if you who don't know, one of the number one reasons dogs are returned to shelters after adoption is lack of training. And for those of you who do know, you are well aware of how essential training truly is, primarily for large, strong dogs such as pitties, and what a game changer it can be for them. Thank you for reading. Again, I am located in Mobile, Alabama. I promise, if you are qualified and looking, this could be your next best friend! I have never know a dog to more loyal or loving!
Point of contact https://www.facebook.com/regina.dunklin.50?mibextid=LQQJ4d