Half 20 mg adderall drug test

Hey guys! I have a new VG2-540 (It's only 2 and a half years old) and when the warranty went out we almost immediately lost the yellow/black head to voltage issues and massive overspray. I replaced the head and everything was fine, but today I'm having the same issues as before. This makes me wonder if it was a head issue at all, so I'm here to ask if anyone knows what's going on here.
Spot black (100% k) will start printing just fine, but as the prints go along the head will start misfiring worse and worse until about 20 inches in it looks like something out of a horror movie. The overspray goes in both directions. Restarting the print just does the same thing. Pausing and waiting in the middle of the print stops the overspray until it builds up again. Crop marks print perfectly, test prints and calibrations all print perfectly.
So do y'all think I fried two heads in under 3 months or is there something else I should be looking at here?

I have advice for new plasma donors who may be considering to try it out and earn extra money:

• Plasma is 92% water and the rest is mostly protein elements.
• The plasma is separated from your blood and your red blood cells are returned to you in cycles.
• Per FDA regulations, you're only allowed to donate plasma twice in a 7 day period, with a 48 hour wait inbetween those two times. Don't risk your health by hopping around to different plasma donation centers to circumvent these regulations, and you may get caught if you do.

1. Eat a meal high in protein 2-3 hours before donating, but your plasma protein levels depend on what you ate the day before.
2. Drink plenty of water and/or non-caffeinated juice before donating to stay hydrated.
3. Avoid caffeine such as in coffee or soda before donating or you may get nauseous and vomit or faint during your donation.
4. No alcohol 24 hours before, and for a little while after donating.
5. No exercising for at least 6 hours after donating as it can put too much stress on the vein.
6. Some people get away with smoking or vaping nicotine before and after donating, but it's recommended not to for 2 hours before and after. The nicotine can raise your heart's pulse rate.
7. If your pulse rate is 100 or above, you'll be able to do a vitals retake after a 15 minute wait. But if it's 100 or higher again you'll be deferred for the day. If your pulse rate is an issue, listen to "Pink Noise" or "Green Noise" at a low volume before donating which may help reduce your pulse rate, along with its effect on lowering your blood pressure.
8. There is a risk of getting a blown vein if the worker is having a hard time finding your vein when they're sticking you with the needle or if you have small veins. You may get deferred until your vein heals if that happens. But it's ok, your body is able to regenerate your veins with a process called Angiogenesis.
9. There is a risk of blood clots, but when your blood is constantly moving through the machine it prevents that from happening.
10. You may be subject to drug screening. The drug screening tests for methamphetamines, cocaine, and heroin. Certain pharma prescription meds may show up as a false positive so you'll want to let the plasma center know what meds you're taking. Testing positive for these drugs can result in a permanent deferral from donating plasma.
11. A sample of your blood will be drawn periodically to test for certain sexually transmitted infections (STIs). A positive test will result in either a temporary or permanent deferral from donating plasma. If you've ever been diagnosed or received treatment for HIV/AIDS, Hepatitis B (HBV) or Hepatitis C (HCV) you will be permanently deferred from donating plasma.'

Donating Plasma with Managed Diabetes
Individuals with well-controlled diabetes can contribute to plasma donation, but certain criteria need to be met:
Absence of Complications: This means no existing diabetic complications affecting your kidneys, heart, blood vessels, or eyes.
Insulin Independence: If you rely on insulin for diabetes management, a three-month waiting period is required after using needles for non-prescribed medications. Additionally, you must be free of symptoms or treatment needs related to blood sugar fluctuations (high or low) for the past three months.

1. Healthy Feet: Active foot ulcers requiring medical attention will disqualify you from donation.
2. Steady Balance: You shouldn't experience dizziness or lightheadedness upon standing.
3. Type 1 Consideration: For Type 1 diabetics, eating within two hours of donation is mandatory.

• Wait a few hours before taking the bandage wrap off of your arm after donating.
• It's recommended to use Vitamin E oil/Mineral oil on the needle site for the puncture area to heal better. A Q-tip can be used to apply it easier. I simply dip the Q-Tip in the bottle, but never dip the used cotton back into the bottle.
• Frequently donating over a prolonged period of time may lead to your body having decreased vitamin D levels.
  
• Red meats are particularly high in the protein vitamins and minerals found in plasma.
  
• Personally, I take a Now brand Vitamin D supplement that contains vitamin D3, Calcium, Magnesium, and Zinc. But I only take a half a dose, 1 gel capsule instead of 2, since I get these from eating meats and other foods as well. It's bad for your health if you take too much of these vitamins and minerals over time. I also take an Iron supplement. I also drink a protein shake before donating. Just to be safe.
  

Link to download app:
https://rewards.cslplasma.com/referral/referral-unique-code/eyJkb25vcklEIjoiMDBEMjNEVSIsImNvZGUiOiJaVUxNSFhYVkNCIn0
CSL Plasma: Get 5,000 iGive Rewards® points ($50) after five donations for new donors! (Plus new donor money) Using the CSL Plasma app! Code: ZULMHXXVCB Thank you!
Code: ZULMHXXVCB

I got an interview for a pharmacy tech in Kentucky! I quit smoking cannabis around a week and a half ago. I was wondering what kind of drug testing they do, oral or urine. Also! Do they do it at the interview or orientation. Thank you in advance!

Did they profit billions? Yes, especially because so many vaccine doses were produced in so little time. They also profited billions off of stuff Joe Rogan used:
Joe's "anti-big pharma" cocktail:

Medicine	Big Pharmatm Producer
Ivermectin	Merck
Azithromycin	Pfizer
Prednisone	Jubilant Cadista
Monoclonal Antibodies	Roche

Joe took monoclonal antibodies. Like the vaccine, these were released under EUA. Guess what?^[1]

The invasion of mAbs in new medical sectors will increase the market magnitude as it is expected to generate revenue of about 300 billion $ by 2025. In the current mini-review, the applications of monoclonal antibodies in immune-diagnosis and immunotherapy will be demonstrated, particularly for COVID-19 infection and will focus mainly on monoclonal antibodies in the market.

300 billion dollars. The expected profits are enormous.
What about the price of Ivermectin?^[2]

The cost for ivermectin oral tablet 3 mg is around $94 for a supply of 20 tablets, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.

And:^[3]

Nowadays, ivermectin by its own has produced sales greater than US$1 billion/annum during the past two decades

A billion per year. During the past two decades. That's 20 billion dollars. Vaccine sales have obviously plummeted in the mean time now that demand has plummeted as well. As was always expected. The profit profile is different because you're selling incredibly large quantities in a short period of time rather than smeared out over decades.
[1] https://pubmed.ncbi.nlm.nih.gov/34958012/
[2] https://www.drugs.com/price-guide/ivermectin
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835698/

Okay, so this might be rambling, but here goes. I'm 37, late diagnosed ADHD, with suspicions of other comorbidities. I've been taking a combination of Bupropion (currently 450 mg a day) and Sertraline (200 mg a day) for almost 2 years now. It helps for the most part, and I have low dose Xanax for the hardest days.
I've had slight dizzy spells for as long as I can remember, but in the past few years(starting before they added the Bupropion and upped the Sertraline) I've been getting dizzy/lightheaded, pre-syncope, and collapsing. Not fully passing out, just collapsing, for the most part. I have had 2 instances where I lost consciousness, but as I was alone when they occurred, nothing doctors can substantiate.
Most recently I've noted at least according to my smart watch, that my heart rate drops during these episodes. My hands get this odd tingle sensation right before/as it happens, and it drops into the low 50s- high 40s. I go to the doctor regularly, have had blood tests done, an ECG, and a CT scan and all come back negative/clean.
I'm currently wearing a heart monitor for 2 weeks, almost at the end of that period and had an EKG, which I still don't know the results of.
All that said, has anyone else experienced this sort of thing as a long term side effect of these drugs? I know the higher the dose of Sertraline the closer to the seizure threshold, could this be part of that? My doctors know about all my meds, so if it's a reaction, they'd know and change the combination, I'd think? If anybody has had similar experiences or can shed light on anything, I'd really appreciate it!

Hello: I had started taking kratom around thanksgiving 2023 and last Friday I had a seizure. I had been taking it for anxiety after a long day as I am a medical student and my friend told me it helps with it because I didn’t want to drink alcohol as it’s harder to be focused the following day. I do take citalopram 10 mg every morning. I was taking the red maing dah but recently tried the white and green. My dose did start getting high. Then two fridays ago I had a seizure and my mother found me. What concerns me is the er doctor told me I tested positive for fentanyl, heroin and cocaine. I think the brand is okay as it has a website and everything and looks legit and I had been drug tested several times in the past year due to hospital requirements for doctors and always negative. So at the ER I told the doctor I took the kratom and he was 70 and didn’t know about it and then came in with my urinalysis while I was with my mother and said I tested positive for fentanyl, cocaine and heroin. My mom and I were shocked as we had been traveling together the previous day and had spent the morning gardening with her. I’m scared that this stuff was laced and was close to dying or hope it was more likely a false positive. Obviously I stopped immediately which I would have done with the seizure any ways but just curious if it’s possible a popular brand could be laced? Thanks and appreciate your info!!

Hi all, a friend’s life was turned upside down after she felt a popping sensation in her head. The night before, she attended a concert involving SUPER loud music, cocaine and molly. She was very active and outgoing before this incident, and now she can barely leave her house.
Personal info: 28f, 5’2, 150 lbs Non smoker non drinker for 2 months / previous smoker & drinker
Medical history: Phyllodes tumor of breast, benign & removed in June 2023
Current meds: 60 mg propronal, & 20 mg amitriptilyne, fish oil omega 3, & magnesium twice a day
Symptoms, tests, treatments in her own words: “In November of 2023 I ran myself into the ground & felt really faint one morning after a night out. I felt a pop in my head induced by stress 1 day after while I was working. A really bad headache then followed with symptoms of vertigo, nausea, panic attacks, extreme sensitivity to light, astigmatism, poor memory, speech impediments, and the inability to drive or be in public places. I quit drinking all together, cut out coffee, cleaned up my diet, limited screen time, and have made a lot of progress since… I’ve seen all types of doctors, have done multiple MRIS with & without contrast, blood work, am currently meeting with a neurologist who has had me try all types of medication. All of the tests came back clear and I’m currently taking a beta blocker to help with the panic attacks as well as a very low dose of anti depressant & both have helped a little bit imo. I also take fish oil omega 3 - & magnesium twice a day. What’s driving me insane is the pressure & buzz like feeling in my head that will not go away. It feels like my ears need to pop but it's in my crown followed by constant tinnitus. I’ve become extremely depressed by all of this and am at the point where I don’t really see any way out so am willing to try anything. At this point we're calling it vestibular migrane but I am still uncertain as to what I am dealing with.”
Does anyone have any ideas about what could be going on, or what steps she should take next?

I am a male 20 yo , i had a one night stand with a trans girl from grindr (my first time) i received unprotected oral sex and had insertive anal (i used a condom) , since i went back home that night and i am anxious and stressed if i caught hiv , i have no symptoms but coated tongue and its been 4 weeks and half , i already got coated tongue before since i am a heavy smoker , today i did a 3rd generation antibody test and came back negative ive read that it can detect up 95 percent after 4 weeks from exposure but i am still anxious , any help nad information please

I am a male 20 yo , i had a one night stand with a trans girl from grindr (my first time) i received unprotected oral sex and had insertive anal (i used a condom) , since i went back home that night and i am anxious and stressed if i caught hiv , i have no symptoms but coated tongue and its been 4 weeks and half , i already got coated tongue before since i am a heavy smoker , today i did a 3rd generation antibody test and came back negative ive read that it can detect up 95 percent after 4 weeks from exposure but i am still anxious , any help nad information please

Posting here because I need help/advice. I 28f have been with my bf 27m for 5 years now. My bf has difficulty holding down jobs. He was always looking for something better which was fine. However last year he quit his job and took on drinking and taking edibles daily. It’s embarrassing to admit but I stayed thru it all. He used insta cart and doordash to make his monthly bills but it’s not enough. I’ll pitch I here and there to help with his car payment. I’ll break down in bullet points bc i don’t know how else to tell my story.
Holidays: For Christmas I bought his family gifts and had him say it was from both of us. I knew they were getting us gifts and I didn’t want to get something without giving them something?? None of my family knows how bad it is. I’m really close to them and I just brush things off. I lied and told them he finally found a job but he hasn’t. I didn’t get a Christmas gift. But I gave him money. He took me to a steak house for my birthday. Paid for it. Then asked I pay back for my meal bc he miscalculated and needed the money. He did buy me flowers for Valentine’s Day. I bought us an expensive dinner for his bday. I will admit I like a certain type of lifestyle even if I can’t afford it so I may overspend on things.
Addiction: Recently he lost his wallet which meant no Id which meant he couldn’t go to the dispensary or buy alcohol. He ended up finding his wallet but I offered to hold onto his id. It was going well but one day I left an expired id with him so he could buy a beer. I left and came back 24hrs later and he was drunk at 5pm. He gets overly emotional and depressed when he’s drunk and I don’t know what to do other than comfort him. Before I would say I was going to storm off or leave him and that would send him into a deeper spiral so now I nod and try to appease him.
Credit card debt: I’ve been swiping my card for food and drinks for both of us. He uses my car for DoorDash which means I pay for the gas. Before he quit his job (he had been unemployed for 3 months before his most recent job) he really wanted and oled tv and asked I put it on my card and he would pay me back. He made payments for the three months that he was employed then stopped. He ended up selling the tv it was $1,100 he kept the money to pay his bills and buy weed. I finished paying off the card myself. I’m in such a hole borrowing money in hopes I can cover my ass until the next paycheck. I got a part time job im starting soon which should help me a lot. I make a decent wage.
Financially irresponsible: we went on a trip to the casino (he was still employed at this time) I booked the hotel on my credit card. He ended up winning $5,000!!! The first night there. Want to guess what he did next??? He took copious amounts of edibles and blew $3,000 of it on more gambling. He won another $1,000 and also blew that. With the remainder he bought a pc AND I had to beg him to pay me for his half of the hotel room. He did pay for dinners and lunch while we stayed there.
Promises: he says he’ll pay me back. I’ve helped him make his car payments. I help him with food. He says things are going to change. He paints this really pretty picture that I so badly want to be true. But it’s MAY 2024. He quit his job June 2023. He promised me Christmas he promised me my birthday gifts. All which fell flat. And now I just feel like a fool. He says once he starts working he’ll pay me back.
I’ve been helping him apply to place none call him back. He also can’t pass a drug test currently.
Relationship: aside from the money I think we’re okay? We trust each other we love each other. When we’re together we’re always laughing and having a good time. We get along. On weekends we take turns on who gets to pick the movie. He’ll watch twilight and mean girls with me.
The only thing is when he is in withdrawal or hungover he becomes easily agitated and needs space to calm down. The worst he’s done is raise his voice and so do I. Normally he just needs to walk it off or blow off the steam and things get better. He’ll hyper fixate on something I did and call me out on it. I’ll apologize but he won’t let off of it when he gets like that there is nothing I can say to change things. In my mind if I did something wrong I get it I’m sorry but there’s nothing I can do to change it? But if he lies or does something he brushes it off and gets upset with me for being upset at his lying?! He’s a terrible texter and never answers his phone. If I needed immediate help I’d be out of luck. But I always have to be there for him. Let’s say he’s having a bad day he needs me there and wants me there. I have to drop everything and if I don’t he feels bad and guilt trips me.
In the end what I would like to see is him get clean and sober find a good job so we can buy a house have a family. Right now he is on an upswing where he makes his promises that things will get better and things will change. If things crash again and he fails to find a job I will have no choice but to leave even if I don’t want to. Go ahead and roast me bc I know I should know better but I can’t bring myself to leave him.

The world was a boozy whirl of lights and sounds. Images, broken and fragmented, came and went. Voices, laughter, screaming. The ground pitched like the deck of a tempest-tossed ship, and he felt heavy, as though the ground were pulling him to it. C’mere, Dommy. He fell, lay on the pavement, and pushed himself up again, staggering like a drunk on his way home. His head spun, his body ached, and things seemed blurry, like half-formed images glimpsed underwater.
It was the light blue hour before dawn and Dom was…somewhere. He should have recognized the stores and street signs around him, but he didn’t. His head felt like it was stuffed with cotton, and a sense of confusion gripped him so strongly that he was beginning to panic. Where was he? What happened?
The world spun away again and the next thing he knew, he was lying in a heap of garbage bags, used needles, and rubbish. He came awake with a jerk and sat up so fast that a bolt of pain jammed into his skull. He winced and pressed his hand to his forehead. He felt hot, clammy.
Something was seriously wrong.
Somehow he got to his feet again and started walking. The sun was up now and the streets were filled with people. They all sneered in disgust as he passed, and he wrapped his arms around his chest like a baby comforting itself. He was getting cold. His muscles were sore. Tears streamed down his face and he wanted to cry.
Going on instinct alone, Dom made his way back home and climbed the steps to his apartment. Exhaustion swept over him and he sagged against the door as he dug in his pocket for the keys. They shook in his hand and he had to focus really hard to get the key into the lock.
Inside, he collapsed onto the couch and his eyelids instantly drooped. He was so weary that he couldn’t lift his head, couldn’t form a single coherent thought. Dom felt himself starting to sink, and snapped his eyes open with a start. Something in his soul told him that if he slept, he would die.
He couldn’t help it, though. He was falling, tumbling, hands reaching up from hell to grab him. His eyes fluttered closed again and the world started to go dark, his heart slamming in fear. He tried to fight, but the pull of darkness was too strong, too alluring. Why was he fighting? Why not just…give up? Hadn’t he thought of killing himself before? Didn’t he hate his life and himself? What was there to fight for? A wife? Kids? A community that loved and respected him? Shit, affordable groceries?
No.
There was nothing.
He had nothing and was nothing.
A sense of peace blossomed from the darkness, and suddenly death didn’t seem so scary. In fact, it was warm…inviting.
It was life that was cold and hateful. Not death.
Death accepted you no matter who you were. It didn’t reject you…it didn’t ignore you. If you sought it, you would find it, and if you embraced it, it would embrace you.
With that thought in mind, Dom gave up.
And died.
***
Bruce Kenner, captain of the 5th Albany precinct, sat behind his desk on the morning of June 28 and lazily leafed through a stack of files as he sipped from a mug of coffee. A roughly built man with a dark goatee and graying blonde hair, he looked more like a small town southern sheriff than a low level public works functionary. In fact, he tended to act like it too. He liked to hunt, fish, and drink beer on his off time. Albany wasn’t a big city, but it was big enough that you never got a fucking break. Run here, run there, arrest this asshole, investigate that asshole. By the time Friday rolled around, he was so ready for the peace and tranquility of a fishing trip he could taste it.
Already this Monday morning, he was looking forward to another one.
Over the weekend, three kids went missing in the Pine Hills and Washington Park area, bringing the total for that summer up to eight. All were teenagers, all were troubled. Most were boys, but two were girls.
Troubled kids run away all the time. They might be gone a few days, sulking at a friend’s house over something their father or mother did, but they’d eventually come home. None of these kids had come back yet and from what he knew, a few of them weren’t the runaway types. They were shits at school and caused problems, but they had no reason to up and leave. Hell, Bruce himself raised hell as a kid, but he always found his way back home, even if he spent the previous night dying in a field from Mad Dogg 20/20 poisoning.
One or two kids going missing…okay, it happens. Eight? Over a span of four weeks?
Yeah, something was wrong here.
But what?
There was nothing on any of these kids. No one saw them, no one knew anything - one minute they were here, the next they weren’t. What could he or anyone else do with that?. The public broke cops’ balls all the time, but if you don’t have evidence, you don’t have evidence. What do you want? Door to door searches? Roadblocks? Dogs and helicopters? Yeah, then when you actually do it, they cry fascism. Guess I’ll just use my Spidey Senses.
Bruce wished he had spidey senses. He wanted to find these kids as much as anyone, and he was starting to get pissed off that he couldn’t. He took another sip from his mug and read on. The latest kids to go missing were three boys between the ages of fourteen and eighteen.
They were all white, all thin (except for one). If there was a serial killer in town - and Bruce hoped to fuck there wasn’t - he had a type. What, black kids aren’t good enough to kill, cannibalize, and wear like a skin suit? They should charge him with a hate crime for discrimination.
That way he’d actually stay locked up.
The door opened and Vanessa Rodregiez, his deputy, came in. A tall, shapely Hispanic woman with dark eyes and a mouth poised always on the edge of a smile, she wore her black hair in a ponytail that would look stern and severe on anyone else, but on her, looked childlike. She was twenty-seven and had been on the force for three years, but you could be forgiven for thinking her much younger. “Bright and early, I see,” she said with a grin.
Bruce grumbled.
Vanessa held down the fort during the graveyard shift, acting to the night as he acted to the day. She was young and full of energy, which clashed with Bruce, who was old and just wanted to be left alone. Despite their differences, Bruce loved her like a kid sister…an annoying kid sister he wanted to throat punch sometimes.
“You missed all the fun last night,” she said and parked her butt on the edge of Bruce’s desk. He glared at her, but she ignored him.
“Good,” he said. Then: “What happened?”
“Big fight outside of Club Vlad,” she said. “It looked like a WorldStar video.”
For a moment, Bruce was lost. “Club what?”
“Club Vlad,” Vanessa said. “Where the Fuze Box used to be.”
Ah, right. The Fuze Box was an Albany landmark, a night club for punks…or goths…or someone. Certainly not for Bruce Kenner. It was small, dingy, and always had people in black waiting outside. On Friday and Saturday nights, it blasted strange music with lyrics about fighting The Man. Kids had been fighting the Man since before Bruce was even born and they hadn’t beaten him yet. Kudos to them for still trying.
Last year, The Fuze Box closed down and someone else bought it. It reopened last month and looked more or less the same: Posers, shitty music, and spiked hair. So much spiked hair. “Place is still a pain in the ass,” Bruce said.
“Yep,” Vanessa chirped. “It doesn’t know what it wants to be now. One minute they play nightcore, the next EDM. It’s all over the place.”
Bruce raised a quizzical brow.
“Not that I’ve ever been there in my free time,” Vanessa said in a tone that suggested she had,
Bruce gave a judgemental hum.
“Anyway,” Vanessa went on, “you see we have some new missing persons?”
Sighing, Bruce sat back in his chair. “Yeah. I did.”
“People are starting to ask questions,” Vanessa warned.
That brought a terse smile to Bruce’s weathered face. “Maybe they’ll solve it then.”
“Ha, fat chance,” Vanessa said. She got up and stretched. “Anyway, I’m bushed. Here’s my…” she trailed off and looked at her empty hands. “Damn, where’s my report? I just had it?” She turned in a confused circle as if she might be able to spot her report making a break for it. “Huh,” she said. She left the office and came back a moment later holding a folder. “Found it,” she grinned.
Bruce just looked at her.
“Um…here it is.”
He didn’t take it.
Her smile faltered. She carefully sat it on top of the files Bruce was looking at.
And his hands.
“I’ll just leave that right here.” She patted it for good measure.
“Thank you,” Bruce said.
“Okay. Night.”
“Goodnight,” Bruce said as she left through a shaft of morning sunlight. Alone, Bruce sat her report aside and went back to the missing kids. This case was giving him a headache and it wasn’t even nine. With a deep sigh, he slumped back in his chair and drummed his fingers on the armrests.
Was it Saturday yet?
He could really use a fishing trip.
***
Dom came awake in the cold purple twilight with a shocked gasp like a man coming up seconds before drowning. His eyes strained from his sweaty face and his mouth hung slack, twisted in a gruesome parody of The Scream. His mind was muddled, murky - he didn’t know where he was or even who he was, but he knew this,.
He couldn’t breathe.
He opened and closed his mouth like a fish, but his lungs did not fill with air. A great, unseen weight seemed to bear down on his chest, and panic gripped him. He tried to move, but his arms refused to heed his brain’s command. The weight seemed heavier, all over, crushing him like a bug. Confusion filled him and he started to pant.
Without warning, his bowels and bladder loosened, and horrible wetness filled his pants. He tried to sit up, but his body felt like it weighed a thousand pounds. His chest rose and fell with the frantic labor of his breath, but his lungs remained inert. A cry of fear bubbled up inside of him, but escaped his mouth only as a breathy groan.
A bust of adrenaline shot through him and he tried to stand, but succeeded only in falling off the couch instead, landing face first against the cold tile floor. He felt his nose crunch, but the pain was muted.
Dom thought he lost consciousness after that, but wasn’t sure. His next memory was of shivering so violently that his teeth clacked together. A phantom chill - perhaps from the floor - had settled into his bones, and was colder than he had ever been in his life, colder even than the time he fell into a snowbank and got lost when he was two. Shudders racked his body, and though he tried to turn over, he was too fucking heavy. It was like every muscle in his body had turned to dead weight. Fragmented thoughts swirled in his head, faint colors in the dark, but he couldn’t put any of them together.
With great effort, he managed to push himself slightly up, but a wave of lightheadedness crashed over him and he lowered his head once more. He stopped trying and simply lay there. Shortly, his eyes began to burn and he realized that he wasn’t blinking. Jesus Christ, he wasn’t blinking.
For some strange reason, that brought a fresh bout of panic. He started to hyperventilate, but his lungs still wouldn’t work. He wasn’t blinking…he wasn’t breathing…what was happening to him?
A whimper burst from his throat and he started to cry.
He must have cried himself to sleep, because he woke sometime later to the most intense headache he’d ever had. It felt like something was eating his brain from the inside out. He was sore all over, and could feel his muscles twitching, as though a thousand living things were burrowing through his body. A cramp shot down his right leg, and the toes of his left foot curled involuntarily. Slowly, his jaw clenched closed, and the muscles in his neck began to strain…then to burn. His panic turned to terror, and Dom wiggled across the floor like a worm, his limbs screaming in red agony and his brain filling with heat. He somehow wound up on his right side, and his arms curled slowly up to his chest, crossing at the wrists like a mummy. He tried to pull them apart, but the slightest movement sent waves of excruciating pain cutting through his body. His knees began to draw up to his stomach, and his fingers clenched tightly.
Cramps and spasms attacked every muscle in his body. He screamed through his teeth and shook, resembling a man in the electric chair as 40,000 volts of justice coursed through him. The pain grew gradually, getting worse and worse as minutes ticked by like hours. Higher, higher, higher - he clenched his eyes closed and shrieked as it became unbearable. Disjointed thoughts flashed through his mind - prayers, threats, curses, Jesus fucking…FUCK.
What was happening? God, what was happening to him? Was it fentanyl? He’d seen videos of people high on fentanyl, and they leaned in weird positions. He didn’t do drugs but maybe he ingested it somehow.
His panic may have returned if all of his muscles hadn’t picked that moment to contract as one. His eyes bulged from their sockets and his jaw unclenched just enough for him to utter a high. Agonized scream that echoed through his empty apartment like thunder.
A human being can only take so much before giving out. When the pain reached a crescendo, and Dom mercifully sank into consciousness once more. The sun rose and cascaded through the apartment’s sole window, falling over his huddled form. Slowly, it tracked across the sky before setting again. As the last rays disappeared behind the horizon, Dom’s eyes opened. The pain of the night before was blessedly gone, replaced by a feeling of numbness - the cool ash after the hot fire. His thoughts were slow and thick like molasses, but he could actually think again. Nightmare memories flooded back to him, but he wasn’t sure they were real. He was lying on his side, his arms wrapped around his chest as if for warmth, and his teeth lightly chattered against the icy chill. He was so cold that he didn’t want to move, but he couldn’t stay here forever. He needed help. He needed…
A shower.
Yeah, a hot shower. That would warm him up.
Gritting his teeth, he slowly sat up, ready for a burst of pain.
But none came.
He did, however, feel heavy. Getting to his feet, he stumbled and nearly fell, catching himself against the counter. His limbs had no feeling. It’s like they weren’t even there. Head hung, Dom tried to catch his breath, but it felt like he wasn’t breathing at all. His eyelids drooped closed and he felt like he was going to fall down. Summoning all the might he could, he shuffled into the bathroom with the stiff gait of an old man. He snapped the light on, and cold, white brilliance filled the space, blinding him.
Leaning heavily against the sink, he gripped the cold porcelain. Suddenly, he was afraid of looking into the mirror. He was sure that whatever reflection he saw, it would be of something else, something monstrous.
Dom lifted his head and faced the glass.
His heart shrank.
The man in the mirror was him but different. His skin was white as milk, lacking all color whatsoever save for the ugly purple patch on the left side. IResembling a giant bruise, it started at the temple and extended down to the slope of his neck, disappearing beneath his T-shirt. He gingerly lifted the shirt, and moaned when he saw that his entire left side was discolored, the purple edged with a puffy shade of pink. His sallow skin clung tight to his ribcage, and his hip bones stuck out so much it looked painful. Back in the mirror, his cheeks were sunken, hollow, and his eyes were a hazy, dishwater gray. His skull seemed bigger, his hair longer. Dom wanted to whip his head away from the phantom before him, to never see it again, but he was transfixed.
There was no way that thing was -
Dom looked away, cutting that thought off before it could finish.
A shower.
He needed a shower.
Slowly, stiffly, Dom undressed, peeling off his shirt and his soiled pants. He dropped them in a heap on the floor and stepped under the spray. He could feel the water pounding against him, but it provided no heat. It was neither hot nor cold. It was simply there.
Dom pressed his head to the slick shower wall and stood there for a long time. He was spent, tired, and fried - he had no more emotions left to give. He got out after a little while, dried off, and put on a clean pair of shorts. He settled into bed and lay there with his hands folded over his chest and his eyes open. They felt gritty, dry. His stomach felt bloated, gassy. He was drowsy now, the weight of the past two days (or was it two weeks?) coming down on him all at once. He closed his eyes and fell asleep.
He was still asleep - but aware - when the knocking on his door started the next morning. Time was funny in this state of being, fast and jerky but also slow and echoing. Keys rattled the knob turned. The landlord came in with a cop. They saw him on the bed, laid out like a corpse for a viewing, and the cop radioed in a code 35. Soon, cops were all around him, making noise and touching things. He had the vague sense of discomfort and embarrassment at the intrusion. A baling man in a suit stood over him, a cop who looked like a redneck beside him. “He didn’t die here,” the medical examiner said.
The cop looked at him questioningly. Dom caught the name KENNER on his name tag.
“See this?” the M.E. said and gestured to Dom’s face. “That’s livor mortis. When you die, your blood pools at the lowest point. If you’re on your left side, for example, it pools on the left.”
Kenner looked at Dom and then back to the M.E. “Someone moved him?”
“Looks like it,” the M.E. said.
“When did he die?”
The M.E. examined Dom as though he were nothing more than a side of beef. “At a glance? Three days. I won’t have a better answer until I open him up.”
Dom was still awake when they put him into a body bag and zipped it up. He felt a stirring of fear beneath the cold numbness, but he was too tired to worry about it now.
Later, he thought.
He would panic later.
For now, Dom slept.

The world was a boozy whirl of lights and sounds. Images, broken and fragmented, came and went. Voices, laughter, screaming. The ground pitched like the deck of a tempest-tossed ship, and he felt heavy, as though the ground were pulling him to it. C’mere, Dommy. He fell, lay on the pavement, and pushed himself up again, staggering like a drunk on his way home. His head spun, his body ached, and things seemed blurry, like half-formed images glimpsed underwater.
It was the light blue hour before dawn and Dom was…somewhere. He should have recognized the stores and street signs around him, but he didn’t. His head felt like it was stuffed with cotton, and a sense of confusion gripped him so strongly that he was beginning to panic. Where was he? What happened?
The world spun away again and the next thing he knew, he was lying in a heap of garbage bags, used needles, and rubbish. He came awake with a jerk and sat up so fast that a bolt of pain jammed into his skull. He winced and pressed his hand to his forehead. He felt hot, clammy.
Something was seriously wrong.
Somehow he got to his feet again and started walking. The sun was up now and the streets were filled with people. They all sneered in disgust as he passed, and he wrapped his arms around his chest like a baby comforting itself. He was getting cold. His muscles were sore. Tears streamed down his face and he wanted to cry.
Going on instinct alone, Dom made his way back home and climbed the steps to his apartment. Exhaustion swept over him and he sagged against the door as he dug in his pocket for the keys. They shook in his hand and he had to focus really hard to get the key into the lock.
Inside, he collapsed onto the couch and his eyelids instantly drooped. He was so weary that he couldn’t lift his head, couldn’t form a single coherent thought. Dom felt himself starting to sink, and snapped his eyes open with a start. Something in his soul told him that if he slept, he would die.
He couldn’t help it, though. He was falling, tumbling, hands reaching up from hell to grab him. His eyes fluttered closed again and the world started to go dark, his heart slamming in fear. He tried to fight, but the pull of darkness was too strong, too alluring. Why was he fighting? Why not just…give up? Hadn’t he thought of killing himself before? Didn’t he hate his life and himself? What was there to fight for? A wife? Kids? A community that loved and respected him? Shit, affordable groceries?
No.
There was nothing.
He had nothing and was nothing.
A sense of peace blossomed from the darkness, and suddenly death didn’t seem so scary. In fact, it was warm…inviting.
It was life that was cold and hateful. Not death.
Death accepted you no matter who you were. It didn’t reject you…it didn’t ignore you. If you sought it, you would find it, and if you embraced it, it would embrace you.
With that thought in mind, Dom gave up.
And died.
***
Bruce Kenner, captain of the 5th Albany precinct, sat behind his desk on the morning of June 28 and lazily leafed through a stack of files as he sipped from a mug of coffee. A roughly built man with a dark goatee and graying blonde hair, he looked more like a small town southern sheriff than a low level public works functionary. In fact, he tended to act like it too. He liked to hunt, fish, and drink beer on his off time. Albany wasn’t a big city, but it was big enough that you never got a fucking break. Run here, run there, arrest this asshole, investigate that asshole. By the time Friday rolled around, he was so ready for the peace and tranquility of a fishing trip he could taste it.
Already this Monday morning, he was looking forward to another one.
Over the weekend, three kids went missing in the Pine Hills and Washington Park area, bringing the total for that summer up to eight. All were teenagers, all were troubled. Most were boys, but two were girls.
Troubled kids run away all the time. They might be gone a few days, sulking at a friend’s house over something their father or mother did, but they’d eventually come home. None of these kids had come back yet and from what he knew, a few of them weren’t the runaway types. They were shits at school and caused problems, but they had no reason to up and leave. Hell, Bruce himself raised hell as a kid, but he always found his way back home, even if he spent the previous night dying in a field from Mad Dogg 20/20 poisoning.
One or two kids going missing…okay, it happens. Eight? Over a span of four weeks?
Yeah, something was wrong here.
But what?
There was nothing on any of these kids. No one saw them, no one knew anything - one minute they were here, the next they weren’t. What could he or anyone else do with that?. The public broke cops’ balls all the time, but if you don’t have evidence, you don’t have evidence. What do you want? Door to door searches? Roadblocks? Dogs and helicopters? Yeah, then when you actually do it, they cry fascism. Guess I’ll just use my Spidey Senses.
Bruce wished he had spidey senses. He wanted to find these kids as much as anyone, and he was starting to get pissed off that he couldn’t. He took another sip from his mug and read on. The latest kids to go missing were three boys between the ages of fourteen and eighteen.
They were all white, all thin (except for one). If there was a serial killer in town - and Bruce hoped to fuck there wasn’t - he had a type. What, black kids aren’t good enough to kill, cannibalize, and wear like a skin suit? They should charge him with a hate crime for discrimination.
That way he’d actually stay locked up.
The door opened and Vanessa Rodregiez, his deputy, came in. A tall, shapely Hispanic woman with dark eyes and a mouth poised always on the edge of a smile, she wore her black hair in a ponytail that would look stern and severe on anyone else, but on her, looked childlike. She was twenty-seven and had been on the force for three years, but you could be forgiven for thinking her much younger. “Bright and early, I see,” she said with a grin.
Bruce grumbled.
Vanessa held down the fort during the graveyard shift, acting to the night as he acted to the day. She was young and full of energy, which clashed with Bruce, who was old and just wanted to be left alone. Despite their differences, Bruce loved her like a kid sister…an annoying kid sister he wanted to throat punch sometimes.
“You missed all the fun last night,” she said and parked her butt on the edge of Bruce’s desk. He glared at her, but she ignored him.
“Good,” he said. Then: “What happened?”
“Big fight outside of Club Vlad,” she said. “It looked like a WorldStar video.”
For a moment, Bruce was lost. “Club what?”
“Club Vlad,” Vanessa said. “Where the Fuze Box used to be.”
Ah, right. The Fuze Box was an Albany landmark, a night club for punks…or goths…or someone. Certainly not for Bruce Kenner. It was small, dingy, and always had people in black waiting outside. On Friday and Saturday nights, it blasted strange music with lyrics about fighting The Man. Kids had been fighting the Man since before Bruce was even born and they hadn’t beaten him yet. Kudos to them for still trying.
Last year, The Fuze Box closed down and someone else bought it. It reopened last month and looked more or less the same: Posers, shitty music, and spiked hair. So much spiked hair. “Place is still a pain in the ass,” Bruce said.
“Yep,” Vanessa chirped. “It doesn’t know what it wants to be now. One minute they play nightcore, the next EDM. It’s all over the place.”
Bruce raised a quizzical brow.
“Not that I’ve ever been there in my free time,” Vanessa said in a tone that suggested she had,
Bruce gave a judgemental hum.
“Anyway,” Vanessa went on, “you see we have some new missing persons?”
Sighing, Bruce sat back in his chair. “Yeah. I did.”
“People are starting to ask questions,” Vanessa warned.
That brought a terse smile to Bruce’s weathered face. “Maybe they’ll solve it then.”
“Ha, fat chance,” Vanessa said. She got up and stretched. “Anyway, I’m bushed. Here’s my…” she trailed off and looked at her empty hands. “Damn, where’s my report? I just had it?” She turned in a confused circle as if she might be able to spot her report making a break for it. “Huh,” she said. She left the office and came back a moment later holding a folder. “Found it,” she grinned.
Bruce just looked at her.
“Um…here it is.”
He didn’t take it.
Her smile faltered. She carefully sat it on top of the files Bruce was looking at.
And his hands.
“I’ll just leave that right here.” She patted it for good measure.
“Thank you,” Bruce said.
“Okay. Night.”
“Goodnight,” Bruce said as she left through a shaft of morning sunlight. Alone, Bruce sat her report aside and went back to the missing kids. This case was giving him a headache and it wasn’t even nine. With a deep sigh, he slumped back in his chair and drummed his fingers on the armrests.
Was it Saturday yet?
He could really use a fishing trip.
***
Dom came awake in the cold purple twilight with a shocked gasp like a man coming up seconds before drowning. His eyes strained from his sweaty face and his mouth hung slack, twisted in a gruesome parody of The Scream. His mind was muddled, murky - he didn’t know where he was or even who he was, but he knew this,.
He couldn’t breathe.
He opened and closed his mouth like a fish, but his lungs did not fill with air. A great, unseen weight seemed to bear down on his chest, and panic gripped him. He tried to move, but his arms refused to heed his brain’s command. The weight seemed heavier, all over, crushing him like a bug. Confusion filled him and he started to pant.
Without warning, his bowels and bladder loosened, and horrible wetness filled his pants. He tried to sit up, but his body felt like it weighed a thousand pounds. His chest rose and fell with the frantic labor of his breath, but his lungs remained inert. A cry of fear bubbled up inside of him, but escaped his mouth only as a breathy groan.
A bust of adrenaline shot through him and he tried to stand, but succeeded only in falling off the couch instead, landing face first against the cold tile floor. He felt his nose crunch, but the pain was muted.
Dom thought he lost consciousness after that, but wasn’t sure. His next memory was of shivering so violently that his teeth clacked together. A phantom chill - perhaps from the floor - had settled into his bones, and was colder than he had ever been in his life, colder even than the time he fell into a snowbank and got lost when he was two. Shudders racked his body, and though he tried to turn over, he was too fucking heavy. It was like every muscle in his body had turned to dead weight. Fragmented thoughts swirled in his head, faint colors in the dark, but he couldn’t put any of them together.
With great effort, he managed to push himself slightly up, but a wave of lightheadedness crashed over him and he lowered his head once more. He stopped trying and simply lay there. Shortly, his eyes began to burn and he realized that he wasn’t blinking. Jesus Christ, he wasn’t blinking.
For some strange reason, that brought a fresh bout of panic. He started to hyperventilate, but his lungs still wouldn’t work. He wasn’t blinking…he wasn’t breathing…what was happening to him?
A whimper burst from his throat and he started to cry.
He must have cried himself to sleep, because he woke sometime later to the most intense headache he’d ever had. It felt like something was eating his brain from the inside out. He was sore all over, and could feel his muscles twitching, as though a thousand living things were burrowing through his body. A cramp shot down his right leg, and the toes of his left foot curled involuntarily. Slowly, his jaw clenched closed, and the muscles in his neck began to strain…then to burn. His panic turned to terror, and Dom wiggled across the floor like a worm, his limbs screaming in red agony and his brain filling with heat. He somehow wound up on his right side, and his arms curled slowly up to his chest, crossing at the wrists like a mummy. He tried to pull them apart, but the slightest movement sent waves of excruciating pain cutting through his body. His knees began to draw up to his stomach, and his fingers clenched tightly.
Cramps and spasms attacked every muscle in his body. He screamed through his teeth and shook, resembling a man in the electric chair as 40,000 volts of justice coursed through him. The pain grew gradually, getting worse and worse as minutes ticked by like hours. Higher, higher, higher - he clenched his eyes closed and shrieked as it became unbearable. Disjointed thoughts flashed through his mind - prayers, threats, curses, Jesus fucking…FUCK.
What was happening? God, what was happening to him? Was it fentanyl? He’d seen videos of people high on fentanyl, and they leaned in weird positions. He didn’t do drugs but maybe he ingested it somehow.
His panic may have returned if all of his muscles hadn’t picked that moment to contract as one. His eyes bulged from their sockets and his jaw unclenched just enough for him to utter a high. Agonized scream that echoed through his empty apartment like thunder.
A human being can only take so much before giving out. When the pain reached a crescendo, and Dom mercifully sank into consciousness once more. The sun rose and cascaded through the apartment’s sole window, falling over his huddled form. Slowly, it tracked across the sky before setting again. As the last rays disappeared behind the horizon, Dom’s eyes opened. The pain of the night before was blessedly gone, replaced by a feeling of numbness - the cool ash after the hot fire. His thoughts were slow and thick like molasses, but he could actually think again. Nightmare memories flooded back to him, but he wasn’t sure they were real. He was lying on his side, his arms wrapped around his chest as if for warmth, and his teeth lightly chattered against the icy chill. He was so cold that he didn’t want to move, but he couldn’t stay here forever. He needed help. He needed…
A shower.
Yeah, a hot shower. That would warm him up.
Gritting his teeth, he slowly sat up, ready for a burst of pain.
But none came.
He did, however, feel heavy. Getting to his feet, he stumbled and nearly fell, catching himself against the counter. His limbs had no feeling. It’s like they weren’t even there. Head hung, Dom tried to catch his breath, but it felt like he wasn’t breathing at all. His eyelids drooped closed and he felt like he was going to fall down. Summoning all the might he could, he shuffled into the bathroom with the stiff gait of an old man. He snapped the light on, and cold, white brilliance filled the space, blinding him.
Leaning heavily against the sink, he gripped the cold porcelain. Suddenly, he was afraid of looking into the mirror. He was sure that whatever reflection he saw, it would be of something else, something monstrous.
Dom lifted his head and faced the glass.
His heart shrank.
The man in the mirror was him but different. His skin was white as milk, lacking all color whatsoever save for the ugly purple patch on the left side. IResembling a giant bruise, it started at the temple and extended down to the slope of his neck, disappearing beneath his T-shirt. He gingerly lifted the shirt, and moaned when he saw that his entire left side was discolored, the purple edged with a puffy shade of pink. His sallow skin clung tight to his ribcage, and his hip bones stuck out so much it looked painful. Back in the mirror, his cheeks were sunken, hollow, and his eyes were a hazy, dishwater gray. His skull seemed bigger, his hair longer. Dom wanted to whip his head away from the phantom before him, to never see it again, but he was transfixed.
There was no way that thing was -
Dom looked away, cutting that thought off before it could finish.
A shower.
He needed a shower.
Slowly, stiffly, Dom undressed, peeling off his shirt and his soiled pants. He dropped them in a heap on the floor and stepped under the spray. He could feel the water pounding against him, but it provided no heat. It was neither hot nor cold. It was simply there.
Dom pressed his head to the slick shower wall and stood there for a long time. He was spent, tired, and fried - he had no more emotions left to give. He got out after a little while, dried off, and put on a clean pair of shorts. He settled into bed and lay there with his hands folded over his chest and his eyes open. They felt gritty, dry. His stomach felt bloated, gassy. He was drowsy now, the weight of the past two days (or was it two weeks?) coming down on him all at once. He closed his eyes and fell asleep.
He was still asleep - but aware - when the knocking on his door started the next morning. Time was funny in this state of being, fast and jerky but also slow and echoing. Keys rattled the knob turned. The landlord came in with a cop. They saw him on the bed, laid out like a corpse for a viewing, and the cop radioed in a code 35. Soon, cops were all around him, making noise and touching things. He had the vague sense of discomfort and embarrassment at the intrusion. A baling man in a suit stood over him, a cop who looked like a redneck beside him. “He didn’t die here,” the medical examiner said.
The cop looked at him questioningly. Dom caught the name KENNER on his name tag.
“See this?” the M.E. said and gestured to Dom’s face. “That’s livor mortis. When you die, your blood pools at the lowest point. If you’re on your left side, for example, it pools on the left.”
Kenner looked at Dom and then back to the M.E. “Someone moved him?”
“Looks like it,” the M.E. said.
“When did he die?”
The M.E. examined Dom as though he were nothing more than a side of beef. “At a glance? Three days. I won’t have a better answer until I open him up.”
Dom was still awake when they put him into a body bag and zipped it up. He felt a stirring of fear beneath the cold numbness, but he was too tired to worry about it now.
Later, he thought.
He would panic later.
For now, Dom slept.

The world was a boozy whirl of lights and sounds. Images, broken and fragmented, came and went. Voices, laughter, screaming. The ground pitched like the deck of a tempest-tossed ship, and he felt heavy, as though the ground were pulling him to it. C’mere, Dommy. He fell, lay on the pavement, and pushed himself up again, staggering like a drunk on his way home. His head spun, his body ached, and things seemed blurry, like half-formed images glimpsed underwater.
It was the light blue hour before dawn and Dom was…somewhere. He should have recognized the stores and street signs around him, but he didn’t. His head felt like it was stuffed with cotton, and a sense of confusion gripped him so strongly that he was beginning to panic. Where was he? What happened?
The world spun away again and the next thing he knew, he was lying in a heap of garbage bags, used needles, and rubbish. He came awake with a jerk and sat up so fast that a bolt of pain jammed into his skull. He winced and pressed his hand to his forehead. He felt hot, clammy.
Something was seriously wrong.
Somehow he got to his feet again and started walking. The sun was up now and the streets were filled with people. They all sneered in disgust as he passed, and he wrapped his arms around his chest like a baby comforting itself. He was getting cold. His muscles were sore. Tears streamed down his face and he wanted to cry.
Going on instinct alone, Dom made his way back home and climbed the steps to his apartment. Exhaustion swept over him and he sagged against the door as he dug in his pocket for the keys. They shook in his hand and he had to focus really hard to get the key into the lock.
Inside, he collapsed onto the couch and his eyelids instantly drooped. He was so weary that he couldn’t lift his head, couldn’t form a single coherent thought. Dom felt himself starting to sink, and snapped his eyes open with a start. Something in his soul told him that if he slept, he would die.
He couldn’t help it, though. He was falling, tumbling, hands reaching up from hell to grab him. His eyes fluttered closed again and the world started to go dark, his heart slamming in fear. He tried to fight, but the pull of darkness was too strong, too alluring. Why was he fighting? Why not just…give up? Hadn’t he thought of killing himself before? Didn’t he hate his life and himself? What was there to fight for? A wife? Kids? A community that loved and respected him? Shit, affordable groceries?
No.
There was nothing.
He had nothing and was nothing.
A sense of peace blossomed from the darkness, and suddenly death didn’t seem so scary. In fact, it was warm…inviting.
It was life that was cold and hateful. Not death.
Death accepted you no matter who you were. It didn’t reject you…it didn’t ignore you. If you sought it, you would find it, and if you embraced it, it would embrace you.
With that thought in mind, Dom gave up.
And died.
***
Bruce Kenner, captain of the 5th Albany precinct, sat behind his desk on the morning of June 28 and lazily leafed through a stack of files as he sipped from a mug of coffee. A roughly built man with a dark goatee and graying blonde hair, he looked more like a small town southern sheriff than a low level public works functionary. In fact, he tended to act like it too. He liked to hunt, fish, and drink beer on his off time. Albany wasn’t a big city, but it was big enough that you never got a fucking break. Run here, run there, arrest this asshole, investigate that asshole. By the time Friday rolled around, he was so ready for the peace and tranquility of a fishing trip he could taste it.
Already this Monday morning, he was looking forward to another one.
Over the weekend, three kids went missing in the Pine Hills and Washington Park area, bringing the total for that summer up to eight. All were teenagers, all were troubled. Most were boys, but two were girls.
Troubled kids run away all the time. They might be gone a few days, sulking at a friend’s house over something their father or mother did, but they’d eventually come home. None of these kids had come back yet and from what he knew, a few of them weren’t the runaway types. They were shits at school and caused problems, but they had no reason to up and leave. Hell, Bruce himself raised hell as a kid, but he always found his way back home, even if he spent the previous night dying in a field from Mad Dogg 20/20 poisoning.
One or two kids going missing…okay, it happens. Eight? Over a span of four weeks?
Yeah, something was wrong here.
But what?
There was nothing on any of these kids. No one saw them, no one knew anything - one minute they were here, the next they weren’t. What could he or anyone else do with that?. The public broke cops’ balls all the time, but if you don’t have evidence, you don’t have evidence. What do you want? Door to door searches? Roadblocks? Dogs and helicopters? Yeah, then when you actually do it, they cry fascism. Guess I’ll just use my Spidey Senses.
Bruce wished he had spidey senses. He wanted to find these kids as much as anyone, and he was starting to get pissed off that he couldn’t. He took another sip from his mug and read on. The latest kids to go missing were three boys between the ages of fourteen and eighteen.
They were all white, all thin (except for one). If there was a serial killer in town - and Bruce hoped to fuck there wasn’t - he had a type. What, black kids aren’t good enough to kill, cannibalize, and wear like a skin suit? They should charge him with a hate crime for discrimination.
That way he’d actually stay locked up.
The door opened and Vanessa Rodregiez, his deputy, came in. A tall, shapely Hispanic woman with dark eyes and a mouth poised always on the edge of a smile, she wore her black hair in a ponytail that would look stern and severe on anyone else, but on her, looked childlike. She was twenty-seven and had been on the force for three years, but you could be forgiven for thinking her much younger. “Bright and early, I see,” she said with a grin.
Bruce grumbled.
Vanessa held down the fort during the graveyard shift, acting to the night as he acted to the day. She was young and full of energy, which clashed with Bruce, who was old and just wanted to be left alone. Despite their differences, Bruce loved her like a kid sister…an annoying kid sister he wanted to throat punch sometimes.
“You missed all the fun last night,” she said and parked her butt on the edge of Bruce’s desk. He glared at her, but she ignored him.
“Good,” he said. Then: “What happened?”
“Big fight outside of Club Vlad,” she said. “It looked like a WorldStar video.”
For a moment, Bruce was lost. “Club what?”
“Club Vlad,” Vanessa said. “Where the Fuze Box used to be.”
Ah, right. The Fuze Box was an Albany landmark, a night club for punks…or goths…or someone. Certainly not for Bruce Kenner. It was small, dingy, and always had people in black waiting outside. On Friday and Saturday nights, it blasted strange music with lyrics about fighting The Man. Kids had been fighting the Man since before Bruce was even born and they hadn’t beaten him yet. Kudos to them for still trying.
Last year, The Fuze Box closed down and someone else bought it. It reopened last month and looked more or less the same: Posers, shitty music, and spiked hair. So much spiked hair. “Place is still a pain in the ass,” Bruce said.
“Yep,” Vanessa chirped. “It doesn’t know what it wants to be now. One minute they play nightcore, the next EDM. It’s all over the place.”
Bruce raised a quizzical brow.
“Not that I’ve ever been there in my free time,” Vanessa said in a tone that suggested she had,
Bruce gave a judgemental hum.
“Anyway,” Vanessa went on, “you see we have some new missing persons?”
Sighing, Bruce sat back in his chair. “Yeah. I did.”
“People are starting to ask questions,” Vanessa warned.
That brought a terse smile to Bruce’s weathered face. “Maybe they’ll solve it then.”
“Ha, fat chance,” Vanessa said. She got up and stretched. “Anyway, I’m bushed. Here’s my…” she trailed off and looked at her empty hands. “Damn, where’s my report? I just had it?” She turned in a confused circle as if she might be able to spot her report making a break for it. “Huh,” she said. She left the office and came back a moment later holding a folder. “Found it,” she grinned.
Bruce just looked at her.
“Um…here it is.”
He didn’t take it.
Her smile faltered. She carefully sat it on top of the files Bruce was looking at.
And his hands.
“I’ll just leave that right here.” She patted it for good measure.
“Thank you,” Bruce said.
“Okay. Night.”
“Goodnight,” Bruce said as she left through a shaft of morning sunlight. Alone, Bruce sat her report aside and went back to the missing kids. This case was giving him a headache and it wasn’t even nine. With a deep sigh, he slumped back in his chair and drummed his fingers on the armrests.
Was it Saturday yet?
He could really use a fishing trip.
***
Dom came awake in the cold purple twilight with a shocked gasp like a man coming up seconds before drowning. His eyes strained from his sweaty face and his mouth hung slack, twisted in a gruesome parody of The Scream. His mind was muddled, murky - he didn’t know where he was or even who he was, but he knew this,.
He couldn’t breathe.
He opened and closed his mouth like a fish, but his lungs did not fill with air. A great, unseen weight seemed to bear down on his chest, and panic gripped him. He tried to move, but his arms refused to heed his brain’s command. The weight seemed heavier, all over, crushing him like a bug. Confusion filled him and he started to pant.
Without warning, his bowels and bladder loosened, and horrible wetness filled his pants. He tried to sit up, but his body felt like it weighed a thousand pounds. His chest rose and fell with the frantic labor of his breath, but his lungs remained inert. A cry of fear bubbled up inside of him, but escaped his mouth only as a breathy groan.
A bust of adrenaline shot through him and he tried to stand, but succeeded only in falling off the couch instead, landing face first against the cold tile floor. He felt his nose crunch, but the pain was muted.
Dom thought he lost consciousness after that, but wasn’t sure. His next memory was of shivering so violently that his teeth clacked together. A phantom chill - perhaps from the floor - had settled into his bones, and was colder than he had ever been in his life, colder even than the time he fell into a snowbank and got lost when he was two. Shudders racked his body, and though he tried to turn over, he was too fucking heavy. It was like every muscle in his body had turned to dead weight. Fragmented thoughts swirled in his head, faint colors in the dark, but he couldn’t put any of them together.
With great effort, he managed to push himself slightly up, but a wave of lightheadedness crashed over him and he lowered his head once more. He stopped trying and simply lay there. Shortly, his eyes began to burn and he realized that he wasn’t blinking. Jesus Christ, he wasn’t blinking.
For some strange reason, that brought a fresh bout of panic. He started to hyperventilate, but his lungs still wouldn’t work. He wasn’t blinking…he wasn’t breathing…what was happening to him?
A whimper burst from his throat and he started to cry.
He must have cried himself to sleep, because he woke sometime later to the most intense headache he’d ever had. It felt like something was eating his brain from the inside out. He was sore all over, and could feel his muscles twitching, as though a thousand living things were burrowing through his body. A cramp shot down his right leg, and the toes of his left foot curled involuntarily. Slowly, his jaw clenched closed, and the muscles in his neck began to strain…then to burn. His panic turned to terror, and Dom wiggled across the floor like a worm, his limbs screaming in red agony and his brain filling with heat. He somehow wound up on his right side, and his arms curled slowly up to his chest, crossing at the wrists like a mummy. He tried to pull them apart, but the slightest movement sent waves of excruciating pain cutting through his body. His knees began to draw up to his stomach, and his fingers clenched tightly.
Cramps and spasms attacked every muscle in his body. He screamed through his teeth and shook, resembling a man in the electric chair as 40,000 volts of justice coursed through him. The pain grew gradually, getting worse and worse as minutes ticked by like hours. Higher, higher, higher - he clenched his eyes closed and shrieked as it became unbearable. Disjointed thoughts flashed through his mind - prayers, threats, curses, Jesus fucking…FUCK.
What was happening? God, what was happening to him? Was it fentanyl? He’d seen videos of people high on fentanyl, and they leaned in weird positions. He didn’t do drugs but maybe he ingested it somehow.
His panic may have returned if all of his muscles hadn’t picked that moment to contract as one. His eyes bulged from their sockets and his jaw unclenched just enough for him to utter a high. Agonized scream that echoed through his empty apartment like thunder.
A human being can only take so much before giving out. When the pain reached a crescendo, and Dom mercifully sank into consciousness once more. The sun rose and cascaded through the apartment’s sole window, falling over his huddled form. Slowly, it tracked across the sky before setting again. As the last rays disappeared behind the horizon, Dom’s eyes opened. The pain of the night before was blessedly gone, replaced by a feeling of numbness - the cool ash after the hot fire. His thoughts were slow and thick like molasses, but he could actually think again. Nightmare memories flooded back to him, but he wasn’t sure they were real. He was lying on his side, his arms wrapped around his chest as if for warmth, and his teeth lightly chattered against the icy chill. He was so cold that he didn’t want to move, but he couldn’t stay here forever. He needed help. He needed…
A shower.
Yeah, a hot shower. That would warm him up.
Gritting his teeth, he slowly sat up, ready for a burst of pain.
But none came.
He did, however, feel heavy. Getting to his feet, he stumbled and nearly fell, catching himself against the counter. His limbs had no feeling. It’s like they weren’t even there. Head hung, Dom tried to catch his breath, but it felt like he wasn’t breathing at all. His eyelids drooped closed and he felt like he was going to fall down. Summoning all the might he could, he shuffled into the bathroom with the stiff gait of an old man. He snapped the light on, and cold, white brilliance filled the space, blinding him.
Leaning heavily against the sink, he gripped the cold porcelain. Suddenly, he was afraid of looking into the mirror. He was sure that whatever reflection he saw, it would be of something else, something monstrous.
Dom lifted his head and faced the glass.
His heart shrank.
The man in the mirror was him but different. His skin was white as milk, lacking all color whatsoever save for the ugly purple patch on the left side. IResembling a giant bruise, it started at the temple and extended down to the slope of his neck, disappearing beneath his T-shirt. He gingerly lifted the shirt, and moaned when he saw that his entire left side was discolored, the purple edged with a puffy shade of pink. His sallow skin clung tight to his ribcage, and his hip bones stuck out so much it looked painful. Back in the mirror, his cheeks were sunken, hollow, and his eyes were a hazy, dishwater gray. His skull seemed bigger, his hair longer. Dom wanted to whip his head away from the phantom before him, to never see it again, but he was transfixed.
There was no way that thing was -
Dom looked away, cutting that thought off before it could finish.
A shower.
He needed a shower.
Slowly, stiffly, Dom undressed, peeling off his shirt and his soiled pants. He dropped them in a heap on the floor and stepped under the spray. He could feel the water pounding against him, but it provided no heat. It was neither hot nor cold. It was simply there.
Dom pressed his head to the slick shower wall and stood there for a long time. He was spent, tired, and fried - he had no more emotions left to give. He got out after a little while, dried off, and put on a clean pair of shorts. He settled into bed and lay there with his hands folded over his chest and his eyes open. They felt gritty, dry. His stomach felt bloated, gassy. He was drowsy now, the weight of the past two days (or was it two weeks?) coming down on him all at once. He closed his eyes and fell asleep.
He was still asleep - but aware - when the knocking on his door started the next morning. Time was funny in this state of being, fast and jerky but also slow and echoing. Keys rattled the knob turned. The landlord came in with a cop. They saw him on the bed, laid out like a corpse for a viewing, and the cop radioed in a code 35. Soon, cops were all around him, making noise and touching things. He had the vague sense of discomfort and embarrassment at the intrusion. A baling man in a suit stood over him, a cop who looked like a redneck beside him. “He didn’t die here,” the medical examiner said.
The cop looked at him questioningly. Dom caught the name KENNER on his name tag.
“See this?” the M.E. said and gestured to Dom’s face. “That’s livor mortis. When you die, your blood pools at the lowest point. If you’re on your left side, for example, it pools on the left.”
Kenner looked at Dom and then back to the M.E. “Someone moved him?”
“Looks like it,” the M.E. said.
“When did he die?”
The M.E. examined Dom as though he were nothing more than a side of beef. “At a glance? Three days. I won’t have a better answer until I open him up.”
Dom was still awake when they put him into a body bag and zipped it up. He felt a stirring of fear beneath the cold numbness, but he was too tired to worry about it now.
Later, he thought.
He would panic later.
For now, Dom slept.

Applied: 12/14/23 Referred: 1/11/24 Interviewed: 1/25/24 Verbal TJO: 1/25/24 TJO: 3/25/24 Drug test/ fingerprints: 4/2/24 Equip/SF86: 4/11/24 Interim granted: 4/30/24 FJO: 05/13/24 EOD: 05/20/24
FJO is for a GS-12 IT position with performance level of 13 TS clearance was needed for this appointment. Don't give up! It's a process, it takes time. Email every two weeks for updates. Good luck!

Is it just me, but since it is so hot here: 26C, my blood sugar dips a lot. I am around 100 mg/dLall day. I ate half a chocolate bar so 50g and it made no difference. Is it the heat bc of summer?
I'm probably T1b -my doc is still testing. But I am on full insulin and usually my range is 180/250 all day or sometimes really high especially during nights. So I had the occasional hypo. But being down all day is new.

Basic shit, I was broke, couldn't get the things I wanted as a child. Got a job pushing baskets at a store in high school and was getting paid like 250 a week. I started buying everything I had my eyes on clothes, games, various drugs, everything. I left after a year my savings had like 60 dollars and sold the majority of my stuff and it was almost like a high to me. I sold the majority of what I had, got a high when they got sold to whoever on offerup, Facebook marketplace etc. thousands of dollars wasted. It got so bad that I ignored my needs and only focused on my wants.
New job same thing I kept buying shit I didn't need then got bored of it in a couple days then sold them for like half of what they cost brand new. I was taking shit to pawn shops and getting scammed, for waaayyy lower than what they were worth. New job, same thing I would work there, them some shit would happen I would get laid off, they moved to a new place, etc. I don't know how to save and have wasted tens of thousands of dollars on shit I don't really need. I feel like it's mostly just boredom mixed in with loneliness because I don't really have friends except outside the Internet, idk. But I can say shopping addiction have put me in the lowest place I've been in my 20 years of life. I'm starting to work on myself though and trying to start working out and finding something to fill up my time with and put myself on a budget. Feel free to bully me

Mast cell activation syndrome (MCAS) is the subject of heated debate. How are mast cell activation syndromes defined? Which diseases are included? What is the diagnosis and treatment of mast cell activation syndrome? Prof. Dr. Knut Brockow, Clinic and Polyclinic for Dermatology and Allergology at the Biederstein, Technical University of Munich answers these questions in an interview with MeinAllergiePortal.
Mast cell activation syndrome: The most important facts!
-The prototype of mast cell activation syndrome is recurrent anaphylaxis
-Other forms of idiopathic mast cell activation syndrome are being sought; however, there are mainly symptom descriptions where the diagnosis cannot be made
-Clinical suspicion of MCAS is based on recurring allergy-like symptoms on the skin, nose, respiratory tract, gastrointestinal tract and circulation
-The diagnosis of MCAS is made according to recognized international criteria based on three criteria
-MCAS is often suspected even when symptoms are inappropriate and the diagnosis is unclear; the suspicion is then not helpful for patients
-The same medications are used to treat MCAS as are used to treat allergies, in particular antihistamines and cromoglicic acid
Prof. Brockow, what kind of disease is MCAS?
Mast cell activation syndrome is not an established diagnosis, but rather a concept. Historically, this concept arose because an increasing number of patients came to the doctor's office with complaints that gave the impression of having been triggered by mast cells. These patients sometimes showed symptoms similar to those of allergic reactions, anaphylaxis or mastocytosis, but a clear diagnosis for these diseases could not be made. Nevertheless, it was suspected that there could at least be a connection with mast cell diseases. Unfortunately, the term MCAS created more uncertainty than understanding. This is because MCAS is now thrown around as a diagnosis for many patients with many symptoms and an unclear diagnosis. This is not helpful for patients and fuels short-term hope of diagnosis and cure, which cannot be fulfilled later.
Is MCAS an autoimmune disease?
No, in autoimmune diseases mast cells are not primarily involved and not as lead cells, but lymphocytes that attack the body's own structures, in some cases by forming antibodies.
Is there a connection between mast cell activation syndrome and autoimmune diseases?
No, there is no known connection between MCAS and autoimmune diseases. It has also been claimed by specific authors that other diseases, such as Ehlers-Danlos syndrome, postural orthostatic tachycardia syndrome (POTS) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are related to mast cell activation syndrome. However, there are no good arguments for this. Unfortunately, such claims are easy to make and difficult to refute.
What is the cause of mast cell activation syndrome?
Mast cell activation syndrome is actually more of a symptom description than a diagnosis in its own right. Mast cell activation syndrome is fully applicable to recurrent anaphylaxis (severe allergic reactions in several organ systems such as the skin, respiratory tract, digestive tract and circulatory system), for example due to insect bites. All the criteria for mast cell activation syndrome are met here. Severe allergic reactions are the most common cause of MCAS. However, although the term MCAS is correct in this context, it does not provide any additional information, as patients with such events are better described as patients with a diagnosis of anaphylaxis or allergy, and the term MCAS is somewhat confusing.
Is mast cell activation syndrome genetic?
MCAS itself is not genetic, but patients with the genetic disease mastocytosis often suffer from anaphylaxis, particularly to insect venom, and therefore MCAS. In addition, it is currently being investigated whether people with genetically determined hereditary alpha-tryptasemia suffer more frequently from MCAS.
How did the term mast cell activation syndrome come about?
There were many patients without a clear diagnosis, some of whom predominantly showed the symptoms typical of mast cell diseases. Accordingly, the experts dealing with mast cell diseases saw the need to develop a concept that took into account the “undiagnosable” symptoms of the patients. In the course of this, the terms “mast cell activation” and “mast cell activation syndrome” were defined. In addition, an attempt was made to sort all mast cell diseases into a classification with regard to mast cell activation. However, the difficulty in classifying these complaints is that many of the complaints described by patients are subjective, relatively non-specific and can be both organic and psychosomatic.
How have you defined mast cell diseases and which diseases do they include?
Mast cell diseases are defined as recurring chronic symptoms that are compatible with mast cell activation.
Mast cell activation is classified on the basis of three criteria:
Recurrent typical clinical symptoms in at least two organ systems
An increase in mast cell mediators can be detected in the blood, most frequently by determining the serum tryptase level during an acute attack
Good response of symptoms to anti-mast cell mediator-directed therapy, especially H1 antihistamines
What types of mast cell disease are there?
The classification of mast cell diseases associated with mast cell activation syndromes defines three groups:
1. primary mast cell activation syndrome
Primary mast cell activation syndrome is explained by a clonal expansion of mutated overactive mast cells. It manifests as systemic or cutaneous mastocytosis. If these criteria are not completely fulfilled, but clonal mast cells have been detected, it is referred to as monoclonal mast cell activation syndrome.
2 Secondary mast cell activation syndrome
Secondary mast cell activation syndrome is present when clear triggers of mast cell activation are known. There are established terms for secondary mast cell activation syndrome that we are more familiar with, such as “anaphylaxis” to a known trigger. The classification in the second group of mast cell diseases is therefore merely a reclassification. Examples of mast cell activation are physical urticaria or cold urticaria. Allergies such as pollen allergies are also secondary mast cell activations, as hay fever also causes symptoms typical of mast cell diseases. In pollen allergies, mast cell mediators are found in the blood serum and drugs directed against mast cells have a good effect. If the symptoms recur in several organ systems, this is referred to as mast cell activation syndrome.
3. tertiary or idiopathic mast cell activation syndrome
Tertiary or idiopathic mast cell activation syndrome refers to mast cell diseases whose triggers are unknown. This group would include, for example, chronic spontaneous urticaria, which has additional symptoms in other organs. Here we know that mast cells are activated, but not by what. This group of idiopathic mast cell activation syndromes would also include patients with as yet undescribed clinical pictures who do not fulfill the diagnostic criteria of known mast cell diseases, e.g. allergy, anaphylaxis, but in whom the disease is triggered by mast cells. In these patients, however, the connection between the symptoms and the activities of the mast cells must be proven.
Does this mean that tertiary or idiopathic mast cell activation syndrome is a diagnosis of exclusion?
Idiopathic mast cell activation syndrome can be described as a diagnosis of exclusion insofar as the prerequisite for the diagnosis is that there is no other disease causing the symptoms. However, the symptoms described are often very, very unspecific and could also be caused by a variety of other diseases. However, there are the three criteria for mast cell activation syndrome already mentioned. If these are not all fulfilled, this diagnosis cannot be made.
How common is mast cell activation syndrome?
Anaphylaxis and severe recurrent allergies are not uncommon and represent the vast majority of appropriate cases for MCAS. In addition, mastocytosis patients often have multiple anaphylaxis and therefore also MCAS. However, our initial idea of finding a new disease, idiopathic mast cell activation syndrome, has not yet been confirmed. There are many patients with many symptoms for whom a clear organic diagnosis cannot yet be made. However, it is almost never possible to prove that a defect in the mast cells is primarily responsible for the symptoms. Many of these patients describe symptoms that could fit, and in some patients anti-allergic drugs also have a positive effect. But in only very few patients can an increase in mast cell mediators be detected during an acute attack. I now believe that somatic stress disorders could play a significant role in many of the patients examined.
Histamine intolerance is also a diagnosis of exclusion, is there a connection with mast cell activation syndrome?
Histamine intolerance can cause similar symptoms, but is not a mast cell disorder and has nothing to do with MCAS. When mast cells are activated, the messenger substance histamine is released, which in turn can cause symptoms. In histamine intolerance, the mast cell is not activated - it is not involved in any way. Rather, histamine intolerance describes patients with an increased sensitivity to histamine, which is supplied, for example, via the diet. This can lead to similar symptoms, but in contrast to mast cell activation syndrome, histamine intolerance has a clear trigger, histamine. As a result, the symptoms occur after eating histamine-rich foods, but disappear again if the patient follows a low-histamine diet. A test is also available to diagnose histamine intolerance.
So there are also patients with suspected mast cell activation syndrome who cannot be assigned to a classification group, even though they have corresponding symptoms?
There are many patients in whom no mast cell activation syndrome can be detected despite suspicion. They do not fit into one of the three groups. However, this also used to include monoclonal mast cell activation syndrome. These patients showed anaphylaxis and a KIT mutation, but not the full criteria for mastocytosis. In the meantime, a separate disease diagnosis has been created for these patients. The independent accepted disease of these patients therefore lies between mastocytosis and normal findings.
We thought that there might be other forms of idiopathic MCAS with clinical pictures that have not yet been described. However, this is not supported by the findings to date. There are patients who show symptoms but do not meet the necessary criteria for idiopathic mast cell activation syndrome. In these patients, the diagnosis remains unclear. In how many of these patients functional physical complaints play a role still needs to be investigated.
Are there risk factors that favor mast cell activation syndrome?
There are hardly any recognized studies on this. In a study conducted by Cem Akin in the USA, patients were examined who met the three criteria for idiopathic mast cell activation syndrome. They had the right symptoms, there was an increase in mediators and their symptoms improved with treatment. It was shown that many of these patients suffered from urticaria factitia, a scratch-induced urticaria, abdominal pain and flushing.
Recently, a genetic trait was discovered, hereditary alpha-tryptasemia with elevated basal serum tryptase levels. In patients with this trait and insect venom allergy, the severity of the allergic reaction appears to be increased. It is also discussed that the frequency of mast cell activation syndrome is increased in patients with this genetic trait. However, the published studies are not yet unanimous in this respect.
What symptoms can occur with MCAS?
The following symptoms could be signs of mast cell activation syndrome:
MCAS symptoms on the skin:
Appearance of sudden intense redness (flushing)
itching
wheal formation
Deep wheal formation (angioedema or Quincke's edema)
MCAS symptoms on the nose:
Nasal congestion
Nasal itching
MCAS symptoms in the airways:
Swelling of the upper airways
Wheezing
Shortness of breath
MCAS symptoms of the digestive tract:
Vomiting
abdominal pain
diarrhea
Systemic MCAS symptoms:
Syncope - where you suddenly lose consciousness, but only for a short time
Sudden drop in blood pressure
Allergic shock
These symptoms can occur together or individually. In principle, symptoms must occur in two or more organ systems for MCAS. These symptoms, together with the typical skin changes and anaphylaxis, are also typical of mastocytosis.
Are muscle pain and hair loss also symptoms of MCAS?
No, why would anyone think that these symptoms are primarily caused by a malfunction of mast cells? Mast cells are not important cells for muscle pain and hair loss.
How is MCAS diagnosed?
MCAS is a diagnosis of exclusion, i.e. there is no mast cell activation syndrome test. However, this does not mean that all other diseases must be ruled out before a diagnosis of MCAS can be made.
When testing directly for mast cell activation syndrome, three criteria would be examined, all of which must be met, not just two:
First, there must be a matching of symptoms to see if the above symptoms are leading, recurrent and occur in at least two organ systems.
Is there a substantial or complete improvement in the clinical symptoms when taking anti-allergic medication, antihistamines or cromoglicic acid? Then this criterion would apply.
The blood levels of tryptase in the serum can now be examined at two different points in time. This would check whether there is an increase in mast cell mediators or tryptase in the blood serum in a highly symptomatic phase or during a seizure compared to a time when there are no symptoms.
What does the tryptase level in the blood mean in the diagnosis of mast cell activation syndrome?
If the mast cell mediator tryptase rises by 20 percent of the basal value, i.e. the initial value, + 2 ng/ml during such an episode, the diagnosis of mast cell activation syndrome has been made without the need to rule out other diseases beforehand. However, taking blood samples to determine the tryptase levels is very time-consuming, because a blood sample should be taken in the normal state and then another blood sample should be taken during a seizure or a highly symptomatic episode. This means that the patient must see a doctor in good time for a blood test during the acute phase. If these tests are negative, mast cell activation syndrome cannot be confirmed.
Elevated tryptase levels also play a role in anaphylaxis, is there a connection with mast cell activation syndrome?
Anaphylaxis is an extremely strong mast cell activation, the “prototype” of mast cell activation, so to speak. The tryptase level rises, so that it is considered an indicator of anaphylaxis. Here too, the basal value is measured and compared with the value during an episode. The relevant factor is the resulting increase in the tryptase value. The therapy against mast cells is effective in this case. In this respect, anaphylaxis is the classic form of mast cell activation syndrome.
The tryptase value also plays a role in the diagnosis of mastocytosis, what are the correlations here?
Mastocytosis patients also have an elevated baseline tryptase level. This is therefore an indication of mastocytosis and an indication for a final diagnosis by means of a bone marrow biopsy. However, there is also a mastocytosis-independent correlation between tryptase and anaphylaxis. People who have a higher number of mast cells often develop more severe anaphylaxis than people with fewer mast cells. The tryptase basal value is therefore considered a kind of indicator for the total mast cells in the body. For example, insect venom anaphylactic patients with elevated basal mast cell tryptase levels in the blood are at increased risk of severe anaphylaxis.
What can be done against MCAS and which medications help?
The aim of treatment for mast cell activation syndrome is to slow down the effect of the overactivated mast cells and to calm the mast cells. In particular, the avoidance of allergic triggers is available for this purpose.
Histamine receptor blockers are tried as medication to block the effects of mast cell activation by histamine. Mast cell stabilizers or blockers of mast cell release, cromoglicic acid, can also calm the mast cells. Cromoglicic acid is also used in mastocytosis patients. It is important to know that the use of cromoglicic acid is not advisable if the attack has already run its course. On the other hand, many patients achieve a significant improvement in symptoms if cromoglicic acid is taken continuously as a preventive measure and in a sufficiently high dose. This has also been shown to be the case with antihistamines.
Another option would be leukotriene receptor antagonists and corticosteroids in the short term, but never over a longer period of time.
Unfortunately, many patients with previously unexplained complaints are given a suspected diagnosis of MCAS in the hope that this knowledge will lead to better treatment or perhaps a cure. However, apart from the drugs mentioned, which can also be used on a trial basis in cases of suspected MCAS, there are no other useful drugs available. In this respect, the suspicion of MCAS unfortunately does not offer patients any additional treatment options.
Are there foods that activate or deactivate mast cells?
No such foods are known in humans. Of course, it is possible to bombard mast cells in a test tube with high concentrations of food and measure whether the natural activation of mast cells is increased or reduced. However, such tests are generally not meaningful for humans when consumed.
Can naturopathy help with mast cell activation syndrome?
I don't know how it could help. Naturopathy is the attempt to achieve a positive effect through naturally occurring active substances. Is the avoidance of allergens in our natural environment already naturopathy?
Could certain vitamins, for example vitamin C, be beneficial for MCAS?
This is claimed by a few doctors without any convincing results. Vitamin C is also said to help against seasickness. After all, vitamin C, taken in normal amounts, is not harmful and is beneficial. Sometimes the conviction that a substance is good for you also helps. That's why the experiment doesn't bother me.
Is it possible to prevent mast cell activation syndrome?
Yes, by avoiding MCAS with a known trigger. This is the case with allergies. In the case of allergies and recurrent anaphylaxis as a form of MCAS, omalizumab, an antibody against immunoglobulin E, can also be used in individual patients.
Prof. Brockow, thank you very much for this interview!
https://www.mein-allergie-portal.com/mastozytose-mastzellaktivierungssyndrom-mcas/925-idiopathisches-mastzellenaktivierungssyndrom-ein-neues-krankheitsbild.html

Hi, i start with tinnitus (due to loud music with headphones) in 2005. In 2 weeks i get used to it.
In these 20 years i have increased moments of it (maybe the clicic name is 'spike' other 2-3 times before this last)
Probabily always for earphones use.
Usually these spikes lasted 2 weeks and in one case it lasted me a month and a half.
One week ago i watched a Twitch direct with airpods (ear phones). In this direct , people could spend 'bits' do send sudden noises. One of them send a sound of a firecracker (2 seconds of sound) After that my Tinnitus seems to be more noticeable to me. The frequency.
Seems the most strong tinnitus i have ever had (high pitch noise) in my entire life, the sound seems similar to my previous tinnitus but is more loud and i can't forget to have it most of the time.
After a week of this *biiiip in my head now i'm exhausted and sad. I honestly don't remember how strong the previous spikes I had in recent years were. If similar to this or if this is stronger. I just know that this is hard to tolerate now.
My doctor immediately gave me some cortisone like prednisone which I am taking, but I don't notice any benefit at the moment and I am almost finishing to assuming it because one week of cure is just pass.
I will definitely never use headphones again in my life.. in the meantime, what advice could you give me?
I already lived with tinnitus, but it was tolerable. I really hope this strong volume tinnitusis that i have now (due to a acoustic trauma) it could be just a bad spike and that it can regress the next weeks as in my past previous spikes.. or that my brain can start to tolerate it more...I really hope so because I'm really desperate and I feel abandoned to my fate without knowing what to do.

TL;DR normally pee 20-40 times a day, can barely get anything out now. Have bladder wall thickening and bladder cyst consistent with urachal remnant.
Hi
25F 130lbs 5’10” no tobacco, MMJ user, Dx bladder partially cystic mural nodularity on the anterior midline, Dx 3mm kidney stone, history of cervical precancer (CIN 3), Rx’d cyclonenzaprine, oxycodone as needed, and protonix.
A few days ago I urinated between 30 and 40 times. This is pretty normal for me. I normally have trouble urinating for about 5-10 minutes and then a normal length (but weak) stream comes out, and I spend a while getting the last drops out. Maybe a 25 minute total bathroom visit at most. I spend a lot of time on the toilet.
Yesterday morning around 9am until noon I sat on the toilet without getting a single drop out, then managed to get out a small stream and took a nap because I’d been up all night feeling like my bladder is gonna burst. Throughout the day I had a few very short streams, and was drinking water (at least half a gallon, maybe more). I stopped peeing around 10 and laid flat in bed trying to take shallow breaths to not put pressure on my bladder and had a few more unsuccessful or two-drop visits to the toilet. Fell asleep around 5am and woke up at 7, continued to really struggle with pain and finally gave into a hydrocodone I had from a while back and that didn’t work. I had already tried pyridium at this point and given it a while, but it didn’t help. I gave the hydro two hours, still no relief and no urine. Finally caved to 5mg of oxycodone because I’m broke and can’t afford copays and desperate to get to work. That didn’t work either. Still only a couple drops or complete inability to urinate. It’s like my brain stopped talking to my bladder.
So I finally called my urologist office saying this isn’t normal for me to have this happen for this long and they were shocked as to why I wasn’t at the hospital with a catheter already. I feel fine other than my insane bladder pressure and sharp pain. My urologist is out of the office but previously told me only to present to the hospital if I test positive on a drugstore UTI test strip. I don’t have money for that so I can’t check. I have $0 to my name and I’m thousands in debt from only being able to work less than 50 days this year due to my bladder. Is the urology office right that this is an emergency and I need a catheter? Or could this just be from the bladder wall thickening?
Every time I go to the hospital they tell me they have no idea how to help me and have never seen bladder wall thickening like this before and the last doc who was the top ER doctor there literally said he’s never seen what I show on CT and I’m discharged within an hour and referred back to my urologist, so I have little hope of anything going right.
I have a cystoscopy scheduled next week. I really can’t wait it out with a higher dose of pain meds? I’m constantly treated like I’m overreacting when I go to the ER and I will be humiliated if it happens again.
Thank you soooo much if you read this far. Any advice appreciated.