Introduction:
Food pipe cancer, medically known as esophageal cancer, is a malignant condition affecting the esophagus, the muscular tube connecting the throat (pharynx) with the stomach. This type of cancer typically starts in the inner layer of the esophagus and can spread throughout the organ and to other parts of the body if not diagnosed and treated early.
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Esophageal cancer often presents symptoms such as difficulty swallowing, unintentional weight loss, chest pain, and persistent coughing. While the exact cause of esophageal cancer isn’t always clear, certain risk factors can increase one’s likelihood of developing this condition. These factors include tobacco use, heavy alcohol consumption, obesity, chronic acid reflux, and a diet low in fruits and vegetables.
Early detection and treatment are crucial for improving outcomes in patients with esophageal cancer. Diagnosis typically involves a combination of imaging tests like endoscopy, biopsy, and imaging scans to determine the extent of the cancer’s spread. Treatment options may include surgery, chemotherapy, radiation therapy, or a combination of these approaches, depending on the stage and location of the cancer.
For individuals in Gurgaon seeking expert care and treatment for food pipe cancer, Dr. Ajeet Tiwari stands out as a renowned specialist in the field. With years of experience and expertise in managing esophageal cancer cases, Dr. Tiwari offers personalized treatment plans tailored to each patient’s unique needs. As the best food pipe cancer specialist in Gurgaon, Dr. Ajeet Tiwari employs the latest advancements in medical technology and treatment protocols to ensure the best possible outcomes for his patients.

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I’ll try to keep this short but there is a lot of nuance. In the past 1-2 years I have recently reconnected with some friends from my younger days (high school into young adult hood). We will call them Aaron (27 M) and Ashley (28->29 F) and I am 28 F. I previously stopped talking to both of them because of unfulfilled promises. Back in 2018, Aaron’s fiancé had moved to another country with his son and my boyfriend of 1 year plus had left to attend a family wedding and would be gone for close to a month.
Aaron and I in our mutual distress wanted to figure out a solution to our problems. Aaron was unable to fly due to not having papers as was worried his fiancé was lonely and I wanted to be with my partners family. Aaron had promised he would have paid for me to go on my trip before everyone left so my boyfriend’s dad did not count me in the budget for the tickets. With his fiancé leaving it then became I would go be part of the wedding then go stay with his fiancé for a bit. Aaron eventually ended up trying to proposition me for sec in exchange for the spend and that did not rub me right. This eventually carried forward into other issues tied to his affections and expectations of me which resulted in us no longer being friends.
We reconnected in 2022 where he apologized and explained more why he did what he did. My boyfriend asked if I was sure I wanted to welcome him back into my life and that he would trust my judgement if I choose to, which I did. Ashley and I stopped being friends back in 2017 because we had planned a trip for us and our partners. She stated she would use her buddy passes since she was a flight attendant to make the ticket costs cheaper.
The week before the trip it becomes I cannot bring my boyfriend. I was very confused by this. Severely confused by this so I asked why she said she didn’t feel comfortable with it. So I said okay. Don’t use your passes. We will pay for our trip and we can stay with his family. She said she still wanted me to stay with her. So I said okay. We will come, he stays with his family and I stay with you. We can all hang out and grab lunch and stuff and him and I go on dates and such.
Then she explicitly states the trip will not happen if I take him with me. Then she tries to turn it into a trip with people we have not seen from high school to recreate a sleepover we had in the 8th grade that got ruined by our parents. (That’s another story. I will add here my mom does not like Ashley never has) in the end it was all just too much and I decided that I no longer wanted to be friends with her because what she was doing was messed up especially so close to the trip. This on top of all the on and off issues I had with her through the duration of high school just didn’t seem worth it to take into adulthood.
Now 2023 Ashley reached out and apologizes. I was very torn up about the decision but after speaking with my therapist and weighing the risks decided it couldn’t hurt to try again. Both my gf and my bf were opposed to the decision but at the end of the day the choice was mine and I chose forgiveness.
Fall of 2023 my gf and I were planning a Christmas trip and Ashley said she didn’t get to see me while she was I my country because of the traumas she was dealing with with her mom so she would like to see me now. I told her I was going to fly out to spend the holiday with my gf so I didn’t think it would be possible. She stated she would see me in the time before I went to see my GF. I told her because of the trip I couldn’t afford it. She said that’s fine.
She would pay for the ticket for me to see her and I worked out an arrangement with my girlfriend where we would split the fair for the flights between all three locations and said her to do what happened the last time and I said yeah I can trust her. It doesn’t happen and that will be that. Lo and behold it does not happen because Ashley says to me two weeks before oh I overdid my shopping on Black Friday so I can’t buy your plane ticket. Ofc this makes me gf big mad and she says see I told you so. She was also confused why I was not upset. I explained that it wasn’t that I was not upset simply that it doesn’t really change much. I just won’t ask her for anything again. Which I haven’t and won’t.
Fast forward to spring 2024. The group is back together, we’re having weekly calls and our group chat chatting and having a blast. We decide we haven’t spent time as a group since 2017 so we should go see Aaron where he lives. I state very openly that I won’t be able to afford this trip. (Both Aaron and Ashley make a minimum of twice my income). Aaron says that’s fine I’ve got you covered. I question it and explain my hesitances because of both past situations. He said that’s fine don’t worry. I said okay. Let’s do this. The trip is slated for now (may 2024) and encompassed Ashley’s birthday.
A lot of things start happening in Aaron’s life and the ticket purchase gets repeatedly pushed off. This starts to make Ashley antsy so she buys her ticket hoping it pushes Aaron’s to buy my ticket. It does not. In moment of anxiety Ashley starts booking airbnbs for her self and asking how much I trust Aaron to follow through. I assure her that I do trust him follow through which I did. Because outside of the one trip he hasn’t not come through when I needed him too. I also stated at worst I end up buying my own ticket but I need to see what my expenses will look like in the end.
We are down to the wire my ticket is not bought so I start adjusting my bills. In the end I am not able to afford the ticket because even after short paying my bills I was left with roughly $120 which isn’t enough to book a flight or an airbnb for a week.
I told Ashley I would still try to figure it out and reached out to Aaron once more. He said yeah he has the money now but it doesn’t feel like a good time. The energy is off and he wouldn’t want me to come and something bad happens. I agree because what else would I do? It’s not my money nor does he actually owe me anything.
Ashley reaches out because I forgot to get back to her. To confirm The plan and I explain that I won’t be able to come because I really can’t afford it and it doesn’t make sense for me to put myself in a situation to be in a strange country with no emergency funds.
Ashley decides my friendship with her will fully change and she won’t take my word for anything again because I didn’t come to avoid having a bad trip not taking her feelings into consideration.
In the midst of this I start feeling anger towards both of them because Aaron didn’t come through as promised and Ashley has written me off over choosing responsibilities. My boyfriend said to speak to both of them and express what I am feeling to see what happens. I was able to resolve things with Aaron and come to a mutual understanding. However when I reached out to Ashley, she said she is on a high and doesn’t want to deal with this right now. She is making new friends and would like to clarify that I am no longer her best friend. She will listen to me when I talk but that’s about it. In my eyes that is a therapist not a friend and I already pay someone for that.
Am I wrong if I decide I don’t want to fix things with Ashley? Is she right for deciding I am not worthy of actual friendship?

It is a man, old and scraggy. He wears a jacket that lays over the red plaid button shirt and blue jeans. He wears an old baseball cap and a pair of glasses. He yelled something to Dad, holding his hands up like he was pleading, although we couldn’t hear it over the truck engine. They talked, but we couldn’t hear what they were saying.
“Hey, what are they saying”, I asked, while petting Matt’s hair, calming him. The old man then put his hands down and came close to Dad in a cautious way. They seem to start having some kind of conversation.
“I don’t really know, hopefully, something good”, Mom answered. They talked for a little while, with daylight beginning to disappear, giving us a sense of dread, and making me more worried about what weird creature was going to show up. Eventually, the old man turned and pointed toward what I think is the northeast. They then shook hands and walked back to their respective vehicles. “What’s going on”, Mom asked as Dad got into the truck.
“Well, our new friend here invited us to dinner at his farm”, Dad replied.
“Does he have supplies?”
“Well, he says has supplies for us to make the journey.”
“Should we even trust him? We just met h-”
“Relax, he’s just an old man, living alone at his farm, feeding his cows. What could go wrong”, Dad countered. The old man then entered the truck that was running and drove slowly, expecting us to follow him.
“Alrighty then, but we have to be cautious”, Mom said, with her suspicions of the old man. We then followed the old truck along the dark, frozen road. It just feels like something is going to show up along the road, but nothing happened. Matt did eventually stop crying, but he is still upset about the Joe escape thing.
“Where are we going”, Matt lamented, with the prior series of events in mind.
“I guess somebody is offering us dinner”, I answered.
“Why can’t we just go home?”
“It’s only going to be a stop, like a hotel. After that, we go to our new home, I guess”, I said, taking another look at Matt and cradling to comfort him. “It’s going to be okay.” I stared out into the darkness. I looked to the sky from the window and I faintly saw something in the clear, dark sky, lit up by the waning moon. They were brilliant, green auroras that defy the bright moon, dancing across the sky like ribbons in the wind. The truck eventually took a right-hand turn into another road, with us following suit. I can see a bright, orange light emerging from a patch of tree. When we passed by, it seemed it was a house, at a farm, burning in a massive flame.
“I guess those people aren’t so, uh, lucky”, Dad said, taking a quick look at it before looking at the road. Passing by, we went on and continued to follow the old man’s truck. We passed onto another intersection until he turned into a driveway to what I believe to be his farm. Going into the driveway, I can see an old house, along with a dilapidated farm further away, barely visible by the headlights. The old man parked by the house, where there were a few other trucks there. We parked alongside the truck and we got out into the cold, near-silent night.
“Welcome to sanctuary, where all are welcome”, the old man bellowed. This is the first time I’ve heard his voice. Matt was the last to get out of the truck, slowly and clumsily climbing out of the truck.
“What’s your name”, my Mom politely asked the old man.
“Oh, I guess your husband didn’t tell ya. My name is Steven, but you can call me Steve”, the old man said, with some crackling in his voice. “I am very proud to host a dinner for you and your family”, he continued. “What’s your name, ma’am?”
“Oh, my name is Janice”, Mom replied, quite pleased at his politeness.
“Hello, Janice, and what are their names”, Steven asked, pointing to me and Matt.
“That’s my daughter Kate and my son Matt”, Dad said to Mom.
“Oh, what wonderful names for a couple of beautiful children you have”, Steve grinned. “Come, it is dangerous out here.” We followed him to the house, which looked like it had seen better days. He entered through the double-set door, the first a solid door and a screen door behind. Entering the house, it smelled like what you’d expect, old man. Looking onto the floor is made of glossy wood and walls with cracks, likely caused by the earthquake. It is dark in there, lit by candlelight from many candles, yet it’s fairly warm here. I don’t know why we went into the house, but Dad was right, Steve is just a lonely, old man. Matter of fact, there seems to be nothing wrong here, other than the cracks in the walls. “Sorry, the power went out. Had to resort to the candles. I knew my wife would come in handy”, Steve explained as he took his coat off. “Oh, supper will be ready right away. Had to use the fireplace to cook. Also, can you take your boots off?” We took our boots and set them aside. We went into what seemed to be a living room, with dusty old-style furniture.
“So, where do we sit”, Mom asked.
“Oh, well, follow me”, Steve commanded, leading us to the dining room, with a long, wooden table and six wooden chairs, along with their corresponding old-fashioned plates, glasses and cutlery, lit up in the candlelight. We noticed that everything on the table was covered in a thin veil of dust. “My apologies, the recent shocks dropped a bit of dust on the table”, he explained as he noticed us looking at the plates and moved into another room nearby. “Take your seats if you like.” We all settled onto the chairs, and blew off our plates of the dust settled there.
“When will we eat”, Matt impatiently said.
“Once Steve comes out with the food”, Mom answered. Matt sat there with a tired look on his face. Dad seemed to be in a better mood than before and it looked like he wanted to start a conversation.
“Hey, should we talk about something”, Dad asked. I then see Steve with a bowl and a silver plate.
“Here we go, may not be much, but at least it’ll fulfil the soul”, Steve said, smiling when he served us mashed potatoes and meatloaf. “So, shall we pray?” That came unexpectedly, as we are not too religious, but we were in his house and gave us shelter and food.
“Sure, we can do that”, Mom said and we all bowed our heads and put our hands together. Steve cleared his throat
“Thank you, Lord, for this good food to feed the soul in these hard times. I shall pray, in the name of the Lord and Jesus Christ, that these hard times shall be over, so we can get on with our lives. Amen.” We raised our heads and grabbed whatever food there was onto our plates. “Oh, there’s no gravy, so we have to deal with bare potaters and meatloaf.”
“Oh, not to worry. Thank you for the food”, Dad thanked Steve. We began to eat the food once we got it sorted.
“So, what brings you here”, Steve asked.
“Well, there is an evacuation order in effect for this area, so we had to go to Regina”, Dad explained, with Steve taking in every word. “So, we came from Strasbourg, we tried going south towards Regina, but we hit an obstacle in the way and we had to take another route, leading us here.”
“And we encountered a few odd things along the way”, Mom added.
“Huh, interesting. What do you guys think is going on”, Steve inquired.
“By the things we saw, we have no idea. Dinosaurs, devil dogs, hell pigs, the whole deal. I shouldn’t forget the earthquake. They told us a pipeline leak caused by the earthquake”, Dad clarified to Steve.
“Hmm… is that so”, Steve wondered. “Wonder what I think is happening? The Rapture is happening. Do you know how the Bible tells us of the end times? Good people sent to be with God and his kingdom, the rest here to suffer the Hell unleashed by Satan.” By this point, he was beginning to rant, but we couldn't stop it as we all began to feel tired and powerless. “So, the Devil will send his demons in the form of these illusions so that they can torment the sinners. It is happening, it is-” Steve manically continued as I drew towards blackness and his voice becoming less coherent. My vision is now all black.
I saw those same lights, but more rapidly than before. I then emerged onto the same clear sky, but something felt different. I can smell something in the air. I can smell what seems to be chemicals in the air. Looking down, I was terrified. Dark, grey rock in the shape of ropes and folds, similar to those I saw of lava flows on a volcano in pictures. This went on as far as the eye could see. I can see no tree this time, just the cooled lava everywhere. I then walked, feeling every bump and crag. I thought I walked forever until I heard a rumbling sound and woke up.
I am in total darkness. It is cold and it smells like cow manure. I tried to move my hand, but it seemed to be bonded behind my back by a rope. I tried to move my feet, but they were also bound by rope to the legs I tried to speak, only to realise my mouth was agape by a cloth in my mouth. I heard shuffling nearby but I could not see. It was then shone in light when Steve entered the door, holding a candle, revealing all of us in the same situation. I then can see what we are in. We are in that same wooden dilapidated barn we saw earlier and seems to be more damaged than the house, wood creaking can be heard.
“These sedatives are more effective than I thought. Maybe I should use them more often”, Steve smoothly explained, like he’s some kind of agent and began pacing. “Wonder why you are here? Well, I wondered the same thing to myself, why didn’t God take me to his heaven? When I first heard of the government telling us of those evacuation plans, I thought it was that, a leaking pipe. I began to notice things I couldn’t believe myself, at least at first. Earthquakes, weird creatures showing up, people disappearing, the whole spiel. I connected the dots. The Rapture is happening, for sure, but why me? Why was I the one left here on this Earth”, Steve calmly ranted, pacing around the barn, but it seemed to sound crazier and angrier the more he paced. “I thought I had lost my way. I’ve been unfaithful to God and his son. But, I realised that God always has a plan and he left me on this Earth to serve a purpose. I wondered what my purpose was until I had a moment.” He then stopped in place and calmed down. He turned to look at Mom with accusing yet crazed eyes.
“I’m supposed to keep the sinners here in line, to earn a place in God’s kingdom, or suffer in Hell. I know you are a sweet woman, Janice, but your treachery with Satan is over and I am going to do what’s right.” Mom then looked at all of us, with assuring eyes like that of an innocent yet caring mother we all know knew. I began crying and trying to speak through the cloth, but I was helpless to watch by. “Forgive me, Father, for what I am going to do.” He then pulled a knife from his pocket and plunged it into Mom’s neck with no mercy. I looked away once he did that, trembling, with tears pouring out and my vision glazed and I fell limp. I could see my brother tearing up, but he did not look away. I can hear Dad behind me, with his screams of agony and anger covered by the cloth. It felt like I was in slow motion, taking in every moment.
I then heard the chair, screeching as Steve dragged the chair containing Mom’s lifeless body towards the door, leaving behind a trail of blood. I couldn’t bear to see my mother like this. I shut my eyes very hard and hoped it would go away. The door then shut, leaving us alone with a candle, fearing what would come next. I stared at the candle, seeing it dance in the flames like a woman dancing in the darkness. Is this how it’ll end, I thought. End up dying to this sick man? My Mom was killed in front of me. I sobbed with that thought, then I began to think about the inevitable death of me. I hope there’s something after I die. Maybe I’ll see Mom again.
It was silent for a while, nearly no sound other than our moans. Dad seems to be fidgeting at the back of his chair, rocking it slowly. Looking past him, I shuddered at the glistening pool of blood, where Mom was last alive, could be my fate. I then see Dad release his arms from the back of the chair and remove the cloth from his mouth. He silently stood up and bent down to untie his legs from the chair legs. He then went to me and removed my cloth.
“H-h-how did you do that”, I silently wept, fearing that Steve would show up at the door and kill us all.
“My binding is loose. The old man probably took a liking to me”, Dad whispered. “I should remove your binds.” He untied them, releasing me, doing the same for Matt. “Now, we need to be quiet.” We then walked, quietly, along the painfully creaking wood in the near dark, following the blood trail, glistening in the candlelight. We cringed and dreaded each sound we made and watched the door in case it began to creak open. A few silent steps later, we made it to the door and we slowly opened it so as not to make any noise. What was revealed to us is nothing new, other than the blood trail continuing in the snow directing towards the back of the barn. “Okay, Kate, Matt, you guys run to the truck.”
“What about you”, I sobbed.
“Don’t worry about me”, Dad responded, giving me his keys and forcing them into my hand. “If I’m not back in a few minutes, leave. Don’t look back, take care of your brother, okay? I love you, no matter what happens.” He then kissed me on the head and ran to follow the blood trail. We quickly walked towards the black truck, stranded there for maybe hours. Getting closer, freedom is getting closer. When we got to a fair distance to the truck, I heard footsteps behind me and, the next thing I knew, I was knocked over to the ground into the hard snow on my face. A hand turned me over to give me a glimpse of a crazed Steve, his eyes wilder than before.
“Oh, yes, trying to escape”, he bragged. I looked at him, frozen in fear, like a deer in headlights and he caressed my face with his bloodied blade. “You do have a pretty face, but I’m afraid you are just one of Satan's creations, made to pull me to lust.” He then raised his knife in the air when a familiar side emerged, out of the blue.
Joe came and bit him in the arm that was holding the knife. Steve screamed in agony the moment he realised what happened. He shook Joe off and stood up to stand his ground. I stood up as Joe hissed and walked around the crazed being he wounded, not in fear but in aggressiveness. “Is this one of your pets, demon”, Steve screamed as Joe came in for another attack, but Steve countered that with a slash to the snout. Joe then ran away, whining, into the darkness. This sequence of events gave me the chance to enter the truck on the driver’s side. I had some trouble starting it, besides this is my first time driving a truck.
Steve menacelily walked towards the when Dad came barreling and tackled him to the ground. Dad was on top when he went limp. I finally put the keys in the engine turned it on and backed out, with memory serving me the instructions on such a vehicle. Steve pushed Dad’s body and stood up, but by that time, we left the farm.
“Turn back, we have to get Dad”, Matt cried, but I was very emotional, accepting what happened. I felt that, without my parents, I feel… useless.
“Dad’s dead”, I screamed at Matt and he began gagging uncontrollably in tears. I began to feel sorry for him. “Sorry, I, I don’t know.”
“It’s okay”, Matt sniffled. “I guess Mom and Dad are dead anyways.” It was silence for a few more minutes, tears welling in our eyes.
“Hey, our parents are in a better place”, I said, trying to make the situation positive.
“But we are stuck here, without them? Don’t we deserve to go to a better place?”
“Don’t say that”, I huffed and I paused for a bit. “I know we are in the, uh, right place now. Let me tell you something, once we get to Regina, I will take care of you, no matter what life throws at us.”
“What about Joe”, Matt asked.
“He’ll be fine. He probably found his girlfriend already.”
“Hey, don’t you have a boyfriend?”
“I, uh, I don’t have one. That I know of”, I spoke, bringing me back to Sam, remembering that she’s the only friend that I ever knew, and I left her. Without her, I felt alone, no one would ever relate. I began to tear up. “I don’t have any friends. I am alone,” I sobbed.
“What do you mean? I’m your brother!” I looked at Matt, and smiled, happy that he acknowledged that we were in this together.
“Thank you”, I thanked him. I slowly stopped on the road, just to hug Matt hard, crying my eyes out. We then heard what sounded like an elephant in front of us. We looked up to see a walking snow-covered brown fur wall with four pillar-like legs in front of us. Its curved tusks gleaned in the light and the eyes reflected in the light. The furry trunk waved around like a searching snake from a tree. We both knew what it was.
“Hey, look at that, a woolly mammoth”, Matt said, excitement running through him. At this point, we weren’t surprised.
“Yep, that is a woolly mammoth”, I added. The mammoth turned to us on the road, seemingly confused about where it was. It looked at our truck and seemed to growl, like an elephant. We are starting to realise this thing is becoming aggressive.
“Uh, should we move”, Matt asked. I remembered hearing something about standing your ground in case of an encounter with an elephant. I hoped it would work for a bigger, furrier version of one.
“No, we have to stand our ground.”
“But, it’ll attack u-”
“Trust me!” I then honked my horn and it backed up. It then rushed, then stopped, a mock charge. Eventually, it moved out of the road, disappearing into the darkness. We sighed in relief.
“That was close”, Matt sighed. I then continued to drive in the night, headlights leading the way. The road is bumpy, as noticed by every ditch and peak we hit, but surprisingly, Matt was fast asleep. I began to get comfortable driving and used to the road by that point. It was silent for a while until we hit a smaller intersection. That is when the truck shut down, completely and stopped. I tried the gas many times but with no effect. There is no light, nothing. It is near-darkness here, shone only by the moonlight.
“Shit”, I yelled, desperate to turn the truck on without much success. Matt woke up, confused.
“What happened”, he yawned.
“The truck turned itself off. I can’t get it back on”, I fretted and at that moment, Matt was just as panicked as I am.
“Why?”
“I-I don’t know. One moment, we were driving, another it just-”, I quavered, when I heard something rustle in the distance. We stood still, hoping whatever it was didn’t find us. I looked around, hoping to see something in the moonlight. I then see a long, walking animal. It looked like some sort of alligator at first, except for a dinosaur-like head. Once I strained my eyes to the darkness, my fear levels rose as I could see it walk on its hind limbs, with its forelimbs dangling nearly touching the ground.
It was wandering around on the road when I heard a near-crocodilian growl at Matt’s side of the truck. Another of those creatures appeared, seemingly looking into the window like a hungry bear, giving us a chance to see its scaly head. Its exposed alligator teeth gleaned in the light like knives, but more terrifying was the eye. Its serpentine pupil shone brilliantly in the light like eyes in the dark. It then ducked down, gave a hiss, and moved towards the other one. A few more showed up and formed a group.
“What should we do”, Matt asked. “Should we stay?” I looked around, hoping for another way to escape them without them noticing. I further strained my eyes and mentally mapped out the area. There is a cemetery on my right-hand side, a grain bin storage yard on my left and a series of trailers on the other side of the highway, which is ahead of us, from the storage area. There, I see a series of white, storage buildings, something we can go to and wait it out inside.
“Okay, so slowly open the door”, I instructed Matt. The click of the doors opening cringed us. We looked at the group, but there was no response from them. We then, as slowly as we could, opened the door and stepped out. Still no response. Matt then quietly ran to the other side, towards me. “Okay, we are going into the storage yard and go to the other entrance”, I said, pointing to the other right-hand corner. I wanted to get as far away from these things as possible before making a safe crossing. “Then, we cross the highway on the other side, run into the buildings and stay there for the night. Are you ready?”
“I guess”, he whispered, looking at me in fearful doubt.
“We are going to do this”, I whispered back. We then silently ran over, having to rely on our night-adapted eyes, to the corner, walking past the bins. We made it and nothing behind us so far. “We’re good so far.” We then crossed the road and noticed nothing. We noticed a tanker truck, leaking some sort of fluid across the road. I easily recognized it as fuel, based on its distinctive, sickly smell. I wouldn’t be worried about it if it weren’t for a collapsed light pole that is somehow still flickering with electricity near the area where the fuel would be flowing. We quickly avoided the fluid when I froze to see the group of the walking alligators, running towards us. “Run!” Matt tried to run, but one of those things appeared and clamped its jaws at the back of his neck. He yelped in pain and it took him down to the ground. “Matt”, I yelled, helplessly watching as the creature tore into him.
Matt reached out his arm before the others came to him, then a flash of fire came. At this point, I knew what happened, but I couldn’t even think before it exploded. It blew me towards the building, far away. I was knocked out for a few seconds before I regained consciousness, groaning in pain on the ice. I noticed something especially painful just below my chest. I reached towards the area with my hand. I pressed on it, more painful than ever and raised my hand, only to see blood, brightened by the fire. I realised I was wounded, maybe by shrapnel made by the explosion.
I looked toward where the truck was and all I saw was a blaze. Those things weren’t there, at least. I also noticed something else, too, there’s no Matt. I tried to look around for something, some sort of sign of my brother within the fire, but I saw none. I then wept, realising I had failed. I have failed to keep him safe. I have failed to give him a better life. I failed him as a sister. I could’ve done better. The thoughts poured in as tears glazed my eyes. At that moment, I failed to look around me.
I noticed a dark thing beside the blaze. I thought it was Matt, preparing to greet him back, even though I knew he couldn’t survive the explosion. The image became clearer and clearer as I noticed it was one of the walking crocs that, glazed by the fire, was coming towards me.
“Just kill me”, I screamed, preparing to painfully die to meet my maker. The creature was about to attack me when something large, silent as the wind, came charging and clamped down its massive jaws, filled with conical teeth on the hapless creature and raised it. The crocodile struggled before going limp with a crunch within its strong jaws. The big, dark and scaly monster that it is towered over me and is as long as a bus, possibly longer. Its large legs are a contradiction to its small arms that hide beneath its scarred, bulky body.
It turned to look at me with an oddly bird-like expression, revealing in the firelight numerous scars from battles I could never know and looked at me with its beady bird-like eyes, breathing out wisps from its nostrils like a dragon in the cool air. I recognized it as a creature I know too well, a T. Rex. I breathed heavily and sickly, looking at the thing, nearly expecting me to drop the body and go after me. Instead, it simply walked away, carrying its bloody prize with it, and steadily retreated into the darkness.
I then lay down in agonizing exhaustion on my back, thinking of the next step of action like I'm on a suicide mission I would never come back from. I looked in the direction of the graveyard and had one thought. I guess I am dying. a graveyard will do. I struggled to stand up, noticing my blood-soaked clothes and felt a broken left leg. I grasped my wound, limping step by step and enduring the sharp pain while shaking in the cold. Every step I took, I remembered all the memories, good or bad, that I had with my parents. My brother. My friends. My family. I eventually reached the cemetery and slouched at a tree.
“Guess I’m joining you, guys”, I said, speaking to the snow-covered gravestones, only to hear something. A familiar sound of chirping emerged and, lit by the blaze, it was a sight I can hope for. “Joe, what are you doing here”, I depressingly cheered as Joe went to me and curled up in my lap as if he were a cat. I noticed the new-found scar he had on his little snout, but I paid no mind as I petted him. “I guess you came back. Thank you so much for what you did”, I thanked him, not expecting such a loyal creature would be with me, comforting me, to the end, like what my mother used to do when I was a newborn. I heard another noise, this time a deep rumble.
I thought it was another earthquake coming, but it got louder the closer it got to me, becoming more animalistic only felt small vibrations I barely felt. Joe stayed put, oddly enough, as T. Rex, different from the first one, came. It walked towards us until it stopped short of us. It began to produce a low-pitched, bird-like purring, attracting Joe. I realised something, that this T. Rex is Joe’s parent. He joined the rest like him, whom they showed up and all chirped around.
The grown Rex then brought its snout closer to me, not to kill me, but to look at me. It did not reveal its teeth and was still purring. I put my hand out and its nose came close to it. It rubbed it against my hand and started to pet its cold, scaly skin as it breathed through its nose and put it on my chest. I rested my head on it before it pulled away. It gave out a hiss, but I knew it wasn’t that of a threat, but more of a thank you for bringing its small, sometimes immature, child home.
That gave me relief, as it felt like I at least did something for once. They walked away, along with Joe, towards the darkness amongst the gravestones in the cemetery. I glimpsed one last desperate look at Joe before walking beside his parent. I looked up at the sky and I could see all the stars, twinkling, and the dancing green auroras. I began to feel limp and felt the cold embrace of death coming over me, tears pouring out of my eyes. The sky then grew brighter and brighter, the stars faded into the light and I could see my family welcoming me to a new home. It then slowly went black, darker than a cave.
You would think this is the end of me. It wasn’t, or else I wouldn’t be writing this right now. I eventually woke up in a hospital in Regina. I was told I was rescued by a team that transported me while I was in a coma. The doctors said I was very lucky to be alive, as the shrapnel narrowly avoided my vital organs. After that, I was adopted into a new family, but I was only with them for a couple of years before finding a new job and moving out.
As for Sam, I don’t know what happened to her. I would like to think she is safe, somewhere else. As for my family, I think of them all the time. I was in a depressive period right after that. Eventually, over the years, I accepted that they were gone and went to a better place. For Joe, I would like to think he is all grown up, like his parents, and becoming the king of the jungle. I hope we meet again.
As for the evacuated area, it wasn’t some pipeline rupture that caused an evaluation, but an anomaly, with the exact reason not known. There are excuses for the claims of weird stuff going on in there, from disease to chemicals, to eventually a previously unknown geological event, but I saw through it all.
You may ask how, it's because I've been there. Take it or leave it, this is the story I have. As the decade came by, cover-ups were made to hide it, even walls were put around it. Since the incident, the exclusion zone grew from a mere 80 kilometers in diameter to 460 kilometers in diameter, emptying entire cities of the likes of Regina and Saskatoon. I had to move to North Battleford, by the recommendation from the same government covering it up, making me think that time will tell before the floodgates of truth open.
The anomaly didn’t have a name initially, however, over the years, everyone agreed on one name in particular: The Saskatchewan Anomaly.

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As a scrub like myself, there's no way I can survive the later floors even if I can do a gazillion dmg; the 32 fear penalties are too much. Solution? Cheese it with Demeter as early as floor 2!

https://preview.redd.it/rrmo5epajd0d1.png?width=1123&format=png&auto=webp&s=b0127fad96ed96145daffe669a914038c30c22b4

This build tries to find as many pre-req boons as early as possible, with 2 boons that act as hyper-carries and trivialize the later floors - Demeter Infusion and Apollo/Hestia duo

https://preview.redd.it/6r6g4ir0kd0d1.png?width=1161&format=png&auto=webp&s=66e5ea6bca199c02e1396b6aad47d19b8da53530
https://preview.redd.it/3frf6ub3kd0d1.png?width=1171&format=png&auto=webp&s=c5ec001a7b2077dcaaae11e7c6a66eaade442c24

Overview:

This build is an non-spell focused builds, with the goal of rushing Coarse Grit (Demeter Infusion) to nullify the dmg increase from Fear and Phoenix Skin(Apollo/Hestia Duo) to heal chip dmg.
They have a heft price to pay - 6 earth to activate the infusion, and at least 4 boons to activate Phoenix Skin (3 pre-req and the duo boon). To accomplish this, we pick every Card that helps make this faster - in my experience, this can consistently get Demeter Infusion Floor 2, and the Duo floor 3/4 (sometimes this duo can fail, then this is still an exceeding powerful and tanky build, just not exactly invincible).
This build can really work with any weapon, since the key is to rush defensive boons. Aspect of Momus with Apollo Special boon is ideal here, since we want to activate Phoneix skin asap and apollo turns your special into AOE. Of course, Poseidon's Special is great as well - but in this build we prefer Apollo to rush the duo. Axe with Apollo Attack is amazing as well - but if you only aim to win once, Momus 5 is just better.
In short - hang on before we rush Demeter Infusion (Consistently floor 2), and chill from that point on!

Grasp Selection: 29 total

One day I will find 3 Darkness... one day
https://preview.redd.it/kcw8afeqid0d1.png?width=758&format=png&auto=webp&s=e9b58e5142ba0fc05f2d23036b76893e01817748
We want everything that:
Increases Reroll (XVI, XVII, XXI, XXII) and boon quality (XX). This will give us 10 rerolls, and good chance to find the Duo first try.
Number of boons (XXIII); I don't even have this maxed, but the 2 extra rewards it gives is already game-changing
And the standard goodies (Everything else); feel free to substitute I for II if you want to be more of a caster. The extra healing from II only really matters during the in between stage of having Demeter Infusion but not the duo.

Fear Selection:

https://preview.redd.it/mvw2vm3qid0d1.png?width=751&format=png&auto=webp&s=164b04d26829e832473f83fa192fe38d29f54605
We pick everything that increase enemy dmg, since we are gonna set it to 15 anyways.
We avoid the heal reduction since it will make the Duo let powerful, the timer since this build is slow, and the boon one since we want to rush critical boons.
Feel free to move some points into the Revenant one, for example 2 from the dmg barrier options if you are using a slow attack speed build like the Axe

Keepsake:

Stage 1 -
Apollo - get the good starter boon that boost dmg
Echo - to double up on Earth Element (only if you are willing to give-up often to try to high roll this)
Chaos (Only at 3 star)- Always a solid starter (if you didn't know, the boon this give stays after switching)
Stage 2 -
Demeter - DO NOT USE HER STAGE 1! The infusion will only be offered when you have at least 1 earth
Stage 3 -
Hestia - To finish the duo
Stage 4-
Apollo - If the duo is still not finished
Luckier Tooth- you have already won at this point, but this can prevent one f-up

Boons/Reroll Strat:

Look for things that complete the pre-reqs. That is:
Earth Element: Hera (the best one since she only have earth), Demeter, Hephaestus, Artemis, Hermes. Pick the best earth element boon if you see one, if not, reroll once.
Apollo/Hestia Duo: don't need more boons than necessary; look at the pre-req in your codex to see what's missing
Before Demeter Infusion Reroll every other God, especially Selene. DO NOT use any more reroll on doors after activating the infusion until stage 3, where rerolls becomes even better.
If another god is offered at the start... consider just ran into enemies ASAP

Other Notes:

Convert all minor finds to major finds ASAP
Pick Hermes over Shop stage 1 to get Earth Element
Froggo Pet for the 40 max health
lemme know what you think or ask any questions!

Disclaimer: These tips are from personal experience from earning my first 10k. and are not officially endorsed by Fiverr. Take them with a grain of salt.
I am going to share tips that anyone can take advantage off. No matter what category.
Why Choose Fiverr?
Fiverr is an excellent platform for careers in design, video editing, interior design, voice-over work, and web development. I am not so sure about other career paths. On Fiverr you have an opportunity to put your services out there for anyone to reach out. You get exposure to many clients with many different real world problems that you get to solve.
The Drawbacks of Fiverr
While Fiverr can be a great starting point, it's not ideal for long-term reliance. As a freelancer, you may feel like an employee without the benefits. Fiverr’s policies tend to favor customers, which can sometimes result in you losing payments. I have experienced many cases where you have done the job, but customer claims they don't like it and Fiverr gives them a full refund on the project so they get away with your work and you don't get paid. Although I must say these cases are rare because you learn to avoid sketchy clients like this as you gain more experience on Fiverr. I will share tips on how to avoid sketchy clients on Fiverr too.
Getting Started: The Right Way
But first, i will talk about how to actually start earning on Fiverr. I will be quite frank with you. You could have setup the best looking profile on Fiverr and go about making no orders for the rest of 4-6 months on that account. If you are just going to follow the tips provided by the official Fiverr, the chances are not going to get any luck finding customers. Here's my tip. Reach out to your closes connections. Let's say your uncle, aunts, friends or family to provide your service that you are offering on Fiverr for them. Share them the link to your profile and ask them to place an order with you. Creating an attractive profile is just the beginning. Here's a strategy that worked for me:
Leverage Your Network: Start by reaching out to friends, family, and acquaintances. Share your Fiverr profile with them and ask if they need any services you offer. Encourage them to place orders through Fiverr to help you get initial traction.
Make It Legit: Ensure the transactions appear legitimate by conducting all interactions on Fiverr. If you’re offering logo design, ask if they genuinely need a logo and handle the entire process professionally.
This is because in a case Fiverr checks your profile, they will know the context and know that your order was legit and not an attempt to boost your profile score.
Now talking about profile score, Fiverr has a like a metric system for every account (they do not share this with you). The more orders you get on the platform the higher the score goes. Things like getting good reviews, your conversion rate, message response time all help. So as a new account, you want to boost this "score" as high as possible. The easiest way is to get orders and leads from your social circle. Round about 3 orders is good enough for someone which a decent looking profile and portfolio to show for. However, try to get like 5 for good measure.
Once that's done, you wait about 1-2 days for your account to start getting organic exposure. Here is where you will start actually earning on Fiverr. Now I am going to share with you how to actually talk to your prospective clients. First rule, don't look desperate. Second rule be desperate. What do i mean by this? I am going to assume you have done the things I have said earlier and now your account is starting to take off. You don't have much time until that fame and glory dies out and your organic exposure goes back to zero. So you are going to have to start "hunting" and putting in the work to get clients.
How to Engage Clients Effectively
Once your profile gains some visibility, effective communication becomes crucial. You will need that as a fairly new account. When a customer approaches you, its important to respond quickly to them. They aren't going to wait all day for you to respond because they don't know you, they don't care much about you and they got other "sellers" as options. So get them to know you, and get to know them. I cannot emphasize this enough:

1. Be Human: Most sellers respond like robots. Stand out by being personable and engaging. Respond quickly and professionally, but let your personality shine through.
2. Show Genuine Interest: Try to use these when you see fit- your goal here is to get them to talk to you and subconsciously make them think they have already chosen you for the job:
   • "I could get around working on your project, but could you tell me more about this? [ ask a question about part of their project brief ]"
   • "I could finish your project within [give them a delivery time frame that they would probably accept] , would you be okay with that?"

Read more...

With Anthony joining the black jackets in the lounge, he felt like he had fully proven himself after his meltdown to get eliminated in Season 11 and Van was happy for Anthony as he had worked his ass off all season and said the final 6 was a strong ass 6 and it was going to be tough to beat anyone in black jackets but he wasn't letting up now. Nick said somehow despite their being less drama that this had been tougher than all stars as he felt the pressure of being a favourite and Paula said she didn't actually expect to this well having been gone from Hells Kitchen for 16 years but was very proud to show she could still work a line after so many years away. Chef Ramsay welcomed back his black jackets and said to show how proud he was of them all getting this far, he reunited them with their families to give them a boost for the next service and said the reward for the next challenge would be spending time with their family with Nick saying this was the exact boost he needed to kick on in the competition. Ramsay said the next challenge was one of his favourites as it was time for the fusion challenge and Nikki said this was the challenge she was looking forward to as she had become a great fusion chef since season 19 and Paula said she could still remember getting a fusion dish on the menu in Season 5 so it was time to relieve her glory days of Hells Kitchen Season 5.
It was King of the Hill with the chefs taking a seat in the chair until a better dish beat them and was being judged by Chef Curtis Stone who said he was very excited for some amazing fusion. First up was Nick with his fusion of Indian and Spanish which he said wouldn't be his ideal fusion as he presented his cod which Stone said was a strong effort, the only issue being there wasn't enough Indian spice in there but it was a good dish as Nick sat in the chair. Next up was Paula with the fusion of Mexican and Japanese which Paula said would not be her first choice and her pork ended up being a bit muddled with flavours as well as having underseasoned daikon and Nick remained in the chair. Anthony was up next with a fusion of France and Thai, and unfortunately his hanger steak was overcooked as well as Stone describing it as a Thai dish with some asparagus lumped in there to make it French as Nick remained in the chair. Kanae was up next with a fusion of Thai and Spanish, and her salmon was praised as being almost perfect and the dish of the day so far as Kanae took a place in the chair to dethrone Nick and Kanae claimed the reign of Queen Kanae was beginning. Van was next with Chinese and Mexican and he also had a superb effort with his snapper with Stone saying the levels had gone up but said Kanae's dish just had the edge! Nikki was up last with French and Indian, and her duck was cooked perfectly as well as combining both cuisines superbly to give Nikki the throne and the victory!
Nikki said to not only get the 2nd black jacket but win the 1st black jacket challenge showed she was here for business this time round and she got to enjoy a lunch and day out with her family while it was ice delivery day for the other 5 black jackets and Anthony said he still thinks about when he overloaded Hells Kitchen with ice. The Chefs had no dinner service tonight so came back the next day refreshed and Chef Ramsay said there was a big challenge coming up in tonights dinner service as the chefs would be facing off against another team of all stars! Out came the first all star who was Season 21 winner Alex Belew and Alex was pumped to take on a team of new all stars and Anthony knew what was up, it was gonna be winners returning. Out came Season 19 winner Kori, Season 17 winner Michelle, Season 18 winner Ariel, Season 20 winner Trenton and Season 12 winner Scott Commings, and Van said this was serious game time tonight as if the all stars could beat a team of winners, it showed Chef Ramsay they had the best black jacket squad of all time. It was noted by Nick that when Scott and Trenton came out, Scott shook everyones hand but Trenton said he'd rather not as it was a competition and Nick said that gave him even more motivation to win tonight and maybe he might be finally able to beat Michelle in a season. Chef Ramsay said both teams could add 2 appetizers and 2 entrees to tonights menu and the black jackets added a tortellini and a tuna tartare appetizer as well as a NY strip and pork entree. The returning winners were less cohesive in picking a menu as Michelle and Trenton disgareed on the entrees and Ariel said it didn't matter what went on the menu as long as they all agreed as they got a shrimp pasta, a squid salad as well as a veal and fillet entree.
The returning winners had Ariel and Kori on appetizers and Kori did admit to being a little nervous to come back as she didn't want to tank on her return on Hells Kitchen but her and Ariel's first risottos and pastas came out perfect and with Michelle serving perfect scallops, Kori said it was just like riding a bike. Ariel continued to have a great service but Kori ended up 2 minutes behind on pasta somehow, and Ariel expected a bit better from Kori than struggling on such a simple dish but Kori did finally complete the ticket as the winners finished appetizers in quick fashion. Scott was happy to be on the garnish station and was extremely vocal as usual with Michelle on fish, and Alex and Trenton on the meat station getting the first 6 top out despite Trenton complaining that Scott doesn't need to count down every 10 seconds as they know what they're doing. Michelle had a strong service on fish but ended up ignoring Alex and Trenton's cry to wait as their steaks and lamb weren't ready to serve her snapper. Alex and Trenton did catch up eventually as the winners continued to serve nice entrees going into the last few tables. Despite claiming he was the prince,of steak, Trenton served an overcooked NY Strip and then served a rare strip on the refire and Alex didn't know how Trenton managed to mess up twice on his own dish. With Alex's help, Trenton got organized and the returning winners completed a strong service with Scott noting that was the easiest service he's had in Hells Kitchen.
Nick and Kanae were on appetizers for the black jackets and Kanae was confident of beating the winners as half of them are probably in their 60s by now and her and Nick worked very well together to serve delicious risottos and carbonara. Anthony on fish ended up dragging on lobster as he hadn't dropped it early enough and Ramsay said we should never wait for lobster as Anthony bounced back to finish the ticket. Nick and Kanae continued to have great services as the black jackets finished appetizers ahead of the winners and Van on garnish was pumped to have his best service yet to lead his team to victory. Nikki and Paula on meat served perfect fillets and duck, and the black jackets finished the first half of entrees in great fashion with Anthony serving nice salmon. Van though started dragging on mashed potato and was unresponsive to Chef Ramsay on a time on mashed potato as Van finally caught up with Paula and Nikki. Nikki continued to have a great service but Paula got behind a minute on lamb and was struggling to stay organized as she had 1 duck ready and 1 not before she finally caught up again, and Ramsay said the bounce backs had been strong all night and to keep it up. Anthony though on a late ticket, realized the skin had fallen off his salmon and had to refire and him and Van's timing went completely off as Anthony served raw salmon and Van mushy cauliflower! Anthony and Van did fight back and the black jackets completed a relatively good service.
Chef Ramsay announced that while 92% of the diners in the red kitchen were happy, the winners had 98% satisfied so the returning winners won and Nick said he still can't beat Michelle. The black jackets had to come up with 2 for elimination and both Kanae and Nick said Van was the first nomination for his issues on garnish but Van said he was by himself and everyone on garnish gets in the weeds at least once and was nominating Anthony and Paula as there was 2 on meat and still issues. Paula said it wasn't her best service but Anthony was the main issue and the team did finally decide on Van and Anthony as the 2 nominees. Despite Anthony pleading for one more chance after his first bad service, Ramsay eliminated ANTHONY for losing control of his station but told him to keep his jacket for being a force all season and said he was happy he invited him back. Van was relieved to survive after his first bad service but tomorrow he was coming back with a vengeance and Nikki said she'd had a couple of great days and was gonna keep it up for the rest of the season to win the whole thing.
Vote HERE for the next 2 chefs to be eliminated!
https://strawpoll.com/GeZAOELbbnV
https://docs.google.com/spreadsheets/d/1lZdCZ5yphKY-xzgCoYI23gLu5dxegS4eB5BC-Slk9ac/edit#gid=0

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As above only have one sat LNB and wanted to know whats the best way to tackle this.
1: how do i organize the feeds so they can be displayed and navigated on a smart tv / phone
2:Do i keep everything on it own separate network?
3:How do i keep it LAN access only?

2.3.5 Controversial views and perceptions of the clinical picture of MCAS
2.3.5.1 Alternative diagnostic criteria ("Consensus-2")
In 2011, the group of authors led by Gerald Molderings from the Institute for Human Genetics at the University Hospital Bonn and Lawrence Afrin published their own approach to the diagnosis of MCAS (51). In contrast to the diagnostic criteria of Valent et al. (1), the focus here is more on clinical symptoms. In 2016, Afrin et al. published a list of the most common symptoms that could indicate MCAS (52). Furthermore a questionnaire was developed and published on a website (53), after the answers to which the suspected diagnosis of MCAS could be supported or ruled out depending on the scores obtained. In a recently published publication, the working group referred to their diagnostic criteria as "Consensus-2" and compared and discussed them with the criteria of Valent et al. from 2016 (so-called "Consensus-1") (51). An important difference to the criteria Valent et al. 2016, the authors consider the symptoms not only as the main main criterion, but also a much wider range of previously unexplained symptoms (111 unexplained symptoms (111 possible symptoms (44)) as the most important indication of a a mast cell-mediated cause (14 symptoms in Valent et al. (1)). As The diagnosis of MCAS is considered confirmed if the main criterion is present together with a secondary criterion and possible alternative diagnoses have been excluded. The secondary criteria, in turn, are based on observations made at the time of the 500 people with suspected MCAS at the time of the first publication (44). Further differences between the two consensuses can be found in the laboratory parameters to be determined. For example, the researchers from different disciplines, which according to their own statements can draw on a wealth of experience of of over 10,000 MCAS patients (diagnosed according to their own criteria, nota bene), consider CgA to be specific for mast cells in addition to tryptase, among other things (44). The counterargument of the lower specificity compared to serum tryptase is granted a certain validity in the addendum to the "Consensus-2" published in 2020 (44), however the differential diagnoses with elevated CgA values should be easy to rule out and other markers are also never 100% specific. However, another group was already able to show in 2017 that CgA should not be used as a marker for mast cell disease(49). Furthermore the group of authors of the "Consensus-2" counts heparin as an important marker for MCAS, which should be determined after venous congestion using a blood pressure cuff (54). This maneuver was reported to cause irritation of excessively activatable mast cells with release of heparin in the congested area. Interestingly, the following section mentions markers such as IL-6 or tumor necrosis factor (TNF) which, due to their lack of specificity, are not used in diagnostics, but only in the evaluation of a successful therapy. The authors of "Consensus-2" criticize "Consensus-1" for, among other things the lack of definitions for a treatment response, whereby the "Consensus-2 does not provide any concrete proposals for evaluating or monitoring the response to therapy. Another point of criticism is the lack of exclusion of other comorbidities or differential diagnoses, such as CFS, EDS and irritable bowel syndrome, as clinical indications of MCAS. [...] In return, the AAAAI expressly points out that there is no evidence to date of a connection between CFS or EDS and MCAS. Overall, the clinical picture of MCAS is so complex and heterogeneous that a precise definition of a diagnostic algorithm is not possible at the present time. Molderings et al. therefore propose the acceptance of both the "Consensus1" according to Valent et al. and their "Consensus-2" until more precise findings are available through research. The resulting disadvantages, such as the the poorer comparability of patient populations in scientific studies would weigh less heavily than those resulting from the rejection of "Consensus-2" (an underdiagnosis due to criteria that are too restrictive according to the authors). On the other hand, the large number of non-specific complaints that are supposedly associated with MCAS harbors the risk of inflationary diagnosis.
2.3.5.2 Presentation in the lay press
An expansion of the MCAS definition with the use of non-validated clinical and laboratory chemical parameters for diagnosis is frequently found in the lay media, above all on websites, but also in the specialist literature. Increasingly, patients with (suspected) MCAS are organizing themselves with commitment and are increasingly organizing themselves into interest groups such as MCAS Hope e.V., which campaigns for the recognition of MCAS "as an independent disease". In addition They also network those affected and their relatives and carry out public relations work, which aims to make the clinical picture known to a broader public. This expansion of the diagnostic criteria described above increases the risk of a misdiagnosis of MCAS and overlooking the underlying disease, which may be easily treatable. On the other hand, such an erroneous diagnosis can also lead to the use of unnecessary or potentially harmful therapies for MCAS and supposed comorbidities (20). Shortly after publication of the review paper "Doctor, I Think I Am Suffering from MCAS: Differential Diagnosis and Separating Facts from Fiction" by Valent et al. a self claimed affected person started an online petition in which she demands the authors and the publishing Journal of Allergy and Clinical Immunology to remove the article (55). Among other things, they criticize the criterion of the tryptase increase, which is too harsh and would therefore prevent many patients from being diagnosed. The clinic also does not typically manifest as anaphylaxis, contrary to what is described in the paper, since mediator release in anaphylactic degranulation differs from that in piecemeal degranulation. Finally, the author of the petition, who sees herself as a "patient spokesperson", reports on personal experiences of frustration and feelings of frustration and rejection that were conveyed to her by doctors in the course of her medical history. The petition has so far reached just under 3,000 of the targeted 5,000 digital signatures (as of December 2020) and shows in particular how emotional the issue of the topic of MCAS is being observed and discussed not only in professional circles, but also among patients. Apparently, some patients find the diagnosis of MCAS to be the last explanation for their multiple non-specific symptoms and hope for more acceptance in scientific circles.
2.3.5.3 Difficulties in making a diagnosis
In recent years, despite the existence of consensus criteria, a (suspected) diagnosis is often made in practice, even though these criteria are insufficiently fulfilled. In some cases, the MCAS diagnosis is also increasingly used for otherwise inexplicable conditions that cannot otherwise be explained. The evaluation of symptoms without a known direct connection with the release of mast cell mediators, for example from the neurological or psychiatric spectrum, as a manifestation of the disease leads to a further dilution of the MCAS diagnosis (43). In the "Bonn" questionnaire, the vast majority of the items asked are not based on the consensus criteria formulated by Valent et al. for example they see the sonographic evidence of an enlarged liver as an indication of the disease (53). The measurement of a tryptase elevation in acute relapse, as required by the diagnostic criteria is difficult to implement in practice, whether for reasons of time, capacity or billing. Targeted therapy trials with maximum specificity with regard to all possible decisive mediators are not possible without prior measurement of urinary metabolites and, in the absence of criteria or measuring instruments often do not produce satisfactory results (43). Last but not least, the wide range of possible differential diagnoses, such as for example from the endocrinological, neurological, psychiatric or cardiovascular area, further complicates the diagnosis (43).
Translated with deep.l
https://refubium.fu-berlin.de/bitstream/handle/fub188/32749/diss_s.gu.pdf;jsessionid=A575C43E11977D2F576404BF69D6469C?sequence=3

It was a winter morning, and I was standing on the railway station of Adityapur, one of Asia’s largest industrial hubs in the outskirts of Jamshedpur, formally known as TATANAGAR, the city known for TATAs & their steel. I updated my current whereabouts to my mother just before boarding the Tata-Gua passenger train, sounding her on my expected time to reach home. I was visiting home after 2 months, the longest interval in the 3.5 years at NIT Jamshedpur due to my business around hosting the first alumni meet of NIT Jamshedpur and a 15-day train travel across India through Jagriti Yatra. I was just carrying my laptop bag as it was a usual 2/3-day trip and I just had my Compaq laptop, a change of clothes & charger to be precise beside my small blue denim wallet & a Samsung smart phone. In 2012, smart phones were just stepping in and my brother-in law was generous enough to lend it to me to take pictures of the places I visit & the events I attend during Jagriti Yatra. Jagriti Yatra is a train ride across India with 600 yatris from different countries, different walks of life who embark on this journey to learn about various social & business enterprise. In that day’s train journey, I was travelling with a batchmate who would get down 2 stations before mine. We’d travel together many times during the four years, and we’d always take the morning train instead of the evening one. It was a passenger train which was always very crowded, and it passed through many small stations in that belt which were dimly lit, these stations were primarily existing to connect industries to the mining towns of Noamundi, Barbil, Jhinkpani and had goods trains plying with iron ore, limestone, cement, so evening trains seemed unsafe for girls travelling alone. Jhinkpani was a small town in that belt with a cement factory, ACC Cements, and a residential township for it. My dad had booked the station trip which was a Maruti Van to ply the resident of the colony from station to the colony which was around 3 kms away & there was no public transport available in this route. I was waiting to board the train all excited to show my parents the pictures of the Yatra clicked on the borrowed smart phone, I’d also met my sister and niece at Visakhapatnam while we visited Akshaya Patra mega kitchen and I remember getting clicked a cute photo of me holding my niece at the station but my excitement was short lived as soon as I kept the phone in the small zipper pocket of my laptop bag. I was modestly dressed in a kurta and leggings, without pockets of-course, pockets are a recent phenomenon in women’s Indian clothing. So, my phone and wallet were always kept in the bag.
As I boarded the train along with around 20 other people from that gate, I felt a sudden force pulling me back, but I managed to steer my way inside but with an eerie feeling, I quickly reached out to check the tiny pocket immediately only to find that both the wallet & the borrowed phone were gone. A shiver ran up my spine and I started to feel numb. There was Rs 200 in cash in that wallet which was a month of pocket money, my SBI ATM card and college i-card. Now, having zero cash, no phone I went about near the gate to see if I can find it, I spoke to couple of people but barely anyone knew Hindi, and it struck me real hard that reaching home was my single motto now. Although scared that I would be scolded by parents for being reckless, I had a sinking feeling as to how would I break this news to my sister & my brother-in-law whose smart phone I’d lost, what would I do about all the lost contacts that I’d woven so meticulously while organizing the alumni meet, what of the memories that I’d captured during the Yatra. My brain started to fizzle with all these entrapping thoughts when my friend shook me to bring me back to the dreaded train which was my reality then and I started planning my next course of action. I first called my mother from my friend’s phone to tell her about the loss, she comforted me and then she informed my dad to arrange a vehicle from the station, the trip was booked but it’d sometimes leave passengers if there are more people than capacity or not turn up due to technical glitch in the age old van that was used. My friend got down at Chaibasa and my heart started racing more as people around me in the train knew my situation and vulnerability and I tried to pose a strong and confident front. The train took more than 20 minutes to travel 17 kms but for me it seemed like ages, the sight of Jhinkpani station never made me so relieved. I quickly deboarded the train, holding on to my bag tightly this time and found a friend waiting there in his Maruti 800. He happened to have met my dad while coming to the station for a personal work and my dad asked him to pick me as well. I finally reached home travelling without a phone and a penny in pocket, my mom was so glad to see me safe and sound. I was taken aback a little to see her overtly calm demeanor at the face of such an adversary and having no concern whatsoever for my lost phone or the wallet. She prayed and thanked God for my safe return and narrated about her dream which she saw about me the previous night. She was very disturbed by it, and she’d been praying from dawn that day for my well-being as the dream was a very bad omen for me. She felt relieved that it was only few items that were lost, and I was completely unharmed. Mother’s love manifests in mysterious ways I thought while gobbling on my favorite sambar, rice that afternoon. Meanwhile, my dad deactivated my ATM card and arranged an old makeshift phone for me to be used in the remaining two months of college. When I sit back to think, I always think about my mother’s reaction and feel relieved that it happened, may be a way to appease myself of the guilt of not thinking through that somebody must have noticed me putting the phone in the small pocket and chanced upon it in the crowd while boarding. To compensate for the loss of phone, I gifted my sister with a digital camera after I started earning 4 months down from this incident. From then on, I never kept anything valuable in such obvious places in public while I maneuvered my ways in Delhi’s metro or the local trains of Mumbai, in the buses of Visakhapatnam or in the streets of Paris. I hold my wallet tight and my phone close.