Hello, people of Reddit! 😊
My dog Mochi, a German Spitz (Mittelspitz), has been suffering from severe itching since March. He licks his paws and scratches his head/eye area frequently. He lost a lot of hair around his eyes.
I hope that someone on here maybe experienced something similar with their dog who can point me to the right direction in where to go from here or give some advice. We’ve already visited the vet a few times because of this and have an appointment for next week as well.
Here are a few photos to show the progression of his hair loss.
As you can see he was completely fine at the start of the year. ☹ It started around the end of March.
He is nearly 2 years old and weights around 10 kg. He has been neutered last year. We’re located in Austria.
Sorry for the long post ahead, but I would like to include as much information as possible.
Information about his food & current medication:

• We have completely switched to Vet Concept Sana Horse (dry and wet food) to rule out a food intolerance
• He gets some salmon hemp oil from Vet Concept every day since the itching started
• He got Bravecto at the start of April for ticks but also as a prevention for mites
• Mochi currently gets prednisolone tablets (5 mg) in decreasing doses. We have an appointment for next week to give him Cytopoint instead. As I understand from my vet, Cytopoint has less side effects and contains no cortisone. We plan to conduct an allergy test (pre-screening) after 4-6 weeks following the Cytopoint injection

The current possible diagnoses are:

• environmental allergy (maybe dust mites?)
• autoimmune disease
• travel diseases (Leishmaniasis?) Info: Mochi has never left the country we reside in (Austria)
• something else entirely

We have also considered:

• Hair loss caused by mites: We had a skin scraping done that came back negative (for mites and fungi)
• a zinc deficiency but if my math isn’t completely off he should be currently getting around 16 mg zinc each day from his food which would cover his need for zinc

Here’s also a short summary of the last two months in case some of these things are important:

• Mochi had bloody diarrhea in early March. We visited the vet for this and got some medicine, and Mochi an injection; he recovered well. Before this point (the diarrhea incident lol) everything was completely okay. He was not itching and his eyes looked normal. I list this point in case the weakened immune system has something to do with the hair loss/itching that followed
• He started licking his paws in mid/late March. At the end of March he started losing hair around his right eye at first, a bit later around his left eye as well
• At the beginning of April we suspected he had mites but the test (mites + fungi) turned out negative. We also changed his food to Vet Concept at this point
• All blood test results so far were perfect (nothing abnormal)

Aside from the itching and loss of hair around his eyes, he is otherwise completely healthy. He still loves to play, has a lot of energy, eats his usual amount and poops like a king.
We are also considering going to a specialist / dermatologist. We actually got a letter of referral from our vet to a dermatologist, but the reviews we saw online were pretty mixed (leaning towards pretty bad) and we will probably try to find another one on our own. Still considering our options here.
I’m feeling pretty lost with all of this since it sounds like it could be basically anything. After each vet visit it went from “it’s probably this” to “actually, it might be this AND this” to “well, we could do this test and this test and…”
The current plan would be to see how the Cytopoint works and do the allergy test and then go from there (and probably look for a good dermatologist). I’m not sure if we should also do a test for Leishmaniasis since most of the other symptoms don’t apply to Mochi.
I also sadly don’t have a pet insurance and now I’m not sure if it’s already too late since Mochi already gets medicine for allergies so I’m not sure if he would automatically get excluded from any future tests even if he doesn't have an official diagnosis yet.
If anyone read all of this – thank you so much! I would be thankful for any advice.

I (24 M) am moving out of my parents on July 15th. 2 friends and I have already found the apartment and are in the process of getting backgrounds cleared so the lease can get signed.
I graduated college and moved back into my parents in September of 2022. About 2 months ago I got my first big career like gig and now make enough to sustain myself.
Living in the USA we have lots of dumb rules for taxes. For example now that I am 24 I can no longer be claimed as a dependent by my parents, as a result I got an extra $240 and my parents received $700 less in their tax return. I talked to my parents about it and agreed I would give them the extra $240 I received. Last week I was sat down and told on June 15th and each 15th beyond I was to pay them $400 a month rent. I found this unfair and said I would pay the taxes or rent not both to which I was told if I argue I will be paying them the $700 they missed out on through me getting older.
I talked to 2 other buddies who are letting me pay $400 a month to stay with them instead. Am I the asshole for moving into a friends place and still paying the same rent? My parents and I have had a few small issues in the 18 months since I’ve came back. While it’s not the rent itself that is bothersome, I t’s the fact that they are aware I am moving out in 2 months. Me paying rent was originally brought up back in December but the next 5 months were radio silence from them until last week. I had mentioned getting a second job to help pay back in January and nothing was said.
I asked why they chose now to tell me these next 2 months were on me and even said is it, “because we are running low on money (to which I would happily contribute), they just want to ring me for a couple hundred bucks before I leave, so that I can be used to paying rent and have more fiscal responsibility or lastly because I wasn’t doing enough to help around the house.” I was told none of those were the reason and they felt “now was the right time.”
I was upset they were doing this so I spoke to my friends, confirmed the plans and upon telling my parents they said they were extremely disappointed and that I was moving out early to slight them.
I guess I just want either a little validation or to be told I’m being an immature asshole. Everything is appreciated.
Thanks!

These last few days have seen the most extreme price run since, arguably, the "Sneeze" of January 2021. There is a major difference, though, which is regarding the Regulation SHO Threshold List. To remind you, a stock is included in this list if meeting the below critieria:
https://www.sec.gov/investopubs/regsho.htm
"Threshold securities are equity securities that have an aggregate fail to deliver position *for five consecutive settlement days** at a registered clearing agency (e.g., National Securities Clearing Corporation (NSCC)); totaling 10,000 shares or more; and equal to at least 0.5% of the issuer's total shares outstanding."*
So what happens if a stock makes it onto the Regulation SHO Threshold List?
"If a participant has a failure to deliver that the participant can demonstrate on its books and records resulted from a long sale, or that is attributable to bona fide market making activities, the participant must *close out** the failure to deliver by no later than the beginning of regular trading hours on the third consecutive settlement day following the settlement date."*
What if they are unable to do so, and the FTDs continue for some time without resolution?
"if, for whatever reason, a participant of a registered clearing agency has a fail to deliver position at a registered clearing agency in a threshold security for *13 consecutive settlement days*, the requirement to close-out such position under Rule 203(b)(3) remains in effect."
I still don't think anyone can precisely say what really happened behind the scenes in late 2020 and early 2021. But we do know certain facts:
▪︎ GME was added to the Regulation SHO Threshold List on 8th December 2020
▪︎ It continued to be on that list throughout the rest of December and early January 2021
▪︎ The share price remained relatively stable for more than 20 trading days during this period
▪︎ Only then on 13th January 2021 did the share price blow up to start the "Sneeze"
▪︎ Meaning that although the stock being placed on the list was undoubtedly causing some kind of intense pressure on failing-to-deliver institutions...it did not impact the share price for many weeks
So what is this key difference between those mechanics 3.5 years ago, compared to what may be happening with GME now? In my opinion, it is the continued absence (at least up until yesterday) from the Regulation SHO Threshold List:
https://www.nyse.com/regulation/threshold-securities
Since Monday 13th May, hundreds of millions (now billions?) of shares have been traded of this stock. But even before that, the price did nearly double from Tuesday 23rd April through to last Friday 10th May. This kind of volatility indicates that there has been a battle raging, most likely with nefarious parties continuing to use illicit methods to try and keep the price from exploding more than it already has. With almost all the methods they can employ, we know there is one result is: more FTDs.
My guess is that at some point - perhaps even this evening - GME gets added to the Regulation SHO Threshold List. Despite all the hoodwinking and crime they use to avoid these things, it would be surprising to me if the stock stays off the list indefinitely. Certainly the volume and pattern of trading over these last two weeks, and especially these last two days, would indicate there is a high probability of that happening.
But we know from 2020-21 that even after being added to the list, it still takes some time for that inclusion to have an impact on the share price. That is, until sufficient pressure through market and legal mechanics has built up, such that it "forces" some of these institutions to try and close out these FTDs. (We know that, sadly, nothing really can "force" them...but at least compelling some of them to do so, let us say...)
However this price run that started originally on Tuesday 23rd April has been occurring with the absence of GME from the Regulation SHO Threshold List. So quite possibly the very thing that triggered the massive price run-up in January 2021, has not even happened yet this time around. Hence if we are already on a 500% price run before possibly being added to the list...and that then this triggers additional intense pressure on the Hedge Funds and Market Makers...just imagine what could happens next???
TLDR: GME's recent price surge is unlike the January 2021 "Sneeze" in one key aspect: the Regulation SHO Threshold List. Back then, GME was on the list for weeks before probably causing the eventual price explosion. This time around, GME has not been placed on the list (yet), despite similarly very high trading volumes and likely additional FTDs. So could we then see an even bigger surge if GME gets added to the list? Only time will tell, but all this may just be an aperitif before we even get to the appetiser!

Female Age 26 On Lexapro for 4 years Also on 60 mg Strattera
Like many throughout this sub, I’ve had the unpleasant experience of gaining a TON of weight since starting Lexapro.
While it may be quite wordy, I wanted to share my story in case someone can relate.
Back when COVID started (March 2020), I was pretty much the skinniest I had been during my early adult years and quite muscular for a woman (coming off being a college athlete).
A couple weeks into March 2020, I unfortunately got very sick with (I believe) an early strain of COVID which feels like it completely changed my brain chemistry/gave me crippling full-body anxiety that is still present to this day.
I couldn’t function socially, I constantly felt like I was about to have a heart attack at any second, yet every test said I was perfectly healthy. An onset of chronic pain in my ribs didn’t help much either.
When my doctor asked if I had tried Lexapro, I was eager to see if this new medication would be the magic fix to my new-found anxiety. Luckily… I was right.
Since about mid-2020, I’d primarily been taking 10mg Lexapro - seeing great results with anxiety relief and finally being able to talk myself down from panic attacks. The new downside, I went from being a 5’2” 130 lb college athlete to a 175 lb work-from-homer that barely gets off the couch.
The last two years have been increasingly difficult for me. I’m constantly in pain from the added body weight, physical activities I used to do with ease have only gotten more difficult even though I still have a desire to do them, and I just feel overall shame and embarrassment.
While I know the Lexapro is NOT fully to blame here (my switch to a more sedentary lifestyle makes a major impact as well), it’s wild thinking back at how fast I put the weight on and how it correlated perfectly with when I started my Lexapro journey.
I should’ve realized that the Lexapro was probably not helping my weight gain, however at the time, I really didn’t think of that side effect and mainly attributed my weight to my new life of trying not to upset my chronic pain by sitting all day.
About two months ago, I felt more anxious and upped my dose from 10mg to 15mg all while starting to watch my calories and MAJORLY increase my physical activity. It stumped me why I started also feeling bigger than ever…
TWENTY POUNDS GAINED! I couldn’t believe I actually weighed 195. Surely I was doing the right thing by increasing my exercise and making progress towards my goals?
While I’ve always been a “the number on the scale doesn’t define me as long as I make good decisions for my body” type of person, I immediately made an an appointment with my Psych.
She thankfully heard my concerns and lowered my dose back to 10mg of Lexapro, and added Wellbutrin to see if it would help combat some of the “unpleasant side effects” I was going through (sex drive had completely tanked as well).
I just picked up my script and I’m starting my journey with NOOM, trying to do whatever I can to get on the right path here.
If anyone has had a similar experience or any advice for starting Wellbutrin on top of Lexapro, I would LOVE to hear feedback! It’s been a very tough road for me with all of this, but I finally feel like I’m on the right track and have a clear mind of what I want to work towards.
TL:DR- In total, gained about 65 lbs since starting Lexapro, finally adding Wellbutrin to try to help. Let me know your experience!

i have:

• tmj
• hearing sensitivity
• tinnitus
• eye floaters
• clicking at back of head with chin tucks or sometimes when turning head.
• Tension at sides of head, and sometimes the back of head and at forehead.
• popping at back of pelvis when standing up from sitting
• popping/cracking noise at doing a shoulder squeeze behind the back, at shoulder squeeze.

Background: sit a lot on pc, didn't exercise much for years. Speculate tinnitus has been caused by poor posture or TMJ.
I've had tinnitus and some of above issues for 4 years, and i think below is the only thing thats been helping lately although might be too soon to say, however gonna share anyway coz so far it has 100% helped me with jaw clicking that i had for many years, a long with back of head clicking noises and is helping with my posture.
note -
When it comes to tinnitus i believe it has helped, however unsure if it will continue helping it or if its just a placebo effect; same for hearing sensitivity.

TINNITUS AND POOR POSTURE TREATMENT

----- working out twice a week or every other day.

• Exercise Tutorial Reps setsrest (mins)
• bulgarian split squat 5 2 1 (glutes)
• pistol squat(sat) 5 2 1 (leg)
• single leg calf raise 10 2 1 (calfs)
• hanging leg raise 10 3 2 (abs)
• pull ups 5 3 1 (back)
• Push ups 8 3 1 (chest,etc)
• pike push up 8 3 2 (shoulders)
• diamond push up 8 3 2 (triceps)

----- taking breaks from computer
Taking breaks every 60 mins from computer, to do following stretches OR stand up!:
https://www.artofmanliness.com/health-fitness/fitness/undo-the-damage-of-sitting/
https://www.youtube.com/watch?v=u9OQMBPrFgI&list=LL&index=2&ab_channel=JeremyEthier
so every 60 mins, u either stand up for an hour, or do the stretches, i personally stand up every hour and sometimes when going to sit back down i do a stretch. Do what you prefer best and suits you.
Note- when standing take note of your posture, such as your feet pointing outwards when standing, this is a sign of duck feet and correct the feet to be straight and aligned.
----- jaw stretch
throughout the day i simply open my mouth as wide as possible, like use all your face and mouth to open, and simply rotate my head around (look left, right, up and down), but dont over do the rotating head part whilst u have mouth open, just look around a bit, left right, up, etc.
Note - i dont have any jaw pain, my tmj could just be muscular and may differ from your tmj, so whether this may be of help to u idk. I noticed that sitting posture influences the back of head cracking noises and jaw clicking.
Also sometimes i may also do jaw stretch like moving jaw left, right and forward and backward. But not often.
----- results after 1-2 days.
ive only done this for 1-2 days so very early to say, but i tell you what, it has done the following:
Pros:

• Less head cracking when rotating head.
• less head tension, but at same time i kinda feel like i still got head tension, so maybe not, but i feel like its helping idk.
• Smoother JAW opening, left jaw used to click a lot but now it feels smoother and less clicking.
• Tinnitus feels quieter, but can still hear it in the day but not too bad. In bed its more louder tbh.

Cons:

• Increased hearing sensitivity after jaw stretch, not sure why but will continue anyways coz fuck it and its helped with jaw opening and back of head cracking noises.
• Still feeling some head tension
• still get cracking noises behind back when i do shoulder squeeze.
• still get popping noises behind my pelvis/ at back of lower spine when standing up from sitting.

----- results after 5 or so days.
pros:

• noticeably less head cracking when rotating head left, right, and doing various circles with head.
• reduced tinnitus, its much quieter
• less head tension
• smoother jaw opening
• despite first 1-2 days my hearing sensitivity being worse, i think its actually slightly improving now.
• when protruding my jaw forward, i notice my right jaw joint doesn't make a click sound as often.

cons:

• Somedays after waking up, tinnitus is reactive and louder, but that goes away after doing jaw stretches and exercising a bit, etc. Note on top of tinnitus being reactive, hearing sensitivity also worsens during these times.
• sometimes still feel some head tension

notes -- things may continue to improve if i remain consistent with the routine, i will update later if i am able to stay motivated with my workouts lol
sharing this anyway coz it probably will help someone out here struggling with finding something to help their tinnitus, tmj and poor posture.
----- notes for sitting on pc

• get an electric desk, so u can switch between standing, or you can raise table to a height that makes it easier to eat without bending the neck.
• knees at 90 degrees.
• elbows at 90 degrees.
• lumbar support.
• dont use arm rests, they are only for resting not for long hours of use on pc.
• middle of monitor screen at eye level.

----- notes for sleeping

• thick memory foam pillows aren't good for me personally, they make it harder to breathe or almost block your breathing during sleep.
• However slimmer foam pillows i think have helped.
• I have tried shredded memory foam as well and not the biggest fan, but i still switch between the thin memory foam pillow and the shredded one.
• I also make sure to always sleep on side.
• And i do not mouth breathe.
• I dont use masking noises during sleep either, even when tinnitus has been the most distracting simply because i have a feeling it would backfire and cause you to rely on a sound to sleep, on top of possibly accumulating hearing loss if its too loud by accident. That said perhaps my tinnitus isn't as loud as yours, so experience may differ.

Most meetings should be an email:
Their “all hands on deck” meetings are early in the morning, even though the first three hours of your workday are your most precious and productive and should be reserved for the most important tasks where focus, attention, high cognitive function, willpower is needed, according to research. Willpower or mental energy regulates your thoughts, emotions, impulses, and performance control.
Top management has recurring meetings but it seems like the topic was determined 5 min beforehand because the meetings are often all over the place, with no clear agenda, and random topics. Often, they feel like a parent lecturing their teenager.
Meetings are mandatory. Most employees do not really have to be there. The meetings do not affect the actual day to day job functions. The main purpose for these meetings seems to be for unity (or the appearance of). They are often not productive. Not useful and not engaging for most employees. Not worth spending company time. Not used for coaching or mentoring. Not used for making decisions. They are not about a complex issue that needs to be talked through ideas and solutions. In actuality, 98% of the meetings should really just be emails. There are three regular weekly meetings: about 80-90% of them include testimonies or personal stories and about 10-20% is someone sharing statistics (about the products they produce) or status updates or the behind the scenes (how the "hotdogs" are made). One out of about four meetings involve a recount of the ministry's history. If one did not attend the meetings, nothing would change. There really would not be any consequences that would affect doing your job.
Finally, Managers or employees who have traveled internationally are the only ones that get to speak and address the entire ministry. Everyone else doesn't get a voice.
Testimonies or personal stories:
Stories and testimonies as a form of encouragement and motivation are not bad or not useful; however, there are other areas in the work culture that are lacking that destroy any built up motivation. Employees are expected to have some kind of emotional response to them. Over the months and years, stories and testimonies become overused. In fact, you will hear so many testimonies that, over time, they will blurr and you will probably become desensitized to them. Stories and testimonies are probably seen as a way of providing support to employees but other supports are also lacking and needed (e.g., better leadership, empowerment, resources, tools, better communication, regular check ins, accountability, empathy, feedback, personal and professional development). Stories, anecdotes, and testimonies seem to be used to deflect from some of the problems in the ministry culture.
Top management pressures employees to feel a certain way. They want them to always feel encouraged and motivated by everything and anything the ministry does:
If you replace "encourage" with Love" and then talk to your wife....
“I took out the trash, that should make you feel loved. I mowed the lawn, that should make you feel loved. I picked up my laundry, that should make you feel loved. I went exercised today, that should make you feel loved. i helped an old lady cross the street.”
This makes it all about YOU, not how your wife actually feels! in fact, you are manipulating her to feel a certain way by what you did!
"If you are not feeling loved by all these things I did, then something is wrong with YOU.”
So management tells employees how they should be feeling about things. Performance is often not rewarded. Many employees do not know how much management cares about them as a person. What would be really encouraging is if management gave employees confidence, listed better, spoke to their needs, and empowered them.
Meetings - introverts vs extroverts:
Meetings are not set up to accommodate the basic differences between introverts and extroverts (e.g., how they best think, work, process information, communicate, learn; introverts typically dislike noise and big group settings) nor of how people need to manage their energy (ultradian rhythms). Management does not use information about individual team members’ personalities and predilections to formulate norms and dynamics that are respectful to everyone. Research indicates that in a typical six-person meeting, two people do more than 60% of the talking. In bigger groups, like the 100+ group at FCBH, the problem is worse. Management allows a certain dominant personality to do all the talking. They are not coached to listen, reflect, and become more open to the perspectives of their more silent peers. Top management does not send the meeting agenda in advance and ask for written feedback to give introverts time to formulate thoughts and summon the courage to share them.
Management’s definition of a “successful” meeting is different from that of other organizations. Top management does not appear to have any training in meeting science. Most meetings do not provide value to all attendees. They are not set up for employees to contribute and add value to them. Also, no opportunities to give feedback on meeting quality when meetings end.
A “Christian” version of CRT:
The opinions and perspectives of international employees are valued over local/american employees. Employees who are international (and especially those who live in persecuted areas) are often prioritized and favored. Their voice, their input, is often considered more important because top management pressures them to share and speak.
If there is a need, entire ministry is notified to pray if the need is from internationals but not if the need is local.
Personal convictions. Money:
Top management tends to have some childhood trauma, that is the root cause of their strong personal convictions, that often comes out during their mandatory meetings. These “preaching” moments usually have to do with money. They grew up poor or had strict parents or been around groups, ministries, and churches that abused money and now they get triggered or feel guilty when they see new things and resist replacing things like whiteboards and chairs: "if we already have something, we don't need to replace it = if it ain't broke, don't fix/replace it. wear your shoes out until your soles poke through the bottom before buying new ones." They seem to get triggered when employees ask them for upgrades/replacements” “if it can still 'technically' work, then it's fine.”
Compromises:
In order to fulfill their deadlines and to keep up appearances with ministry partners and donors, management will often “let things go”. Things such as quality of the recordings or training issues with internationals. They are willing to sacrifice quality control to get the results their supporters want to see.
Employee well-being:
Top management often makes assumptions about the well-being and contentment of employees.
They do not invest time and effort in comprehending genuine emotions and needs to create a supportive and harmonious work environment.
No consideration for managing energy or attention. No discussions on employees’ health and wellness goals. Instead, employees are expected to focus, to look at computer screens for extended periods of time (an 8 hrs shift includes two short breaks) even though editing and processing audio and video requires high mental energy and prolonged focus. Management often ignores telltale singles of burnout and fatigue. No effort is made to increase energy, reduce fatigue, and improve job performance. So, consistency, accuracy, and quality of recordings are affected as well as employees’ well-being.
Moveover, no paid maternity or even work from home options for new parents. Many new moms have left. New parents must be use PTO if they want time with their new baby.
The end result? Low moral, isolation, aloneness. Many employees are overworked and underappreciated. Many are not satisfied with their position. Most work until they burn out. Someone said this and it's true: for every employee that leaves, they have to hire at least two people to replace them. Sure, there are some long-term or for life employees who have been around for 10+ years. Unfortunately, most of these employees have outdated skills and would have a difficult time finding work (there is no continuing education or certifications offered) if they wanted to leave (or were let go). In addition, many of the skills employees learn on the job are non-transferrable. So, many choose to stay and remain loyal to the ministry because the cost of leaving is just too high.
No windows; no natural light:
Most of the building has no windows. Something to note if you struggle with depression.
People are different:
Management seems to lack an understanding of how people are wired, how each person is different, what drives their behavior and what they’re capable of doing with their skills. Not much consideration for each person’s individual goals, strengths, and weaknesses. Management does not create situations that encourage employees to motivate themselves.
So, work areas do not reflect the needs of Gen Z and millennials, the basic differences between introverts and extroverts (e.g., how they think, work, process information, communicate, learn), how personality impacts work preferences and styles. No awareness of how people need to manage their energy (ultradian rhythms). They do not allow people to work the way they want to; extroverts should feel comfortable taking time to socialize, while introverts should have license to work remotely or take breaks from the team.
Top management does not recognize that individuals may not always express their inner concerns or desires openly. They don’t sculpt jobs to enhance individual engagement: they don’t seek to understand the unique motivations of employees or develop each employee’s career. No incentives or rewards are provided. Not much authentic appreciation is shown. Employees have value as people (not just as producers), and management needs to communicate in ways that are meaningful to the recipient (as opposed to just going through the motions). Management must adopt business practices that help employees have a personal life.”
Work family:
Despite current best business practices, management will continually use the phrase “work family”.
All about the numbers:
There is more focus on production than the core values of the ministry. Top management almost idolizes how many bibles are produced. There is a focus on goals and numbers which often comes off as self-righteous and self-promoting and self-important: Numbers of bibles produced, numbers of people who receive those bibles, numbers of testimonies from those that get the bibles. Focus seems to be on the products FCBH produces over the people reached. Focus is on getting bibles to people. Focus is not on discipleship or teaching people how to correctly interpret the Bible they receive so they can become more like Jesus. Top management seems to be more focused on what they have done well rather than on what others have done well. And they often take credit for accomplishments that should be credited to God.
Theology at work:
Management does not want discussions to get “too theological”, they want to keep it “practical”, as though good practice did not require careful thought to direct it. They discourage employees from discussing theology because they want to keep “unity” and avoid division among Christians, however, they will present their own theological positions and convictions but not allow other employees to question or share their own views and opinions especially on controversial topics (e.g., spiritual gifts, hearing from God, fasting, finances, stewardship, prophesy, replacement theology).
Favoritism:
Major donors to the ministry are singled out to entire staff and praised. The poor widow with two coins wouldn't get any mention. This makes it seem that the ministry only really cares about the major donors. All donors should be anonymous to employees that are not directly working with the donors.
Employees who are pastors are also favored:
They are often asked to pray or give a word in meetings as if their prayers and words are above employees who are not pastors. As if God will take extra time and attention to hear from them and answer their prayers.
Inconsistencies:
Some “special” employees are allowed to work remotely for some unknown reason. Most employees requesting to WFH are denied. This is never explained and so it creates division, confusion, and envy.
Birthday, thanksgiving, and Christmas parties vary drastically by department: some departments work half day and get together off site to celebrate; some work full day and have no party; some work full day and have a 30min party onsite (during work hours?); some have food only, some have food and games, some have everyone bring in food but some have the ministry? provide the food; some have gift exchange and some don’t….
​
Conclusion:
Some people might say this is all superficial and selfish, all that really matters is getting bibles to people. You be the judge. Many have chosen to ignore these issues and remain loyal to the ministry; some stay and think things will get better; others stay because they have nowhere else to go; some mentally check out; some have spoken out and been labeled as “causing disunity” and then let go, and many others have chosen to leave. Unfortunately, the people most sensitive to a decrease in the quality of the culture are typically those with the most resources, skills, and talents that could be used to effectuate improvement. The people who are the least sensitive to quality usually have fewer resources, skills, and talents.

Hi, apologies for the long post. Please note I’m already working with our regular vet but I am seeking advice from others. My 10 year old staffy recently had a small pink growth removed from her bottom jaw/gum and sent off for histo. The results aren’t necessarily conclusive as you’ll see below. My questions are, if the radiographs are clear, what if it’s too early for bone lysis to be present anyway? Would you recommend follow up scans and if so, how long should I wait? What kind of risk am I putting my girl in by assuming if there’s no bone lysis that this growth is benign? The downfall is that if it is a SCC, she would require a mandibulectomy so putting her through that on a “could be this, could be that” scenario is extremely drastic. We already sent the whole external growth off so it’s not as though we can send more tissue for testing without removing bone anyway. I’m just very anxious and don’t want to miss anything or put my girl at further risk. This is a photo of the growth and below is the histo report.
Any advice is greatly appreciated. Thank you so much for taking the time to read this!
Histology 1 Tissue HISTOPATHOLOGY
10/05/24 INTERPRETATION: Moderate squamous cell hyperplasia and dysplasia with pyogranulation tissue
Pending: Deeper sections to further exclude squamous cell carcinoma
COMMENTS: The hisological atypia observed in chronically inflamed dysplastic squamous epithelium overlaps with the features of malignancy seen in squamous cell carcinoma, and deeper sections are pending to further exclude this possibility. If you could possibly submit gross images or provide additional history regarding the site, appearance of lesions, presence or absence of underlying bone lysis in ……. lesions
HISTOPATHOLOGIC DESCRIPTION:
The tissue has a hyperplastic epithelial surface with invaginating trabeculae of squamous epithelium lined by moderately dysplastic cells showing anisokaryotic vesicular nuclei with 1-2 prominent nucleoli and increased mitoses (up to 5 per 400X HPF). There is a core of markedly reactive fibrovascular granulation tissue that is heavily infiltrated by neutrophils.
Addendum:
13/05/2024
INTERPRETATION: Emerging squamous cell carcinoma vs focal fibrous hyperplasia with marked dysplasia
COMMENTS:
Thank you for the additional history that this is a single small gingival mass, with other skin masses removed but not submitted at this Histologically the dysplasia in this lesion (multifocal suprabasal mitoses, prominent multiple nucleoti) raises concern for emerging squamous cell carcinoma and clinical correlation is required, possibly including detailed dental radiographs to assess for any evidence of underlying bone lysis to further exclude the possibility of an emerging squamous cell carcinoma.
The differential diagnosis is focal fibrous hyperplasia with dysplasia caused by inflammation (inftamed fibrous epulis) is a common benign hyperplastic growth on the gingiva of dogs which when localised, appears as a discrete, tumour-like mass. Focal fibrous hyperplasia may arise as a result of chronic gingival inflammation or irritation. Periodontal disease may be a predisposing factor. The presence of neutrophils may suggest secondary bacterial infection.
Both lesions may recur following incomplete surgical excision but fibrous hyperplasia should not result in bone lysis.
HISTOPATHOLOGIC DESCRIPTION: Deeper sections show similar changes with a core of moderately cellular fibrous connective tissue overlain by markedly hyperplastic gingival epithelium that in places forms nests within the fibrous core, with a mixed, often neutrophillic, inflammatory reaction

Avrobio - Deep Value Arbitrage Potential on Reverse Merger With Tectonic Therapeutic $AVRO
After a very lengthy strategic review process beginning in July 2023, Avrobio announced in January 2024 that they would pursue a reverse merger with Tectonic Therapeutic.
The shareholder vote for the proposed merger is on June 11th, 2024, and the merger is expected to close shortly after (before the end of June).
The deal is priced with Avrobio bringing $65 million cash at closing, and in turn current shareholders will own approximately 22.3% of the new company listing under the ticker symbol TECX. If Avrobio closes with cash greater than $65.5 million, the ownership percentage will increase, and Avrobio estimates they will bring $65 to $75 million at closing.
Tectonic has raised or entered agreements for a $130.7 million private placement, and these investors will own 37.9% of the new company, with current Tectonic shareholders owning 39.8%.
Avrobio shareholders will receive CVR’s for all existing IP, should the new company be able to find interested parties.The full merger prospectus can be viewed here
Value, Arbitrage, & Upcoming Catalysts
Avrobio had a closing price of $1.23 on May 10th, 2024. The new syndicate of investors bringing $130.7 million are effectively buying into the company at a 39.3% premium to what Avro is trading at today.
There is a high likelihood based on Avrobio’s Q1 2024 financials that they will bring closer to $75 million cash at closing, swelling the premium that the new institutional investors are paying. Avrobio had over $90 million cash at the end of Q1, with a burn rate of ~ $7m in the quarter.
I expect this discount to narrow or close entirely should the deal close successfully, with the possibility that Avro trades at a slight premium to the private placement due to shareholders receiving CVRs on existing IP.
Tectonic Therapeutic is planning to release confirmatory Phase 1A data mid 2024 for their lead asset TX45, and I would expect this data to be released very shortly before or after the completed merger and listing of the new company.
Eli Lily, also working on a competing biologic of Relaxin, is releasing P2 data sometime in Q3 of 2024. Tectonic’s Relaxin has early indications of being best in class, so should Lily’s data be promising, this could be a major external catalyst for Tectonic.
CVRs
Avrobio shareholders at the time of closing will receive CVRs for all existing assets, and there is always the potential that there could be an unexpected pay day in the future should Tectonic’s management find a buyer.
In June 2023, Avrobio sold their Cystinosis Gene Therapy program to Novartis for $87.5 million along with a 12 month license to their PLATO platform.
The Gaucher gene therapy program was at a similar stage of development prior to Avro announcing that they were seeking strategic alternatives, so should any of their remaining gene therapy programs have value, it would likely be Gaucher.
They also have earlier stage gene therapy programs for Hunter syndrome, Pompe, and Fabry.
There isn’t a lot of evidence to support the idea that these programs will find a buyer, but the potential is always there.
The Plato platform may actually deliver some value however, as Novartis’s license to use it expires in June 2024, so there is a chance that they either purchase it or re-license it to continue with their Cystinosis program.
I don’t personally assign a lot of value to the CVR’s, but there is a non-zero chance that they may deliver significant value in the future to Avrobio shareholders.
About Tectonic Therapeutic
Tectonic’s management is composed of top talent with a strong history of success both in drug approvals and exits.Tectonic is a biotechnology company focused on the discovery and development of therapeutic proteins and antibodies that modulate the activity of GPCRs. The discovery of biologics that can modulate GPCRs has historically been quite challenging. Tectonic has developed a proprietary technology platform called GEODe™, with the aim of addressing these challenges to enable the discovery and development of GPCR targeted biologic medicines that can modify the course of disease. Tectonic focuses on areas of significant unmet medical need, often where therapeutic options are poor or nonexistent, as these are areas where new medicines have the potential to improve patient quality of life.Tectonic’s lead asset, TX000045 (“TX45”) is an Fc-relaxin fusion molecule that activates the RXFP1 receptor, the GPCR target of the hormone, relaxin. Relaxin is an endogenous protein, expressed at low levels in both men and women. In normal human physiology, relaxin is upregulated during pregnancy where it exerts vasodilative effects, reduces systemic and pulmonary vascular resistance and increases cardiac output to accommodate the increased demand for oxygen and nutrients from the developing fetus. Relaxin also exerts anti-fibrotic effects on pelvic ligaments to facilitate delivery of the baby. It has long been hypothesized that these unique dual aspects of relaxin biology may offer therapeutic potential in the treatment of cardiovascular disease. Unfortunately, the development of a viable therapeutic has been challenging, primarily because of relaxin’s very short half-life. Tectonic believes TX45’s pharmacological profile, the direct result of applying Tectonic’s protein engineering capabilities, has the potential to overcome the limitations that have impeded previous attempts to develop relaxin as a therapeutic protein. To interrogate the therapeutic potential of relaxin, Tectonic has identified Group 2 Pulmonary Hypertension (“PH”) in the setting of Heart Failure with Preserved Ejection Fraction (“HFpEF”) referred to as Group 2 PH / HFpEF hereafter, as the initial disease setting. Tectonic hypothesizes that in this setting, treatment with relaxin could improve hemodynamics through effects on vasodilation and potential remodeling in both the pulmonary vessels and the heart which could translate into a clinically meaningful improvement in exercise capacity in these patients. Clinical trials are planned to confirm this hypothesis. Despite this belief, Tectonic’s business carries substantial risks, including Tectonic’s limited experience in therapeutic discovery and development, and the risk that that the platform may never result in the regulatory approval of a product candidate.
Conclusion
Purchasing Avrobio at current pricing offers a very significant discount to the valuation private placement investors are assigning to the new company Tectonic.
With a high probability of the deal closing, the risk/reward on Avro is quite attractive both from an arbitrage and catalyst vantage point.
Should the deal fail to close, Avro investors would still likely profit in the event of liquidation, though the process would be time consuming and the potential upside is significantly less than what the merger offers.
Disclosure
Author owns a long position in Avrobio shares

I'm going to try to keep this short, but also give enough information for analysis and advice. Feb. 20, 2024 I underwent the All-on-4 procedure for my top arch. I'm a 29-year-old female battling with chronic illness my entire life. That, paired with other factors, has caused massive tooth decay in my mouth starting very early. I have some fears regarding dental work related to a bad experience having my wisdom teeth & "12 y/o molars" being removed at 15. But I got over it and sought the treatment. Open and willing to do whatever was needed to get my smile back and be able to eat normally. I've lost over 30 pounds in the last year, and I'm basically malnourished at this point.
I went to an implant clinic local to me and financed a 20k loan for just my top arch. Thats all I can afford right now. This whole experience has been SO traumatic for me.
From being fully awake through the whole process, after I was promised that between the night before meds and morning anxiety medication along with nitrous that I would be totally out. The meds were never called into the pharmacy. I was told me they would only be available the night before for pick up. When they weren't found at any pharmacy in town , I called and their office was closed already. Nobody answered the after-hours line. So I just had to show up at 7am for my procedure without having taken them. I let them know and they told me that the nitrous should still knock me out. Which i believed to be true, past dental work with it would have me knocked out!
But I sobbed and cried and prayed for almost 6 hours while they extracted 14 teeth, it wasn't quick or easy at all, then they placed my implants. 5 of them.
All of my care has been from different providers at the same office. The dentist who I was told would be taking care of my entire process did my numbing shots then left. Someone I didn't know took over. I've never seen her in the office since that day. This has happened almost every follow up.
My pain for the first month was truly unbearable. I work 45 hours a week and they promised me I would be totally fine to work. I wasn't. I did still work without missing a single day, but that was by the grace and strength of God. Also, the demand of my huge loan payment monthly. The gum pain, nerve pain, constant intense throbbing finally subsided less than a month ago. I still get a lot of throbbing at my implant sites, but I continue to hope it's just the osseointegration that I'm feeling.
I went in weekly describing my pain and concerns and was ignored and told 'its normal". They refused to do any scans, check my stitches that never dissolved, I had to nicely demand the remove them after about a month in half because they were all untied and hanging out of my temp but also lodged underneath it.
I have almost ZERO ability to clean in between the acrylic temp and my gums. One side has space the other is smashed into my gums. Totally uneven. It even feels completely unbalanced in my mouth and moves and makes loud clicking noises. I've timed the amount of time I am cleaning and water flossing in a single day and it typically is about an hour total. Yet my mouth tastes terrible all the time. I can feel food lodged between that I'm not able to get out. I've told the dentist this every single time and I'm ignored.
I have so many questions and concerns regarding this whole experience, but most importantly is this:
Next week I start getting fitted for my permanent teeth. I feel so insecure in my knowledge of how this is supposed to look, fit, and feel. I dont know how to properly advocate for myself and care. I always trust the experts. I'm not a dentist, they are. But I dont trust mine. He has mislead me on many things, gets angry if I say i don't want or like something. For example my current and only temp just simply doesn't fit. It looks ridiculous. I'm not the only person wo has expressed this. My entire family has said the same things. But he refused to even discuss a differnt temp that I have had to wear for months. I explained it not even the aesthetic that I can't deal with its the fit and feel. He was clearly annoyed and told me he's not making another. Mind you he prints these in office with a 3d printer. When I had something almost pertruding through my gums in the front of an implant site he wouldn't do a scan. They finally agreed to do it at my next appointment, only because it's time anyway since this would be my first scheduled "pre op" appointment. If I hadn't been there by request weekly the first two months this would've been the only time I was seen or checked in this whole process.
My screws have fallen out and been replaced. Each time this happened I asked if they would please just check underneath for trapped food and I was told No every time. With no explanation. Is this normal?!!? I truly don't know. But it doesn't feel normal or right. I paid 20k for this. I feel like I've been scammed in way.
If anyone at all could give me ANY info or advice I would be so grateful. I can elaborate more on anything needed I just don't want to ramble and complain. I just wanted my smile back and the ability to eat. Im down to 94 pounds. Eating is barely possible. They didn't tell me anything about my diet restrictions until after the implants were in. I totally get why it would be soft foods only, but I don't understand why they wouldn't tell me things like this at my consult. It's one of the many things that I feel was ignored and left out when discussing this treatment option for me.
One final thing. While adjusting my bite one day he was filing down the implants in the back. I must note that my bottom teeth aren't in great condition but I'm taking great care of them until I can afford to have them done as well. Without any warning the dentist started filing down MY natural bottom teeth. Not just a little, noticeably even to the eye. I made many noises and waved my hands trying to get him to stop. He continued until I got loud and was pulling my head away. He removed he his hands from my mouth clearly annoyed with me. I asked "are you filing my bottom teeth?!?!' His response- "they're bad anyway". He knows that i can't afford to fix them right now. We discussed this many times. Needless to say, I left in a complete panic attack. Why was that necessary?? Or even an option to him. I now understand dental work and standards are different all over the world. I had zero issues with the ethnicity of who provided my care. But after further research I've seen many things about dental work in India and how brutal it can be. I'm truly don't mean this in a bad way. It's just what I've read in my many hours of research on the topic.
Dentists, assistants, anyone with knowledge or experience. PLEASE any info would be so helpful to me.
Please and thank you again. Sorry for the long post. This truly is the abridged version of this story sadly. I'm just read for this to be over. But I just need the results to be worth the 20k and the trauma.

My husband and I have been trying to conceive for almost a year now unsuccessfully, so my doctor was able to refer us to a fertility clinic and are currently undergoing the early phase of testing.
My husband has provided a sperm sample and did his hormone testing as well. We don’t know any of his results yet.
Based on some of my bloodwork that I’ve already done my DHEA levels came back elevated. I was able to view these results due to the fact that I completed them at an external lab and was able to sign up to see said results.
Seeing as I am unable to speak to my fertility doctor until all tests are completed I did consult my family doctor and she said elevated DHEA levels sometimes mean PCOS but we would have to wait and see what other results come out with
I did my Day 3 FSH blood work as well as a hormone panel yesterday which includes progesterone , LH and FSH among other things.
Here’s where some of my researching made me question whether my PCOS could be Adrenal PCOS, if it is that then it would explain so many things ! Especially my chronic stress levels
I should add my periods I guess are considered regular , but I ovulate very differently. This is based on LH tests and temperature taking
if it is adrenal PCOS how easy is it to manage?

I'm going to try to keep this short, but also give enough information for analysis and advice. Feb. 20, 2024 I underwent the All-on-4 procedure for my top arch. I'm a 29-year-old female battling with chronic illness my entire life. That, paired with other factors, has caused massive tooth decay in my mouth starting very early. I have some fears regarding dental work related to a bad experience having my wisdom teeth & "12 y/o molars" being removed at 15. But I got over it and sought the treatment. Open and willing to do whatever was needed to get my smile back and be able to eat normally. I've lost over 30 pounds in the last year, and I'm basically malnourished at this point.
I went to an implant clinic local to me and financed a 20k loan for just my top arch. Thats all I can afford right now. This whole experience has been SO traumatic for me.
From being fully awake through the whole process, after I was promised that between the night before meds and morning anxiety medication along with nitrous that I would be totally out. The meds were never called into the pharmacy. I was told me they would only be available the night before for pick up. When they weren't found at any pharmacy in town , I called and their office was closed already. Nobody answered the after-hours line. So I just had to show up at 7am for my procedure without having taken them. I let them know and they told me that the nitrous should still knock me out. Which i believed to be true, past dental work with it would have me knocked out!
But I sobbed and cried and prayed for almost 6 hours while they extracted 14 teeth, it wasn't quick or easy at all, then they placed my implants. 5 of them.
All of my care has been from different providers at the same office. The dentist who I was told would be taking care of my entire process did my numbing shots then left. Someone I didn't know took over. I've never seen her in the office since that day. This has happened almost every follow up.
My pain for the first month was truly unbearable. I work 45 hours a week and they promised me I would be totally fine to work. I wasn't. I did still work without missing a single day, but that was by the grace and strength of God. Also, the demand of my huge loan payment monthy. The gum pain, nerve pain, constant intense throbbing finally subsided less than a month ago. I still get a lot of throbbing at my implant sites, but I continue to hope it's just the osseointegration that I'm feeling.
I went in weekly describing my pain and concerns and was ignored and told 'its normal". They refused to do any scans, check my stitches that never dissolved, I had to nicely demand the remove them after about a month in half because they were all untied and hanging out of my temp but also lodged underneath it.
I have almost ZERO ability to clean in between the acrylic temp and my gums. One side has space the other is smashed into my gums. Totally uneven. It even feels completely unbalanced in my mouth and moves and makes loud clicking noises. I've timed the amount of time I am cleaning and water flossing in a single day and it typically is about an hour total. Yet my mouth tastes terrible all the time. I can feel food lodged between that I'm not able to get out. I've told the dentist this every single time and I'm ignored.
I have so many questions and concerns regarding this whole experience, but most importantly is this:
Next week I start gettting fitted for my permanent teeth. I feel so insecure in my knowledge of how this is supposed to look, fit, and feel. I dont know how to properly advocate for myself and care. I always trust the experts. I'm not a dentist, they are. But I dont trust mine. He has mislead me on many things, gets angry if I say i don't want or like something. For example my current and only temp just simply doesn't fit. It looks ridiculous. I'm not the only person wo has expressed this. My entire family has said the same things. But he refused to even discuss a differnt temp that I have had to wear for months. I explained it not even the aesthetic that I can't deal with its the fit and feel. He was clearly annoyed and told me he's not making another. Mind you he prints these in office with a 3d printer. When I had something almost pertruding through my gums in the front of an implant site he wouldn't do a scan. They finally agreed to do it at my next appointment, only because it's time anyway since this would be my first scheduled "pre op" appointment. If I hadn't been there by request weekly the first two months this would've been the only time I was seen or checked in this whole process.
My screws have fallen out and been replaced. Each time this happened I asked if they would please just check underneath for trapped food and I was told No every time. With no explanation. Is this normal?!!? I truly don't know. But it doesn't feel normal or right. I paid 20k for this. I feel like I've been scammed in way.
If anyone at all could give me ANY info or advice I would be so grateful. I can elaborate more on anything needed I just don't want to ramble and complain. I just wanted my smile back and the ability to eat. Im down to 94 pounds. Eating is barely possible. They didn't tell me anything about my diet restrictions until after the implants were in. I totally get why it would be soft foods only, but I don't understand why they wouldn't tell me things like this at my consult. It's one of the many things that I feel was ignored and left out when discussing this treatment option for me.
One final thing. While adjusting my bite one day he was filing down the implants in the back. I must note that my bottom teeth aren't in great condition but I'm taking great care of them until I can afford to have them done as well. Without any warning the dentist starting filling down MY natural bottom teeth. Not just a little, noticiably even to they eye. I made many noises and waved my hands trying to get him to stop. He continued until I got loud and was pulling my head away. He removed he his hands from my mouth clearly annoyed with me. I asked "are you filing my bottom teeth?!?!' His response- "they're bad anyway". He knows that i can't afford to fix them right now. We discussed this many times. Needless to say, I left in a complete panic attack. Why was that necessary?? Or even an option to him. I now understand dental work and standards are different all over the world. I had zero issues with the ethnicity of who provided my care. But after further research I've seen many things about dental work in India and how brutal it can be. I'm truly don't mean this in a bad way. It's just what I've read in my many hours of research on the topic.
Dentists, assistants, anyone with knowledge or experience. PLEASE any info would be so helpful to me.
Please and thank you again. Sorry for the long post. This truly is the abridged version of this story sadly. I'm just read for this to be over. But I just need the results to be worth the 20k and the trauma.

Hey all,
First post here, and it is a LONG one, so go easy on me. I am not a mathematician, and I am not seasoned like some of the other creators here, but I figured I'd share my favorite paladin build (for the casual 2H enjoyer) and the calculations (for any nerds like me) for a few variations focused around the Balduran's Giantslayer for Honor Mode.
Credit to u/Prestigious_Juice341 for inspiring me with all of their builds. Their old Oathbreaker build is what sent me down this rabbit hole and inspired the foundation of the Paladin variants.
Basics & My Favorite Variant
6 Vengeance Paladin > 4 GOO lock > 2 Fighter
Start Vengeance Paladin with 17 CHA, 10 STR, rest is up to you. I recommend 16 DEX. Use Hill Giant Strength from Ethyl until character level 9/Warlock level 3 when you can bind your weapon. You can also go 10 Paladin and respec at level 10 if you want 2 feats sooner and don't mind the respec.
Feats: Savage Attacker > Great Weapon Master
End Game Items:
Weapons: Balduran's Giantslayer; Deadshot
Helmet: Diadem of Arcane Synergy
Cloak: Cloak of Protection
Armor: Persistence/Helldusk
Gloves: Helldusk
Boots: Whatever you want here can work. Evasive probably ideal for frontline playstyle, but can also go nightwalkers or acrobat shoes if other classes prefer Evasive.
Amulet: Greater Health
Rings: Strange Conduit Ring & Risky Ring or Caustic Band (I prefer Risky)
Elixir: Hill Giant(early), Vigilance
Key Items to grab prior to BIS:

• Weapons: Everburn Blade, Svartlebee's Woundseeker in Act 1; Halberd of Vigilance in Act 2
  
• Adamantine Armor is my personal armor choice prior to Act 3
  
• Crusher's Ring, Ring of Protection, Caustic Band, and Strange Conduit Ring are all available in Act 1
  
• Disintegrating Nightwalkers will last you through to act 2.
  
• Gloves of Belligerent Skies and Boots of Stormy Clamour are also good options for Act 1.
  
• Grab amulet of the Harpers as soon as you enter Act 2 for free shield and WIS saving throws.
  

Playstyle: Hyper aggressive frontliner. Run at the strongest enemy, burst 'em down with big swings and big smites. Hex and Action surge late game for more big swings and bigger smites. You'll have advantage from Risky Ring & Crit Reduction from Deadshot + GOO Passive so you'll crit somewhat often with high damage rolls thanks to Savage Attacker.
For those who couldn't care less about numbers or the more powerful but less flavorful fighter variants, the guide ends here! Hope you like it!
Calculations and other Variants I toyed with
Assumptions:

• All variations use GWM and Savage Attacker
• Not calculating for attack roll probability.
• All variations use ability drain illithid power for permanent arcane synergy.
• Honor Mode which means:
  • No pact weapon stacking
  • Must either take alert as 3rd feat or use a vigilance elixir. Could theoretically boost damage by ignoring this point, but I really value initiative in Act 3.
• Base stats are 12 ST14 DEX/14 CON/20 CHA (17 + Mirror of loss/hag hair). Patriar's memory could net you an extra +1 in STR but requires luck and isn't a noticeable difference either way.
• Not counting things other than what’s listed (i.e. draconic weapon, weapon coatings, haste, etc.)

Dice:
2d6(base weapon damage) + 1d4(Strange Conduit) + 1d6(hex) + 1d6(helldusk gloves) + 3d8 (level 2 divine smite) + 1d6 (hex proc from smite)
Total Dice: 5d6 (5-30) + 3d8 (3 – 24) + 1d4 (1-4) == 9 – 58 per swing

A) 8 Oathbreaker Paladin/4 Warlock -- most flavor, least damage
\* Pact Bound:*
3rd Feat = +2 CHA; Elixir = Vigilance
+3(enchantment) + 6(Char of 22) + 1(str of 12 giantslayer) + 6(aura of hate) + 6(arcane synergy)
Flat Damage Total: 22 + 10 (GWM) = 32
1^st Turn Max Damage (2 swings – pact variant): 58 + 32 = 90 x 2 == 180
\* Not Pact BOUND:*
3rd Feat = Alert; Elixir = Cloud Giant Strength
+3(enchantment) + 8(STR of 27) + 8(str of 27 giantslayer) + 5(aura of hate) + 5(arcane synergy)
Flat Damage Total: 29 + 10 (GWM) = 39
1^st Turn Max Damage (2 swings – non pact variant): 58 + 39 = 97 x 2 == 194

B) 6 Vengeance Paladin/2 Fighte4 GOO Lock – requires vigilance potion, gets action surge, keeps most of the flavor. Less Death Knight, more Vengeance Knight.
Total Dice: 9 – 58 per swing (level 2 smites)
Action Surge = 8 - 50 per swing (level 1 smites)
+3(enchantment) + 5(Char of 20) + 5(Inquisitor's Might) + 5(arcane synergy)
Flat Damage Total: 18 + 10 (GWM) = 28
1^st Turn Max Damage (4 Swings) = (58+28) x 2 + (50+28) x 2 == 328
C) 11 Fighter – 1 Warlock loses smite and aura of hate, but gets action surge, hex, and 3 feats still which frees potion slot for 27 STR, and 20 CHA.
Total Dice: 8 - 52 subtracting smite results in 5 – 28
+3(enchantment) + 8(STR of 20) + 8(str of 27 giantslayer) + 5(arcane synergy)
Flat Damage Total: 24 + 10 (GWM) = 34
1^st Turn Max Damage (6 Swings) = 28 + 34 = 62 x 6 == 372

D) 11 Fighter – 1 War Cleric: loses smite, loses hex, gets divine favor (1d4), gets another attack as a bonus action, and 3 feats still which frees potion slot for 27 STR, and 20 WISDOM – use hag haimirror of loss on WIS instead of CHA obviously.
Weapon Damage: 2d6
Extra Dice: 1d4(Strange Conduit) + 1d4(divine favor) + 1d6(helldusk gloves)
Total Dice: 3d6 (3-18) + 2d4 (2-8) == 5 – 26 per swing
+3(enchantment) + 8(STR of 20) + 8(str of 27 giantslayer) + 5(arcane synergy)
Flat Damage Total: 24 + 10 (GWM) = 34
1^st Turn Max Damage (7 Swings) = 26 + 34 = 60 x 7 == 420

Conclusions & Comparisons:
Comparing the better Paladin variant vs the better Fighter Variant:
Total First Turn Damage Range for build B: 150 - 332
Total First Turn Damage Range for build D: 273 – 420
Both Fighter variants are stronger than the paladin variants with the war cleric version being the best option in terms of max damage in the 1st turn. That's without including BM bonuses as well, which just put it over the top and it's not even close. As seen above, it also has a higher first turn floor and, due to fighter's consistent 3 attacks and 2 more turns of war cleric extra attacks, it is far and away the best option past turn 1 when you consider smite spell slot fall-off. However, it lacks any flavor (in my own personal opinion). Also, prior to level 11, it's a lot closer in terms of consistent output as fighter doesn't have its 3rd attack or its war cleric charges while paladin still has smite.
I'm sure there are other ways to boost the damage in minor ways by sacrificing AC or funneling items that would be more useful on other builds, but I assume that DEX gloves are going to be better served on an SSB or Sorcerer, so I tried to somewhat account for that here.
Lastly, you could go 6 Sorc 6 Paladin and lose either a feat or the vigilance elixir, but that leaves out action surge as well. This would be better in longer fights and bring more utility than either of the Paladin variants, but it has far less first turn burst than builds B, C, or D.
If you're here, thanks for reading!

Perhaps the market is not in our favour, but we are getting offers that will result in 31% dilution at seed. The founders would only own 56% after the round. This could very easily put the company on the wrong track, and the investors will lose everything.
I decided to ask the investor to show me the pathway into the future with such a high level of dilution, and to explain how this isn't a risk for the company. Who knows what response I will get.
Anyone ever not meet predatory early stage investors? How do you know early if they are there to work with you, and not against you? Any advice here would be helpful.

Dear players,
we hope you are having a great day! We would like to share a few more news regarding our projects.
On Athena, the Delegation quest was modified to support shared loot, like the other quests we have updated so far.
We have also evaluated the results from the PvP week, in preparation for the next step of the PvP tournament! We have started preparing the special realm for the actual tournament, and we will share more details with you soon!
The raid reduction values will be decreased next week, on Wednesday, May 22, as follows:

T11

10-man heroic damage reduction: 0% 10-man heroic heal/absorb reduction: 0% 25-man heroic damage reduction: 0% 25-man heroic heal/absorb reduction: 0% 

T12

10-man normal damage reduction: 10% 10-man normal heal/absorb reduction: 7.5% 25-man normal damage reduction: 7.5% 25-man normal heal/absorb reduction: 5% 10-man heroic damage reduction: 20% 10-man heroic heal/absorb reduction: 15% 25-man heroic damage reduction: 20% 25-man heroic heal/absorb reduction: 15% 

The next decrease will be in one month.
As for our Mists of Pandaria development, we are happy to announce the next big step in the development of patch 5.2 and the Throne of Thunder ‒ the raid is now available to test on MoP PTR! If you wish to try out the raid and share your feedback, we would be grateful, but please be mindful of a few details:

• While all bosses should have their mechanics nearly finished, the raid is still in an early state, and there will definitely be more updates as we do our research and polish the experience.
• You can access the raid by using our custom NPC found in all starting zones and capitals and close to all MoP instances. A new feature added to this NPC is the option to reset all instance locks (you need to leave the group to use this option).
• We have also made a new NPC to teleport you to a selected boss, so you don't have to kill all the previous bosses. This and the previous raid helper NPC (offering damage, health, healing, and periodic full heal buffs) are spawned at the start of the raid and at a location of each boss.
• Health, melee damage and immunities, as well as tier 15 set bonuses, are not done yet ‒ please do not report issues related to this, as those aspects will change in the future.
• In this or any other raids on MoP PTR, you can now enter MoP raids without a raid group, and you can also enter Heroic difficulty raids without clearing the Normal difficulty first.
• Information for testing specific bosses: Megaera needs to be summoned first by clicking on three bells located in her cave. Ra-den will only spawn after Lei Shen is defeated; you will not find him there otherwise.

We encourage you to report any encountered bugs using TwinHead ‒ general instance bugs and trash related bugs should be reported here, while boss-specific issues are reported in their corresponding pages (via the links in the general report).
Thank you for all your support, and we wish you a lot of fun!
TwinStar Team

I'm going to try to keep this short, but also give enough information for analysis and advice. Feb. 20, 2024 I underwent the All-on-4 procedure for my top arch. I'm a 29-year-old female battling with chronic illness my entire life. That, paired with other factors, has caused massive tooth decay in my mouth starting very early. I have some fears regarding dental work related to a bad experience having my wisdom teeth & "12 y/o molars" being removed at 15. But I got over it and sought the treatment. Open and willing to do whatever was needed to get my smile back and be able to eat normally. I've lost over 30 pounds in the last year, and I'm basically malnourished at this point.
I went to an implant clinic local to me and financed a 20k loan for just my top arch. Thats all I can afford right now. This whole experience has been SO traumatic for me.
From being fully awake through the whole process, after I was promised that between the night before meds and morning anxiety medication along with nitrous that I would be totally out. The meds were never called into the pharmacy. I was told me they would only be available the night before for pick up. When they weren't found at any pharmacy in town , I called and their office was closed already. Nobody answered the after-hours line. So I just had to show up at 7am for my procedure without having taken them. I let them know and they told me that the nitrous should still knock me out. Which i believed to be true, past dental work with it would have me knocked out!
But I sobbed and cried and prayed for almost 6 hours while they extracted 14 teeth, it wasn't quick or easy at all, then they placed my implants. 5 of them.
All of my care has been from different providers at the same office. The dentist who I was told would be taking care of my entire process did my numbing shots then left. Someone I didn't know took over. I've never seen her in the office since that day. This has happened almost every follow up.
My pain for the first month was truly unbearable. I work 45 hours a week and they promised me I would be totally fine to work. I wasn't. I did still work without missing a single day, but that was by the grace and strength of God. Also, the demand of my huge loan payment monthy. The gum pain, nerve pain, constant intense throbbing finally subsided less than a month ago. I still get a lot of throbbing at my implant sites, but I continue to hope it's just the osseointegration that I'm feeling.
I went in weekly describing my pain and concerns and was ignored and told 'its normal". They refused to do any scans, check my stitches that never dissolved, I had to nicely demand the remove them after about a month in half because they were all untied and hanging out of my temp but also lodged underneath it.
I have almost ZERO ability to clean in between the acrylic temp and my gums. One side has space the other is smashed into my gums. Totally uneven. It even feels completely unbalanced in my mouth and moves and makes loud clicking noises. I've timed the amount of time I am cleaning and water flossing in a single day and it typically is about an hour total. Yet my mouth tastes terrible all the time. I can feel food lodged between that I'm not able to get out. I've told the dentist this every single time and I'm ignored.
I have so many questions and concerns regarding this whole experience, but most importantly is this:
Next week I start gettting fitted for my permanent teeth. I feel so insecure in my knowledge of how this is supposed to look, fit, and feel. I dont know how to properly advocate for myself and care. I always trust the experts. I'm not a dentist, they are. But I dont trust mine. He has mislead me on many things, gets angry if I say i don't want or like something. For example my current and only temp just simply doesn't fit. It looks ridiculous. I'm not the only person wo has expressed this. My entire family has said the same things. But he refused to even discuss a differnt temp that I have had to wear for months. I explained it not even the aesthetic that I can't deal with its the fit and feel. He was clearly annoyed and told me he's not making another. Mind you he prints these in office with a 3d printer. When I had something almost pertruding through my gums in the front of an implant site he wouldn't do a scan. They finally agreed to do it at my next appointment, only because it's time anyway since this would be my first scheduled "pre op" appointment. If I hadn't been there by request weekly the first two months this would've been the only time I was seen or checked in this whole process.
My screws have fallen out and been replaced. Each time this happened I asked if they would please just check underneath for trapped food and I was told No every time. With no explanation. Is this normal?!!? I truly don't know. But it doesn't feel normal or right. I paid 20k for this. I feel like I've been scammed in way.
If anyone at all could give me ANY info or advice I would be so grateful. I can elaborate more on anything needed I just don't want to ramble and complain. I just wanted my smile back and the ability to eat. Im down to 94 pounds. Eating is barely possible. They didn't tell me anything about my diet restrictions until after the implants were in. I totally get why it would be soft foods only, but I don't understand why they wouldn't tell me things like this at my consult. It's one of the many things that I feel was ignored and left out when discussing this treatment option for me.
One final thing. While adjusting my bite one day he was filing down the implants in the back. I must note that my bottom teeth aren't in great condition but I'm taking great care of them until I can afford to have them done as well. Without any warning the dentist starting filling down MY natural bottom teeth. Not just a little, noticiably even to they eye. I made many noises and waved my hands trying to get him to stop. He continued until I got loud and was pulling my head away. He removed he his hands from my mouth clearly annoyed with me. I asked "are you filing my bottom teeth?!?!' His response- "they're bad anyway". He knows that i can't afford to fix them right now. We discussed this many times. Needless to say, I left in a complete panic attack. Why was that necessary?? Or even an option to him. I now understand dental work and standards are different all over the world. I had zero issues with the ethnicity of who provided my care. But after further research I've seen many things about dental work in India and how brutal it can be. I'm truly don't mean this in a bad way. It's just what I've read in my many hours of research on the topic.
Dentists, assistants, anyone with knowledge or experience. PLEASE any info would be so helpful to me.
Please and thank you again. Sorry for the long post. This truly is the abridged version of this story sadly. I'm just read for this to be over. But I just need the results to be worth the 20k and the trauma.
edit: I don't smoke or drink at all. I can add pictures upon request and hopefully will be receiving copies of my x-rays this week. Several requests have been made by me to the office for them but I still haven't received them yet.

I would like to share some tips that helped me do well on all my ATI exams! For reference, I got a level 3 on all but one ATI exam! Fundamentals was my first ATI exam ever which I got a 2, and it helped shaped the way I continued to study for ATI. I hope this helps anyone who is either struggling with ATI or wanting to increase their scores.

• This one is obvious, but ATI is your best resource. Start early. Utilize the book. It’s not a typical textbook so it is easier to get through compared to your average 2,000+ page textbook. If you start early and it’s not huge like the med-surg one, you can get through the majority of the chapters before test time. You do not have to read every word.

How I utilized ATI textbooks:

• For courses that required an ATI exam, I read the chapters that corresponded with the lectures - except med-surg… have you seen that thing? I relied on the Lewis Med Surg book that was required for our class because our Med-Surg 1 & 2 class HEAVILY tested on that book.
• I get highlighter happy at times, but I tried to limit myself to highlighting important things that would jump at me if I had to later refer back to a chapter. I highlighted drug names in green. I also highlighted measures/numbers/lab values and random facts that ATI likes to throw at you in. Like if you have a latex allergy, you can be allergic to strawberries kinda thing.
• Do the practice questions at the end of the chapters. If you don’t want to read the chapters, at least do the questions (usually only 5) to see if there are any gaps of knowledge. If you get something wrong, refer back to the book to read over that section.

Practice Exams/Dynamic Quizzes

• Plan to complete all dynamic quizzes for that subject. If you can only do ONE thing, complete all the quizzes. I can’t emphasize that enough. You hear it over and over again, but read to understand rationales, writing out the ones for unfamiliar topics or easily forgotten details. They will help in future ATI exams! The goal isn't to memorize practice questions, but to learn and understand. Refer to the book for content review when needed. If you know you have 400-1,000 questions to get through, start early. Mark the ones you get wrong or guessed correctly so you can review later and when your exam gets closer.
• Take Practice A & B exam and take it seriously. As tempting as it may be, do not google the answers. These exams give you an idea of areas you are struggling with. I recommend doing focused reviews because it takes you to the exact area where you missed the question. I would hand write the areas I missed.
• If you see the same thing over and over again during your quizzes and practice exams, pay attention. ATI is giving you hints on what you may see on the exam.

Extra Tips for ATI

• Be familiar with National Notifiable Conditions for those dreaded “which one do you report?” questions. You don’t have to memorize them — just know the main ones. There is a page in the Community ATI book with some of the main ones, but the CDC website is a quick reference. Bookmark it!
• Know antidotes, especially to common drugs.
• Know what you can delegate to UAPs and LPNs. In short, do not delegate what you can EAT (Evaluate, Assess, Teach). Remember, LPNs can only reassess after the RN has done the first assessment. This includes if a patient came back from surgery. The RN will assess and do vital signs if the patient has come back from surgery or is unstable, not the LPN and definitely not the UAP. Also, LPNs cannot do the initial teaching, but they can reinforce the teachings (example: self-administering insulin).
• Review frequently missed content because a lot of that stuff may be on your exam.

Outside resources

• The only resource outside of ATI I used are the LevelUpRN videos, which I am sure many of you already know about. Her playlists follow ATI closely enough without her getting sued again lol. If you can get your hands on her cards, that’s great but do not neglect the quizzes.

Test taking prioritization strategies you have to understand:

• Least invasive vs most invasive, acute vs chronic, unstable vs stable, expected findings vs unexpected findings (aka complications), & ABCs go without saying.
• Go through the NurseLogic 2.0 modules (under the learn tab) if you need help with prioritization. This is often what gets us the most but you’re always going to RUN to the patient who will die without intervention first. If you see a patient with stridor vs chest pain, who do you think is the priority? What about the patient with laryngeal edema or the stroke patient with hemiparesis? The patient with a sudden, severe headache or the patient with heart failure and 2+ edema? The asthmatic patient who stopped wheezing or the patient with chronic angina clutching their chest after walking?
• In a disaster situation (moreso for the community & leadership ATI exam), the patient who will die without intervention, but can survive with intervention is the priority (red tag). The patient who is dying (SCALP, not facial lacerations, fixed and dilated pupils) is the least of the priority (black tag) due to limited resources.

Other test taking strategies

• Go with what you know, but if you see 2 answer choices that are basically the same but worded differently, eliminate those. If you see 2 answer choices that are opposites, one of them may be the answer.
• When in doubt, avoid absolutes like “always, never, only, everyone” (unless it’s something accurate like ALWAYS practice hand hygiene lol but ATI usually doesn’t use absolutes like that)
• Look for keywords. Is the question asking what the nurse should do FIRST or what is the best nursing action?

It’s true that ATI will test you on things from other courses (some you haven’t taken yet), but the majority of it will be over the course you are studying for. The goal isn’t to get every question correctly. The goal is to use prior knowledge and test taking strategies to help you at least narrow down to 2 answer choices, and hopefully choose the right one. After doing a bunch of questions, you start to see patterns and understand how ATI wants you to choose the answer.
I know this is a lot, but I just wanted to be as thorough as possible. Please let me know if you have any questions! I am happy to help! 😊