Story set in the NoP 1 universe, created by u/SpacePaladin15
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Memory Transcription Subject: Lyra, Dossur
Lakeshore, Twilight Region of Venlil Prime
Date [Standardized Human Time]: 7 January 2137
[[ Dream State Detected – Consult Archivist User Manual for Warnings and Options Related to Dream State Transcriptions ]]
[[ Enabled Options: Skip Gaps, Smooth Interpolation ]]
I flick my tail in irritation while typing on my holopad.
Speh! This job might pay the bills, but it’s so boring. It requires no creativity to maintain this brahking warehouse machinery. It’s just an endless tail-chase of diagnostics, updating firmware, chasing more diagnostics, analyzing operating logs…
I submit my latest diagnostic summary, stand up, and stretch.
Time for a snack while that batch processes.
I step away from my desk and find that I’m completely buried in a large pile of strange looking strayu. It’s much denser and more crumbly than the Venlil strayu, round and somewhat flat, with an unfamiliar grain and dried berries scattered within. I break off a paw-sized chunk and nibble on it while climbing my way out.
This weird flattened grain tastes fantastic! These berries are familiar; I think Rolf called them [dried wine-fruit].
Emerging from the pile of sweet, Terran strayu, I find Rolf curled up on the ground. His voice trembles as he apologizes for dropping the pile of baked goods on me. He’s mumbling something about exterminators when I place a paw on his knee and try to calm the anxious Human down.
“Hey, Rolf, it’s OK. There’s no need to act like a Sivkit. Come on. Take a few slow breaths.”
Rolf lifts his head and looks directly at me. I barely suppress a cry of shock at the sight. His head is unusually large, perfectly round, and covered in brown fur. He has long ears, similar to a Farsul and a ball-shaped nose sitting beneath two large forward facing eyes.
“Brahking speh! Why the jump-scare, Rolf?”
After a closer look at Rolf’s bizarre appearance, I stifle a giggle.
“Or should I say Rowlf? You look like that weird Farsul Muppet that plays the odd looking Terran flytser.”
Rolf responds in a deep growling voice.
“How in [deity]’s name do you know what a Muppet is? That show is 150 years old! There’s no way the Muppets were included in the public data dump; not with their forward facing eyes, Muppets constantly eating each other, the explosions…”
I wrap my tail around my leg as my ears bloom green.
“I might have… um, borrowed your old Terran tablet. I wanted to see if I could modify it to connect to the Venlil Prime network. After the FTL comms came online between Earth and Venlil Prime, I discovered your tablet had full access to the uncensored Terran internet.”
I look at the ground, signing >embarrassed< with my tail and ears.
“Rolf, you know how much I love movies and art. I just couldn’t resist exploring all the fascinating media you Humans have created.”
I look up, expecting to see disappointment, or at least exasperation, in Rolf’s face. Instead, I find a Kolshian dressed in federation military regalia glaring at me with one of his eyes.
“I grow tired of asking you to share the hidden Terran media. Perhaps you’ll respond to an alternative form of persuasion.”
My tail drops and my whiskers quiver with outrage.
“The more you tighten your grip, Nikonus, the more star systems will slip through your fingers tentacles!”
The Kolshian simply signals >smug< with his tail.
“Not after we demonstrate the power of this battle station. You have determined the choice of the planet that will be destroyed first. Since you’re reluctant to provide us with the location of the Rebel base Terran media, I have chosen to test this station’s destructive power on your home planet of Mileau.”
The shock from that statement hits me like a kick to the stomach.
“No! Mileau is peaceful. We have no weapons. You can't possibly…”
“You would prefer another target? A military target? Then name the system!”
The Kolshian waves a menacing tentacle at me.
“I grow tired of asking this. So it'll be the last time. Where is the Rebel base Terran media?”
I collapse to the floor, unable to hold back my tears.
My parents! My brothers! Why is the federation attacking Mileau? How could they develop something like the Death Star without using it to defeat the Arxur? Why did I leave my family?
I feel a familiar hand scratching my neck and back. The fog in my mind starts to clear and my tense muscles relax. I open my eyes and find myself sitting on one of Rolf’s arms as he tries to comfort me.
“It’s OK, Lyra, let it all out. I felt so much better after I allowed myself to cry. I still don’t know if my parents survived the attack on Earth. I spent weeks trying so hard not to cry. That was a mistake – all that emotional turmoil was eating me up inside.”
My trembling voice breaks through my sobs.
“Eating…, eating you up inside? Even your gr- grief is pred… predatory!”
I try to laugh, but choke on a sob. Rolf simply gives me a gentle hug.
“I know it’s overwhelming. Just know that I’m here for you.”
I take several deep breaths and try to calm down.
Wait, do I hear music?
I find myself walking to the other side of a dark warehouse, towards the faint music.
I’ve heard this before.
“Rolf! Do you hear this? It’s one of the songs from that movie we watched several herds of paws ago. Before that [religious feast] – um, Christmas? That movie with the elegant leaping and dancing.”
My breath hitches as I see a pair of glowing eyes in the darkness. I shake my head and look again, but there’s nothing there.
Not this again! I thought I was done with that silly nightmare!
I continue walking towards the music. I see two figures in the dim light. One of them is lying on the ground while the other kneels over them. The figure on the ground is covered in grey fur, resembling a large Terran rat the size of a Venlil, a broken crown lying next to his head. The other figure resembles a Human, dressed in brilliant red pelts.
The rat king and the nutcracker. Well, that explains the music.
Looking closer, I notice the rat’s eyes are dull and lifeless. The nutcracker is bent down so far, his face appears to be pressed against the rat’s torso. I hear an unusual sound and suddenly, everything feels wrong. It’s that same dreadful feeling of being watched that plagued me a herd ago.
Not this again!
My ears lay flat against my head and I feel my hackles rise as the nutcracker lifts its head from the body of the rat. It turns and stares directly at me with its forward facing eyes; blood and viscera drip from the nutcracker’s mouth as the glowing yellow eyes pierce the darkness.
I can’t move!
My desperate attempts to scurry backwards do nothing. I try to yell, but can’t produce a sound. The music that lured me here is drowned out by the growing intensity of my heartbeats. The nutcracker’s glowing eyes fill my vision, growing larger and brighter until their terrifying light envelopes me completely.
[[ Dream State Ended, Continuing Standard Memory Transcription ]]
I jolt awake with a breathless scream on my tongue.
I’m trapped! Consumed by a bright void. I’m, I’m…
Looking more carefully, I find that I’m surrounded by a smooth, cylindrical, white wall. I’m also buried in a strange kind of fluffy white material. I take a slow breath as recognition slowly ebbs into my confused brain.
Oh speh! Not again… Should I be less embarrassed now that this has happened a pawful of times?
I find my footing underneath the sea of exploded grain, reach up to grab the lip of the bowl, and pull myself out. I brush bits of popcorn and popcorn kernels off my fur as I look around for Rolf.
Apparently, a Star Wars marathon is a terrible idea when my home planet is under siege by those federation brahkasses. Ugh, I’m so tired of stressful dreams!
I shiver from whiskers to tail-tip as I remember the horrifying visage of that nutcracker.
What in Solgalik’s left paw was that? Maybe the pest control job is affecting my mind… I can’t believe the Humans were so careless with their ships. Now we have a rat infestation in the food storage warehouse.
As I stretch, I hear a familiar set of footsteps.
“Sleeping beauty has finally awoken, I see.”
I glare at Rolf as he walks up to the couch.
“You knew I fell asleep in the popcorn and you just left me there?”
“You looked so peaceful! What kind of friend would I be if I disturbed your beauty sleep?”
I huff indignantly while signing >outrage< with my tail.
“Where did you run off to, anyway? Abandoning your defenseless friend in this den of slobbering predators?”
Rolf raises an eyebrow while brushing an errant popcorn kernel off my head.
“Lyra, I’m pretty sure every slobbering predator in this refugee center is terrified of _YOU._”
I can’t help but chitter at Rolf’s accusation.
“You Humans can’t handle the simplest of Dossur pranks! Not even a Mazic freaks out that much when a Dossur pops out of a cupboard or the cold box.”
Rolf shakes his head with a sigh.
“Lyra, I’m pretty sure giving more anxiety to traumatized Humans is not the best way to make friends.”
I flick Rolf with my tail, “It worked great with you!”
Rolf just sighs and sits down on the couch. I climb onto his shoulder and wrap my tail around his neck.
“Rolf, you look more anxious than usual. I didn’t think that was possible. You were pretty chipper before I slipped into a food coma.”
I flick my ears mischievously and sign >teasing< with my ears and tail.
“Is your girlfriend jealous that we spent two claws together watching movies?”
Instead of his usual defensiveness, Rolf just lowers his head and looks tired.
“I went to take food to my roommate. But, she wasn’t there…”
I stifle a gasp and place a paw on Rolf’s neck.
“Teeya never leaves your apartment. Where would she even go?”
Rolf shakes his head, his voice quivering a little.
“I don’t know. She’s not here in the refugee center. I don’t even know when she left. I’m… I’m really worried about her safety.”
I hop down and put a paw on Rolf’s leg, trying to keep my voice level.
“I know you’re worried about the exterminators. It’s…, well, it’s been several herds of paws since there was an incident between Humans and exterminators here in Lakeshore. I… I’m sure she’ll be OK. She’s been hiding in that apartment for [months]! Maybe she’s finally stretching her legs and getting some air?”
Rolf scratches my neck and sighs. After a moment, he stands up with a muffled groan.
“I hope so. Thank you, Lyra, I appreciate the positive thoughts. But, I don’t want to make you late for your work claw. Go, embrace your inner nutcracker and battle the rat hordes while I search the neighborhood for Teeya.”
I suppress a shiver at the nutcracker reference. We leave the refugee center and I signal >comfort< to Rolf as we part ways. I continue nightward, towards the warehouses.
Rolf is gonna be a nervous wreck when I get back. I should be helping him look for Teeya instead of hunting down those stupid rats. I don’t understand why Teeya is so skittish compared to the other Humans here in Lakeshore.
[[ Memory Fragment, 14 Dec 2136, Lakeshore, Terran Refugee Center, Art Room ]]
I splatter some purple paint on my canvas. My tail twitches in agitation as the purple splotches remind me of Kolshian blood. My whiskers shiver as I push that thought away. Rolf walks over and looks at my painting.
“Nice! I can see you’ve been studying Rothko and Pollock.”
I flick my ears and tail appreciatively.
“I’ve spent so much time looking at their work in that public data dump. Their creative vision is fresh air through my fur, especially after a lifetime of stale federation art that hasn’t changed in centuries. Thank you again for the art supplies – painting always calms my nerves.”
I flick some green paint onto the canvas, wondering how much Dossur blood has been spilled by the federation attack on Mileau. I take a slow breath and look up at Rolf.
“I know this sounds trivial compared to everything else going on; but, I’m worried about rent. Inflation is already crazy and now that piclil landlord is raising my rent again. With my debt from art school… Ugh, I just feel like I’m drowning!”
Rolf scratches the fur on my neck and shakes his head as he sighs.
“I still can’t believe student debt is a problem here in the federation. Everything else is so advanced and… Wait, I thought you were a maintenance engineer for a warehouse. Aren’t engineers paid well?”
My tail flicks in frustration as my whiskers quiver with outrage.
“Hah! Outside Mileau, it’s standard practice to pay Dossur a fraction of what they pay other species for the exact same work! It’s flagrant brahking specism! Do you know what employee resources said when I pointed out this speh? ‘Dossur eat less food and live in smaller apartments.’ Vyalpic! Do you know how many Dossur apartments even exist in this backwater venpic town? None! That’s how many!”
Rolf frowns as he shakes his head.
“So much for taking care of the herd. It’s too bad the UN won’t let you live in the refugee center. We spend enough time here, it really wouldn’t make a difference.”
The tip of my tail taps the floor as my ears twitch thoughtfully.
“You know, that’s not a bad idea… We spend so much time watching Terran movies together, I should just move into your apartment! My stuff won’t take up much space. I even have a large wall-mount holoscreen. I can build an adapter for your old tablet and we can watch Terran movies from the comfort of your apartment.”
Rolf smiles wistfully.
“That would be fun. I would really like that… It’s just, well, my roommate, Teeya. I don’t think it would be safe for you two to live together.”
My whiskers droop.
“You’ve mentioned something about that before. Is she allergic to Dossur or something? I haven’t even met her, so it can’t be a grudge from one of my pranks.”
Rolf sighs and sits down.
“No, it’s just… with everything, she… Teeya is struggling with this move to Venlil Prime. She never leaves our apartment. I can’t have any visitors over.”
Rolf sighs and I angle my ears towards him while continuing to paint.
“I don’t want to sound insensitive; but, couldn’t Teeya just room with one of the other Humans here?”
Rolf smiles sadly while shaking his head.
“I wish it were that easy. I’ve known Teeya for almost ten years. I promised that I’d take care of her before we left Earth. I’m the only one she trusts here. She’s actually very sweet; I…, I just worry what would happen if she were alone with a Venlil or a Dossur.”
[[ Resuming Standard Memory Transcription ]]
I sigh and push that memory aside.
I know it’s not Teeya’s fault that she’s struggling. It’s just, everything would be simpler if I could room with her and Rolf: I wouldn’t have to work two jobs; I could spend more time with Rolf; I could…
My thoughts are interrupted by a pair of glowing eyes within a shadow off to my left. I stop abruptly, panic rising in my chest. I look again, but see nothing.
Stupid nightmare! Now I’m jumping at shadows again. I thought I’d moved past this.
I let out the breath I was holding and walk a little faster towards the warehouse complex. A feeling of dread festers in my stomach as my instincts scream that I’m being followed.
This is all in my head. Stupid dream! Stupid prey instincts! I can’t let fear control me. Fear is the mind-killer. Fear is the little-death that brings total obliteration. I will face my fear. I will permit it to pass over me and through me…
By the time I reach the warehouse where I work, my heartrate is back to normal. With another sigh, I open my locker and start gathering my gear.
Let’s see: high-visibility vest, safety glasses, helmet, tranquilizer gun, and a jet injector.
I shake my head and sigh at the typical federation hypocrisy.
If an extermination officer saw a Human killing a rat, they’d torch the ‘dangerous predator’ faster than I can blink. But, it’s just fine for a Dossur like me to kill rats every brahking paw as long as I’m registered with the local extermination office.
I double check the supply of tranquilizer darts and fill the injector syringe with warfarin.
As a ‘prey species’ I should feel awful about this job. I’d never admit this to my exterminator colleagues, but I actually find this job comforting: I get to be a psychopomp, taking rats on a peaceful journey to the other side before the exterminators have a chance to burn them to ash.
I shudder, imagining how awful it would feel to be burned alive with a flame-thrower.
Well, which of the many Terran psychopomps should I be this work-claw? Freyja, perhaps? Yes, Freyja with her cat-drawn chariot. Cats are ideal for a rat infestation.
I power on the motorized transport that acts as my hearse. I configure the autopilot so it follows me through the warehouse as I check the traps hidden in various crawl spaces that only a Dossur can reach. The first quarter claw is quiet; every trap I check is empty. My thoughts drift back to Rolf and Teeya.
Heh, despite my teasing, I’m sure Rolf and Teeya really are just roommates. Rolf is just so adorable when he’s flustered. He reminds me of my brothers. My brothers… I really hope they’re still alive.
[[ Memory Fragment, 16 Nov 2136, Lakeshore, Terran Refugee Center, Media Room ]]
What would my brothers think if they could see me right now? Sitting on a predator’s shoulder. Watching a movie created by predators. Inside a building filled with predators of all ages. Distressed predators whose homeworld was attacked. Would my brothers freak out or would they be jealous?
My tail flicks with happiness as I consider how much Rolf reminds me of my brothers. I’m constantly amused at how often he acts like a young Dossur. And he’s so much fun to tease! I flick my ears mischievously as I search for a suitable topic.
“Rolf? Your head-fur is brown…”
“Excellent observation, Watson!”
I flick Rolf’s neck with my tail.
“You didn’t let me finish! Your head-fur is brown, but your pelts are covered with long white hairs.”
Rolf raises an eyebrow.
I continue, “Well, Sherlock, applying that deductive reasoning you always lecture me about, I conclude that you and your roommate spend a lot of time cuddling.”
Rolf blushes slightly and coughs, “No, it’s, it’s not like that!”
“Oh, really? I think the evidence speaks for itself.”
I can hear Rolf’s heartbeat increase as he stumbles over his words.
“Look, when I… well, when I brush Teeya’s hair it just, well it kind of, um, just gets everywhere…”
“Ah, so you brush her hair? My deduction that you two are more than roommates still stands.”
“We’re just close friends! We’ve been friends for 10 years. There’s nothing romantic…”
My ears perk up and I flick Rolf with my tail again.
“10 solar cycles! And the two of you haven’t weaved a vyalkit, yet?”
Rolf looks completely exasperated.
“I don’t even know what that means…”
I wrap my tail around his neck and pat the side of his head.
“Rolf, just promise that you’ll invite me to the ceremony when you two make things official.”
Rolf shakes his head and sighs.
“Lyra, how can I convince you that I have no plans to marry Teeya?”
[[ Resuming Standard Memory Transcription ]]
I chitter out loud at that memory.
Stars, that was funny! Oh, it always feels like home when I’m with Rolf. If Teeya could just work up the nerve to actually meet me, I’m sure we’d get along. Heh, if she’s known Rolf for 10 years, she must have all kinds of great anecdotes about Rolf.
My thoughts are interrupted as I find a rat inside a trap. As usual, the rat is almost as large as I am!
What shall I call this one? Remy? Yes, that Terran movie about food; Remy was a rat with good taste.
“Remy, my friend, the reaper has come calling. It’s nothing personal. You just don’t belong here on this planet. When you get to the underworld, give your ancestors an earful on my behalf. They’re the ones who stowed away on the Human’s refugee ships.”
Remy the rat simply looks at me curiously as I fire the tranquilizer gun. Once the rat’s unconscious, I inject it with warfarin and pull it from the trap. After resetting the trap, I pull Remy’s corpse out to the hall and load it into the cargo transport.
[[ Advancing Transcript by 3 Hours ]]
I’m exhausted after a work claw hauling dead rats into the cargo transport. I put my gear away and bring my make-shift hearse outside. I start sealing up the cargo hold so the autopilot can deliver the corpses to the local extermination office for incineration. I’m interrupted by a loud panicked squeal of a rat.
Huh, did I catch a rat in one of the traps outside the warehouse? That’s unusual.
As I walk in the direction of the noise, I briefly see two eyes glowing in the darkness. My heart beats faster as I struggle to get my instincts under control.
Speh! I don’t have the emotional energy for this! It’s just my mind playing tricks on me…
I continue walking until I reach the trap. It’s empty. The next trap is also empty. As I walk to the third trap, I feel my hackles rise. That familiar, dreadful feeling of being watched descends over me. Once again, I see light reflecting off a pair of eyes from within a dark shadow. But, they’re gone when I look more carefully.
Maybe Rolf is right. I need to stop watching Terran movies that are so intense.
Arriving at the final trap, I’m surprised to find a rat lying on the ground outside of the cage. The rat isn’t moving, its eyes dull and lifeless. As I get closer, I can see that the rat is lying on its back with deep cuts and bite marks on its neck and belly. Blood is pooled around the corpse. I can feel bile rising into my throat as my mind is flooded with memories of that horrifying nutcracker from my dream. I’m brought back to my senses by the sound of an animal scampering off nightward in the dim eternal twilight.
Shit! Speh! Fuck! What could even do this? A shadestalker? But a shadestalker wouldn’t leave their catch. They certainly wouldn’t hesitate to attack a lone Dossur…
I try and push down the panic welling up inside me. After a couple slow breaths, I take a picture of the eviscerated rat with my holopad and send it to my contact in the extermination office. I also send the image to Rolf with a note about my suspicions and a warning to be careful.
This is bad! This is so bad. Not even Humans are safe from shadestalker attacks. Several [months] ago, a Human was attacked and severely injured by a shadestalker that wandered into the Twilight. If shadestalkers are in Lakeshore, Rolf needs to find Teeya and get her to safety!
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[Information]

• Age: 26
  
• Height: 195cm
  
• Weight: 99KG last time we checked but might be more or less.
  
• Country: Ireland
  
• Sex: F (though I am trans, I don't know if that matters - FtM)
  

[Diagnosed Conditions]

• Marfan Syndrome
  
• Borderline Personality Disorder
  
• Fibromylagia
  
• Chiari Malformation
  
• Tarlov Cyst Disease
  
• C-PTSD
  
• Afib
  
• Aflutter
  
• Cellulitis
  
• Bursitis
  

[Medication I'm on]

• Sotalol 40mg twice a day
  
• Warfarin ranges from 4mg to 6mg once a day
  
• Nexium 40mg once a day
  
• Prozac 40mg once a day
  
• Abilify 15mg once a day
  
• Phenergan 25mg once a day
  
• Tylex 30mg/500mg six times a day
  
• Lyrica 100mg four times a day
  

[Notable + Recent Procedures]

• Had my lenses replaced in each eye at ages 7 & 8
  
• Aortic root replacement at 10
  
• Aortic and Mitral valve replacement at 17 (why I'm on warfarin)
  
• Had a small hole in my eye at 24 and they put a bit of sclera on it in a surgery. I don't know how to describe it well, I'll answer any questions you may have. English is not my first language.
  
• 2 Cardioversions this year
  
• 2 Cardiac Ablations
  

AND

• AWAITING a pulmonary vein isolation which will happen in July.

So what is my problem?
I was diagnosed with bursitis 3 days ago. Pain was mild, no fever. Doctor in Urgent Care gave me an elbow pad. Told me to take off the elbow pad in 2 days and that he wouldn't give me anything for pain or treatment because it's not a painful condition, nothing paracetamol won't cure (which, like, I wasn't asking for pain pills because Im on Tylex and Lyrica so idc but perhaps some kind of steroid injection treatment?) and that it'll pass on its own. That night I had 38.8°C temperature, I felt awful. Pain got so bad I couldn't move my arm much. Still can't.
I feel absolutely terrible. I feel I'm getting worse. My temperature keeps going to 39°C. My arm ls bright red and hot. Hurts a ton. But he said it'll pass on its own and the elbow pad I had for 2 days will do the trick.
It didn't.
I want to ask a few questions:

• should I see someone else? Like, am I just overreacting and it perhaps just will pass on its own? I'm asking because Google said that this can be treated with things like injections but I've been told to stop Googling my conditions because it's often a case by case type deal.. so perhaps for some reason I just can't.
  
• given my other conditions, would bursitis be a risk to me by any means? I'm asking because like I know, for example, things like untreated infections can cause endocarditis in people who have Mitral and Aortic valves replaced to metallic ones. But I might be wrong so I'm sorry if I am.
  
• given my medication, specifically warfarin, could I realistically be given an injection for this?
  

I'm so sorry for the long post. I'm just worried about this and I wanted some reassurance. Thank you in advance.

I just started daily Lovenox injections in order to conceive with a Protein S deficiency. Looking for advice and tips on how to function with this new medication.
Also wondering if people have experience with Lovenox and cannabis (I smoke for anxiety and take CBD oil/gummies for cramps). Since I'm not pregnant right now I'm wondering if I can still use cannabis on Lovenox. I never had any problems with it on Elliquis.
Background: had a DTV 16 years ago in my neck/shoulder area (3 clots) and nearly lost my right hand in the process. I was on Warfarin/Coumadin for about 7/8 years before switching to Xeralto for a short while (intense side effects) and have been on Elliquis/Apixaban since. I never had any other clot. I had Fragmin injections early on and three other times while switching between other meds. So far, Lovenox hurts a lot less than Fragmin but I've only had one shot of Lovenox at this point.

Axstrom's Notes

1. The list is here: big jump list
2. The draw (2-5387) is 1836, 5196, 1005, 2546, 2440
   1. Drawing 5 so there are backups in case of issues, but the jumper gets to choose among 4
   2. 1836 is Iron Grip 1.1 - Dieselpunk Videogame
   3. 5196 is Generic Yandere - famous for its drawback to make your Benefactor want you to chain fail - vetoed by the benefactor
   4. 1005 is Lewd Sonic the Hedgehog - yall need a Grass Touching jumpdoc
   5. 2546 is Push - Movie about people with a variety of psychic powers
   6. 2440 is Mystara - The cobbled-together D&D setting
   7. Jumper chooses Push
      1. Jump Doc
      2. Reddit discussion
   8. Benefactor adds: "Generic Psionics" as a supplement
      1. Supplement Doc
   9. Recent discussion

Build Notes

Boudicca's wishlist: immortal soul (300 - no die), thoughtform (300), power overwhelming (200), well of power (200), infusion (200), Ren: thoughtform (300), spiritual healing (300), well of power (200), unified practice (200), occultism (200), Axstrom: thoughtform (300), attunement (300), paragon (300), networking (300), well of power (200), unified practice (200), subtle psionics (200), mental barrier (200), the sight (100), unbreakable focus (100), restraint (100), cognitohazarddous pigment (100), mental realm (300) Recommended: 100 : Survival Kit, Cog Pigment, Training, The Sight, Accepted, -- 200 : well of power, multithreading, anti-psi, subtle psi, -- 300 : the origin, mental realm, thoughtform, networking, spiritual healing, paragon, You get 5 Psionic Tokens. You can exchange one for any given purchase in this jump, but you can only exchange one for a 300 CP perk twice at most.

1. Drawbacks
   1. Push - Hunted By Division - Worth a lot, plays in with what I want to do integrating Push and Generic Psionics and 10 years
   2. GP - Asset Recovery - Essentially in line with Hunted by Division
   3. GP - Veteran of the Psychic Wars (lesser) - what happens after the week of Push? Escalation, as always
2. Shared - I'm taking a few things that are common to me and both companions
   1. Push - Enhancement Drug - the claim is that it doubles any psychic abilities you have when you take it, and unlocks the "enhanced" versions of Push powers; this is great in Push but with Generic Psionics, there are a lot more abilities in play for it to enhance
   2. GP - Psionic Potential - This is a freebie for everyone. Everyone starts with minor proficiency in one discipline, and they can improve in that discipline over time, and unlock other disciplines - for this jump, we'll treat everyone's starting discipline as their Push discipline
   3. GP - Well of Power - GP abilities are generally powered by mentally straining yourself, and this gives you a "mana pool" for psionics you can use before straining yourself, increasing power and endurance
   4. GP - Thoughtform - transcend the limits of your biological body, but get the best of both worlds: count as fully biological for when that suits you, and fully psychic when that is preferable, plus immunity to hunger, starvation, poison, disease, and organ damage
3. Companions -
   1. Nosogi Ren - selected by the team and highly synergistic with GP due to her existing specialties in toxins / medicine / healing
      1. Push - drop-in shifter
      2. Shifter - Illusions - with the enhanced version buffing the ability and eventually trapping people in a world of illusions
      3. Run - free for drop-in, improved speed and situational awareness
      4. Plan - being able to interleave future events is valuable
   2. GP - synergies with existing healing and medicine/poison affinity 1. Therapist - implied to include general knowledge of psychology and theory of mind; it makes sense for illusions to be more effective if they are what the victim wants or expects to see 1. Mindscape - synergy with the final tier of shifter, plus therapy / psychic healing 1. Spiritual Healing - aligns with existing healing / medicine abilities, and likely useful in this setting 1. Survival Kit - The magic raincoat alone is great, but free (if bad) food and magic water filtering is a cherry on top 1. Drug Lab - extreme synergy with existing perks of medicine making and toxikinesis, this suffices for both
      1. Psi-Weapon (import: Dagon Killer Shotgun) - increased effectiveness against the supernatural, damage scales up with psychic power level, use negligible psi energy in place of normal ammo, imbue with extra effects from your disciplines, and you can dismiss and recall it at will
   3. Boudicca - my lieutenant / bodyguard-in-training could use a bit more supernatural "oomph", and chose to become basically unkillable
      1. Push - gangster mover,
      2. Mover - Telekinesis - even non-enhanced movers can shield themselves and nearby allies from bullets, and the enhanced version can distintegrate solid objects and affect anything within a 5km range
      3. looks - see below
      4. Intimidationg - see below
      5. Connections - see below
   4. GP - Defensive powerhouse that always comes backups
      1. Covert Operative - stealth, social reading, etc., good for a commando 1. Strainless Steel - even after the well is exhausted, less affected by strain and recovers more easily from high strain or other mental damage 1. Training - more power / techniques in starting discipline (telekinesis), fundamentals of psychic power theory, adapt faster to other power users, and this translates to other supernatural systems in future jumps 1. Anti-Psionics - nullifies the primary threats in this jump, but in a power-vs-power way, not absolute. Can be trained to do even more, including apply to other supernatural abilities. Fiat permits this to coexist with the owner's psychic powers. 1. Immortal Soul - Even if your (thoughtform) body is completely annihilated, you continue to exist as a psychic entity (but you can be killed in that state), synergy with Thoughtform to reincorporate faster, reincorporating costs strain but we have that covered already 1. Survival Kit - see above 1. Psi-Weapon (import: Signature Sword) - see above
4. Origin (Push) - Gangster - none of the backgrounds are amazing, and this one promises some starting benefits with few obligations
5. Perks
   1. Push
      1. Porter - Teeleportation - this seems to be one of the most versatile teleportation powers, since the enhanced version lets you teleport others, teleport objects held by others, and teleport things at range - should synergize with Martian Successor which offers basic teleportation at extreme (interplanetary) range
   2. Looks - not just attractiveness, but DGAF charisma
   3. Intimidation - maybe unnecessary given everything else, but it's good to have it in writing
   4. Connections - know a guy who knows a guy for all things illegal
   5. Nemesis - Foil others' plans, your target will always be on the backfoot, good to push your psychological advantage
   6. GP - going for the unified powers build
      1. Accepted - people judge you on your merits and actions, rather than traits; good in general, but especially if you have scary powers
   7. The Sight - detect psychics and psychic phenomena, resist illusions, more easily learn information-related psi techniques
   8. Mental Barrier x2 - automatically resist all mental intrusions and psychic attempts to affect your body, plus identify such attempts, maybe unnecessary for the jumper but more defenses stack to resist stronger threats
   9. Occultism - your psychic abilities can extend to more mystical phenomena than is usually allowed, also part 1 of psychic / magic integration
   10. Subtle Psionics - Your psi power is generally masked, and active usage is only noticeable if directly observed, also ability to scale down powers or use them in deniable ways
   11. Unified Practice - conflicting powers can coexist for you, also part 2 of psychic / magic integration
   12. Networking - form voluntary bonds to share senses, thoughts, and even powers, or involuntary bonds to weak/helpless targets to probe their mind and otherwise subjugate them - power sharing alone is worth the cost, plus this should function as an amazing teaching/training booster, but the involuntary bonds will be very helpful in a covert war
   13. Attunement - a weird strange where you get "motes" by overcoming challenges, and the motes can be temporarily drained for a one-off power spike that is on-demand and unconditional (so not only based on an emotion or a being overwhelmed, just when you want to), or permanently drained for an upgrade or benefit you could get from training, so a training booster, either would be valuable
6. Items
   1. GP
      1. Cognitohazardous Pigment - pigment you can work into paint, food, etc to imbue a perception or impression, or even a power; refilling and extremely versatile
   2. Mental Realm - psychic demiplane you can design which gives you increased abilities and recovery, and eventually you can forcibly bring unwilling targets
   3. The Origin - crystal that allows you to awaken psi powers in someone who doesn't have them, or introduce psi powers into a world

Jump Notes

1. The warehouse is truly a welcome sight, after being locked out in a 20 year gauntlet
   1. And we thought this last jump before all the warehouse drawbacks wore off would be nice and quick
   2. The last of the bat guano has been stuffed in a barrel, the cave structures are gone, there's no more heckling, and the rooms are where they're supposed to be - what a relief
   3. Ren and Seijiro had been given warehouse authority, and turned on stasis mode after waiting about 3 months
   4. As is tradition, the others chat and prepare a party while I check out the Benefactor's Lounge,
      1. This time there are four envelopes with potential destinations, instead of the three I've been getting until now - no complaints from me
      2. Push is a movie about people with special powers chasing eachother around
      3. Mystara is a D&D setting that was made from various different canons being jammed together, and sounds like fun
      4. Mystara appeals to me at first, but after the frustration engine that is Worm-verse, I really want to be able to let loose, and I'm at least familiar with Push, so it gets affixed to my chart of jumps
   5. After affixing the sticker, I notice a second sticker right next to it: "Generic Psionics" - I wonder if that's the supplement that the Benefactor's agent told me would be coming
   6. The companions have predictably elected Ren to join on the next adventure
   7. There wasn't a whole lot of great cuisine to be had in post-apocalyptic Worm-verse, and we didn't have warehouse access to stash away the good stuff when we could find it, so the night's feast is a bit simpler than usual - vermicelli with scallops, in honor of the worm entities and their shards
      1. After dinner, we get together to watch Push, and talk about what we might like to do there
      2. Consensus is that we should visit the wet market in search of better quality scallops than whatever the warehouse provided tonight
   8. But this is our first time working with a supplement, so everyone is quite interested in what that will do to the setting, and how long we'll stick around, since the movie takes place over either a few days or 10+ years depending on how you look at it
   9. The rest of the week is mostly just a chance for us to relax and enjoy some luxury after the grimness of Worm-verse
2. Boudicca and I pop into an exotic animal store at the street market in Hong Kong - one that apparently sells some of my spiders
   1. Ren bamfs into the world a moment later - with no backstory or connections here, not that she'd really need them
   2. We quickly take stock of the situation, and finding no immediate risk, duck out and take stock
      1. I know I have a fairly large condo nearby, a noodle restaurant with a subterranean base, a secret hideout, a "novelty shop" selling occult items, and a spider farm in a rural part of the mainland, and Ren's got a lab around somew
   3. My gang was dissolved when the leaders were arrested in France, so Boudicca and I are officially free agents
   4. A little snooping around tells us that although the events of Push seem to be proceeding as expected, the specifics are wildly different, and psi empowered individuals are much more powerful in this supplemented version
      1. That sinks my plan for being able to just "let loose" here, but from what I can tell, the upgrades from the Psionic Supplement are quite potent, so it makes sense
3. After some discussion we work out a plan for the next few months
   1. All of use need to start seriously training our powers
      1. First, I must get Networking and Mental Realm up to snuff to use them as training aids while the others practice training eachother to learn how to effectively teach their discipliens
   2. Once we're ready to learn efficiently, the telekinetic bullet defense is the technique we all agreed upon
   3. Boudicca keeps an eye on the Push protagonists using anti-psionics to avoid being found, and generally acts to gather information and build good relations
   4. Ren works in the lab, adapting her existing medicines and poisons, and learning to produce psi-drugs
      1. The medicines and psi-drugs will be our main "business" for quite some time
      2. Our long-term plan is that she'll learn to synthesize the Enhancement Drug from Push
   5. I start working on building up our "enterprise"
      1. With the plan to build up a sizeable group of loyal psychics before things really kick off
      2. Kai steps in to help with recruiting and placement
      3. We take a bus out to the spider farm to get familiar with the location so we can teleport in the future
   6. During this time, we have our first run-in with Division agents
      1. When trying to make contact with a buyer of Ren's product who was trustworthy last time we met, but must have been leaned on in the interim
      2. As soon as they see me, one tries to Push me to come with them, and my mental barrier alerts me immediately, the Network informing the others
      3. It's nice to know that they're going to try to find us through contacts, since we can use that to our advantage when we're ready
4. Some of the fights between the Push characters aren't subtle, and within a few days, tabloids and bloggers are peddling all kinds of stories about what's really going on
   1. You'd think it would cause the Division and triad groups to lay low, but they all seem to think they can strike while the others hide
   2. According to the message boards, it's happening elsewhere too - a few days later in LA, and the next in Singapore, and all over
5. That marks the start of a steady escalation in direct conflicts and civilian witnesses
   1. Memory wipers get to some of them, but a few were able to make video recordings and publish them
   2. Division forces try to track us down a few weeks later, but we engineer the situation in which they "ambush" us
      1. It turns out they're more powerful than their Push counterparts, but physically, they're still baseline humans and they go down easily
      2. Unfortunately the ones sent to apprehend us don't have much useful information, even when subjected to Ren's examination of their Mindscapes
   3. Our recruiting and training efforts make good progress, and the origin crystal makes it all possible
      1. Within 6 months we have 12 psi officers in training, and by a year into the jump, each of those officers is leading a squad of 5 to 15 gangsters
      2. Most of the squads are pushing drugs, but a few are involved in gambling and other vices
      3. The existing triads try to push back at us, but lack coordination among their psi operatives
6. In the following year, various sides continue escalating with more and more public conflicts
   1. Most of the time it's not even clear what they're fighting over, but it sounds like it happens when watchers on one side or another get a hunch that the time and place are right
   2. Our training regimen has been strict, and the three of us have all mastered the TK bullet shield
   3. Division and triad agents keep trying to come after me, but even with their resources, we can see them coming and hand them their asses
7. A few years pass, with violent incidents coming in waves, before something snaps
   1. Ren figured out how to synthesize the enhancement drug in her lab
      1. Beyond that, she figured out how complementary medicines to make it safe to take, and one of them is a slow-acting antidote that causes the ability to enhancements to last a short while
   2. The Triads know that we're behind this new drug, and they're sick of being surpassed by the Americans (who stabilized their version of the drug within the first two years)
      1. So they try to make a move on us
   3. Our known fronts in Hong Kong are destroyed overnight, including the restaurant an the hobby shop
      1. The local Division agents are happy to have us at eachother's throats, and stay out of the way
   4. Of course, we could just let this slide, but we'd rather not
8. Over the next two years, we systematically track down and destroy every Triad psychic in and around Hong Kong
   1. The intel we've been collecting along the way pays off, and my training in using my Psi-Sight lets us hunt them down relentlessly like bloodhounds
   2. We lose a few of our carefully trained gangsters, and even a few highly gifted officers, but the ranks are soon replenished by triad goons who can see which way the wind is blowing
   3. Their "final boss" isn't even that interesting - he's a skilled fighter, and highly proficient in telekinetics and precognition
      1. But we aren't subject to precognition, and when Boudicca cancels his Telekinesis, Ren blasts him with her shotgun
   4. The interrogation doesn't lead us to much - we already had the information advantage
      1. But as his body heals, we are able to "adjust" his mind to accept our authority
   5. So we trot him back out into the streets of Hong Kong, singing our praises, and allow the effects of our dominance to spread to the rest of the criminal underworld
9. With that chapter resolved, we still (and likely always will) have a target on our backs, but no one dares provoke our wrath against
   1. And with a little bit of stability and some degree of trust in our well-trained organization, we finally take our enhancement drugs
      1. Beyond just our Push powers, the other disciplines and techniques we've been practicing gain significant potency
      2. Our Network is stronger, the Dreamscape doubles in size, and my companions' psi-weapons now penetrate AR500 steel like it was aluminum foil
   2. We continue to expand our gang, and branch out to things like community outreach and helping the homeless
      1. The plan is to run our neighborhoods like Skitter's organization ran the Boardwalk - building up the community
      2. The officers had all been picked from the start with this in mind, and the transition isn't as jarring as it would be for some gangs
      3. We even offer psi-enhanced medicine and counselling services to those who need it, which lures in enough "immigrants" that we have to start putting down limits
10. Following the loss of the triads' best psychics, Division agents go on the aggressive against them
    1. Both sides wisely avoid antagonizing my employees, and avoid getting to close to my territory in Kowloon during their skirmishes
    2. The three of us actually live a fairly nice life in fancy newly-constructed Condos for the remainder of the jump
       1. Of course we continue training, and Ren still has chemistry work to do while Boudicca and I oversee the business and neighborhood obligations, respectively
    3. We also load up the warehouse with a fair amount of construction materials and tools, as well as gold and weapons we liberated from the Triad offices we raided
    4. On our last day, we dedicate a new clinic, and offer gifts and advice to our officers who will be taking over as leaders of the gang and the community
       1. And of course, we get the best and freshest seafood we can - skipping the wet market and taking it directly from fishing boats we commissioned for the morning for just this purpose

Notes on the Jump Doc (Push)

1. This was a bit of a weird one - mediocre perks, mostly mediocre items, and then pick one really cool super power, and an expensive item that makes it better
   1. So on the balance, a decent jumpdoc in terms of power / cost
2. 200 cp for a companion import is expensive, but ok because there isn't too much you need to buy here unless you're just starting out
3. The movie itself takes place in about a week, so it would be nice if the jumpdoc provided either an "express jump" option to be deeply involved in the plot, or some guidance on what to do for the other 521 weeks you're here
   1. Especially because there are watchers who have plans extending that farm
   2. I think a lot of people have seen the movie, and if not it's fairly approachable, but apparently there are also a few comics that might have plot-relevant info?
4. Power level available is probably building level, and threat level is probably at least city level, depending on whether that old shadow lady gets enhancement serum maybe?
5. Overall pretty good, and a good choice to pair with something more meaty

Notes on the Jump Doc (Generic Psionics)

1. What to say?
   1. I wish I could have gotten everything in this jumpdoc. It doesn't even go into what powers you can get from the "disciplines", but the powers and items it describes are all awesome
   2. And unique - so many things here that I haven't seen in other jumpdocs, but make so much sense in this one
2. Some of the perk / item descriptions get a little lengthy, and it would be nice if they could be pared down, but the uniqueness of the offerings means that some of them need a fair amount of description
3. Power level here is pretty high since you can get various approaches to melt minds and near immortality (like Boudicca)
4. Threat level is up to interpretation as a generic, but if you enemies have access to these perks as well, you should be sure to have some kind of mind control immunity before coming in
5. In general I highly recommend this jumpdoc

25 - Push Build

Point Summary

Point Total: 1600 CP 1000 (Base) + 600 (Jump Drawbacks)

Jump Details

Document name: 25 - Push Author: The Vale Source: https://drive.google.com/file/d/1dnCSxbyWZW_RvO_c7U9ad1i3NcYZ_WRk/view

Jump Duration

Years: 10

Origin

Origin: Gangster You are a career criminal. An officer within the family, a made man, an enforcer. Regardless of which organisation you belong to, you have a small measure of authority, a reputation (good or bad) and people you can rely on.

Perks

Power: Porter (Enhanced) (Free)
A Porter can teleport vast distances at will. The ability of a porter is inherently unstable at first, triggered by merely “wanting to be somewhere else.” Eventually a Porter can develop their ability to transport others as well as themselves.
Enhanced - The gun isn’t in your hand, it’s in mine:​ With practice you will be able to increase control over your teleporting ability, now able to control orientation and momentum through your teleportations, either cancelling or maintaining momentum through a teleport. Transporting people with you has become easy. With practice you might even be able to teleport others without moving yourself. With true dedication of time and effort, you may even be able to teleport things at range.
Looks (Free)
A pretty face can take you far in the world, but more than that what sets you apart is attitude. You have a certain presence about you, in the casual confidence with which you hold yourself that draws attention with ease.
Intimidation [100/900 CP]
​You are a badass, and you don’t have to do much for people to recognize it for themselves. A simple stare, a few choice words, or a casual loom can have even hardened men feeling the pressure and when you turn up the heat, you can clear a room.
Connections [200/700 CP]
​You know people. And your people know people. From drugs to guns, assassins to whores, money launderers to smugglers, back alley doctors to corrupt cops - you’re the guy who knows a guy.
Nemesis [300/400 CP]
​You have a particular ability to foil other people's plans, to interfere in their business and pursue them into ruin. Whether you are one step ahead or doggedly pursuing from half a step behind, the target of your attention will find you to be their most fearsome foe.

Items

Enhancement Drug [300/100 CP]
​A single dose of a psychic enhancement drug developed by Division. To date, only a single subject has survived injection, becoming the most powerful Push on record. The full depths of power which this drug unleashes are unknown, though it will take time and training to make use of your new potential. Effects are permanent. 100% guaranteed to work, 100% non-lethal.

Companion Imports

Import Boudicca and Ren [400/-300 CP]
200: You may import one companion with 600cp to spend on perks, and they may purchase a single power. Imported Companions

Drawbacks

Hunted By Division [600/300 CP]
​Division wants you locked up in an experimental facility where they can brainwash you, run tests and experiments on you, and eventually turn you into an obedient living weapon.

25A - Generic Psionics Build

Point Summary

Point Total: 1700 CP 1000 (Base) + 700 (Jump Drawbacks)

Jump Details

Document name: 25A - Generic Psionics Version: v1.2 Author: HOnSide Source: https://drive.google.com/file/d/1_nJOwGC4BsZDf5m8ogRO1VCQMLwCgH2W/view

Perks

Psionic Potential (Free)
You have a gift. Psychic powers. You can channel your mental energies to manifest supernatural effects. This is tiring to do, but with practice, you will be able to manifest stronger effects more often, with less strain. You already have minor proficiency in a common psychic discipline, such as telekinesis or telepathy, and can develop new psychic disciplines or techniques from those disciplines with effort and study.
Accepted [100/900 CP]
Psychic powers can be unpredictable, and as such, a psion may at times find themselves persecuted under the assumption that they are dangerous or uncontrolled. This problem will not strike you, however. Others will never take an inherent trait of yours as evidence that you are somehow flawed, judging you for your actions and merits instead. You may still be seen as evil or reckless for taking actions that are actually evil or reckless, but not because of your powers, nor things like your gender or race.
The Sight [100/800 CP]
A common enough gift among the psychic community, though by no means universal, you have opened your third eye, metaphorically speaking. You can perceive psychic phenomena as though they were visible to your senses, and can much more easily pierce illusions, glamours and similar effects. You can learn to detect the presence of other psychics, and not only find it easier to learn psychic disciplines that reveal information (such as psychometry, precognition and more) but can also easily integrate these with your senses, making them almost effortless to maintain and manifest instinctively.
Mental Barrier (x2) [200/600 CP]
Your mind is a fortress (and yes, it’s gates are both barred and guarded). You have potent psychic defenses which passively and strainlessly draw on your psychic power to harden your mind against intrusion. Any effect that attempts to reach your mind for any reason, whether to influence it, read it, or do something else, is halted by this barrier. This barrier is not unbreakable, but it cannot be circumvented entirely, and you are aware of any force that interacts with it. Even someone powerful enough to break past it will be taken note of, however subtle their attempts are, giving you the chance to react. This awareness also means you can identify what effect such powers are attempting to induce by analyzing it, and you can voluntarily let it through, such as when someone is simply trying to send you a telepathic message.
For an additional 100 CP, this effect has expanded into a full psychic field across your body. A field like this can, in addition to the perks normal functions, also defend against and detect attempts to affect your body in any supernatural way. If someone wishes to telekinetically throw you across the room, they must first break through your barrier. Because of this, you are also aware of any attempts to affect your body in the same way you are aware of attempts to affect your mind.
Occultism [200/400 CP]
(cut for length)
Unified Practice (Free)
(cut for length)
Well of Power (Free)
Psychic power is often channeled directly from the mind. ‘Psionic energy’ does exist, but is less a source of power and more an effect, with blasts and constructs of psionic energy being more common. For you, it’s different. You have a pool of psionic energy you can use to fuel your powers, which can be filled by incurring strain beforehand, or passively attracting psychic energy at a slower pace.
You can consume this pool to replace the usual strain of your psychic powers, allowing you to use your powers for much longer, and without incurring the usual headaches, exhaustion and other consequences of strain until this well runs dry, as well as to increase the raw power of your gifts. With training, the size of this pool, and the rate at which it regenerates can be improved, and you can find new uses for it.
This psionic energy is particularly suited for fueling powers that channel it more directly, such as the aforementioned psychic constructs.
Thoughtform (Free)
As long as you desire it, your body remains indistinguishable from a mundane biological body, but in truth, it is a stable psychic projection. This extends several benefits.
Firstly, the form of your body is influenced by your self-image, which grants you both very minor shapeshifting (as your body adapts slowly to match your idea of what you should be) and enhanced healing (as your body steadily returns to its intact shape). If desired, you may lock your body, partially or wholly, into a coherent shape, preventing your self-image shapeshifting from taking effect. Useful for those with an unstable self-image, such as the mentally unstable.
Secondly, while your body's functions still depend on your mind, the opposite is now less true. So long as you retain a certain amount of body mass, you can retain function. Destruction of your heart would not prevent your body from functioning, and destruction of the brain would not end your thought processes. In addition, your body sustains itself from your mental energy, so you no longer require food or drink to live, though you can still indulge if desired.
Finally, the psychoreactive nature of your body makes it much more responsive to your powers. Powers that improve your body or change the way it works are much easier to develop, making it easier to learn skills like phasing, shapeshifting and other powers of that type.
Networking (Free)
Connections are important. You are clearly aware of this, as you are quite capable of connecting to others. You can establish a bond with a willing being to bind yourself together with them. When you are bonded in this way, you are able to share mental data with one another, from senses, to thoughts, to memories and more. Transfers like this only work when both parties are willing to engage in them. When both parties open themselves up to this bond, it eases their communication and coordination, making it easy for both parties to cooperate and ensuring that any misunderstandings are easily resolved. Either member of the bond can annul it when desired.
More than just this, the bond also permits the sharing of your psychic powers. You could use this to help telekinetically protect your bond member, for instance, or to manipulate probabilities around them for the better. If they are also psychic, they can use this to aid you in the same way, and you could even pool your powers together to manifest effects you couldn’t produce on your own. With time, you might learn to share other powers this way as well.
When you have more than one person bonded to you at a time, you can also help facilitate bonds between them, allowing them to share in the benefits of this perk with each other in addition to you.
That said, this connection can also be established more forcefully, if desired. When a target is helpless, unconscious or otherwise not capable of overcoming your power, you can establish a bond with them which they are incapable of annulling. You have full control over what this bond transfers on both ends, allowing you to read the mind and emotions of your target, affect them with your powers from anywhere, and even draw on their powers to boost your own, or force them to accept strain on your behalf.
Attunement [300/100 CP]
(cut for length)

Items

Cognitohazardous Pigment [100/0 CP]
(cut for length)
Mental Realm [300/-300 CP]
Located somewhere between the material world and a greater mental realm (such as the Collective Unconsciousness, the Astral Plane or the Realm of Dreams), This realm is a veritable font of psychic energies to which you are uniquely connected. You may travel to this realm from anywhere with a few seconds of focus, and can return to where you left in the same way. You can also bring a few willing people along when you do so.
The plane itself has a general design of your choice, whether a castle, forest, or complex of comfortable apartments, and can contain up to a city park in space. While you are in it, you can draw power from it to recover from strain and restore energy at a massively accelerated pace. Within the plane, your use of powers is also much enhanced, allowing you to accomplish far greater acts than you would normally be capable of.
Your unique connection to the realm can be developed, eventually enabling you to do things like bring unwilling targets into it, increase its size using your powers, draw on the plane’s restorative energy even while outside it, or use it as an in-between to travel to the psychic realm it borders.
The Origin [300/-600 CP]
This unusual segment of glowing crystal a little larger than a fist fills the area with an unusual buzzing feeling. When someone who does not possess psychic powers from this jump makes contact with the crystal, their psychic potential is awakened, granting them the effect of the Psionic Potential perk, and a smattering of psychic talents on par with the perks in this jump.
By crushing the otherwise nigh-indestructible crystal in your hand (something that is easy to do deliberately, as if the stone reacts to your will) it releases a wave of invisible energy that causes the same buzzing feeling as the crystals presence, and causes a portion of people across the world to awaken their psychic potential in the same way as touching the crystal.

Drawbacks

Asset Recovery [300/-400 CP]
Seems like someone out there considers you proprietary technology. There is an organization out there, perhaps one involved in your creation or simply one that wants to understand how you came about, that intends to retrieve you for study by any means necessary.
This organization is one with access to a truly ridiculous amount of funding and resources, and they are rather familiar with the function of psychic powers. While they don’t know how to artificially produce psychics on your level yet, they can feasibly field anything from heavily armed hit squads of psychic drones to genetic monstrosities empowered with specific psychic techniques, and they have enough influence not to care about things like ‘casualties’ and ‘war crimes’, though they might not be able to arrange for an assault in a truly public location like a busy city square. Best to mind your manners. You are being watched. Veteran of the Psychic Wars (400) [400/0 CP]
Tension has been building beneath the surface of the psychic communities for a long time now, and shortly after the start of your jump, that tension will boil over as the community features into several warfarin factions. It won’t be impossible for you to escape the war efforts, but the chance of you laying low for your entire stay are miniscule at best.

Hi everyone, I apologize if this is the wrong place for my post but I’m desperate for help and I found a lot of posts related to Lovenox in this sub.
I 28F have been suffering from a chronic UTI since August 2023. I found a urogynecologist who ran a series of blood tests and found I have the 4g4g mutation of the PAI-1 gene, which shows I’m at a high risk of clotting. I’ve never had PE/clotting issues or anything like that before, this was the first I’d ever heard of it. She said that people with this mutation are prone to forming biofilm infections due to excess fibrin production. She put me on 30 days of Lovenox alongside antibiotics.
Problem is, I have a deathly fear of needles to the point of fainting each and every time. I literally have an hours-long panic attack every single day trying to inject this medicine and I’m only on day 3. Today I passed out on my bathroom floor. As I held the needle over my skin, my head started to feel like radio static and my entire body went numb. My knees shook like a newborn faun and I collapsed to the floor screaming and crying uncontrollably. Another hour later and I’m still staring at this unused syringe. I cannot bring myself to do it. I know this sounds extremely dramatic and trust me, I am severely embarrassed. I thought I could overcome my fear of needles but self-injection is proving to be absolutely impossible.
I have no one in my life who I can ask to do the injections for me. My husband refuses to help as he believes this doctor is a quack and he is adamantly against me taking this medicine in the first place so he will not help me take it. I have no other friends or family who can help me, I live 1,300 miles away from anyone who could help.
All the stress and despair aside, the sheer time it takes me to perform the injections due the panic attacks is severely impacting my daily life. I had to call out of work this week because of it. How am I going to do this for 30 days?! I called my doc yesterday and asked if there was an oral alternative and she said flatly that no, there was none, and basically told me good luck and goodbye.
I have virtually no body fat which I think makes the injections that much worse. Like I can’t pinch off a substantial amount of skin/fat anywhere on my thigh, butt, or midsection. I’ve lost a substantial amount of weight due to the extreme stress of dealing with a chronic, debilitating infection for almost a year. And honestly I feel like these injections are just adding insult to injury. I couldn’t have imagined my suffering could become any worse than it already was but here we are.
So my question is: can’t I insist my doctor prescribe me warfarin? Or some other oral blood thinner anticoagulant? Why does it have to be Lovenox, and what would happen if I just stopped taking it? I can’t get my doc to pick up the phone and I don’t have another appointment until next week, but frankly the thought of doing one more injection makes me want to die. If anyone has any help or advice, please I am so desperate.

Welp, my wife joins our little club of bleeders here... unfortunately. Diagnosed with a PE this past friday.
Because she is on anti-seizure meds, she cannot take eliquis or xarelto and is stuck with warfarin... because she is "bridging", she also has to have the 60mg lovenox shots she has deemed me to give her.
Thankfully, Ive never experienced the hell that is the lovenox shot, but I have read and now know just how painful they can be.
We're hoping that her INR will be in range this coming monday so she cans stop these shots, however, in the meantime... is there anything that can be done to ease her pain from the injections?
There is no bruising with them.

Just thought I would share my story and would love to know if anyone has a similar story to me and is able to ease my mind/give me advice 😊
Back in early September I (20F) was walking my dog on a local field at around 4/5pm when my ankle rolled causing me to shock myself and fall to the ground (on grass luckily!), I brushed myself off and was limping for a bit and had a sore ankle but didn’t think much of it. I woke up the next morning at 5am with such a tightness in my chest and a shooting pain in the left side of my ribs and all down my back on my left side, I was due in to work for 10am but the pain was so severe I had to call in sick, I started to feel better throughout the day so I called in and said I’d be back into work the next day. The next day comes around and the pain is still there but not as severe as it was, I assumed it was from when I fell on the field I thought I may have pulled a muscle or something, so I carried on working, I work with babies so as you can expect I do a lot of picking up and I’m always on my feet, throughout the day my coworkers could see I was slowly deteriorating, I lasted 7 hours at my job but 5pm rolled around and I couldn’t bare the pain anymore, I was leaving and as I was leaving one of my coworkers told me to get myself up to a&e to be sorted.
After my coworker dropped me off home I got onto the phone to 111 (for anyone outside of the UK it’s a number we call if it’s a smaller emergency than if we were to dial ambulance/police) they advised me to get myself up to a&e within the next hour to get seen so that’s what I did. I got seen within 45 minutes, the nurse was checking my obs and she said that my heart rate was a little high so she was going to give me a blood test just to double check, after my bloods were taken I got sent to a private room where I was told I was going to spend the night, I was hooked onto a cannula in which I was being fed antibiotics through, the nurse told me I was going for a CAT scan in the morning (at this point I was so confused as I didn’t know anything). 5am in the morning rolls around and I’m being taken down to a CAT scan, I had it done and went back to my room, later on that morning 4 doctors came into my room and told me I have pneumonia, I was so confused as to how it happened, one of the doctors then said to me that I am at risk of having blood clots but they’re going to send me for a X ray to see, that’s when it was confirmed that I had quite a few blood clots on my left lung (hence all the pain being on my left side). I can’t fault the doctors as they caught onto it all pretty early and started treating me then and there, I had a couple of allergic reactions to some of the antibiotics they were giving me which unfortunately caused my hand to swell up and was in quite a bit of pain for days 😞
Overall i was in hospital for a week getting injections, antibiotics through a cannula and orally, im so so thankful I did something about it and didn’t just suffer else I dread to think what would’ve happened. When leaving the hospital I was put on Enoxaparin injections but I am now within my range (my target INR is 2.0-2.5) so I am now on 8mg Warfarin tablets a day with no injections! Did anybody else on this sub have a similar or the same experience as me? Would love to know.

IgG 4 related disease (IgG4-RD) is a systemic fibroinflammatory disease characterized by dense infiltration of IgG4-positive plasma cells in the affected tissue(s) with or without elevated plasma levels of IgG4.1 The inflammatory infiltration along with a characteristic storiform fibrosis can lead to the development of chronic damage and/or tumefactive lesions1 that may affect any organ.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140155/
Autoimmune inflammatory reactions triggered by the COVID-19 genetic vaccines in terminally differentiated tissues
The spike protein can independently cause damage, regardless of interaction with ACE2 receptors. The only difference between the spike protein in the virus vs the vaccine is that the one in the vaccine has a tiny tweak that limits its interaction with ACE2: it does not shape to "post fusion" shape. This could be why vaccine-injured have similar symptoms to Covid.
Now a study funded by the Dutch government, currently available as a preprint, provides further evidence that the mRNA COVID-19 jabs are increasing IgG4 antibodies. The researchers state: “Repeated mRNA vaccination against SARS-CoV-2 has been shown to induce class switching to IgG4, a non-inflammatory human antibody subclass linked to tolerance.
Vaccinated children were significantly more likely than the unvaccinated to have been diagnosed with the following: allergic rhinitis (10.4% vs. 0.4%, p <0.001; OR 30.1, 95% CI: 4.1, 219.3), other allergies (22.2% vs. 6.9%, p <0.001; OR 3.9, 95% CI: 2.3, 6.6), eczema/ atopic dermatitis (9.5% vs. 3.6%, p = 0.035; OR 2.9, 95% CI: 1.4, 6.1), a learning disability (5.7% vs. 1.2%, p = 0.003; OR 5.2, 95% CI: 1.6, 17.4), ADHD (4.7% vs. 1.0%, p = 0.013; OR 4.2, 95% CI: 1.2, 14.5), ASD (4.7% vs. 1.0%, p = 0.013; OR 4.2, 95% CI: 1.2, 14.5), any neurodevelopmental disorder (i.e., learning disability, ADHD or ASD) (10.5% vs. 3.1%, p <0.001; OR 3.7, 95% CI: 1.7, 7.9) and any chronic illness (44.0% vs. 25.0%, p <0.001; OR 2.4, 95% CI: 1.7, 3.3).
We now know the truth. The lipid nanoparticles, or LNPs, travel widely throughout the body. These LNPs carry the Frankenstein mRNA that causes the cells to produce spike proteins.
New British government data showing mRNA vaccinated dying 52% more than unvaccinated - aka 1.5x accelerated death rate
Elaborate breakdown of how widespread vaccination data is misrepresented in scientific papers.
Leaked documents show that some early commercial batches of Pfizer-BioNTech’s covid-19 vaccine had lower than expected levels of intact mRNA, prompting wider questions about how to assess this novel vaccine platform
UK Scientist Reveals Data Analysis: Some Batches Are 50 Times Worse Than Others.
Japan finds another Moderna vial suspected to contain foreign substance
Vietnam province suspends Pfizer vaccine batch after 120 children get hospitalized
The BioNTech/Pfizer and Oxford/AstraZeneca coronavirus vaccines are associated with seven rare neurological complications, according to the most comprehensive study of the side effects from the two jabs.
U.S. Federal Court prove Pfizer, the FDA & Fact Checkers lied when they said Toxic Graphene Oxide was not inside the Covid-19 Vaccines
DNA should not be more than 0.033 per cent of the total nucleic acids in the dose. But McKernan’s analysis demonstrated DNA contamination of up to 35 percent in the bivalent injection samples. This is up to 1,000 times higher than deemed to be ‘acceptable’ by the regulating authorities.
Hepatitis C Virus Reactivation Following COVID-19 Vaccination
Bad Pfizer Vaccine Batches Account for 4.2% of doses but 71% of Serious Adverse Events
How did MRNA technology go from having safety issues in 2017 to being “completely safe and effective” in 2020?
Cardiovascular, neurological, and pulmonary events following vaccination with the BNT162b2, ChAdOx1 nCoV-19, and Ad26.COV2.S vaccines: An analysis of European data
DNA fragments detected in monovalent and bivalent PfizeBioNTech and Moderna modRNA COVID-19 vaccines from Ontario, Canada: Exploratory dose response relationship with serious adverse events.
SV40: On contamination, monkey viruses and their parts
“These mRNA shots differ completely from all other previously available “vaccine” products, not only because of their mRNA component, but also because of LNP components. LNPs are the engineered additive used to attach and deliver mRNA genetic coding for Covid-19 spike into the cells of a patient for the purpose of making mRNA stable and permit cellular absorption and transcription. Without LNPs, any RNA product would rapidly degrade. Having worked with RNA in the laboratory, I can also personally attest to RNA’s extreme fragility. “
Risk of immunodeficiency virus infection may increase with vaccine-induced immune response
Ban on Gain-of-Function Ends.30006-9/fulltext)
More indication that the spike protein may be independently causing heart damage
What are the real risks of myocarditis after Covid infection and after Covid vaccine?
Half of Vaccinated People Never Stop Producing Spike Protein, Study Found
mRNA & Breastfeeding: COVID-19 vaccine mRNA found in Breast Milk00366-3/fulltext#:~:text=Our%20findings%20suggest%20that%20the,two%20days%20after%20maternal%20vaccination.)
Chinese Load Cow's Milk with mRNA Exosomes--Successfully Immunize Mice
Michigan judge denies drug manufacturer's immunity in case of contaminated COVID-19 medication
SARS-CoV-2 vaccination was associated with higher risk of myocarditis death, not only in young adults but also in all age groups including the elderly. Considering healthy vaccine effect, the risk may be 4 times or higher than the apparent risk of myocarditis death. Underreporting should also be considered. Based on this study, risk of myocarditis following SARS-CoV-2 vaccination may be more serious than that reported previously.
A new study from Scandinavian countries is out:
The authors worked for health departments of the four Nordic countries. They were tasked with looking at their entire populations (and their computerized records), seeking out instances of myocarditis. They had vaccination records for all people as well.
Revisiting the claim that “myocarditis is more common after covid than after the vaccine”
One of the most comprehensive studies looking at the risk of myocarditis after covid infection was this study out of Israel (which has an advanced and comprehensive electronic medical records system), covering a large population of nearly 200k subjects.
The authors “did not observe an increased incidence of either pericarditis or myocarditis in adult patients recovering from COVID-19 infection”.
This is, of course, entirely consistent with what is the strongest (and also simplest) evidence against the core claim, which is that numerically an increase in myocarditis cases simply wasn’t a feature of 2020, but rather this started in 2021.
Figure 1: Incidence of myocarditis across 40 hospitals in USA
...
Heath Advisory and Recovery Team: Myocarditis began with vaccine rollout
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COVID Vaccines Damage ALL Hearts, Study Finds Radiology Tests Detect Myocardial Damage in Covid-vaccinated patients "Conclusions: Focal myocardial 18F-FDG uptake seen on oncologic PET/CT indicates a significantly increased risk for multiple myocardial abnormalities."
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JAMA STUDY BY US FDA REPORTS RECORD-BREAKING 50-FOLD INCREASED RISK OF MYOCARDITIS, 10-FOLD INCREASED RISK IN 5-11 They did not stratify the results by gender & dropped 75% of the cases due to lack of medical records. Relative risks reported? 10.19, 10.26, 22.44, 8.72, 18.65, 10.29, and 50.01!
Excerpt:
Safety of the BNT162b2 COVID-19 Vaccine in Children Aged 5 to 17 Years Pediatrics JAMA Pediatrics JAMA Network
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An epidemiologist asks the right questions.

JAMA Peds publishes myo/peri study on kids - without stratifying for male/female? And threw out 75% of cases due to not having medical records to review?

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Close inspection shows that one of the high relative risk values, which for one database for one age group was a record-breaking RR = 50.01, was in fact elevated in 5-11 year-old vaccinees.

RR = 3.49 and 10.29???

​
Myocarditis: Once Rare, Now Common A Comprehensive Review of Myocarditis, Covid and COVID vaccines
The Ultimate List: mRNA Vaccines + Myocarditis The evidence is now OVERWHELMING - a very real risk to kids, young adults and possibly all ages.
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First our quick one-liner summaries for your tweeting pleasure: FDA finally admits in its own report on 65+ mRNS recipients: Risk of lung clots up 50% - Risk of heart attacks up 40%+ https://www.sciencedirect.com/science/article/pii/S0264410X22014931
Jan 2022, JAMA study found myocarditis risk increased in multiple age, sex groups after mRNA COVID-19 vaccination, highest in young men. https://jamanetwork.com/journals/jama/fullarticle/2788346
Study of VAERS data between Jan-Jun 2021 found highest rate of myocarditis in young boys 12-15 after dose 2 of mRNA COVID-19 vaccination. https://onlinelibrary.wiley.com/doi/10.1111/eci.13759
This slide presentation to the CDC and FDA on myocarditis should have rung some IMMEDIATE alarms bells - but we went on vaxxing the young lads anyway. https://fda.gov/media/159007/download
Study in Nature found increased risks of myocarditis and pericarditis in France after Covid-19 mRNA vaccines, particularly after 2nd dose and in age 18-24 yrs, both male and female were affected. https://www.nature.com/articles/s41467-022-31401-5
CDC report 2022 found 14 cases of myocarditis or pericarditis among 102,091 males aged 16-17 who received Pfizer-BioNTech Covid-19 vaccine, significant departure from reported rates in 2021, showing concerns labeled as misinformation are real. https://thefederalist.com/2022/09/09/cdc-admits-post-vaccine-myocarditis-concerns-that-were-labeled-covid-misinformation-are-legit/
Study found myocarditis/pericarditis as rare side effect of mRNA COVID-19 vaccines, disproportionately affects young male adolescents, commonly after 2nd dose of primary series and 1st booster. https://www.acpjournals.org/doi/10.7326/M22-2274
The estimated MMRRs and SMR were about 4 times higher than the MMRRs and SMR. The study concludes that the SARS-CoV-2 vaccine is associated with a higher risk of myocarditis death in all age groups, including the elderly. The risk may be 4 times or higher than the apparent risk of myocarditis death. https://www.medrxiv.org/content/10.1101/2022.10.13.22281036v1.full.pdf
Markedly elevated levels of full-length spike protein were detected in the plasma of individuals with post-vaccine myocarditis, whereas no free spike was detected in asymptomatic vaccinated control subjects. It suggests that the cause of myocarditis may be linked with spike antigen. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.061025
The risk ratio for the mRNA vaccines combined is 1.43 which means that recipients are 43% more likely to have a serious adverse event. https://www.sciencedirect.com/science/article/pii/S0264410X22010283
You’re going to have to vax 35K young adults to prevent one hospitalization and in doing so you’re going to send nearly 20 of these folks into a serious adverse reaction from the vax. https://jme.bmj.com/content/early/2022/12/05/jme-2022-108449
Review of studies on vaccine-induced myocarditis finds that the Science we're meant to be Following pervasively obfuscates the risk of the mRNA jabs for young men
Of the few studies that even attempt to assess the population-wide risk of myocarditis following vaccination, nearly three-fourths neglect to include the proper stratifiers
mRNA Vaccines Injure the Heart of ALL Vaccine Recipients and Cause Myocarditis in Up to 1 in 27, Study Finds
"Circulation" Medical Journal: Circulating Spike Protein Detected in Post–COVID-19 mRNA Vaccine Myocarditis "Free spike antigen was detected in the blood of those who developed post-mRNA vaccine myocarditis.
JAMA: Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military "In this case series, myocarditis occurred in previously healthy military patients with similar clinical presentations following receipt of an mRNA COVID-19 vaccine.
This article seems to suggest that autopsies are the only main way to test vaccine injuries for sure, as it explored the strong possibility of long term effects of the vaccine.
Reuters is trying to say that hospitalizations didn't skyrocket in 2021, they are trying to say that data was so poorly reported between 2016-2021 that a 300 percent increase, in some cases, is now just back to normal, and there are no problems with reporting currently, of course.
Risk of Myocarditis After Sequential Doses of COVID-19 Vaccine and SARS-CoV-2 Infection by Age and Sex
‘Spikeopathy’: COVID-19 Spike Protein Is Pathogenic, from Both Virus and Vaccine mRNA
Systematic Review of Autopsy Findings in Deaths after COVID-19 Vaccination (Independent study)
Pfizer and Moderna dodge questions and plead ignorance at Senate hearing
Florida Health Alert (with some relevant links to data on COVID vaccine injury)
Jeffrey Sachs, Ph.D., chair of the COVID-19 Commission for the Lancet, one of the most prestigious and oldest peer-reviewed general medical journals, presents evidence of possible lab origin of Covid-19
"Surgisphere", A fake company, were able to get wildly incorrect studies about the "dangers" of a known remedy for COVID published in Lancet, a well-regarded scientific journal.
DNA contamination in mRNA vaccines
Florida calls the COVID vaccine a "bioweapon" and seeks to make it illegal
“Nevertheless, the expert group believes that, for some of these frail patients, common adverse reactions may have contributed to a more serious course of their disease.”
Are Covid Vaccines Riskier Than Advertised?
in the FDA who refuse to take the jab
Censored Scientific Journal from 2021 detailing deaths caused by the vaccine.
Another Scientific Journal Linking Myocarditis to the COVID Vaccines
47-year-old UK man faces speech issues and memory reduction after Covid vaccine, seeks compensation for brain injury
The British Medical Journal has investigated the CDC's vaccine surveillance efforts and deems the system "overwhelmed."
"Dr. Gatti’s 2017 study showed an incredible amount of contamination in a whole host of traditional vaccines in the form of tiny nanoparticles, mostly metallic."
Ignored Danger Signals: Newly Released Pfizer Trial Data Shows 8 Sudden Deaths in Vaccinated Subjects Vs. Just 4 Sudden Deaths in the Unvaccinated
Cerebral venous sinus thrombosis in the U.S. population after SARS-CoV-2 vaccination with adenovirus and after COVID-19:
Cerebral venous sinus thrombosis negative for anti-PF4 antibody without thrombocytopenia after immunization with COVID-19 vaccine in a non-comorbid elderly Indian male treated with conventional heparin-warfarin based anticoagulation.
Cerebral venous thrombosis after BNT162b2 mRNA SARS-CoV-2 vaccine.
Cerebral venous sinus thrombosis 01788-8/fulltext)after vaccination: the United Kingdom experience.
US case reports of cerebral venous sinus thrombosis with thrombocytopenia after vaccination with Ad26.COV2.S (against covid-19), March 2 to April 21, 2020.
Management of cerebral and splanchnic vein thrombosis associated with thrombocytopenia in subjects previously vaccinated with Vaxzevria (AstraZeneca): position statement of the Italian Society for the Study of Hemostasis and Thrombosis (SISET).
Vaccine-induced immune thrombotic thrombocytopenia and cerebral venous sinus thrombosis after vaccination with COVID-19; a systematic review.
Early results of bivalirudin treatment for thrombotic thrombocytopenia and cerebral venous sinus thrombosis after vaccination with Ad26.COV2.S.
A rare case of a middle-aged Asian male with cerebral venous thrombosis after AstraZeneca COVID-19 vaccination.
Cerebral venous sinus thrombosis and thrombocytopenia after COVID-19 vaccination: report of two cases in the United Kingdom.
Diagnostic-therapeutic recommendations of the ad-hoc FACME expert working group on the management of cerebral venous thrombosis related to COVID-19 vaccination.
COVID-19 vaccination: information on the occurrence of arterial and venous thrombosis using data from VigiBase.
Cerebral venous thrombosis associated with the covid-19 vaccine in Germany.
Cerebral venous thrombosis following BNT162b2 mRNA vaccination of BNT162b2 against SARS-CoV-2: a black swan event.
The importance of recognizing cerebral venous thrombosis following anti-COVID-19 vaccination.
Cerebral venous sinus thrombosis negative for anti-PF4 antibody without thrombocytopenia after immunization with COVID-19 vaccine in an elderly, non-comorbid Indian male treated with conventional heparin-warfarin-based anticoagulation.
Vaccine-induced immune thrombotic thrombocytopenia and cerebral venous sinus thrombosis after covid-19 vaccination; a systematic review.
A rare case of cerebral venous thrombosis and disseminated intravascular coagulation temporally associated with administration of COVID-19 vaccine.
Cerebral venous sinus thrombosis in the U.S. population, After SARS-CoV-2 vaccination with adenovirus and after COVID-19.
Cerebral venous thrombosis after COVID-19 vaccination: is the risk of thrombosis increased by intravascular administration of the vaccine?
Central venous sinus thrombosis with subarachnoid hemorrhage after COVID-19 mRNA vaccination: are these reports merely coincidental
Cerebral venous sinus thrombosis after ChAdOx1 nCov-19 vaccination with a misleading first brain MRI
Early results of bivalirudin treatment for thrombotic thrombocytopenia and cerebral venous sinus thrombosis after vaccination with Ad26.COV2.S
…
The real Covid jab scandal is finally emerging The young and healthy, who were at minimal risk from Covid, should not have been told they had to take the vaccine.
Texas Gov. Greg Abbott signs bill banning COVID-19 vaccine mandates by private employers.
Cambridge professor cautious about calling vaccines ‘safe and effective’
Families of AstraZeneca vaccine victims fight to get jab listed on death certificates
145-Country Study Shows Increase Of Transmission And Death After Introduction Of Covid Vaccines
Infant mortality rates regressed against number of vaccine doses routinely given: Is there a biochemical or synergistic toxicity?
Swiss Policy Research: DNA Contamination in Pfizer and Moderna Covid Vaccines "The potential pharmaceutical and clinical effects of the newly discovered plasmid DNA fragments in Pfizer and Moderna covid vaccines need to be investigated very carefully."
The Telegraph: Oxford AstraZeneca Covid jab was ‘defective’, claims landmark legal case } Victims of VITT - a new condition identified by specialists - question the Government's monitoring of the vaccine's rollout and its efficacy.
Questioning Lipid Nanoparticles mRNA shots differ completely from all other previously available “vaccine” products, not only because of their mRNA component, but also because of LNP components.
Oxford AstraZeneca Covid jab was ‘defective’, claims landmark legal case.
MSM reporting several instances where COVID-19 vaccine deaths were not reported as such until relatives fought to set the record straight. New study also shows twice the number of sudden deaths in Pfizer's trial amongst the vaccinated. Also the case of the 'unjabbed COVID death' subject who actually died days after taking the Moderna jab.
Newer COVID-19 vaccines: Still lights and shadows? "Thus, an enhanced malfunction of ACE2 receptors is not to be excluded. In other words, new COVID-19 vaccines (2023–2024) might be associated with an increased risk of adverse reactions when compared with previous formulations."
Preprint: "Among those with previous SARS-CoV-2 infection(s), when comparing two vs. three Wuhan vaccine doses, there was no observed difference between groups. Additional Wuhan platform mRNA vaccines did not improve NtAb response to BA.4/5, but prior SARS-CoV-2 infection enhances NtAb response."
Nature: Duration of SARS-CoV-2 mRNA vaccine persistence and factors associated with cardiac involvement in recently vaccinated patients "These results suggest that SARS-CoV-2 mRNA vaccines routinely persist up to 30 days from vaccination and can be detected in the heart."
Circulation: Circulating Spike Protein Detected in Post–COVID-19 mRNA Vaccine Myocarditis "Markedly elevated levels of full-length spike protein were detected in the plasma of individuals with postvaccine myocarditis, whereas no free spike was detected in asymptomatic vaccinated control subjects."
Do People Care Enough About Each Other to Speak Out Against Catastrophic 'Vaccines'? It's past the time to continue to tolerate this "mRNA vaccine experiment.” We were promised that the COVID-19 shots were going stop the spread of the ‘virus’ and end the pandemic. We were lied to.

Hey,
I posted a while back about my partner inflicted with an unprovoked upper limb DVT, it is in both her sub clavical & Auxiliary veins, the A&E Doctor also found clotting going down her right arm. We opted against getting thrombolysis at the time as the cons seemed to outweigh the pros and she found her arm mobility improved on just the heparin. She still gets tremors & fatigue in the affected arm but she'll be getting physio soon and we're hoping that will improve things.
We've since been to haematology and she tested positive for APS on her first test, the doctors said she had the highest amount of the problem antibodies they had ever seen so they felt pretty certain that she has APS and promptly switched her from apixaban to warfarin. We found that on apixiban her fatigue worsened vs the heparin injections, and the switch to warfarin has been an improvement except for the occasional drop in INR.
She has her 2nd test next week.
We didn't fuly appreciate how much the diet can impact her INR, so we did what we used to do, bulk making food for a week. This has resulted in fluctuating INR levels (i.e the other week I made a caserole with lots of spinach, and her INR dropped drastically). We think we're getting a better handle on that side of things, but I constantly worry about how much I feel like we're on the knifes edge.
I'm trying to do what I can to make this a new normal, but while she's doing the regular appointments, taking her meds on time, getting back to work. Sometimes I feel like she doesn't fully grasp the situation, almost as if pretending there's a way back from this. I don't think she fully appreciates the range of symptoms that comes with APS. I feel like I'm having to take some of the burden of reading more into the condition and almost cautiously observe without worrying her too much, but I don't know how that can be sustainable.
Sometimes I feel like she's becoming forgetful & muddling her words in a way that i've not seen before. It could just be me incorrectly attributing it all with the diagnosis, but things just seem different.
Anyway, this just turned into a big brain dump.
I was just hoping to get some advice from any other suffererers or SO's on how I can be there for her, as right now all I feel I can do is continue working, helping her make her appointments, be there for her mental health and observe.

Firstly hi all. Secondly I'm in the UK so I apologise if any terms etc I use or med names differ to the US.
So about a month ago I was having chest pains and breathing issues which were leading to full blown panic attacks cos of the hyperventilating. Long story short I was diagnosed with a chest infection and given steroids and anti bionics. And I got better then two weeks ago the symptoms came back although the chest pains weren't as bad the breathing was worse assuming it was a reoccurrence of infection or as I suspected COPD (yes I'm overweight and a smoker for 30 years) my GP was concerned because my Sat's were down to 80 so she sent me back to the hospital.
Eventually they tell me I have what they referred to as "massive blood clots" in my lungs which was also very slightly increasing my heart enzymes. I was admitted and kept in for 3 nights ( which in the UK you know its serious when they give you a NHS bed for 3 nights)
I barely slept in the hospital I even was given zopiclone on two nights and didn't manage more than about 7 hrs sleep over 3 nights. So I was desperate to come home.
So I got off the oxygen and was shown how to eject myself with dalteparin and was told I'd also be started on warfarin. And would need inr tests till they got me to the therapeutic levels required and that the warfarin would probably be for life.
As keen as I was to come home now I am home I'm really really really scared. I'm in a lot of pain, I'm covered in bruises cos of the injections and anti-coagulants. I'm starving hungry but then have no appetite when I actually get food. My breathing is still laboured. Although I slept slightly more last night it was very interrupted maybe 5,5 hours waking up 6 or 7 times.
I know I'm going to have to make significant lifestyle changes but here's where I'm struggling most. Even doctors have told me quitting smoking and dieting at the same time can be a bad idea cos changing so much at once can be difficult to maintain (let's be honest the health risks aren't a factor and I say that because as someone who has smoked for over 30 years knowing full well the risk of cancer heart disease etc) but obviously I want to.
The more pressing concern for me is the most likely cause of my PE is poor lifestyle combined with being incredibly sedentary. So yeah I know fully self inflicted. And I know it's gonna be really important to be more physically active. But I live in a first floor flat and can barely manage the stairs, I don't know how to be more active when doing so causes so much pain and difficulty breathing.
Every twinge feels terrifying. I don't feel safe at home at least at hospital there was pure oxygen and trained medical professionals to step in should I throw another clot or if my heart is unable to cope. A massive heart attack.
I already had diagnosed anxiety and depression so my already poor mental health is at breaking point and I have no one to talk to. My husband does his best but I'm so angry at him (unfairly) because last week when I was trying to tell him there was something really really wrong he thought I was just being over dramatic (not in a nasty way. It was a logical conclusion given my history of anxiety and panic attacks) so even though I know he did nothing wrong I'm angry at him
If I didn't trust the GP I saw, if I listened to my husband I would likely be dead right now. That is so scary a thought to navigate and I can't currently switch that thought off.
Sorry for the extremely long post
Oh I forgot to say I'm currently on 18,000 Iu/0.72 ml of dalteparin injections twice daily and 10mg of warfarin tablets once a day. That goes to 5mg tomoand then I guess they play with it depending on the results of the INR blood tests.
Basically if anyone has any advice on how to navigate these next weeks and months I'd be so grateful.
Thank you

I had to go to the emergency room due to a complication for a ln epidural procedure where I have steroids injected in different sections of my spinal cord (in the L & C spine). I came into the hospital because I lost feeling suddenly in my arm, severe pain, and loss of control in my neck(my chin rested on my chest, very difficult to move, if at all). The triage nurse mostly dismissed me when I came in, although I couldn't support my head & neck, and was losing more control of the rest of my body. It was hard to communicate, and I had tried taking my scheduled pain medication to help before getting there, but I know my words slur a bit when I do. I asked several times for her to take my medications I brought to put them in my chart. (I have a rare blood condition, and am on quite a few daily meds, like anticoagulants. Without them I develop blood clots and quickly. I had to fight for the first 24 hrs to get them to take down my medication list and to give me the right medication. Several times I had nurses try to give me meds that I was no longer on, but wouldn't give me my apixiban or my inhalers. Fwd to last evening, the nurse tells me I won't be given my apixiban until today. (My INR was 1.2 and I had been off them for my epidural on monday for a few days and I had only last Friday switched from warfarin to apixiban. My feet were numb from lack of circulation, and i wasnt really aware my feet were now useless at this point. The nurse came back, and said the changed the order for my anticoagulants and she had them for me and a couple other medications for me to take. At this I'm genuinely afraid of the the drs in charge of my meds, and can't trust them. So I ask her what she's giving me first. I get my reg dose of trazadone, my apixiban tablet, and then she grabs a prefilled syringe. That syringe she says is an anticoagulant and that she's going to give me it. I yelled no. I wasn't being bridged, there was no need to that medication. I argued with bc she was trying to make me take it. Finally she goes and checks her chart, turns to me and says, oh yeah thats not for you- it's someone elses. She leaves after I demand to speak to the Dr. At this point i felt like I'd be safer out of the hospital than in it, even though I can't really move yet. So I remove my IV, and make an attempt to get out of bed and to my walker. That's when I found out my feet didn't work, and I was too weak. I fell and landed on the floor. I banged my head on my walker on the way down. The dr came in and asked what happened. I told him. He said it was my choice but if I stayed he'd order me the medication they've been using and let the nurse know I would need help off the floor. I can hear his conversation. These are thin curtains. And then I hear a different nurse chime in and say "if she wanted to be on the floor maybe she should stay there". I couldn't reach my call button, and my voice isn't very loud so I guess no heard me asking for help. I stuck on the floor, half naked, and part of my curtain was open so people could see me. I was in 10x more pain by the time I got help into the bed, and I was completely frozen. I've only just got warmer today.
The time line for this part of my stay in hospital of horrors starts around 5-6 pm last night until 1030-11pm. I was left in the floor from 910-1015 before my nurse came in and asked if I wanted help up. It was a full hour that I was stuck laying on the floor beside my hospital bed.
That is just part of the bad practice I've experienced since coming in Tuesday night.
I did speak to the floor supervisor today, who was really helpful and said she is looking into it bc there were protocols not followed.
TLDR: I need to make a complaint about my hospital stay and how I've been treated up until today, but im not sure who to contact.
I am in Ontario Canada.
Any help or advice would be greatly appreciated.
I have a lawyer currently from my past MVA almost 7 yrs ago i was riding my bike when a bus decided he wanted my lane. I did contact him, but as per usual he's not gotten back to me. My original lawyer quit the practice and I got stuck with a new lawyer from the firm.
So I feel lost and unsure of the what steps to take next.

patientcare #healthcare #health #doctor #medical #hospital #medicine #patientexperience #patientsafety #nurse #patients #physician #primarycare #patientsfirst #healthcareprofessional #medicalcare #news

Back in the spring of 2014 I was 38 in good shape and had recently retired from the military. I was jogging two to three times a week and after reporting soreness in my left calf to my health care provider, she recommended I purchase a muscle roller stick.
After two weeks my left calf begin to swell and was warm to the touch. My fiancée suggested I may have a blood clot, so I went back to my healthcare provider and they did a ultrasound of my calf and found nothing. The clot was too deep and missed by the scan, my fiancé (who is a nurse) suggested. I was given given a pain reliever and crutches by my doctor and sent home.
The following Friday night I was laying in bed and felt like someone was sitting on my chest. The next morning my girl took me to the ER where I was given a cat scan. The ER nurse told me I was being admitted and would be staying over the weekend. The ER doctor told me I had Multiple PE blood clots in my lungs and that I was lucky to be alive.
After seeing multiple examples of incompetence by the hospital staff my girlfriend recommended a care plan that the doctors agreed to which included Lovonox injections to break up the clots and warfarin with weekly checkups to monitor dosage. My doctor told me since I had no family history of blood clots and no evidence on how I got the clots I would probably be on blood thinners for life.
In 2015 I moved to San Diego and under the care of a new hospital and health care provider, I have been receiving great health care and around 2018 I was offered Xarelto, which I accepted due to the annoying blood level monitoring. I have had little to no issue with the medications or with clotting.
Just wanted to share my story and provide hope to others.

Hi all, I’ve been on warfarin for just over a month now. Finally off of the inhixa injections and trying to get my INR levels stable. It keeps dropping to .3 under my lowest level so I keep having to change dosage and go back. I had some alcohol over the weekend for the first time (couple of glasses of wine, nothing extravagant). How long would that potentially effect my INR results? How long did it take other people to get to their ‘stable dose’?

• 40 year old
• Male
• 6'2"
• 245 lb
• Caucasian
• USA
• Known allergy to CT Scan Contrast Dye (hives). This was discovered in a hospitalized scenario (gallstone induced pancreatitis) and I was highly medicated on morphine, so I don't know much more about how it made me feel or other symptoms than what got put on the report. I don't know whether it was iodine-based or gadolinium-based. I don't have an allergy to eating shrimp, but my dad does.

Current medication:

• Testosterone cypionate 130mg/week (through legit, in-person doctor)
• Anastrozole 0.5mg/week (same)
• Cardarine/GW-501516 20mg/day (illicit)

Currently actively losing weight with strict ketogenic diet and fasting. I mention this because I'm deeply adapted to ketones and low blood sugar. I had an A1c of 4.2 at last physical and routinely see blood glucose numbers in the 60s while feeling great. I've never had an issue with donating blood or TPs before, even on multi-day fasts, but never done double reds before.
Fitness enthusiast, primarily endurance/cardiovascular. Due to TRT and exercise I have a high hemoglobin/hematocrit and have been donating blood regularly to offset this.
The morning of the blood drive, I had a ~45 minute run and then a large breakfast of steak, eggs, and butter around 6am. I also had an electrolyte drink with 1200mg sodium and 600mg potassium.
Upon showing up at the blood drive, which was at noon, my hemoglobin was tested with an instant-read device at 17.8 which is about what I expected it to be.
I typically squeeze the ball pretty aggressively when donating blood. I was not familiar with the double red procedure and wasn't able to tell when the return vs draw was happening. This was an at-the-workplace blood drive and didn't have constant supervision.
At some point during the procedure the needle infiltrated and I ended up with a bulge on my arm about 0.5" high and maybe 2"x3" in width/height. The nurse showed some concern when she pulled the needle but said it would go down. I thought nothing of it and went on my merry way. I did not eat/drink anything caloric.
When I got back to my desk (just upstairs), I started itching. Probably 10 minutes after finishing the procedure. All over my body but most noticably on both of my shoulders (the blood draw was at the usual location, inside the elbow) and my head. I noticed hives on my shoulders.
I went back downstairs and told them about it, they had me talk to a doc via phone and fill out a report. I wasn't especially concerned, moreso just wanted answers in-case there's something I need to know about for future care. This was the first time the nurses had seen any kind of reaction like this that wasn't local to the injection site.
The doc did not seem willing to speculate on what could have caused it but advised me to leave work, take two benedryl, and if I had trouble breathing, to use my son's epi-pen (when explaining, I mentioned that my son had a nut allergy so I had a bit of experience with allergic reactions) and call 911. I think she is supposed to call back today for follow-up.
I went home (~40 minute drive) and felt completely fine by the time I got home. Still I took the benadryl as advised, zonked out, and am totally fine today. Had a bad run this morning, but that's to be expected with the red blood cell loss.
What I can't understand is what I could have possibly had an allergy to. They return your own blood + saline into you, and I can't imagine having an allergy to saline -- seems like that would not be compatible with life. I've also had IV drips before of saline, glucose, and medication.
The nurse mentioned that an anticoagulent agent might be part of it, but didn't know what it was. I think it would just be citrate? Which again seems like something unlikely to be allergic to? I've taken tons of medications and supplements in my life that are bound to citrate, and I'd assume I've probably had it intravenously at some point, having been on a few IV drips in my life.
Heparin might be used but it seems rare, and heparin allergies are also very rare?
It wouldn't have anything like warfarin in it, would it? I can't imagine that.
I think it was definitely something in the return, because it wasn't localized to the injection site. I'm also not allergic to latex.
Could there be a common component of CT scan dye and apheresis return solution? That seems like it would make the most sense.
I guess I'm just totally puzzled into what this could be.
Is this worth following up with my PCP (IM) over now? Or should I just bring it up at my next routine visit?

Female 57. Warfarin, Evoxac and Vit D. Lupus, Fibromyalgia, Limited Scleroderma, Sjogrens, Reynauds, Inflammatory autoimmune arthritis, TMJD etc.
Had a colonoscopy and endoscopy yesterday (amazing, kind team) and had to halt Warfarin then do self injected Lovenox.
I'm not sure how deep to put the needle! I did the first this morning and got no bruising so worry I didn't go deep enough. I'm injecting into my stomach.
I'd guess it's a half inch needle, I'm scared of going too deep and too shallow.
Thank you, this is pretty stressful for me.

My mom is hospitalized, she has PVT and she has been taking clexane 0.6 ml 2 injections throughout the day and 1 warfarin 5mg dose once a day for last 3 days. Her pain is almost gone however INR level is still very low. Before clexane and warfarin she was on heparin 50 ml dose that lasted 44 hours. Before clexane and warfarin her INR was 0.99 and in recent test it was 1.02. Doctor has said that she can't be discharged until INR is above atleast 2. How long does it usually take to get therapeutic range after starting warfarin and clexane?

Hi to anyone who may read this.
​
My mother-in-law (F62), 5'7'', 220 lbs, white, non-smoker and non-drinker passed away this April from necrotizing pancreatitis. The medical team asked the immediate family if they would like an autopsy done to determine the exact cause of death, but they declined. However, my husband and I are kind of confused about how this could have happened and would like to learn how and why this condition caused her death.
​
My MIL survived an aortic dissection in 2019. She was left with left ventricular failure and had developed stage 3 kidney disease over the past three years. Before that, she had uncontrolled high blood pressure. Her blood lipids and glucose were within normal ranges, I believe, as she wasn't taking any medicine for that.
​
Sometimes in winter 2021, she started getting right upper quadrant pain and an ultrasound found a huge gallstone and a thickened gallbladder wall. She was diagnosed with cholecystitis and put on a low-fat diet and given medication. Since her condition wasn't improving, she pushed to have her gallbladder removed in April. She discontinued her warfarin and was given injections, I believe to reverse the effects of warfarin so she can undergo surgery.
​
In later April, she complained of worsening pain that was now constant and she stopped eating and drinking. She was taken to the doctor and they found fluid around her lungs but no action was taken and she was sent back home. Next day, she was taken to the emergency room and they determined she had acute pancreatitis along with decreased kidney function. Over the course of 10 days, it seems like she developed multi-organ failure and went into cardiac arrest.
​
Could her poor general health have contributed to her death and how common is it for gallstones to end up so deadly this way?

Near the center of Terra, a country could be found there.
Although their influence in this world could rival even the ancient Yan, they choose to be a more neutral power in the grand scheme of the world.
They were the founders of the well-known Arts weapon named ‘guns’. Because of that, they held a monopoly on the production of Said firearms. Laterano was also considered holy by its citizens.
The rain that was falling on one avenue of the country was viewed as a gift by God for the holy lands.
Aleth. That was the name of the city the rain was falling on to. Located on the outskirts of the country, near the border of Victoria.
The sky above it was dark. Most of the inhabitants of the city have preferred to stay indoors, sheltered from the rain pouring outside.
However, not everyone in the city was of the same mind.
A red-haired woman in a raincoat walked through the streets alone. If people saw them from afar, they would know that she was a local with how she carried herself. As the woman was walking through the rain, when she saw a figure at the local dessert store, her face morphed into a scowl. She picked up her pace and bolted to the store.
When she arrived at the small store, the woman pushed the door open and let herself in. The sound of a sweet chime greeted her and a sweet couple behind the counter nodded at her with smiles on their faces. She sent a quick nod their way as she took off her raincoat. It only took her a few seconds to walk toward her target. She was blissfully eating a doughnut as she stared at the rain falling outside at the table near the window of the shop.
The woman pulled the chair that was facing her target and sat in it. Like always, her horns that she did not bother to cover up caught her eyes first.
Feeling her gaze on her, Mostima pulled her gaze from the rain and stared at her. Putting down her half-eaten doughnut, she smiled at her new guest, "Don't stare at my horns so much." She chuckled, "It's embarrassing."
The newcomer was not amused at what Mostima said but it did not falter the smile that was on her face though.
"If you are so bothered with people staring at your horns, why not just cover them up? You do have a hood," The woman suggested in a dull tone, "If you do that, it saves a lot of your time."
Mostima hummed at her suggestion. She then took one of the doughnuts on her plate and lifted it near her face.
"True," Mostima smiled at the sweet, "But it might be hard for him."
The woman did not need to ask who the man was that Mostima was talking about. Ever since she came back from Lungmen, that man was the only thing that was on Mostima's mind. The fallen would talk about the man at every possible chance that she got.
How he loved the rain.
How he loved animals.
How he enjoyed spicy food.
Those were just a few of the things that she had to hear from her.
But something did not sit right with her. Although Mostima knew so much about this man, this man did not come up in the files that the grand church gave her about Mostima.
How was this man able to meet Mostima without the grand council knowing about him at all?
"… Hard for him to do what?" The woman asked.
Mostima smiled at her.
"Hard for him to find me again."
Mostima took another bite from the doughnut. This earned a glare from the woman. Although she was being glared at harshly by her, Mostima was not bothered by this and was more focused on finishing her doughnut.
Knowing what she was doing was futile, the woman gave up and went straight to the reason why she was here. Slowly told Mostima something.
"Is he really worth it?" She asked the fallen.
Rather than answer her, Mostima smiled and glanced back at the final doughnut left on her plate.
"… Blueberry," She muttered the flavour of the doughnut. A genuine smile blossomed on her face, "His favourite doughnut."
A vein popped on her head.
"That is not what I want to know!" The woman grumbled under her breath.
Mostima sighed, "Maybe your codename should be Suffering with how uptight you are," She laughed, "Loosen up a little."
"You know what will happen to you after this," The woman ignored Mostima's previous words and continued with her point, "You might die."
Although what she said was serious, Mostima's smile did not lessen in its shine.
"I won't die," Mostima confidently said to her, "I have to be alive to be by his side after all."
"…" Her response made Mostima's escort dumbfounded.
She did not know what to say.
"… Why? For a man that you just met?" She managed to ask, "You know how ridiculous you look now?"
"Like what?" Mostima smirked, curious about what she was thinking.
"A love-struck girl that views the world through rose-tinted lenses," The woman harshly answered, "Are you really going to risk your life for something like love?"
Mostima whistled at her and claimed, "Aren't you being a little harsh there, Miss Suffering?"
"Was I wrong though?" The woman dared Mostima.
The fallen angel just smiled and leaned back on her seat, "Of course you are."
She placed a hand on her chest and smiled gently at herself. The image of that black-haired man smiling down on her only made her smile brighter.
"The relationship that I have with Ye is not as simple as love," She hummed, "I want to be with him when he's at his worst, best, and in between. I want to help him, no matter how big or small his request would be. I am not bothered if he does not have the same feelings as me."
Mostima raised her head and smiled at her guest, "I just want to be by his side forever."
The woman was stunned in place by what she just heard.
Before she could say anything, Mostima stood up with her plate that had the blueberry flavour doughnut on it.
"Let's continue this outside," Mostima said to her as she made her way to the counter.
"Miss, can you pack this up for me?"
The woman behind the counter nodded. Seeing that she did not have a choice, the red-haired woman stood up from her seat and followed Mostima.
After a while passed, the two of them were now standing in front of the store's door. The bit of roof that was sticking out from the building was just enough to shield them from the rain that was still pouring outside.
Mostima turned to face the woman and raised both of her hands towards her. In one of those hands was a paper bag.
The woman pulled out a pair of handcuffs but she did not put them on Mostima immediately.
She stared into her blue orbs and saw she was not afraid in the slightest of what was going to happen to her after all of this.
"This is your last chance. You can still save yourself," She said to the fallen, "Are you truly sure of this?"
And like always, Mostima smiled.
But the smile that she was showing her now was so different from how she used to have.
It was genuine.
This was all because of that man.
"From the moment I saw him again," Mostima said, "I already decided I will do anything for him."
And the rain continued to pour down on the holy land.
{Rhodes Island's Psychologist}
Kal'tsit raised Eyjafjalla's medical documents closer to her face and read them. After a while, she put them down and looked at the research team in front of her. Rather than being in the meeting room, they were all gathered in a single medical room.
Why? You may ask. The answer will come.
"The type II of the cure performed better than what we guessed it would," Ka'tsit told the group, "It exceeded our expectations."
"Yes," Olivia nodded, "After doing some testing on her body we found that the density of Originium in her blood significantly decreased in numbers."
"Although that is the case, we are still far from gaining a true cure for Origiunium," Saria voiced her thoughts to the rest, "She is still considered an Infected. The only difference is just that she is now no longer in danger of seeing the infection. We are close to the cure."
The hair on Ptilopsis' head twitched, "I am amazed that Operator Eyjafjalla even survived."
The vampire of the group puffed up her chest. A smirk could be seen on her face.
"Were there any doubts I would not be on time," Warfarin confidently said, "It's me you are talking about? Of course, I was able to make a cure on time."
Kal'tsit raised her brow at her, "you say this but I remember you looked nervous when you injected the cure into Eyjafjalla."
The smirk that she had on her face, instantly disappeared when she heard this.
"… Um… Guys."
The people in the room turned their heads to the source of that voice. Their faces were not amused when they saw who it was.
"I know we are talking about something important," Lin Ye said nervously. The attention that he was getting now was not something he wanted, "Can I ask for one little thing?"
They all stared blankly at him.
"… What is it, Ye?" Warfarin asked in an indifferent tone at him.
Lin Ye innocently looked at them.
"Well…." He looked down at his body and back to them, "Can you untie me from this bed? It's getting uncomfortable here."
This was the answer to the previous question. The reason why all of them were gathered here and not in the meeting room was because of the person that was strapped into the medical bed they were surrounding.
Lin Ye expected a lot of things when he woke up.
The first thing he saw would be a white ceiling? Yes
Waking up after a week? Yeah.
Getting glares from some people? Expected.
However, being strapped into the bed he was resting on was something he would never guess to wake up to.
Before he could ask what was going on, Kal'tsit instantly held a meeting near his bed.
And here they were. Discussing their finding near his bed like he was a dying old man.
He felt old, it did not mean he was though.
"… Seeing how you bring that up," Olivia hummed, "Why don't we discuss your small episode last week."
Lin Ye froze.
"… Forget what I said just now," He chuckled, "The straps are growing on me now."
"No, let's," Kal'tsit said as she glared at him, "The moment you relax, your body gives up on itself."
Lin Ye slowly looked away from her but his eyes landed on Olivia now. She was just as or more disappointed in him.
"Ye, tell me the truth," She got closer to him. Now worried at his condition, "How long did you not sleep?"
"…" Lin Ye was debating with himself on whether it was wise for him to answer.
"… Ye, please," Olivia pleaded at him when she saw him struggling to answer.
After much consideration, Lin Ye finally gave up and sighed.
"Fine…" Lin Ye groaned, "About… When I came back from Yan."
"A month!" Warfarin shouted at him and shoved her face to his, "You did not sleep for a month! How are you even alive and sane!?"
Lin Ye tried to raise his arms, but they were tied.
"In my defence, that month was not kind to me okay," Lin Ye explained, "And compared to you, I am completely sane. With or without sleep."
"What are you trying to imply?!" She growled at him, "Remember, you are the one tied down."
"… Shit."
Warfarin lifted the files in her hands above Lin Ye. His eyes widened at this.
"Don't you dare." He warned.
"Oh?" She smirked at his weak attempt to intimidate her, "I dare."
"Warfarin-! Blurghegd!"
His shout was cut off by her slamming the papers on his face.
Kal'tsit sighed at the antic of those two. The rest also followed her lead.
Were they really the people behind the hope of Terra?
"Saria, untie him." Kal'tsit glanced at Saria, "I need him at my office now."
{Rhodes Island's Psychologist}
Lin Ye was now sitting in front of Kal'tsit's table in her office. He massaged his face to soothe the pain that he felt on it because of a certain vampire abusing him. She even had a worrying blush as she kept on smacking his face.
The owner of the room threw some documents in front of him. He looked down and read them.
Lin Ye's eyes widened but it did not take long for him to recover.
"So Eyja will be joining us with the research of the cure?" Lin Ye raised his head and leaned back on the chair, "So she found it out that fast?
Kal'tsit nodded, "Yes. This was expected. She is an amazing researcher. The moment she woke up she knew that we used something that could be considered a cure and that it was still in development. She offered to help, and we agreed."
"… I see," He nodded but he was not satisfied yet. There was something more, "But that is not the only thing you want to discuss, no?"
"You are correct," Kal'tsit easily admitted, "I want to discuss what we will do after the cure is finished."
"… I see," He hummed and leaned into her, "So? What do you need me to do?"
A miniature map then appeared on the table between them. All the countries on Terra could be seen on it.
"We need to have a better relationship with the countries on Terra," Kal'tsit explained to him, "Not just for our protection but the protection of the cure."
Lin Ye understands where Kal'tsit was coming from.
Some parties were not keen on the idea of the cure of Originium compared to most.
On the map, the territory of Yan and Kjerag was coloured black.
"We have an amazing relationship with Kjerag, something that not even many countries could say," Kal'tsit stated, "The same goes for Yan. We almost have the full protection of the royal family after we sent out the results to the prince."
"However, that is not enough." She looked up at him, "If we want to send out the cure to everyone in this world, we need to gain a good relationship with all the countries in front of us."
"You want me to do that? "Lin Ye guessed.
Rather than answering him, Kal'tsit explained even further, "You were the one that gave us such an amazing relationship with the two nations." She said, "I am asking you to gain the rest."
"…"
Both knew how obscure what Kal'tsit was asking him. Getting a good relationship with one country was impossible on its own and now she was asking for him to get Rhodes Islands a good relationship with the damn world.
Impossible. That was what she was asking him to do too. To do the impossible.
"I know I am asking much but I hope you would-." Kal'tsit was about to lower her head at him but was cut off when she heard him talk.
"Sure," He agreed, "I would be more than glad to agree to that."
"… Why would you agree so easily?" Kal'tsit did not understand. The weight of the responsibility such a task would bring was unfathomable.
She was asking so much from this man. If he denied her, it would not surprise her. And yet again, Lin Ye subverted her expectations.
"For the people that need us," Lin Ye smiled at her, "Infected or not, we need to help them."
Her eyes widened. The image of a man replaced Lin Ye. Then the two merged into one and leaving only Lin Ye sitting in front of her.
She was sure of it.
"… I see," Kal'tsit nodded and went to her drawer.
It did not take her long for her to fish out what she wanted and place it between her and Lin Ye.
He looked down and saw it was a card key. Something was written on it.
[The Doctor.]
"You need this to be able to do all that I am asking for."
Lin Ye connected the dots and the realization hit him. He raised his head from the card and stared at Kal'tsit.
"I want to see what Rhodes Island will become under your command." Kal'tsit stared into his eyes, "Guide us to a better world…"
"Doctor."
{Rhodes Island's Psychologist}
Draft: Jaq
Proofread: Discord
Edit: Jaq

Preface: I am a third-year medical student, with a HBSc in Biology and a minor in chemistry. I have worked with physicians performing the administrative aspects of their clinical trials, and I have spent this summer on a research project that involves me determining the cause of every episode of hypoglycemia among hospitalized patients at our institution within a several-month period. Despite this, I fully recognize that I am not an expert on this topic, and that the average patient with diabetes probably knows more about some of the practical aspects than I do.
None of this is medical advice. I am not telling you to switch your insulin. Talk to your doctor.
The Awakening
Prior to the discovery of exogenous insulin, a diagnosis of diabetes was almost universally fatal. Children found to have diabetes would be placed on a strict low-carbohydrate diet, but they would inevitably die within several months after losing nearly all their body weight. The only treatment was effectively starvation.
In 1922, Banting, Best, Macleod, and Collip were the first researchers to successfully isolate and purify insulin from the secretions of dog pancreases. While Banting, Best, and Macleod were awarded the Nobel Prize, it was really James Collip who was responsible for purifying the insulin - an obstacle which Banting and Best could not overcome. The story is rife with drama, with Banting at one point having to be held back from punching Collip. He unsuccessfully demanded that Macleod (the principal investigator overseeing the funding) remove Collip from the project. Nevertheless, the small team succeeded, and insulin soon entered the modern pharmacopeia. Armed with the purified insulin extracts, physicians could literally awaken children from the brink of death.
Fredrick Banting and his team would sell the patent of insulin to the University of Toronto for $3, stating “Insulin does not belong to me, it belongs to the world.”
Here is a really fantastic video discussing the dramatic story behind the discovery of insulin for anyone interested. I clicked it once expecting them to commend Banting based on the title, but they basically just end up shitting on him for 25 minutes.
In 1922, Eli Lilly and Company would send representatives to Toronto to request a license to produce insulin, promising they could create the highest quality product at the lowest cost to consumers. When granted with a year-long experimental license, Lilly quickly monopolized the insulin industry within the United States. Even when the University of Toronto began granting licenses to other companies, they could not out-compete the already established manufacturing lines of Eli Lilly and Company. Since the beginning, insulin has remained the highest revenue generator for Eli Lilly.
In 1923, a German scientist would perfect his own method of isolating insulin from pancreatic extracts. His pharmaceutical company, Hoechst AG, was granted the sole rights to produce insulin by a German committee. It would eventually merge with Aventis, which would then later merge with Sanofi to form Sanofi Aventis.
In 1926, a representative of the insulin laboratory in Scandinavia gained authorization from the University of Toronto to produce insulin in their country. The laboratory was called Nordisk Insulin Laboratory and was a non-profit at the time. This non-profit would go on to form one of the world's largest pharmaceutical companies, Novo Nordisk.
These three companies today control 100% of the insulin supply in the United States.
The Modifications Begin
The first form of animal-derived insulin would only last several hours, requiring multiple daily subcutaneous injections. Subcutaneous injections are are deposited into the layer of fatty tissue under the skin, and slowly absorbed into the bloodstream. These multiple injections proved cumbersome for patients – and a Danish chemist named H.C. Hagedorn aimed to enhance the medication for his diabetic wife. He discovered that by complexing the insulin with a protein called protamine, it would delay its absorption into the bloodstream and create a longer duration of effect. This was the discovery of intermediate insulin, named neutral protamine Hagedorn or NPH.
Instead of the usual 2-5 hours provided by regular insulin, NPH could would last for about 10-16 hours, thus reducing the number of required injections. Generally speaking, it is administered 2x per day in order to maintain a stable effect. Patients could use NPH as their basal dose to cover their baseline requirements throughout the day. In addition, they could inject regular insulin as their prandial dose at mealtimes to cover the subsequent spikes in blood glucose. This is known as the basal bolus regimen.
In Toronto, researchers discovered that by adding varying concentrations of zinc, they could alter the absorption rate of insulin in a linear manner. Zinc causes insulin to aggregate together promoting the formation of hexamers (six molecules linked together) that are too large for absorption. Over time, individual insulin molecules slowly break off and enter the blood stream.
Physicians soon realized they could mix regular insulin with NPH insulin and varying concentrations of zinc. This combined the abilities of regular insulin to lower blood glucose after meals and intermediate NPH to keep the blood sugars under control after the regular had worn out, all within a single injection. This was the discovery of pre-mixed insulins. They could adjust the mix ratios to achieve the desired blood glucose control in each individual patient depending on their unique needs.
Up until the 1980s, the only insulins available were derived from the ground pancreases of slaughtered livestock. This caused issues with impurities and possible allergic reactions. In the late 1970s, researchers discovered how to insert the human gene for insulin into the genome of E. coli bacteria using recombinant DNA technology. The bacteria could be grown in large industrial vats and secrete the insulin into the surrounding media, similar to the production of alcohol. This could then be purified and isolated without the need for any animals, with the resulting product being chemically identical to the insulin produced in our bodies. This was the creation of recombinant human insulin.
One thing you will learn very quickly is that every medication in diabetes management goes by several different names. Recombinant human insulin is more colloquially known as human insulin, and is sold under the brand names Humulin (Eli Lilly) and Novolin (Novo Nordisk). These are available in regular (R) or intermediate/NPH (N) formulations (e.g. Humulin R, Humulin N).
Novolin-N and Novolin-R are also sold through an exclusive partnership with Walmart under the brand name ReliOn. It is the exact same as Novolin, just with a different name. Walmart sells it at a lower price than Novolog does ($25 per vial vs $155 per vial without insurance), even within the same pharmacy. Walmart essentially acted the same way an insurance company would, negotiating the price down by offering Novo Nordisk access to their lucrative market.
The Birth of Analogues
An analogue is a drug that is similar in structure to the original, but has been slightly modified to alter its absorption, elimination, or effect on the body.
As diabetes patients began to live beyond childhood for the first time in history, we soon saw a rise in chronic complications of diabetes that occur later in life. In 1993, a foundational clinical trial concretely demonstrated that blood glucose control was directly correlated with diabetic complications. The goal became to discover an injectable insulin that would more closely mimic the effect of the endogenous insulin that is released directly into the bloodstream from the pancreas after meals.
Researchers discovered that by genetically modifying the code of the insulin gene in bacteria to add certain amino acids, they could prevent the insulin from spontaneously aggregating into hexamers. All the insulin molecules would stay as individual monomers, allowing for very rapid entry into the bloodstream. In 1996, the first rapid-acting insulin analogue was created by Eli Lilly and Company by adding the amino acids Lysine (Lys) and Proline (Pro). It would be called insulin lispro, sold under the brand name Humalog.
In 2000, Novo Nordisk would capitalize on the same phenomenon. By adding the amino acid aspartic acid (Asp) to the insulin chain, they could achieve the exact same effect. They would call it insulin aspart, sold under the brand name Novolog. It is now also sold under the ReliOn brand by Walmart using the name ReliOn Novolog since 2021.
In 2004, Sanofi would introduce their own version. They added a Glu (glutamic acid) and a Lys (lysine), creating insulin glulisine, sold under the brand name Apidra.
An image demonstrating the modifications for each of the rapid-acting insulins can be found here.
While rapid-acting insulin analogues allowed for swift reductions in blood glucose following meals, they also have a very short duration in the body. This leaves the patient prone to high blood sugars in between doses of their rapid-acting insulin. Even though NPH has done a great job providing basal glucose control since the 1930s, it also has a peak-onset of 4-6 hours after administration. This peak makes it harder to keep blood glucose under tight control since patients must compensate by perfectly timing and portioning their meals. As a result, they are theoretically more prone to both highs and lows because of inadequate or over-compensation. See this image showing duration of insulins for a better understanding.
Patients desired an insulin that would last sufficiently long enough to cover them throughout the entire day - but without any peak; allowing for a smooth effect that mimicked the baseline release of insulin by a functioning pancreas. Researchers soon discovered that by adding a glycine (Gly) and two arginines (Arg), they could decrease the solubility of insulin injected subcutaneously. This would promote aggregation into hexamers and create a smooth, delayed release of insulin over a 24-hour period without any peaks. In 2000, the first long-acting (basal) analogue named insulin glargine was introduced by Sanofi, and sold under the brand name Lantus.
In 2015, the 15-year patent for Lantus ran out, and Eli Lilly decided to seize the opportunity. They created the first biosimilar approved by the FDA. A biosimilar is essentially a generic form of a medication that it is a biologic (e.g. protein) rather than a chemical. Biosimilars are more difficult than generic drugs to create and receive FDA approval, since it is harder to prove that your bacterial factories are producing a bioidentical protein than it is to show that you are combining chemicals in the appropriate order and fashion. This is one of the factors that makes it difficult for “generic insulin“ to reach the market.
Eli Lilly dubbed their biosimilar version as Basaglar, which is the exact same as insulin glargine but available in an easily injectable pen. Sanofi would soon follow suit by creating their own pen-version called Toujeo, increasing the concentration of glargine to allow for a smaller dose, from 100 units/mL in Lantus to 300 units/mL in Toujeo. More importantly it allowed them to give glargine a fancy new name complete with a shiny new patent. You may be aware of a term that describes the practice of making slight modifications to a drug or the method of delivery to create a secondary patent, it is called evergreening.
Creating pen-like delivery devices, altering insulin mix ratios, and modifying the concentrations of insulin are all common methods that are used used to create secondary patents, despite making no “improvements” to the underlying drug itself. Sanofi holds over 74 secondary patents on Lantus. These secondary patents make it more difficult for competitors to enter the market with a biosimilar, as they will need to avoid infringing on them, or fight them in a court of law to have them overturned. A pharmaceutical company named Mylan recently won a court case invalidating several of Sanofi's secondary patents on Lantus in regards to its more concentrated version, Toujeo.
Other long-acting insulin analogues exist as well. In 2006, Novo Nordisk introduced insulin detemir, sold under the brand name Levemir. It was created by the addition of a Lysine residue and a fatty acid to the insulin chain to promote aggregation and slow absorption - and sadly this is where the fun naming conventions come to an end. In 2016, Novo Nordisk introduced ultra-long acting insulin degludec, sold under the brand name Tresiba. They added a molecule (hexadechanoic acid) to a Lysine residue that promoted also promoted aggregation, allowing for very delayed release up to 42 hours.
Finally, I arrive at my favorite one. In 2006, Pfizer marketed an inhalable human insulin called Exubera that could be used by those wanting to avoid needles. It involved patients taking hits from a device that looked strangely similar to a bong. For some inexplicable reason, Exubera would fail.
Sanofi would soon pick up the reins with the launch of Afrezza in 2015, an inhalable human insulin inhaler that shared less resemblance with a bong. It is still available on the market.
And there you have it, a (nearly) exhaustive list of all available insulins in the United States and their origins. It is important to note that with each new modification (no matter how simple), the pharmaceutical companies were required to perform expensive rigorous clinical trials to bring the product to market. It is also a very difficult process to standardize and upscale these bacterial factories to allow for a high-quality product. It is not as simple as the recombinant DNA experiments you may have performed in an undergraduate biology laboratory.
In my humble opinion, the groundbreaking discoveries were the introductions of animal-derived insulin, NPH, recombinant human insulin, lispro, and lantus. Most of the improvements since then have been rather minor. In terms of devices, there have been incredible advancements in blood glucose monitoring and insulin pumps. But these would presumably generate profit on their own, and would not need to be subsidized by insulin medications. Blood glucose monitoring devices and pumps require refills of test-strips, batteries, sensors, etc. similar to a subscription model, generating large amounts of revenue.
While I think it is unnecessary to even clarify this, I am in no way saying that insulin analogues should be sold at cost of production. Obviously there are other costs which must be factored in when calculating the market price. But I don't believe that the excessive costs of insulin can be explained by R&D alone. When lispro was released in 1996, it was priced at $21 per vial. It is now $275 per vial, which is 8 times the 1996 price when adjusted for inflation. I cannot find a way to justify that increase for lispro in particular other than to attribute it to pharma companies capitalizing on a oligopoly.
When outright asked about increasing insulin prices, pharmaceutical companies will often claim that the prices are so high because they give away the drug for free or reduced cost through their compassionate access programs. Perhaps if the price wasn't so exorbitantly high, not as many individuals would need to use the access programs. But hey, I'm not an economist.
Analogues over Regular?
Before we begin looking at the data, it is important to know what A1c is. It is a measure of how many red blood cells are glycosylated (connected to sugar). High blood sugars cause more red blood cells to become glycosylated. Since red blood cells last ~120 days, A1c is a measure of long-term blood glucose control.
You will often see people online talking shit about Walmart insulin, stating that the insulin analogues are massive upgrades compared to regular human insulin. Insulin analogues often do provide greater satisfaction due to the convenience that is afforded by using them. Timing and portioning of meals becomes much easier and requires less foresight. No longer does a patient need to know the exact amount of carbohydrate they will eat 30 minutes prior to their meals as they might with regular insulin. No longer will they need to stop eating if they are still hungry after they finish the portion they expected would fill them - they can simply inject more rapid-acting insulin. But the question is, do analogues actually improve clinical outcomes? The answer seems to be a surprising no.
In 2005, Schoof and Ehlers published an article in a journal by the American Academy for Family Physicians aiming to answer the following question:

“Are short-acting insulin analogues (lispro, aspart) better than regular insulin for controlling blood sugar levels, reducing A1C levels, and preventing long-term complications of diabetes?"

They found:

For patients with type 2 diabetes, regular insulin and short-acting insulin analogues are equally effective in the treatment of diabetes and in lowering A1C levels. For patients with type 1 diabetes, short-acting analogues produce a slightly greater reduction of A1C levels than regular insulin. Regular insulin and short-acting insulin cause hypoglycemia at similar rates. No studies have compared the effects of regular insulin and insulin analogues on the long-term complications of diabetes.
Patients can achieve effective long-term control of blood sugar with regular insulin or a short-acting analogue. Regular and short-acting analogues are similar in achieving glycemic control in studies performed to date. Short-acting analogues may be advantageous in allowing for greater flexibility and convenience. For patients with type 1 diabetes, insulin analogues are slightly more effective than regular insulin, especially if the patient uses an insulin pump.

They based this on a 2004 Cochrane Review (often seen as the gold-standard of systematic reviews in medicine) by Siebenhofer et al., which found:

Altogether 7,933 participants took part in 42 randomized controlled studies. Most studies were of poor methodological quality. In patients with type 1 diabetes, the weighted mean difference (WMD) of A1C was −0.1 percent (95% confidence interval [CI], −0.2 to −0.1) in favor of insulin analogue, whereas in patients with type 2 diabetes the WMD was estimated to be 0.0 percent (95% CI, −0.1 to 0.1).
The WMD of the overall mean hypoglycemic episodes per patient per month was −0.2 percent (95% CI, −1.2 to 0.9) and −0.2 (95% CI, −0.5 to 0.1) for analogues in comparison with regular insulin in patients with type 1 and type 2 diabetes, respectively. For studies in patients with type 1 diabetes, the incidence of severe hypoglycemia ranged from zero to 247.3 (median 20.3) episodes per 100 person-years for insulin analogues and from zero to 544 (median 37.2) for regular insulin. In patients with type 2 diabetes, the incidence ranged from zero to 30.3 (median 0.6) episodes per 100 person-years for insulin analogues and from zero to 50.4 (median 2.8) for regular insulin.
The authors conclude that their analysis suggests only a minor benefit of short-acting insulin analogues in the majority of patients with diabetes who are treated with insulin. Until long-term efficacy and safety data are available, the authors suggest a cautious response to the vigorous promotion of insulin analogues.

ELI5: Analogues were only associated with a 0.1% reduction in A1c, and a 0.2% reduction in hypoglycemic episodes per month.
A later systematic review by Singh et al. published in the Canadian Medical Association Journal (CMAJ) found:

We included 68 randomized controlled trials in the analysis of rapid-acting insulin analogues and 49 in the analysis of long-acting insulin analogues. Most of the studies were of short to medium duration and of low quality. In terms of hemoglobin A1c, we found minimal differences between rapid-acting insulin analogues and regular human insulin in adults with type 1 diabetes (weighted mean difference for insulin lispro: –0.09%, 95% confidence interval [CI] –0.16% to –0.02%; for insulin aspart: –0.13%, 95% CI –0.20% to –0.07%). We observed similar outcomes among patients with type 2 diabetes (weighted mean difference for insulin lispro: –0.03%, 95% CI –0.12% to –0.06%; for insulin aspart: –0.09%, 95% CI –0.21% to 0.04%). Differences between long-acting insulin analogues and neutral protamine Hagedorn insulin in terms of hemoglobin A1c were marginal among adults with type 1 diabetes (weighted mean difference for insulin glargine: –0.11%, 95% CI –0.21% to –0.02%; for insulin detemir: –0.06%, 95% CI –0.13% to 0.02%) and among adults with type 2 diabetes (weighted mean difference for insulin glargine: –0.05%, 95% CI –0.13% to 0.04%; for insulin detemir: 0.13%, 95% CI 0.03% to 0.22%). Benefits in terms of reduced hypoglycemia were inconsistent. There were insufficient data to determine whether insulin analogues are better than conventional insulins in reducing long-term diabetes-related complications or death.

ELI5: Both rapid and long-acting insulin analogues were only associated with a very modest reduction in A1c of about 0.1%. Results on hypoglycemia were inconsistent.
The only conflicting review I have found in the literature was published by Melo et al. in Diabetology and Metabolic Syndrome in 2019, which found:

Results: Of the 2897 articles retrieved, 22 (6235 patients) were included. Short-acting insulin analogues were associated with a decrease in total hypoglycemic episodes (risk rate 0.93, 95% CI 0.87-0.99; 6235 patients; I2 = 81%), nocturnal hypoglycemia (risk rate 0.55, 95% CI 0.40-0.76, 1995 patients, I2 = 84%), and severe hypoglycemia (risk rate 0.68, 95% CI 0.60-0.77; 5945 patients, I2 = 0%); and with lower postprandial glucose levels (mean difference/MD - 19.44 mg/dL; 95% CI - 21.49 to - 17.39; 5031 patients, I2 = 69%) and lower HbA1c (MD - 0,13%; IC 95% - 0.16 to - 0.10; 5204 patients; I2 = 73%) levels.

ELI5: This study found quite significant reductions in nocturnal (45%) and severe hypoglycemia (32%) associated with analogue-usage. Average reduction in A1c 0.13%.
An updated 2016 Cochrane Review by Siebenhofer et al. found results consistent with their earlier 2005 review:

The mean difference (MD) in glycosylated haemoglobin A1c (HbA1c) was ‐0.15% (95% CI ‐0.2% to ‐0.1%; P value < 0.00001; 2608 participants; 9 trials; low quality evidence) in favour of insulin analogues. The comparison of the risk of severe hypoglycaemia between the two treatment groups showed an OR of 0.89 (95% CI 0.71 to 1.12; P value = 0.31; 2459 participants; 7 trials; very low quality evidence). For overall hypoglycaemia, also taking into account mild forms of hypoglycaemia, the data were generally of low quality, but also did not indicate substantial group differences. Regarding nocturnal severe hypoglycaemic episodes, two trials reported statistically significant effects in favour of the insulin analogue, insulin aspart. However, due to inconsistent reporting in publications and trial reports, the validity of the result remains questionable. Our analysis suggests only a minor benefit of short‐acting insulin analogues on blood glucose control in people with type 1 diabetes. To make conclusions about the effect of short acting insulin analogues on long‐term patient‐relevant outcomes, long‐term efficacy and safety data are needed.

In 2008, Siebenhofer, Horvath, and Plank would release an article in CMAJ titled Insulin analogues: too much noise about small benefits

Despite the evidence, myths abound regarding the benefits of insulin analogues and require correction. First, compared with regular insulin, insulin analogues produce only minor additional reductions in hemoglobin A1c.
Second, severe episodes of hypoglycemia are rare. Even if nocturnal hypoglycemia occurs slightly less frequently with insulin analogues than with conventional insulins, the overall difference in hypoglycemia is small. A cross-sectional study in Germany involving 35 723 patients (5891 with type 1 diabetes and 29 693 with type 2 diabetes), 59% of whom used insulin analogues, showed that treatment with insulin analogues was not associated with a decreased rate of severe hypoglycemia.
Third, advantages in terms of quality of life reported with rapid-acting insulin analogues were driven mostly by changes in convenience, flexibility and adherence to treatment. (...) In addition, a double-blind trial comparing rapid-acting insulin analogues with regular insulin did not show an improvement in any quality-of-life measures with insulin analogues.

The meta-analyses have consistently found a very modest reduction in A1c of 0.1% associated with rapid-acting and long-acting analogues. To put this in perspective, an A1c over 6.5% is considered diabetic. Below 5.7% is considered non-diabetic. Most diabetes medications are expected to reduce A1c by 0.5-1.5%. Introduction of insulin to an insulin-naïve patient generally causes a reduction >2.5%.
While it seems there was a modest reduction in hypoglycemic episodes with rapid-analogues, the evidence seems to be of low-quality. With the extensive promotion of analogues that I often see online and even among some healthcare providers (see this post in this subreddit), I would like to see some more high-quality evidence supporting this finding given the elevated cost.
The Based Take
Walmart’s ReliOn insulin (which is the exact same as Novo Nordisk’s brand name insulin) is legitimate and can be used as an alternative to insulin analogues. This is especially true now that Walmart has its own rapid-insulin analogue. It can less convenient, but it is a fully suitable alternative for diabetic patients that are on a budget. Some people with diabetes (small minority) even prefer using regular insulin versus analogues. They are not inferior, they are not lower-quality, they are just different. NPH is still frequently used in hospitals for in-patient management, while regular insulin less so.
If you do not believe me, here is a video by a young “patient-expert” on managing T1DM with Walmart regular and NPH insulin which echoes my sentiments.
Here is a video by a patient advocate with Type 1 diabetes who challenged himself to give up his insulin pump in favor of Walmart insulin for 30 days in order to see if it is a reliable option for people in dire circumstances.
He says it was difficult (expectable when moving from a pump that perfectly mimics a functioning pancreas versus having to inject multiple times per day and count carbohydrates), but it was a doable and legitimate option. He suffered from swings due to the peaking effects of human insulin throughout the month, which to be fair he said was rather exhausting. Here is an hour long podcast where he describes his experience more in-depth.
Despite the massive increases in prices observed with the introduction of analogues, the improvement in clinical outcomes seems to be modest at best based on existing evidence. Access to insulin analogues seems to be more of a matter of convenience than efficacy.
While convenience is obviously an important aspect of patient satisfaction, the hard question that remains is whether patients are entitled to more expensive medications based on convenience alone? Obviously to some degree - we will pay for a prosthetic leg instead of forcing someone to use crutches, but where do we draw the line?
As an example, prescription medications are not covered by the provincial healthcare plan in most provinces of Canada, and require private insurance. If you develop a blood clot (which then requires long-term prophylactic anticoagulation) and cannot afford your prescription medications, the provincial access plan will pay for you to take Warfarin. This drug is more colloquially known as rat poison, although physicians try to avoid using such a term. It is a very effective medication, but it is hard to find the proper dose for each unique patient. Those taking the drug must have their blood drawn several times per week for the first month in order to accurately titrate the dose. After that, they require bloodwork every 2-4 weeks. This is incredibly cumbersome for patients, and we already have an alternative. Direct oral anticoagulants are approved in Canada. They are functionally equivalent to Warfarin (in fact they are superior), and they are pills/injections without the need for any frequent monitoring.
The difference is that Warfarin costs about $7 per month, and DOACs cost about $100+ per month. The provincial plan has determined that neither the added convenience nor the small additional efficacy are worth the allocation of limited funds. So poor people are put on Warfarin, and rich/employed people are put on DOACs. For the case of diabetes, insulin analogues are covered by the provincial access plans since they have been able to bargain the price down to a reasonable level.
TL;DR: I have essentially written a 4,500 word essay on why I should be banned from this subreddit (just kidding... hopefully).

Hello everyone!
I'm so happy I found this sub. I was hoping to get some support from people who (unfortunately) may have been in my shoes before. Much thanks in advance.
I was first diagnosed with a pulmonary embolism when I was 19 (I'm 37 now), thanks to taking birth control pills. My chest pain and inability to breathe was misdiagnosed twice, before finally a doctor heard me say I was on the Pill and sent me to the ER right away. Xray showed nothing, CT scan showed multiple and massive clots in both my lungs. The doctor said if we hadn't caught it then, I most likely would have had a heart attack or stroke within 2 weeks. I stopped the birth control, was on Warfarin for a year and it was smooth sailing since.
I got pregnant in November and went on blood thinner injections since I'm high risk for more clots. I unfortunately had a miscarriage in January, stopped the blood thinners so I wouldn't bleed out at home when I passed everything. I passed everything the first day but then suddenly the cramping started getting worse the next day. I wound up having to go to the ER the pain was so bad, and what do you know, I had clots blocking everything.
Now we come to these past couple weeks. I got Covid and was off work for a week and a half, not moving much thanks to it knocking me on my butt. I went back to work for 3 days (I work in long term care), enjoyed my days off, and then I woke up with pain in my calf. I thought it was sudden and strange but still went to work. It slowly started feeling more painful through my shift and the next day I was really struggling to walk. Stupid stubborn me, thought it might be my Achilles tendon.
Eventually I finally realized it really wasn't improving no matter how much I iced or rested it, I went to the hospital. They did a D-dimer test thanks to my prior PE and it was positive so they gave me an injection and booked me an ultrasound for today. Sure enough, a DVT. I've now started on Xarelto and the doctor just told me to keep resting it and using a warm compress. I'm due to return to work on Friday depending how my leg feels and if I can handle my job.
I apologize for the novel, but my questions are...
-When it comes to exercise, is there anything that's safe for me to do right now or over the next couple weeks? I'm still in constant pain and it hurts to put weight down, I'm limping something awful. I've heard both that exercise is good and bad for clots so was just curious what other's experiences may be. If you did do some exercises afterwards, what exercises did you do?
-For those who have been taking Xarelto, what was your experience like? I'm curious how quick this pain will start to improve. Are there any diet restrictions I should watch out for? I know with Warfarin back in the day, there were things I needed to not overdo it on (Vitamin K). I know I can't do ibuprofen or drink alcohol.
-Did anyone have any anxiety/PTSD type symptoms when diagnosed? I've always been an anxious person, but I really realized yesterday when the possibility of another clot came into play that I may have been more subconsciously still affected by the PE than I realized. I couldn't stop crying every so often for a couple hours and had to try and explain to my fiance why I was so upset when it wasn't even certain yet. He's been very loving and supportive through all of this and with me at the hospital and helping me at home, but sometimes things he says come out sounding a bit harsh so that definitely didn't help the situation. He apologized for insinuating the situation wasn't serious once I explained that DVTs can lead to what I experienced before. If you did/do have anxiety over your clot experiences, how do you handle it? How do you explain it all to family or loved ones?
If anyone made it through this gigantic post, I appreciate you immensely!
Take care everyone. :)