I'm only a 4.3k EUW player, so please stop reading if you don't care about the game at my humble MMR, especially given turbo
https://stratz.com/players/83907961?duration=MONTH&durationAmount=1&gameModeIds=23&heroIds=93
Feels good, as someone who had like 300 ranked games of Slark but could not enjoy him after the map was enlarged this felt good again.
The winrate is not anything to brag about, if I played one more game it could easily drop to 50% but it felt very impactful, even on the games I lost I felt like I contributed a lot. and ofc I did end up going offlane a couple times which matters a little, although much less in turbo.
I hadn't played Slark more than one or twice in months leading up to this so I was mechanically rusty for a few games. I also played more turbo shown here than all other turbo I've played since the mode was released combined, so I was also rusty on how to play turbo. And experimenting with the build. I learnt a few things. Shroud doesn't feel good except very situationally. If I was against enough mana burn, or a 90% magic damage line up that I cannot avoid through ulti I'd consider it, but otherwise I found it was not as good as Octarine, aghs, or s&y.
After some refinement I have basically settled on the build:
4111 by level 7 as normal.
Bracer situationally (remember to hide and backpack bracer for faster regen ironically)
Usually like to rush boots and windlace to weave in and out of vision to maximise regen before 6 and get more hits off. Especially vs ranged heroes and their harass the gloves of haste matter less.
Always finish lane with at least treads + null talisman + wand + windlace. then "rush" radiance.
Then after that you have lots of options. If the game is slow or you are ahead then Octarine is easily the best farm accelerator. Some games you just want an early shard (counter duel, chrono, dismember, etc). S&Y if you want more immediate survivability against blinkers and/or ground target stuns like axe, tiny, pudge, SS, lion, LC, etc.
Then you usually want aghs, your essence shift is maxing out at this point and/or getting your 15/20 talents and you want to capitalise on that.
You can go back for Octarine after aghs if you didn't get it in the above step.
Likewise very few games do you not want S&Y eventually, the entire item synergies with Slark quite well. problem is slots, e.g. if you need abyssal badly then you may have to give up the slot.
With radiance, octarine, aghs, s&y, treads you can consider disassembling radiance into blfy and nullifer, or you can get blink first, depends on the game.
very few games do you want BKB with this build imo, you don't burst people in a 6 second window, you just spam 9s cd pounces, swinging 32 stats EVERY TIME, hitting them, and wearing them down, and getting absurdly high armour. but sometimes BKB is too important. you are very hard to kill without bkb because every item you build increases your survivability, as opposed to orchid/diffusal which doesn't.
ofc some games you need linkens but it is rarer with this build.
silver edge has 100% uptime with octarine so that can be fun.
you rarely initiate but you want to be deep in the backline but close to the whole enemy team to attract as much focus as you can, with a 22.5s cd ulti you can usually ulti twice per fight, but only if you use the first one earlyish which may not be a good idea every game. shroud is still too long cd to use twice so account for that, pounce early and often, even if the enemy isn't moving you want the stats steal and if you're sitting on 2 charges then you're "wasting" casts.
with octarine I don't think about dark pact much and just spam the button almost constantly, still tread switching, you're not made of mana even with this.
You basically play like a lifestealer, you take kills if you can but farm up dangerous areas and apply pressure that way instead of being fixated on kills like a riki.
some tips, none really specific to this build but whatever:

1. set cl_dota_alt_unit_movetodirection "1" in your autoexec.cfg, this allows you to directional move (no path finding just face+walk the direction you click directly) with just alt+right click. for pounces
   
2. when you get low hp and hide to regen backpack your aghs octarine for a moment to basically double your regen or more, don't backpack s&y though
   
3. run mid ASAP at the very start with a sentry, 80% of games you can find an observer ward and help your midlaner so much
   
4. really try to avoid missing pounces, as I said, 32 stat swing each time you land one, that's like 2k gold value minimum, hard to quantify ofc because branches are 50g but it's also more than an eaglesong, so at bare minimum it's 600g, but branches are really unfair to use because they're slot inefficient. anyway, the point is it's a massive deal, it's like fighting with a eaglesong in your backpack instead of your inventory and feeling like an idiot after the fight ends and you realise. hence why blink is usually in the lategame items. try to not use pounce to escape, with these items you should be tanky enough to just run away without pounce, better to use some of your ulti than a pounce to escape if possible.
   
5. you can effectively farm triangle after you finish radi, normally slark SUCKs at farming ancients. you take too much damage and deal too little damage. this doubles your dps if not more and stops ancient camps killing you so quickly.
   
6. people will cry, even in turbo, even if you're doing well, just mute and play
   

oh and it goes without saying, always take the pounce facet, this hero doesn't exist without it.
this is not an amazing build by any means, but I think it's more viable than diffusal, and often better than orchid. those two being by far the most commonly built on d2pt. and I think there are several better carry heroes this patch (although it is better vs TA and CK than normal Slark). But if you like Slark but stopped playing him due to his weakness then consider trying it, even in just turbo, to enjoy it again. In none of these games did I feel "helpless", which was a VERY common feeling the last several losses I had on slark in ranked.
next up is ranked, going to stick to playing it with my five stack at first though, don't want to grief strangers nor get mass reported when it turns out it falls apart outside turbo.
There's still more room for optimisation, I wasn't using pounce much for moving from camp to camp because I have muscle memory of running out mana doing that with diffusal builds. But I should have been.

Wanted to post this tip in case anyone needed it. I can’t help but to pick at my skin 😞 but have found that dotting Avene’s Cicalfate then placing a weak pimple patch like starface overnight has greatly reduced scarring. It’s worked incredibly well to the point a scar doesn’t even develop at all on some picks. I would encourage trying this for anyone who struggles with this.

Apologies for any spelling mistakes, I am dyslexic and sometimes my phone doesn't even know what I'm trying to say. TW this post will also include a lot of mentions of harm and sharp objects and some SA and abuse at the end. I have had on and off bad, realistic, sensory nightmares but tonight was the worst I habe ever experienced. I'm not sure why this is happening or what I should do so if anyone has any tips or helpful insight please I'm all ears. It started off with me playing dnd. It was outside in a huge board and I was one of the smaller characters. Lots of things happen and I end up matched with there 2 other girls. Somehow it transitioned to me in a hospital being forced to take all my clothes off to be washed in front of a lot of other people all just staring. I didn't want to and the 2 people I had been with start threatening me. Slicing at me with knives and scissors cutting tiny bits off me. I can feel literally everything they are doing. It goes on to be needles being shoved in me all over. I somehow pass out in my nightmare and wake back up to literally little blades pushed under, through and back out of my skin. But I hadn't noticed that atm, what i had noticed were all the tiny scalpels woven into my shirt and pants along eith needles and pins placed every few millimetres from one another. Every breath, every movement or even the gurls forcefully pushing me ended in thousands of tiny cuts and piercers orblades and needles sinking deep into my skin. I was still feeling all of this. I had to get this shirt off and for some reason they wanted me to too. However the fear of the sharp objects touching my face was terrifying and so I started pulling each piece out of the shirt so I could get it off without tearing up my face. It was slicing up my fingers as I went. The more I pulled out the more j saw whT was burried in my skin. Same as the shirt every few mm my skin was shoved full of objects. I started removing those too. However, the more I removed from my body and my shirt the worse it got. They'd made this sheet of nedes that they called the walking something. They sewing needles had been placed together in a big flexible sheet that crawled its way down by back and front shoving deep into my skin as it went. The removing of the blades and needles took hours. From my toes to my neck I was covered and every now and then the people would either unleash another trap on me or push on existing ones still left in me. Somehow my sister turned up. I was forced to put on long sleeves and pants and greet her like nothing was wrong. Nothing was said bit it seemed to be an understanding that I was to say nothing about any of this to her as they kept a super close eye on me amd didnt allow me to be alone with her for a second. I could tell my sister knew something was up but didn't know what and was on her way out the door when I got the final searing pain. A huge maybe cm wide nail was hammered one hit right into just above my wrist, inbetween my bones. My sister took one look at me and I knew i had to leave all my possessions and run. We sprinted for a Ute she had driven for some reason which had impossible door handles to open, tricky locks and were heavy. However we made it. I was being chased by the main lady with scissors down the driveway and as I felt a tiny sense of relief about being free.... I woke up. I proceeded to wail cry and sob harder than I have in years and years and kept going for about half an hour. I can still rememwber the pain Nd tbe fear. I then came here to figure out what just happened
As some background i habe been a victim of SA many times, abused by exs and dealt with a lot of manipulation and abuse especially in one past relationship. I habe also been clinically diagnosed with severe anxiety, severe depression, manic bipolar, borderline personality disorder, adhd and autism. My psychologist and psychiatrist have both mentioned that I probably also have minor DID as in stressful situations I basically black out but still stay awake amd apparently moving while holding very mini.al conversation usually with just "Yes" "no" and "im fine" being all i say. I ha e no memory of anything that happened while I was out. No full diagnosis has been made tho. Any thought would help. I'm terrified to go back to sleep

I desperately want to try out azelaic acid correctly this time. I've been on metronidazole cream for a month and it has helped a lot with my pimples and bumps that appeared on my rosacea. Although now, I am left with acne scars and my redness has not improved at all. I want to now focus on healing up my scars and getting rid of this redness! My skin is very sensitive.
Do you guys recommend it? Does it work well? Or is there another brand I should check out? I did want Paula's choice but it's too pricey. :(

Age:59 Race:white Ht.5'6 Wt.130 Smoker No medical issues No medication
Greenish worm-like things in scalp,sinus and under skin near face.HELP!
59 year old female ht. 5'7, wht. 130 . Medical conditions- history of deep vein thrombosis, carbuncle ,asthma, smoker 1/2pack a day. I have suffered for a year now with having sensations of crawling on my scalp and in my sinuses. In the beginning it was tolerable.NOW , I have patches of baldness, and can physically see these greenish "worm-like" things coming out of my hair follicles,and in my ears. (I have a ton of videos of these) .I went to ER one time and the triage nurse asked me if I was on methamphetamine WHAT! I LEFT.my daughter has seen these too because she is my hair dresser and is trying to help stop my hair loss. I had COVID two years ago "a pretty bad case of it" , and thru all my research, I'm finding out that there is an underlining condition that usually causes these things. I have had Carbuncle on my scalp before.AND I AM NOT CRAZY,have no mental health issues.but this is driving me insane.i can't go out without a hat on, and heat seems to intensify it. By the end of the day you can physically see these worm like things on my hair. I know it's either some type of infection or parasite PLEASE HELP

Don't know if this is the right tag. My tragus has been pierced for a month and there feels like there is a line coming from the piercing under the skin and i feel a bump next to the piercing. Is my tragus cartilage split. If so do I remove the piercing or what do I do. Any advice helps. Thanks

Got my nose pierced a little over 8 months ago and it seemed to have healed just fine, so I switched it out for a seamless titanium ring about 2 weeks ago. I couldn’t get that tiny gap closed no matter what I did and later noticed that it would keep getting stuck inside the pierced hole and I’d have to push it out to prevent the skin from growing over it. I’m guessing this caused irritation bumps on both sides of my nostril which I’ve been keeping clean with saline, but they’ve grown pretty sizable in a short period of time. I couldn’t put my original labret back in because it’s too short and the bump inside is in the way, so I replaced it with an L-shape in the meantime hoping that’ll get the bumps to go away. Again, the bumps are pretty angry so the jewelry’s sticking out a bit. I put a bandaid very loosely over the top just to prevent it from falling out. Is this okay? It’s still breathable, I’m just afraid that it’ll somehow fall out without me noticing and close. I live in a small town so I unfortunately don’t have a piercer nearby that I can check in with, so if anyone has any advice or can let me know if I’ve done anything wrong please let me know! These bumps are causing me so much grief.

My daughter is 12 weeks old and has now had specks of blood in her stool for over 4 weeks now. I’m sorry the post is a bit long, I really just need some reassurance 😭
Mid march - LO was born via (sort of) failed induction which led to over 30 hours of labor and ended in me requiring a forceps delivery in theatre. Both LO and I were put on antibiotics due to a small temp I had during labour.
I noticed very early on that her poos were mucusy but when I showed photos to multiple medical professionals (GP, lactation consultant, health visitor, peads doctor) they all said they were normal so I tried not to worry. LO had mild colic as well (I say mild as it was not every day but could be quite bad on some days). She also had reflux and still does but we have managed this without medication (just by keeping her upright after feeds and in her cot at night as recommended by the GP)
I believe that I had an oversupply (milk would spray out regularly and I was engorged even after 6weeks) and LOs latch was not great (I was having nipple pain) but no one really cared as LO was gaining like 70g a day (she is now 7.2kg at 12 weeks). I decided to go to a private tongue tie practitioner who said that LO had a mild tie and we divided to have it revised. The afternoon after the revision I first noticed red specks of blood in LOs stool, I originally thought this was due to the procedure but it then carried on and has not stopped.
I have cut dairy (4+ weeks), soy (4+ weeks), oats (2+ weeks), wheat (1+ weeks) and egg (4+weeks) which I have introduced back this week because I was literally starving myself and I really worried for my supply (as well as my mental state!)
On the days where I was literally hardly eating anything the blood seemed to be better but now I have had to add things back in (to stop myself from starving!) the blood is worse than ever. It’s still specks of red blood but there is much more of them and her stools are greenish/yellow/brown with lots of mucus. She doesn’t have any skin issues, has tiny amounts of spit up but nothing crazy.
I feel beside myself with worry. My husband just says oh she’s just getting used to food but I can’t just see blood and mucus as normal. I feel like I am being robbed of the joy of having my baby right now when I just want to relax and enjoy it all. We are talking her abroad next week to meet her grandparents for the first time and I feel like I don’t even want to go. I am questioning everything I am eating and cutting foods out constantly thinking that they are hurting her. Crazily enough, although the blood/mucus seems to have got worse this week her temperament is not bad at all, she’s generally been a happy baby with a normal amount of fussiness.
The only thing I can think of is that she’s reacting to eggs that I have added in again this week and I need to cut them out again but without oats/eggs/dairy I am short on things for breakfast and worried I am going to hurt my supply by doing this.
We have seen a doctor but she just said keep cutting out the dairy/soy and she’ll see us again in 6-8weeks. But I’m worried, am I damaging her by allowing blood to remain? I’m not prepared to stop breastfeeding as there is no guarantee that things will get better on formula and I would be devastated to lose my supply and her still have these issues.
I would love if anyone has had a similar journey and could offer any advice or their own experience. Or if anyone has had symptoms get worse around 4 weeks before getting better? I’m just feeling really fed up and overwhelmed at the moment. Thanks 🙏🏻

Many different types of stone flooring can bring natural beauty to the inside and outside of your home.
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Marble flooring is known for its luxurious aesthetic, dramatic veining, smooth texture, and high-gloss sheen. It is available in various colors, with white Marble being the most common.
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Given the variety of floor tile options, Marble is an excellent choice for flooring and countertops in many homes. However, it would be best to think twice about using Marble in your kitchen.
Advantages of Marble flooring;

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• Durability: It can withstand a lot of foot traffic.
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Disadvantages;

• To avoid damage during the monsoon season, several types of stone must be regularly in seal.
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It can resemble Marble in appearance yet has the durability, performance, and low-maintenance characteristics of Granite.
Quartzite is used by people who find the busy patterns of Granite and the upkeep of Marble a little too much.
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The appearance will alter slightly when put outdoors due to weather.

Good marrow, bonelickers!
Early last month I announced the 19th Speedlang Challenge. I broke the mould with it a little bit by confining how the ambitious among you would actually put together your speedlangs rather than defining a number of requisite features. The bulk of this process had speedlangers root all their creative linguistic decisions in a small set of natlangs, and these natlangs specifically had to be native to areas representative of a chosen clade of organisms. To ensure the clade of organisms was well represented, I also asked for a number of lexical items and conceptual metaphors that had to be specifically inspired by the clade in some way, as well as some aspect of the phonology.
Like last time, I'll provide my thoughts about what I think makes each submission special and the features I particularly like. Afterwards, I'll quickly review what was inspired by the chosen clade, in case that has any bearing on what you kind readers might like to check out, and give out brownie points for any easter eggs I spot, whether intended or not.
Overall this has been a deeply creative round of submissions and I learned a lot, both things I set out to achieve when I thought up this particular challenge. I hope it was just as rewarding a challenge for everyone who submitted as it was for me getting to read up on each entry, and I hope it will be the same for anyone who reads up on them, too.
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Seba Bàsa by Miacomet

Gyps (griffon vultures); Chamic, Bengali, Santali & Mundari
With a name including the element Bàsa, I knew this had to have Indic flavours of one sort of another, and indeed it does! This conlang is largely Austronesian in origin with sound changes from Old Cham, but it has a lot of Bengali influence and is well situated in the Indian subcontinent, and I greatly appreciate the nod to Parsi funerary traditions as an inspiring reason for choosing Gyps. Amusingly, this conlang has many features that fit right into the inspiration for the last speedlang challenge, which I find just delightful, with some split-S marking, dative enclitics, and grammaticalised constructions for simultaneous and sequential events, and light pronouns. Therebeside, the historical clipping, CVK syllable structure, postpositional pronouns, and aspectual auxiliaries speak to sensibilities in my own conlanging, and the dissimilation processes in some of the affixes are a nice touch, too. I'm also a big of fan just how the split-S system is implicated in some verbal polysemy, and I really like how the few voices seem kinda muddy but have clear use cases. What really sets this conlang apart, though, is the consideration paid to the effect of prestige languages. Some phonemes are restricted to loanwords from the local prestige language, and one is even only confined to prestige language-educated speakers, which causes some allophony other speakers don't have. Loaning processes are detailed, too, and the number and classifier system also draws nice lines along the prestige axis with a total of 3 parallel number systems, spread out across both divisions of native vs. loaned classifiers, which themselves have specific semantic domains they each classify, and across divisions of prestige language education. The story at the end, too, is a real treat: it's a translation of Hindu vulture myth, perfect for this project.
Seba Bàsa's Gyps-inspired phonology includes the development of creaky voice from the loss of glottals, glottalised consonants, and final /s/ in Old Cham to recall vulture cries. It's inspired lexicon includes some fun polysemy of vulture behaviours like circling = waiting or sheepling = looking for something desirable. I'm also a big fan of kite (the bird) = messy eater. It's inspired conceptual metaphors include dividing the beginning, middle, and end of a process into eating skin, meat, and bones, respectively, and equating head height/position with one's health or comfortableness as inspired by how vultures droop their heads when ill.
We're starting off string with double brownie points for meeting both the space epic easter egg by calquing the Ewokese word for 'outsider' and the empress easter egg by referring to Buddha's Birthday!
​

Kogëdek by u/Porpoise_God

Setonix & Macropodidae more generally (quokkas + kangaroos & wallabies); Noongar, Pitjantjatjara, Wajarri, Guugu Yimithirr, Miriwoong, Guniyandi, Dyirbal, Mbabaram
Aside from the one splant you'll soon see, I think this entry gets the prize for the most unique chosen clade by being A) not a bird, and B) not an ungulate. As great as birds are, quokkas are pretty amazing, too. I'm not too familiar with Pama-Nyungan languages but this did a good job of affecting some of the features I've come to know them for, including but not limited to the phonological natural classes of peripheral vs. coronal, coverb constructions, and the word for 'dog' bearing a striking similarity to English. Split-ergativity features across the noun-pronoun axis, and there's a unique set of duals that specifically refer to sibling, parent-child, or spousal pairs of individuals that I might have to steal for myself. The case marking includes a lative case I haven't seen before, and implicates the comitative in a neat way in comparative constructions. I also appreciate the what-looks-to-be resumptive subject pronominal proclitics; very speedlang 18, and a great example of a fossilised mistake, which I always love to see! The verbs also feature multiple conjugations, and the imperative is implicated for its tenselessness in certain subclause constructions, which has a certain type of quirkiness I'd expect out of some past speedlang challenges.
Kogëdek's Setonix-inspired phonology included a /ç/ in the proto-lang, which bears some resemblance to quokka calls, although it was lost to /s/ and /x/ in the modern language. The inspired lexical entries include roots for different kinds of macropods and styles of jumping, and conflates jumping with breathing. Some of the idioms include "pouch-baby" for pejorative "mama's-boy" and using kangaroo badassery as a metaphor for all sorts of less than ideal situations.
Brownie points for a particularly insidious word-form for 'father'.
​

Yatakang by Lichen

Bubalus (water buffaloes); Hindi-Urdu, Thai, Vietnamese, Khmer, Burmese, Malay
This one's a little rough around the edges, but it's a good foundation for a nice mix of both SEA features, like the isolating morphosyntax, and unique features, like the class agreement system. It's also got clicks limited to avoidance speech! Diachronics from a proto-lang where considered, and I really like how the typologies of the inspo langs were used as targets for the sound changes. I'll have to keep this workflow in mind! Some of the sound changes include expanding the number of stop contrasts to match the average number of contrasts, or eroding the number of vowels to match that of Malay. Phonotactics were carefully considered with full structures for both mono- and disyllables as well as bare roots vs. compound stems. Grammatically, morphology is mostly limited to a host of different reduplication patterns, which in itself is something I'd really like to see more of! Where this really shines, though, is with its agreement system: nouns are sorted into a 3x2 matrix of 6 classes, portmanteau agreement particles mark for the class of both the subject and the object, the system implicates the social hierarchies common to many SEA languages, and the position of the particle marks modality. Incredibly inspired to pack all that into a set of maybe 36 particles, if you ask me, never mind how it helps to disambiguate fluid word class and how it might be implicated in future plans for Indonesian object-oriented verbs. I'm also a fan of how the temporal question verb patterns like an agreement particle to mark for tense by co-opting the modality marking. We also get some prosody-syntax interfacing with different pitch contours at clause boundaries operating as different sorts of conjunctions.
Yatakang's Bubalus-inspired phonology includes a combination of creaky voice and syllabic nasals to affect a mooing phonaesthetic. The lexical entries exhibit some nice semantic drift from water buffalo activities and behaviours towards more human behaviours, and the planned phrase of hat-hand stroke fur for "suddenly realise a problem, and then pretend there isn't one" just feels exactly like an observation a water buffalo would make observing its human, which I really like. The inspired metaphors are also simple and straightforward, likening roundedness to goodness or knowledge to food, which makes for some brilliantly idiomatic language like "I ate the book" to mean "I read and understood the contents of the book."
Extra brownie points for including both halves of the space epic easter egg to placate both sides of nerddom; the term 'tax-man' is everything it ought to be.
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Kurikiri by Jjommoma

Casuariiformes (cassowaries and emus); Dhuwal, Motu, Tok Pisin
Compared to most other entries, this one's very short and sweet with some Australian sounds and some head-final Papuan grammar (however loose a description that is). That being said, Kurikiri is very inventive in being partially signed with much of its grammatical marking encoded by actions done with the foot, including number, case, definiteness, and some basic TAM.
Aside from the cassowary foot action grammar markers, as well as some lexical entries there-related, Kurikiri also equates flightedness to being ostentatious, disdaining flighted birds out of envy, which I think is a fun thought process for these terrestrially confined birds. There's also some neat phonosemantics in the taboo word for predator being especially difficult to pronounce.
This wasn't the intent, but I'm giving some space epic brownie points for the foot grammar if for nothing else than that it reminds me of Paul Frommer's Thark from John Carter and its telepathic grammatical and verbal lexical expression.
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Whaynisiday by u/Fimii

Spheniscidae (penguins); Māori, Xhosa, Quechua
What do you do when the entire population of penguins achieves human-like levels of intelligence after some gene splicing and they start calling for a language to call their own? Why, you do exactly what the prompt of this challenge asks for and combine the languages native to the homeland of the blue, african, and humboldt penguins! The write up for this conlang does a great job of pointing out what features are from which language exactly, and plays a fun balancing game between some of the phonological and grammatical extremes in its sourcelangs. In so doing it has a few quirks that really tickle the intersection of my linguist and conlanger venn diagram, specifically the presence of what I'd have to interpret as onset morae, as well as semantic noun class marked solely through agreement (which is very Varamm, so I'm not at all biased towards it). There's a handful of fun, rare cases, and the simulative mood fits right into the inspirations for the last challenge to create some vaguely Tupian simultaneous actions. There's a bunch more little grammatical bits that are fun, but impressionistically I appreciate how the more isolating grammar of Māori was incorporated into the synthetic common ground of the other 2 sourcelangs.
Whaynisiday's Spheniscidae-inspired phonology includes a couple syringeal sounds to complement the otherwise human capable inventory. The highlighted lexical entries pay special attention to how penguins locomote with basic stems for different kinds of movement options both on land and in the water, as well as a split in breathing for whether its on land at rest or in the water being active. The conceptual metaphors include a great model of time with the past on land and the future in the inky depths, and the very adorable notion that safety = community, and so naturally a farewell would be a wish of friendship.
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Poro by The Inky Baroness

Rangifer tarandus subsp. (domestic reindeers); Proto-Samic, Komi-Zyrian, Tundra Nenets, Chukchi
Where do I even begin with this one? I was excited to read this one when I first received it, but it was even better than I could have hoped when I got round to reading it! Although, not for any linguistic reasons: the first half of the doc reminds me of Gillian Teft's Anthro-Vision as an anthropological account of reindeers written by a fictitious Finnish researcher rather than any sort of sketched reference grammar, which I love dearly. The latter half, meanwhile, goes into great detail about what went into the first half, including all sorts of motivations or reasons for the decisions made. Some diachrony is detailed, as well as the effects of language contact rooted in actual historical events relevant to the chosen sourcelangs, which is just great to see. I loved the ways in which each of the different sourcelangs were all represented in the final product with it being Samic in origin but including some phonological and grammatical borrowings from Komi and Nenets like the lack of consonant gradation, the verb-final syntax, some vowel changes, and a fantastic predestinative affix that interacts with the conceptualisation of time in some neat ways. All the while, care was taken to do a wealth of research at every step in the process with a fairly extensive bibliography. Hoof clicks all around for this one!
Poro's Rangifer-inspired phonology includes a deer bellow as some sort of epiglottal obstruent that actually patterns with the Nenets glottal stop, as well as some other approximated reindeer vocalisations including what I presume to be grunts or chuffs, both oral and nasal. Care was also taken to think about what a fully reindeerised descendant of Proto-Samic would look like as accords with the included etiological myth for reindeers and reindeer husbandry, but this was well beyond the scope of a speedlang. The lexical entries include all sorts of terms for reindeer physiology, including but not limited to antler velvet, different types of vocalisations, and hoof clicks. These lexical entries feature in some wonderful idioms using antlers to describe social hierarchy, useful- or uselessness, and glibness or malicious intent, as well as an equivalent to "when pigs fly": "to catch a bird between one's hooves."
Extra brownie points both for the nominal hierarchical exaltation of mothers baked into reindeer culture and inclusion of an anti-imperialist message in promoting the research of the under-represented and often stigmatised language and culture of traditionally reindeer herding peoples. Also do keep an eye out for Dr. Dolittle easter eggs: Inky will reward you handsomely if you can spot one!
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Kiwi by NerpNerp

Apteryx & Novaeratitae more broadly (kiwis + cassowaries & emus); English, Māori, Traditional Tiwi, Miriwoong, Bardi
Given the number of bird entries with Indo-Pacific flavours, I'm almost half surprised this was the only kiwi entry: they're such good birbs! As might be expected, this conlang endeared itself to me just as its namesake does. The phonology has all sorts of trills and rhotics, and limits itself to high vowels; it's also got some neat phrase level prosody to mark different sorts of modal information and focus, even including an intrusive glottal stop at the sentence level. Noun incorporation is varied and detailed, and can create some polysynthetic constructions as a consequence of just how exactly the rest of the otherwise fairly analytic morphosyntax works. I'm a particular fan of the deictic categories including 7 different degrees of deixis characterising both distance and motion, and I'm also a fan of of the grammaticalised time of day. Heximal numbers and coverb constructions also feature. There's even a kiwi-capable featural alphabet that each of the examples show off!
Kiwi's Apteryx-inspired phonology includes the trills and high vowels being inspired by kiwi calls and I imagine a little of their anatomy with those long, thin bills. The inspired lexemes include specific types of smells humans can't detect at the expense of any colour terms, reflecting kiwis nocturnal, smell-based lifestyles. The idioms for "a long time ago" or "once upon a time" is absolutely delightful--"when kiwis flew"--and the grammaticalised time of day subdivides the night but not the day, as might be expected from a nocturnal beastie.
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Asamiin by Christian Evans

Asamina (pawpaws); Ottawa, Unami, Tuscarora, Mikasuki, Chitimacha, Timucua
The speech that nourishes! And a splant, too, no less; I was hoping for at least one of these! This one's made all the better by delving into some Eastern North American languages and I really like the flavours this lends itself to. Syncope is abound with all sorts of morphological obfuscation through detailed phonological processes, and animacy plays a key role in the verb complex. Care was also taken to find a phonological common ground between all the sourcelangs, which made for a really interesting set of vowels with a basic 6 vowel inventory, but with 2 nasal vowels that can surface as vocalic allophones to the nasal consonants. The grammar is fairly straightforward but has a few quirks that I really appreciate, including but not limited to the fluid O placement to make for some syntactic focusing strategies I so adore and the optional, enclitic case marking narrowed by various postpositions used as another, separate means of focus. Overall just really well laid out and the formatting is really cute, something I've now come to expect after Yumpịku last time.
Asamiin's Asamina-inspired phonology includes a pharyngeal approximant to recall the really long taproot pawpaws grow, as well as regressive sibilant harmony to recall the mimicry the flowers employ to attract pollinators, both of which are some really inspired departures from the sourcelangs.
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Ekaangäq by Atyx

Haliaeetus pelagicus (Steller's sea eagle); Chukchi, Alyutor, Koryak, Itelmen, Ainu, Nivkh, Evenki, Uilta
A bird that escapes any Indo-Pacific flavours? Well I'll be! Instead of South Pacific this one gives all sorts of North Pacific energy being spoken by a population of eaglefolk native to the Sea of Okhotsk and representative of the languages spoken along its coasts. The Ainu flavours are especially strong with both an Ainu-based consonant inventory and a kana orthography, among others. The vowels also show some interesting lopsidedness with 2 creaky vowels complementing an otherwise fairly straightforward 6 vowel system that feature in a front-back vowel harmony system, though I'm a real fan of the sandhi rules at word boundaries that cause all sorts of fun consonant alternations. Word stress is also detailed and has funky placement rules at odds with my understanding of theoretical prosodic processes! Grammatically there's a few quirks that really stand out to me and tickle my curiosity: a dual distinction on the nouns but not in the pronouns, and polypersonal agreement in a transitive alignment system, the only departure from direct, accusative, and/or ergative alignment in this round of submissions. I also appreciate some of the syncretism in the pronouns!
Ekkangäq's Haliaeetus-inspired phonology includes entirely unrounded vowels and a lack of any labial consonants to reflect the speakers have beaks, as well as the 2 creaky vowels as rooted in their physiology, a common theme for this challenge. The lexicon includes some distinctions between diving and eating as it applies to different kinds of prey. The conceptual metaphor, though, I think is really great equating the passage of time with ice: an iceberg calving off a glacier is birth, melting is ageing, and melting all away is dying. Great stuff!
I think I actually have to give negative brownie points for this one: as much as I appreciate 3 separate orthographies (Kana, Cyrillic, Latin) for some historicity, they are all at odds with the anti-imperialism the brownie criterion requires, and there's no girl power to balance it out.
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Taqồpaq by accruenewblue

Gallus (jungefowl); Hindi-Urdu, Burmese, Thai, Punjabi, Tamil, Indonesian
I'm a little surprised this is, I think, the only truly tonal submission despite all the SEA birds, and it's less synthetic than most in this round of submissions. In either case, this one does a great job of illustrating some tonogenesis and some recent and still very transparent synthetic developments from a formerly isolating language. The tones are simple registers, but they interact with morae in some neat rightwards reassigning sandhi patterns, and they complement a system of 12 vowels in a 3x2x2 matrix of height, frontedness, and roundedness. There's even some vocalic nasal allophones (which is twice now in this round of submissions), and labial consonant-vowel harmony to boot! Grammatically I greatly appreciate all the call-outs for similarities to natural languages, and I wanna shout-out the use of a positive tag question instead of negative. The numbers have this funky sexagesimal base with an octal sub-base and remnants of an old decimal sub-base, which recalls some of the duodecimal remnants in the otherwise decimal system of many European languages.
Taqồpaq's Gallus-inspired phonology includes the tonal system being described as recalling a rooster's crow. The lexicon includes roots for all things chicken, including using the word for 'wattle' as a classifier for hanging things, which is so delightfully what I wanted out of this challenge. The more idiomatic language makes use of chicken behaviours as descriptors: dust baths are metaphors for something useful but not everyone's cup of tea, and continuing to brood after the chicks have hatched is a metaphor for doing a good thing so long it has negative consequences.
Extra brownie points for exalting queen Trưng, first queen of Vietnam, and a nationalist hero who fought against Chinese imperialism. Double whammy right there!
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Ngālin by u/borago_officinalis

Aptenodytes forsteri (emperor penguins); Awabakal, Māori, Norwegian
We already had a penguin splang but this one's a nice twist by focusing on the territorial claims of Antarctica rather than the ranges of more temperate inclined penguins where there are actually native languages. This does a great job of shirking the indigenous implication in the language selection step of the challenge (although I'm very glad to see no English or Spanish), so there's a really neat mix of isolating Māori particles with a fusional Germanic verbal system, and I was able to easily pick up on both reading through the doc. The verb system actually pleases me greatly with a strong/weak contrast and a V2 word order wherein the strong verbs mark tense through stem change and the weak verbs with a tense auxiliary, all whilst maintaining a very Polynesian aesthetic despite the very Germanic number of vowels. The Māori possessive system is also really fun, I think. I can't speak to the Awabakal influences, but I was able to pick up on the one, tiny Mapudungan influence of tone tag particles before it was even explicitly mentioned! Not sure where the negation system came from, but it implicates the weak verbs in a way I so adore. Really sweet, despite the fun grim facts about emperor penguin hatchlings, and I found this one just darling. The myth at the end about how penguins lost their ability to fly is also real treat and is a perfect fit for the project.
Ngālin doesn't have any A. forsteri-inspired phonology, but it makes up for it with the inspired lexicon and idiomatic language. The emperor penguin breeding cycle is detailed with translations for all the important terms along the way, including but not limited to the ritual of transferring egg from mother to father and "motherless" to refer to a newborn, whose mother hasn't yet returned from the sea. There's some great, everyday idioms elided down from full phrases for greeting and consoling another penguin being "which way?" and "next year", and conceptualising a long distance as specifically the distance from colony to see is a nice touch. I also appreciate how the relationship between creche-mates is more important than that between (half-)siblings.
I have to give queen exaltation brownie points purely for the one illustrative example of āmā o pipa "hatchling's mum" grammatically indicating the senior authority of an empress penguin.
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Honourable Mention

I've been kept somewhat apprised of a Urile (North Pacific cormorants) splang by u/PastTheStarryVoids. It's still very much in the works, but it sounds funky with both some polysynthetic flavours, no doubt inspired by some PNW languages, I imagine, and some formorant (cormorant formant) analysis! Keep an eye out for it, I'm sure it'll grace the sub in due time!
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And that's everything I've seen in the time I put together this showcase. I know there were a few among you all who felt inspired but couldn't put anything together during the course of this challenge. I remember mention of a banana and a tree kangaroo splang on the announcement post. If anyone ever uses the challenge to inspire a future project of theirs, please keep me apprised! I'd be interested in seeing them if for nothing else than to see some more projects outside of South Asian and Oceanian birds, as great as those birbs are. I can't believe I didn't see a single monotreme or non-ungulate eutherian, and that there weren't any non-avian reptiles or anything fully aquatic! And no fossil clades, too, for that matter! I'm positive there are the makings of some really funky splangs if the relevant modern continental and climactic boundaries didn't yet exist.
In any case, I hope all parties involved had a great deal of fun through the course of this challenge! I know I did! Until next marrow, bonelickers!

• firstly baby dinos, this could be implemented exactly like planet zoo. Just make the dinos do their social animation then later let one of ‘em lay eggs. The eggs could just act like a decoration. Then let the baby’s spawn next to the eggs and make the eggs disappear or change to shells . The eggs would need six looks total. Three for the different sizes of dinos that lay them and three for when they are broken. The option for birth control would be there just like in planet zoo and baby dinos would not count as population till adult. The baby’s would just be a small version of the dino and all have the same skin. After a few in game years they could reach adulthood by just instantly changing in a grown dino with the skin of one of their parents. This seems to me like a fair deal at launch. Flyers and aquatics wouldn’t need breeding per se but would be appreciated.
  
• bigger aviaries and invisible fences for flyers
  
• Natural lagoons that can be placed like a normal one
  
• Semi aquatics that can swim in water you place, would just be cool not necessary for me but cool
  
• Animals don’t starve themselves
  
• Animals don’t just stop moving and die
  
• Have all the buildings from both games
  
• Have the meeting of the elders type socialising back
  
• Instead of having to place a ranger station in the enclosure just select the enclosure or the area you want covered by rangers. This area should be upgradable
  
• Cenozoic animals, I get some people really don’t see them fit and I get that but it would be cool too have a herd of mammoths in the snow or a smilodon on the hunt. What I mean is that for a sequel to be worth it it would have to innovate and a few of the best known cenozoics would be a great addition for me.
  
• a good well rounded campaign in which you can unlock everything the game has to offer as you progress. Maybe return to the five deaths but now you can control the whole of the islands and not only a tiny bit of them. Peña would suck but that’s why it exists I guess. Maybe a campaign through eras or separate campaigns through different locations and time periods. Anyway just a campaign that keeps you playing too unpack another reward or unlock a different dino and improved your parks. Of course you have multiple revisitable maps in each campaign in which progress carries over.
  
• I want better terrain editing tools but don’t make the fences obsolete. Playing a mission which has sabotage or other problems that cause your dinos to wreak havoc would be entirely pointless if they can’t escape because of some cliff or river.
  
• Upgrade the skins so we can implement different patterns and colours next to some presets. The skins of the last few games are really hit or miss so let us choose the colours and if possible in some way the patterns so they feel like our dinos
  
• Don’t let the animals die of old age if there are no babies to keep the species in our parks going. It also makes it hard to form an attachment to an “asset” when they just roll over and die in a few hours.
  
• Scientists are just a pain just make them a bonus or something to get a better success rate or an even faster expedition.
  
• All species from jwe2 MUST BE THERE! I ain’t paying for spinoraptor or huayangasaurus for a third time.
  
• Make marines more than just glorified goldfish and make flyers walk. No clue how marines could be more interesting but at least fix the lightning and make them have specific needs like depth of water and certain kelp or coral.
  
• I personally liked the style of jwe1 better in therms of how it looked so make jwe3 an improvement on that. Jwe2 is objectively more beautiful but just feels off at certain points don’t quite know how to explain.
  
• More decorations and more organisation of decorations. Also make guests appreciate decorations
  
• Make guests see dinos through bars, but give visibility a boost in attractions
  
• More attractions
  
• Fix the four guest types to either just one or just regular and rich guests. Of course the rich bring more income.
  
• Make at least all vehicles able to tranq.
  
• Don’t have small animals transported via helicopter but instead via a truck. The truck don’t care about what route to take and delivers dinos to selected locations no matter how.
  
• Make dinos act like animals and not like monsters. The indominus and Indoraptor are monsters so they’ll kill anything but a lone carnotaurus won’t attack every hadrosaur it sees if it’s not starving or at least hungry that’s just not how animals act. This would make site b parks a lot easier
  
• Make a random island generator so our maps are more unique and personal
  
• Make herbivore feeders return. Just make most of the food come from feeders and a small part from plants and foliage. I’m sick of my sauropods needing an entire jungle in wich I can barely see them
  
• Different live feeders like cows, deer, sheep etc
  
• Probably other stuff but this is what’s most important to me if I’m to spend money on a third Jurassic park builder
  

I’m a new mom so, I can admit, I can be super sensitive to comments about my 7 month old. One thing i’ve been super shocked/annoyed about is CONSTANT. comments from strangers on my son’s size. For example, today we were in a waiting room and a woman stopped me to ask how old my son is. I told her 7 months and she looked at him and said “wow you’re so tiny. my grand baby was your size at 3 months!” Now, for context, I EBF so any comments about him being “small” just send a dagger through my heart and I start to question if my body is giving him enough. Honestly, I have a bit of a complex when it comes to his size due to feeding issues when he was a newborn. Also, my son simply is NOT small. He’s 21lbs and in the 84th percentile for weight. I really shouldn’t be bothered by these comments because I know he is plenty big and very healthy. This isn’t the first time this has happened. It feels like these comments ALWAYS come from the older generation and they always feel a little bit judgmental. I really need to grow thicker skin I know! I guess it just kind of reinforces my insecurities that i’m not doing enough for him!!! not sure if any other moms can relate. Just tired of comments from strangers.

Hey all, this is going to be quite a long read so I ask you to bear with me and my Google translated English.
I grew up catholic, but like many others of you, the answers were not good enough. I tried past life regression with the help of a CD, that’s how old I am. :) It didn’t work during the meditation but I always had very vivid dreams and even now I can tell if it’s something prophetic (concerning my life only) or just a dream processing the daily life. But oh boy! the dream I had after hearing the track for months was intense and didn’t feel like a dream at all but a memory.
Let’s start with me knowing that I was not really alive. No physical body but a form of remembering how I looked before or should look. My external appearance mirrored it. I found myself among thousands of other souls in a bright place. Huge! No boundaries, we all were wearing the same simple linen clothes. All including myself were happy, playful, loving and funny, even ecstatic! Right there I understood why one would miss this place and how it explained my homesickness and sadness, longing for this feeling! It was pure bliss. I wandered around for a long time, watching all of them being so happy and thinking to myself how this even was possible? I mean, I felt it too but at some point, it was … enough? I felt filled up. Also there was no challenge, no learning. I felt bored. And here comes a cut to another memory inside the dream. Like the answer to my internal question.
I was standing along a wall (although there was no ending or beginning) with many others in a long line. We were waiting for new clothes. Witch I found strange. Finally I saw those in front taking off their old clothes and putting on the new ones. The sudden change in their mood was striking. When it was my turn I realized that the wall I was standing at, had huge windows, behind them stood people no different to us, except their clothes were brighter and they seemed to be operating some consoles, looking at us and giving out the new garments. I received mine. The tunic felt damp and heavier than the one I was wearing, and it was coated with a creamy substance. Suddenly I knew these were drugs and I already felt it on my souls skin. It was not really skin, energy pattern of some sort.
I feel really stupid about this, because only a few days ago I fully realized that drugs inside clothes are absolutely a thing. To my defense, I haven’t been thinking of this reincarnation dream for a decade.
I was reminded of my dream due to an interview Dr Ammon Hillmans gave and his statements about drugs Jesus used.
Anyhow…. I went away and left the clothes somewhere or refused to take them. I remember that this caused a commotion inside the laboratory? or whatever this place was. I will call it that for now for lack of a better description. They watched me and tried to keep track of where I was going. I started panicking and told those around me, that something was wrong and this place was like a prison of joy and that they have been drugged for whatever reason all of this was not real. I think some had already thoughts of their own. I could see the change in their faces. But nobody could answer me where we were, or for how long, nor why! Many just ignored me. I knew my time was up.
Then the next memory cut: I am caught. I am inside, or can see inside the laboratory. Someone with authority is entering the room and is giving instructions. He comes towards me and is suddenly really huge, like… I can only see his face. As if I would see him through a screen or a peephole. He says something about sending me away. I want an explanation but he just leaves me.
He has a white beard and reminds me of the typical children drawings of god on a cloud.
I realize, I’m in a round tiny vessel, but it’s made from my soul. I am the vessel and it’s my boundary. As if one is hold by a magnetic field which also forms you into this vessel. I have the feeling of being betrayed or robbed. Then I’m out in space. I can’t steer the craft. I recognize Earth quite late and I’m not happy about it because there is not much there! Except vegetation. My soul swirls towards a clearing in a jungle. In the middle is a machine and it seems to be the receiver of the field I’m bound to. My soul enters it.
Next memory cut: The machine looks like two narrow cones pointing towards each other. The cones are from a dark metal or rock. Where the apex meet, a dark substance is formed. I am now outside of the memory and move around to watch what happens. I am now aware that it is a dream. A man with cloths from feathers also in his hair is operating the machine. I had the feeling to know him. And that he is the first or one of the first operating on Earth. He somehow knows that my now-me is watching. He smiles and puts his hand around the black mass forming in the machine. It’s like a tiny pebble of wobbeltet material. Cut: I’m again in my souls body. He opens his hand and I see his huge smiling face. I’m a black caterpillar in his palm. My thoughts suddenly change. I can describe it like this: you always play a highly sophisticated game with many buttons and options and then suddenly you go retro and switch to a two button game. My thoughts became harder to remember. They changed to expressions of the outer world. His palm was open in the sun, so the thoughts were: Light! Hide shadow! Predator! Bird. But there were no birds. Feelings did not change. I felt fear of being eaten and being in the sun. He puts me down on a big green leaf: Green! Eat! Crawl shadow. Eat! I really tried to remember that I was human, but it was not possible in this new body! Yet, from time to time other, deeper thoughts came through but did never last. Just a knowing of something more. Then I woke up.
I asked to know about my first life on earth. That was it. I have so many questions! I don’t know if this process of happiness is something that is needed, a form of relaxation maybe? But then I remember, that I didn’t agree with it. I wonder how much details I missed during the cuts and if there are others who remember something similar?
Thank you for reading :)

Hi all, After reading a lot of post here recently, I kinda wanted to tell my story to give others perspective about treatment options. Obviously, this is MY story and everyone here is different. My experience will not be the same as yours, and I am not a doctor telling you to try these options. But I have had a lot done, and I think it might be helpful if people understand what they can try.
I appreciate everyone who reads even one section of this saga. I am happy to answer any questions that people might have. Again, this was my journey and these things might not be the best options for you. But I want to highlight that pain, itself, is not the disease. It is a symptom. Find doctors who will help you find the cause of it. Sometimes it's difficult to pinpoint the source of pain, but there are options to try different things.
Part 1: How it Started
In 2007 I was 17 years old. During the summer, I got a job working as a bus boy at a reception hall. One night, I was sweeping the floor, nothing different than normal, but I suddenly had intense shooting pain down my hip and leg just from the way I bent down to sweep. That was all it took to set me off on what would be a long life of pain.
I remember the sciatica being really bad during this period. My parents and I were taking care trips to look at colleges and sitting in a car was torture. At some point they told me to see a chiropractor so I started doing that on a pretty regular basis. I went to college in 2012 and continued to have pain. There was always constant pain but I would always have times when it was much worse and it was painful to even walk normally. I recall having my parents visit and I was limping all day because I couldn't extend my left leg out fully.
I continued to see a chiropractor in the area for maybe two or three of the years I was away at school. Chiropractor never really helped though. During one of the summer breaks, I went to a chiropractor who had this decompression machine that would literally strap you down and pull you apart in an attempt to relieve pressure. It never helped. I am pretty sure by this time I already had an MRI done that probably showed some level of lumbar herniation so I guess that is why I wanted to try that type of treatment.
Chiropractics is not a legitimate science. I hadn't realized this until later in college (I was a biomed major). Their theories on spinal health do not align with known medical science. Some chiropractor align more with real medical science, but a lot of them only believe what the area of chiropractics says. I strongly recommend NEVER seeing a chiropractor, especially if you have back pain. It could be dangerous.
Part 2: The First Surgery and More Treatments
So when I graduated from college in 2012, I sought out an orthopedic surgeon. We did more MRIs. I can't recall if we tried anything more conservative first, but I did end up having surgery with him in 2013. We did a microdiscectomy and hemilaminectomy on both L3-4 and L4-5. Recovery from this was about what you would expect. Lots of bed rest for maybe 6 weeks or so, but I recovered well and went to PT for a couple of months. I think the surgery was successful in treating a lot of the serious sciatica I was having. But I was still having some level of back pain months and months after. I was then seeing the pain management doctor at the same office as the surgeon, and we tried a LOT of different additional things. Facet joint injections specifically, trigger point injections, medications. Nothing ever helped. I still have this pain in my low back and it was difficult to bend over without bracing myself, and there were times when I would get sciatic pain but not nearly as bad as it was before the surgery.
At one point I went to a rheumatologist because the pain doctor did some blood work and found I was positive for a gene that is related to ankylosing spondylitis. I was never actually diagnosed with this, but we tried to medications (I think maybe methotrexate but I could be wrong). The rheumatologist ended up putting me on humira, which looking back was a odd decision without actually officially diagnosing me with anything. Humira is a monthly injection, and I think after two months, my pain actually got a lot worse, and I stopped taking it and never went back to him.
For the most part after this, I was just taking Tramadol an naproxen to deal with my pain. I was going to the gym and doing what I could, but often the gym would exacerbate my symptoms. It was just difficult to do anything without feeling weak and obviously, it definitely contributed to some depression.
Part 3: New Pain Doctors and Spinal Cord Stimulator
In 2016, I got a new job that brought me into NYC and I now had access to great insurance and a wide array of great doctors. I found a new pain management doctor and tried a lot of things with him. He put me on Nucynta at some point, which is a narcotic, though I would only take it when I had break through pain. Pretty quickly, only a couple months after in 2017, we decided to try a spinal cord stimulator since I had already tried all these other things with other doctors.
I had to see a neurologist who would be doing the actual implanting of the device. I also had to see a phsychiatrist to get I guess "mental" clearance that I was in sound mind to be making this decision about a medical device implant. Not sure if that was just for the insurance or something the doctors also require. Before doing a full implant, they actually do a test run. I guess I had gone under general anesthesia for this, but they implant the wires (explained more below) and the wires come out of my skin to an external device and all of that is taped down to my low back. They do this so that they can make sure you actually get relief from the device before all the time, energy, and money is spent doing the full implant. I had it for a couple weeks, and decided to move forward. They had to remove the wires from me and scheduled me for just a regular office visit, and I was thinking well how the heck are they removing these wires from me. Well, it was very easy. They literally just pulled the wires right out of my back. Didn't feel anything. It was wild.
I have a Nevro brand stimulator impanted inside me shortly after. Surgery and recovery were as you would expect. I don't thinm recovery was as long as my back surgery was. There is a little 1x1 inch square box that sits above my right glute, around where my waistband would sit. There are two sets of wires that run over my spine to the left side (so I can actually feel the wires right under my skin at this part) and then they go between my vertebral space and then all the way up my spinal canal to my thoracic area. At the end of the wires (aka "leads") there are several evenly spaced electrodes and these are the functional part of the device. From what I understand, they send small electrically pulses very rapidly against my spinal cord and the idea is that these electric signals will over power pain signals coming from below, effectively making my brain blind to sciatic pain. It came with a remote to change the settings and a charger that uses a wireless pad that you hold over the box to charge. I had to charge it ever two or three days. The technician from the company does the initial set up (they device doesn't operate until you are recovered from the procedure and see the technician at your next office visit, I believe). The technician will turn the device on wirelessly and play with the settings and ask you to tell them when you feel something as the increase the magnitude of the stimulation. When you feel it, it does feel like a little electric buzzing in your back. But you aren't supposed to feel it at all, so they the turn it down just below where you felt the sensation. The remote has a couple different programs that I could change through that the technician programs, I guess changes in the frequency of the pulsing or things like that. I could also increase and decrease the magnitude within a set range, but for the most part I never messed with any of the settings. Nevro has a care team that I can contact at any time with questions or concerns and they will follow up with me occasionally to see how I am doing.
Part 4: Life After the Stimulator
I always had the stimulator on, and always said that it did help alleviate the residual sciatic symptoms I had, but I still had this low back pain that wouldn't go away. I continued to see the pain management doctor and we tried so other things. More trigger point injections, medications, etc. He had me on what is called "Low dose naltrexone" which is essentially a very low dose of an existing drug, used off label for chronic pain. It had to be specially made at a compounding pharmacy because the dose you need isn't commercially available. I tried that for a couple months and can't say it helped. In fact, I think it made me very nauseous a lot of the time. I remember I had to stop drinking coffee at one point because the taste of it would make me feel queezy, and one or two times I ran to the bathroom because I felt like I was going to throw up. I decided to stop taking it.
After that, I mostly just lived with my stimulator and dealt with any pain I had (hadn't seen the doctor since 2020). I was going to the gym someone regularly at this point, but like before it would often increase my pain symptoms so I would need to take extended breaks from exercise.
Part 5: Recurrent Herniation
At the beginning of November 2023, I started to feel something new. I was starting to slowly get sciatic symptoms again and was having flashbacks of my symptoms when I was in college. I was starting to get sciatica in both legs, and my right foot would sometimes start going numb if I stood for too long. It was getting more and more severe. Within a few weeks, I had to stop commuting into work because the pain was getting so bad. I contacted my pain management doctor who I hadn't seen in years. Their office was telling me how since I hadn't been there in so long I had to be treated as a new patient and the first opening for a new patient was like 2 or 3 weeks out. I was pretty angry at them about this. I mean, this doctor did the implant of the medical device that I have...should that not exempt me from this rule? Its not like this was an appointment for an unrelated issue. Anyway, the first available appointment was with a different doctor, but I was desperate so I saw him. He was not helpful. I was basically begging for pain meds and he was like welllll the other doctor should really prescribe you something because he knows your case better. It was such a a waste of time.
About a week or two later I did in fact see my original doctor, and he had the Nevro technician come because he thought it could potentially be an issue with the device. The technician found that there was "impedence" on one of the leads, a couple of the electrodes weren't working as they should. So she did some adjustments to compensate for that. I have it a week or so, but that did not fix the problem at all. I stopped charging the stimulator altogether because it wasn't doing anything for me. I had to start using a cane to get around because if I was standing, I needed something to lean on so I didn't have to keep my back straight. It was getting very difficult.
The doctor had me get a regular CT done, because I cannot get an MRI due to the stimulator (the stimulator itself is actually MRI safe and I think most of them are not, but because of the issue with the electrodes, my Nevro care team told me I could not get an MRI). So I and the CT and I could see it myself. It was absolutely clear that there was a herniation at L4-L5. Clear as day. So I had a video call with the doctors assistance soon after and to my dismay, they suggested treatment was to get an epidural to reduce the pain. Here I am, knowing full well that my symptoms and the results of the MRI are definitely worthy of surgery, and they want to give me just an epidural. I asked her about surgery and she said something about not opting for surgery until exhausting other options. I said okay. After the call, I immediately reached out to my friend who worked at the Hospital for Special Surgery in NYC. She actually works with the director of Spinal Surgery. Immediately, I was in contact with him and his entire team and they moved quickly to get things moving. I regret not having reached out sooner.
Part 6: Prep for Second Surgery
So the first thing to do was get better imagining. Since the MRI was out of the question, I had to do something called a CT Myelogram. Oh boy this was not a fun diagnostic procedure.
You need to be accompanied to the appointment because they will be giving you some very light sedative. You are hooked up to an IV, and they bring you into a room with a special x-ray table that rotates so you can be either laying flat or raised up so you are nearly standing, and the X-rays can be taken from many different angles. The doctor there take a couple of initial scans to find the location where they go in. I am queezy just talking about it right now. What they need to do is inject contrast dye right into my spinal canal. An epidural goes AROUND your spinal canal, but for this they need to pierce the dura and go in.
So they do local anesthesia and then take quite a large needle and go in. It is painful because it is going so deep. But God, you can feel the piecing of the dura layer when the needle goes through. I immediately feel my body hating it. Then they inject the dye, and you can feel that sort of cold sensation spreading across your back. And then he takes the needle out. I start to get VERY hot and am about to pass out, so they put some ice on the bacm of my neck and give me a minute to come back down. They also gave me some IV zofran to help with nausea and some IV sedative for the pain Thankfully it passed. But that wasnt even the difficult part.
Next, they have to make sure the dye gets into all the crevices. So the doctor rotates the table to different angles and has you try and bend in specific ways. It was incredibly painful to do. When he had me in an almost standing position, and the pressure of the dye was increasing my leg pain beyond anything I had experienced so far. It was really difficult. But once they are satisfied with the X-ray that shows the dye has spread well, they send you to the CT scan. Once I was laying down again the pain subsided and I was feeling better. They did the CT scan and then rolled me back to the recovery room, and by the time I was back in there I was feels 100% back to normal and had no issues getting up and walking. So that was that.
The image results were very telling (gunna try and include them here or in a comment if I can). The point of this type of imaging is that the contract dye with spread anywhere that the CSF can go. You should be able to clearly see the space all around the spinal cord, and if there are spots where you don't see the dye, you will be able to see what is causing some problems. It was plain to see how severe this herniation was. It was compressing my spinal cord and pushing it all the way to the back of the spinal column.
So the doctor said we have two options. A microdiscectomy or a fusion. We decided to do a MD though I would be okay with a fusion. Well guess what, two days before the surgery the doctor changed his mind and said that after reviewing the imaging again the best course of action would be to do a fusion. I was very excited for that.
Part 7: The Fusion
So at the end of Feb 2024 I had my fusion done. It was your standard surgery, nothing too crazy. Recovery was tough though. Basically with a fusion, they take out the herniation and most of the disc and they put this rubbery block in there that contains bone graft. That is what is going to grow to fuse the two vertebrae, but that process can take a year to fully fuse the bones. So they put in four screws, two in each vertebrae, and join them together with rods. This holds the bones together completely so that they do not move independently. They are essentially fused at this point, but only with the rods.
For recovery, the first couple days were difficult, mostly trying to stand up from laying down because I had like no low back strength. The pain was also pretty constant so I was taking a lot of muscle relaxers and narcotics to help me stay asleep as much as possible.
The surgery area was quiet large. There were two large bandages and two small bandages and the entire area was covered in a large adhesive patch to keep everything clean and dry (it was also very orange from the iodine). So I could shower without worrying about it. Within two weeks I was moving around a lot better. I might have stopped using my cane at this point, though anything that required me to reach forward, like washing my hands at the sink, was difficult because it would require back strength. By 2 weeks, the bandage had because really really frustrating. The huge adhesive patch was causing my skin to become itchy and irritated, and I could see they I was starting to develop some red bumps like pimples underneath. Thankfully 2 weeks was the point I could remove it (after my first follow up call with the doctors team). So I took it off which was not easy. The whole area was soooo sticky, I tried to remove a lot of the stickiness with either rubbing alcohol, soap, or Vaseline. I was able to get a lot of it off but some stickiness still lasted for several days. There will tiny bandages over the incision sites that covered the stitches and those would eventually all fall off themselves. I had two larger scars at the top where they did most of the work of cutting out the disc and putting in the graft, and then two tiny scars lower down where I assume they put in the screws for the lower vertabrae. My back does not look pretty.
I started PT at four weeks was doing better but still had a weak back and was very cautious with my movements. Did PT for 12 weeks and made a lot of improvement. I was back to how I was. The fusion 100% fix the issues that this new herniation had caused, and it was such a relief to finally have a procedure that was totally effective. However, the back pain that I had already had for many many years was and is still there and I am still not certain what is causing it.
Part 8: Now
I am about 20 weeks out of surgery and am still doing great. I still do not use my stimulator and don't plan to, but having to get it removed would be a really huge pain. I have started to actually go to a gym again and life weights to stay active. I am mostly convinced that this low back pain I still have is really muscle related, caused by the years of instability, and that I can address it by strengthly my core muscles and following my PT exercises. I think a lot of these muscles issues, like trigger points, can mimic sciatic symptoms. Knowing what REAL sciatic symptoms feel like again, this pain doesn't feel like I have a herniation pushing on my nerves. So I am going forward with that in mind and trying to deal with this pain muscularly.
As for the fusion, I don't notice any new limitations in my movement. I avoid rubbing the area because I could feel the rods if I rub it hard enough. But I feel normal. I had a follow up with the doctor with another X-ray and everything looks great. I am hoping that this can be a turning point for me to really live as close to a pain free life as possible.