Anthem medicare prior authorization forms for medications

The Specialty Pharmacy Subreddit

2016.07.28 21:37 drgncabe The Specialty Pharmacy Subreddit

Discussions and posts related to the Specialty Pharmacy Industry.
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2024.05.15 15:04 Lazy_Contact_6315 Insurance Voiding Prior Authorization Requests

For the last 5 years I have been self submitting prior authorization requests for medically necessary out of network services with a specialist DO for my medically complex children. The insurance is NYS CHIP. Through NYS external appeal process awarded medical necessity for these OON services.
As of January 2023 my health insurance has been voiding my prior authorization requests upon submission. No denial letter. No communication whatsoever in response to submission.
In the past NYS DFS has ordered my insurance to process the prior authorization. I filed a compliant with NYS DFS about insurances new tactic of completely ignoring me, DFS said it was a DOH problem. I filed a complaint with DOH who said there’s nothing they can do.
I’ve contacted my insurance multiple times. The last time I called the rep told me it’s my providers fault for refusing to contract with them and they will only process authorization requests submitted by the provider even though NYS external appeals awarded me medical necessity. How is this legal? The federal affordable care act protects my right to see OON providers for medically necessary specialty services.
I’m at a loss. Who can I complain to? NYS Attorney General? Try NYS DFS again? Is there a federal body that enforces ACA?
I have a year and a half of claims worth 17K+ at this point. I have to get someone to look at this. My kids need these services and as Medicaid recipients we cannot afford to continue care without reimbursement.
submitted by Lazy_Contact_6315 to HealthInsurance [link] [comments]


2024.05.15 14:37 Legitimate-Payment50 Should I be worried about my recent GERD exam?

The VA reopened a previously denied GERD claim due to an error made by either the examiner or rating specialist, or both. A VA rep over the phone wasn’t able to tell me what the actual error was.
I underwent a new C&P exam where the examiner sat across from me, taking notes as I answered his questions. Despite the short Q&A session, I realized he didn't inquire about how my condition affects my daily life or job. This leaves me wondering if I should be concerned about the outcome. I did fill out a questionnaire prior to the exam where I described the difficulties and how it affects me on a daily basis. Should this suffice for him to form a medical opinion and am I overthinking this?
submitted by Legitimate-Payment50 to VeteransBenefits [link] [comments]


2024.05.15 14:20 HotSarcasm $ADAP: Adaptimmune Reports Q1 2024 Financial and Business Updates

$ADAP: Adaptimmune Reports Q1 2024 Financial and Business Updates
  • Afami-cel commercial and regulatory update presented at Company's Investor Day; FDA review and inspections progressing with PDUFA date of August 4th, 2024
  • Commercial and manufacturing infrastructure in place to support afami-cel commercial launch upon approval
  • Data from SPEARHEAD-1 pivotal trial with afami-cel published in ~The Lancet~; data from a planned interim analysis of pivotal lete-cel IGNYTE-ESO trial to be presented at ASCO
  • Cash runway into late 2025
Philadelphia, Pennsylvania and Oxford, United Kindgom--(Newsfile Corp. - May 15, 2024) - Adaptimmune Therapeutics plc (NASDAQ: ADAP), a company redefining the treatment of solid tumor cancers with cell therapy, today reports financial results and business updates for the first quarter ended March 31, 2024. The Company will host a live webcast at 8:00 a.m. EDT (1:00 p.m. BST) today.
Adrian Rawcliffe, Adaptimmune's Chief Executive Officer: "Support from the sarcoma community continues to highlight the high unmet medical need for new therapies for synovial sarcoma and we are making great progress preparing for the commercial launch of afami-cel on approval. Behind afami-cel, we plan to launch lete-cel for synovial sarcoma and MRCLS in 2026 with projected peak US sales of $400 million for our sarcoma franchise."
Sarcoma Franchise with afami-cel and lete-cel
  • U.S. FDA accepted the BLA for afami-cel for the treatment of advanced synovial sarcoma with priority review and a PDUFA date of August 4th, 2024
  • The BLA mid-cycle review meeting was held with FDA in April
  • FDA GCP Bioresearch Monitoring Program (BIMO) inspections have been conducted at Adaptimmune and at selected clinical sites that participated in the pivotal SPEARHEAD-1 trial
  • FDA GMP Pre-license inspections (PLI) have taken place at the Company's Navy Yard facility and at the lentiviral vector contract manufacturer's facility
  • Preliminary plans for confirmatory evidence for afami-cel's full approval were previously agreed with FDA, including Cohort 2
  • Adaptimmune expects to discuss post-marketing requirements and commitments at the late-cycle meeting which is scheduled for the second half of May
  • To date, the FDA has not requested an Advisory Committee meeting or a REMS program
  • The marketing application for the companion diagnostic for MAGE-A4 is currently under FDA review and is expected to be approved contemporaneously with the BLA
  • Adaptimmune is preparing to launch afami-cel on approval in the U.S. Initially, launch will be focused on 6-10 selected treatment centers ("Authorized Treatment Centers" or "ATCs") and will expand to up to ~30 ATCs.
  • 100% of the customer facing commercial and medical affairs teams is now in place
  • Company launched www.Tcrtcell.com: an unbranded website aimed at educating healthcare providers about TCR T-cell therapy in solid tumors, including synovial sarcoma, and the role of biomarkers and testing to determine future treatments
  • The second product in Adaptimmune's sarcoma franchise, lete-cel, is being investigated in the pivotal IGNYTE-ESO trial (NCT03967223), which at a planned interim analysis exhibited response in 18/45 of patients (ORR 40%). The primary efficacy endpoint requires 16/60 patients have responses, so this trial has met its primary endpoint for efficacy. The full pivotal analyses are anticipated in late 2024.
  • Lete-cel will enable Adaptimmune to expand its addressable synovial sarcoma patient population by targeting the NY-ESO cancer antigen, in addition to MAGE-A4 targeted by afami-cel, as well as treating Myxoid Round Cell Liposarcoma (MRCLS) patients.
  • Sarcoma franchise of afami-cel and lete-cel leverages same development and commercial footprint with US peak year sales projected to be up to $400 million
  • Data presentations
    • Data from pivotal SPEARHEAD-1 trial with afami-cel published in The Lancet: article entitled "Afamitresgene autoleucel for advanced synovial sarcoma and myxoid round cell liposarcoma (SPEARHEAD-1): an international, open-label, phase 2 trial"
    • Data from the planned interim analysis of the pivotal IGNYTE-ESO trial with lete-cel to be presented by Dr. Sandra P. D'Angelo, M.D., Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center, in an oral presentation at ASCO entitled "Lete-cel in patients with synovial sarcoma or myxoid/round cell liposarcoma: Planned interim analysis of the pivotal IGNYTE-ESO trial" during the Developmental Therapeutics-Immunotherapy session in Hall D2 on June 3, 2024 at 11:30 a.m. CDT
Clinical pipeline
  • Uzatresgene autoleucel ("uza-cel", formerly ADP-A2M4CD8) is being investigated in the SURPASS-3 Phase 2 clinical trial (NCT05601752) for the treatment of platinum-resistant ovarian cancer. Uza-cel received FDA RMAT designation in 2022 for the treatment of patients with platinum resistant ovarian cancer. The SURPASS-3 trial is currently enrolling patients.
  • Cohorts in the Phase 1 SURPASS trial are ongoing for people with head & neck and urothelial (bladder) cancers with uza-cel in combination with standard of care checkpoint inhibitor therapy.
Preclinical pipeline
  • IND-enabling studies are underway for ADP-600 (PRAME) and ADP-520 (CD70) programs.
  • Wholly owned allogeneic pipeline advancing; process development in progress at Adaptimmune's allogeneic manufacturing facility in Milton Park, UK.
  • Data presentation
    • Poster presented by George Pope, Ph.D., Associate Director Preclinical Safety at Adaptimmune, entitled "Development and Preclinical Characterization of an Engineered T-Cell Therapy Targeting PRAME-Expressing Solid Tumors" at the American Society of Gene & Cell Therapy (ASGCT) Annual meeting
Corporate news
  • As announced earlier today, Adaptimmune has secured up to $125 million in debt financing with Hercules Capital with the first tranche of $25 million available upon closing; and an additional $25 million available upon afami-cel approval
  • Cash runway into late 2025 which includes current cash on hand, anticipated revenues from the launch of afami-cel, expected future income from partners and other non-dilutive capital sources including the Company's new debt facility with Hercules Capital
  • Company announced that its strategic collaboration with Genentech was terminated
~Financial Results for the three months ended March 31, 2024~
  • Cash / liquidity position: As of March 31, 2024, Adaptimmune had cash and cash equivalents of $140.7 million and Total Liquidity\1]) of $143.7 million, compared to $144.0 million and $146.9 million respectively, as of December 31, 2023.
  • Revenue: Revenue for the three months ended March 31, 2024, was $5.7 million compared to $47.6 million for the same period in 2023. Revenue has decreased in 2024, compared to the same period in 2023 primarily due to the termination of the Astellas collaboration in the first quarter of 2023, resulting in the remaining deferred income for the collaboration being recognized as revenue in March 2023.
  • Research and development (R&D) expenses: R&D expenses for the three months ended March 31, 2024, were $35.2 million compared to $25.5 million for the same period in 2023. R&D expenses in the three months ended March 31, 2024 increased in employee-related costs and additional costs associated with lease properties following the acquisition of TCR2in June 2023 and a decrease in offsetting reimbursements receivable for research and development tax and expenditure credits.
  • General and administrative (G&A) expenses: G&A expenses for the three months ended March 31, 2024, were $19.7 million compared to $20.4 million for the same period in 2023. G&A expenses in the three months ended March 31, 2024 decreased due to restructuring and charges recognised in the first quarter of 2023 and a decrease in other corporate costs due to an increase in accounting, legal and professional fees incurred in relation to the TCR2Therapeutics, Inc merger agreement that were not repeated in 2024, offset by an increase in depreciation due to leasehold improvements capitalised in 2023.
  • Net loss/profit: Net loss attributable to holders of the Company's ordinary shares for the three months March 31, 2024, was $48.5 million ($(0.03) per ordinary share), compared to a profit of $1.0 million ($0.00 per ordinary share), for the same periods in 2023.
Financial Guidance The Company believes that its existing cash, cash equivalents and marketable securities, together with anticipated revenues from the launch of afami-cel, expected future income from partners and other non-dilutive capital sources including the Company's new debt facility with Hercules Capital announced earlier today, will fund the Company's current operations into late 2025, as further detailed in the Company's Quarterly Report on Form 10-Q for the three months ended March 31, 2024, to be filed with the Securities and Exchange Commission following this earnings release.
Today's Webcast Details A live webcast and replay can be accessed at https://www.gowebcasting.com/13334**.** Call in information is as follows: 1-800-806-5484 (US or Canada) or +416-340-2217 (International and additional options available HERE) and the passcode is 3025919#. Callers should dial in 5-10 minutes prior to the scheduled start time and simply ask to join the Adaptimmune call.
About Adaptimmune Adaptimmune is a clinical-stage biopharmaceutical company focused on designing, developing, and delivering cell therapies to transform the lives of people with cancer. The Company's unique engineered T-cell receptor (TCR) platform enables the engineering of T-cells to target and destroy cancers across multiple solid tumor types.
Forward-Looking Statements This release contains "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995 (PSLRA). These forward-looking statements involve certain risks and uncertainties. Such risks and uncertainties could cause our actual results to differ materially from those indicated by such forward-looking statements, and include, without limitation: the success, cost and timing of our product development activities and clinical trials and our ability to successfully advance our TCR therapeutic candidates through the regulatory and commercialization processes. For a further description of the risks and uncertainties that could cause our actual results to differ materially from those expressed in these forward-looking statements, as well as risks relating to our business in general, we refer you to our Annual Report on Form 10-K filed with the Securities and Exchange Commission for the year ended 31 December, 2023, our Quarterly Reports on Form 10-Q, Current Reports on Form 8-K, and other filings with the Securities and Exchange Commission. The forward-looking statements contained in this press release speak only as of the date the statements were made and we do not undertake any obligation to update such forward-looking statements to reflect subsequent events or circumstances.
Total Liquidity (a non-GAAP financial measure) Total Liquidity (a non-GAAP financial measure) is the total of cash and cash equivalents and marketable securities (available-for-sale debt securities). Each of these components appears separately in the condensed consolidated balance sheet. The U.S. GAAP financial measure most directly comparable to Total Liquidity is cash and cash equivalents as reported in the condensed consolidated financial statements, which reconciles to Total Liquidity as follows (in thousands):
https://preview.redd.it/hsnd589f1l0d1.png?width=1318&format=png&auto=webp&s=5c2d7bc5f2f06871993309dc9b4e125672e82dfd
The Company believes that the presentation of Total Liquidity provides useful information to investors because management reviews Total Liquidity as part of its assessment of overall solvency and liquidity, financial flexibility, capital position and leverage.
Condensed Consolidated Statement of Operations (unaudited, in thousands, except per share data)
https://preview.redd.it/6lyfu3gj1l0d1.png?width=1642&format=png&auto=webp&s=7e8d43f0c148dac5f17389d0e6891fbcbe634052
Condensed Consolidated Balance Sheets (unaudited, in thousands, except share data)
https://preview.redd.it/1ro5ubbp1l0d1.png?width=1474&format=png&auto=webp&s=148a070d003d85bcbbc258d996e3f85b586bcb65
Condensed Consolidated Cash Flow Statement (unaudited, in thousands)
https://preview.redd.it/mdyx2ups1l0d1.png?width=1368&format=png&auto=webp&s=fcbea401b0e4a5add6c2f6c41be868a29151fd22
FULL RELEASE: https://www.adaptimmune.com/investors-and-media/news-centepress-releases/detail/268/adaptimmune-reports-q1-2024-financial-and-business-updates
submitted by HotSarcasm to adaptimmune [link] [comments]


2024.05.15 14:02 kinexxona06 Outcast

[Orbital Observatory Update on Client Species #0458-1, Sol III]
[Priority of message: Urgent Emergency]
[Receiver: Glokknar IV - Galactic Security Council]
[Psionic Encryption to view document is advised]
Last update on humans was 789 cycles ago {25 Earth years ago} and now as of 15/05/2024 in the earth calendar, humans have reached a critical development in forbidden technologies that will trigger a singularity event in less than 150 cycles estimated by current models. A major human organisation under the name OpenAI announced their new {translation error} in cooperation with another organisation, namely Apple. This is most likely to me a forbidden technology and after hours of investigation we found it’s called an “Artificial intelligence” or “AI” for short and now possesses a similar cognitive level to that of a human (significantly more intelligent than an average galactic sapient).
It is important to note that humans’ have a much greater advantage in parallel thinking due to the fact that how their brain is structured and their face recognition is at the high end of the spectrum, because of their social nature. Biologically they’re the only bipedal species and their stance is the most unusual in all across the galaxy. It is theorised by many that they may be the descendants of one of the precursor species and the fact that most of the architecture and technologies or technological path they’ve taken suggests that they are most likely to be the descendants of the Olympians. Critical point to note is that after the Great Galactic Selection War, our ancestors millions of cycles ago never found or knew the exact location of the Olympian homeworld.
It appears that in the last 789 cycles what we observed proved many theories that due to the natural environment humans or olympians have been forced to use inorganic technology and started to bend nature to their will. The humans have built everything on their planet out of stone and metal beginning with from their smallest huts up to the largest cities. The sheer abundance of biological resources meant an absurd amount of biodiversity and an estimated 8.7 million species, but it means most of the biomass is actually CONSUMED by humans only. Yes, they are a predatory species that should be noted late on security assembly. From all animal biomass 6% is wild and the rest is bred by the humans for human consumption on the industrial scale for 8.1 billion humans. The obscene amount of food produced by the humans would be able to sustain 4 of the core worlds, but because of the high calorie required to sustain them it’s questionable whether or not they’ll be able to survive in their own next century.
Yes, they are overpopulated at an absurd level, but now it’s unstoppable, because if they stopped their economy and society would collapse. Life expectancy is through the roof.
Back to the main topic. Forbidden technologies such as AI or anything computer related is widely acknowledged in the galactic community and everyone enforces it, but because Pre-FTL civilizations are protected and have to be left alone and let them develop, but because we discovered the humans much later and the development path they took now they are now in such a late stage that it is unstoppable and may cause an existential safety to the continuation to our glorious Galactic Imperium. We have made a list of potential targets to be eliminated in the human elite who lead these researches. We’ll attach the documents along this report to the Galactic Security Council.
They began to dive into cybernetics related to the brain like the Neuralink chip that had already just a few human weeks prior to this report being successfully able to use a human computer and commercial use is only in a few year's time after approved by authorities. The current uprising that is centred around those ancient cyborgs that have awoken are no match to what these precursor apes are going to be able to pull off if we don’t intervene.
This human year will be significant as they’ll start to settle their moon and what the humans call a “space race” start as the major nationstates or private organisations start to lay claim on all of the unclaimed territory. The Forbidden technology that I want to talk about is AI. Humans are the first ones to ever experiment with real artificial intelligence in the new galactic era from the 4598 species. They had the concept since the earliest days of their civilization in the form of mythologies, books, music and art. A visual entertainment media I advise to the military personnel to watch is the Terminator, where the human AI goes berserk and takes control of their nuclear arsenal and wiping its creators out, (sigh) they have tens of thousands of nuclear warheads too. This planet violates every galactic law in existence.
What worries us here at the observation post about humans is the imminent technological singularity in a very short time and effectiveness of their AIs in researching new cures as an example is horrifying. I advice a full revision of Olympian archives and a military mobilisation to prepare for the great return
[Scientist muttering to each other in background]
People, we are confirming human origins to be Olympians and technosignitures confirmed. Waiting Council response.
Sincerely
Head Observer Ukna'h the Third of Osiris
[Transmission terminated and sent for evaluation]
[Expected response: 2 cycles]
[End transmission]
submitted by kinexxona06 to HFY [link] [comments]


2024.05.15 13:47 Total-Mastodon-6888 The Essential Guide to the Immigration Process: Your Roadmap to a New Beginning

The prospect of immigrating to a new country can be both exciting and daunting. It represents a chance to chase dreams, explore new horizons, and build a fulfilling life. However, the immigration process itself can seem like a labyrinth of complex procedures and unfamiliar terminology. Here at Adric Immigration Consultants
in Bangalore, we’re dedicated to empowering you with knowledge and guidance throughout this journey.
This comprehensive guide serves as your roadmap to navigating the essential steps of the immigration process, providing clarity and demystifying the path ahead.
Step 1: Identifying Your Goals and Visa Options
The first step is to clearly define your aspirations. Are you seeking temporary work opportunities, pursuing higher education, or aiming for permanent residency? Understanding your goals will steer you towards the most suitable visa category.
Common Immigration Objectives and Corresponding Visas:
Researching Visa Options:
Each visa category has specific eligibility requirements, application procedures, and processing timelines. Utilize the official government websites of your target country for the most up-to-date information. Here are some helpful resources:
Consulting an Immigration Consultant:
Immigration laws are intricate and constantly evolving. Partnering with a reputable immigration consultant like Adric Immigration Consultants can significantly benefit your journey. Our experienced professionals can:
Step 2: Preparing the Necessary Documentation
Once you’ve identified the relevant visa category, meticulous document preparation becomes crucial. Common documents required for most visa applications include:
Meeting Specific Requirements:
Each visa category might have additional documentation requirements. It’s crucial to meticulously review the specific guidelines for your chosen visa to ensure you submit all necessary documents.
Obtaining Certified Documents:
Certain documents might require translation by a certified translator and official legalization or apostille seals from the issuing authority. Plan accordingly to avoid delays in the application process.
Step 3: Completing the Application Process
Visa applications typically involve online forms and submission of supporting documentation. Here’s a general breakdown of the process:
Step 4: Awaiting the Decision and Potential Next Steps
Processing times for visa applications can vary significantly depending on the visa category, workload of the processing center, and individual circumstances. Once you submit your application, you will receive a tracking number or case ID to monitor the status online.
Approval: If your application is approved, you will receive your visa electronically or affixed to your passport. Carefully review the validity period and any conditions associated with your visa.
Denial: If your application is denied, a notification will be issued explaining the reason for denial. In such cases, consulting with your immigration consultant is crucial. Depending on the reason for denial, you might be able to reapply after addressing the issues or explore alternative visa options.
Administrative Processing: Sometimes, applications require additional administrative processing, which can extend the waiting period. Stay patient and maintain open communication with your immigration consultant during this time.
Step 5: Entering the New Country and Maintaining Status
Once you receive your visa and make travel arrangements, ensure you have all necessary documents readily available for border crossing. Upon arrival, a border officer will verify your documents and grant entry for the authorized period.
Maintaining Visa Status: For temporary visas, it’s crucial to comply with the conditions and duration of your stay. Overstaying your visa can have serious consequences, including deportation and ineligibility for future visas.
Transitioning to Permanent Residency: For those pursuing permanent residency, the process often involves additional steps after initial entry, such as obtaining a green card (U.S.) or permanent resident card (Canada). Adric Immigration Consultants can guide you through these subsequent procedures.
Partnering with Adric Immigration Consultants for a Smoother Journey
The immigration process can be intricate, and navigating it alone can be stressful. At Adric Immigration Consultants in Bangalore, we understand the complexities involved and provide you with the expert guidance and support you need throughout your journey.
Our Services:
Contact us today for a free consultation and let our experienced immigration consultants transform your immigration dream into a reality. With Adric Immigration Consultants by your side, you can embark on this exciting new chapter with clarity, confidence, and peace of mind.
submitted by Total-Mastodon-6888 to u/Total-Mastodon-6888 [link] [comments]


2024.05.15 13:37 Loud_Skirt_7421 Help me type myself

How old are you? What's your gender? Give us a general description of yourself. 17, male Just your average quiet teenager • Is there a medical diagnosis that may impact your mental stability somehow? not that I know of • Describe your upbringing. Did it have any kind of religious or structured influence? How did you respond to it? Growing up isn't a thing I really recall easily, but I was born in a semi-poor family of 4 members(me,brother,and parents ofc), parents didn't really get along and eventually they split up and I had to fill the role of the father for my brother. Mostly my mother would insist on religion and such, and most of my morals are from her. Now I just think some of them are pretty stupid • What do you do as a job or as a career (if you have one)? Do you like it? Why or why not? I am in high school currently, I would like to become a doctor, something that ties into sports because I do karate and I really love this sport (I am at the brown belt currently) • If you had to spend an entire weekend by yourself, how would you feel? Would you feel lonely or refreshed? It could go both ways, either I do something by myself in that weekend or I would like to go hang out with others(on calls mostly just to listen and maybe include myself, joke around and all) but if I really have nothing to do I feel miserable if I stay and think about my current situation, not having much going on for me.. • What kinds of activities do you prefer? Do you like, and are you good at sports? Do you enjoy any other outdoor or indoor activities? Playing on my computer and Karate, I am pretty good at sports now but before I really wasn't in a good physical condition (I was fat). But I prefer both indoor activities and outdoor , but mostly sticking with indoor cause no opportunities to go outside which is sad really... • How curious are you? Do you have more ideas then you can execute? What are your curiosities about? What are your ideas about - is it environmental or conceptual, and can you please elaborate? Not really curious about stuff that aren't of use to me or I don't see value in, like yeah if I need to know something I will hold onto that but for myself for no reason going out to learn something isn't really for me.. • Would you enjoy taking on a leadership position? Do you think you would be good at it? What would your leadership style be? I don't really go for leadership if I don't have a good level of expertise on the subject, but when I do it's good. I try to simplify my strategizing because there's no point in complicating a plan and plus it helps with staying flexible • Are you coordinated? Why do you feel as if you are or are not? Do you enjoy working with your hands in some form? Describe your activity?
I don't know what to answer on this "coordination" thing.. But I do enjoy working with my hands even if it won't be good, from time to time I think about cooking food and such for myself/ family • Are you artistic? If yes, describe your art? If you are not particular artistic but can appreciate art please likewise describe what forums of art you enjoy. Please explain your answer.
No, I used to like it as a kid mostly because of school, it would get recognition and I would actually think "hell yeah I am the best artist!" (kind of), but since it wouldn't get much recognition I stopped being like that.. kind of cringing at my past behaviour honestly • What's your opinion about the past, present, and future? How do you deal with them?
I don't think bout them too much About the past I really don't recall memories, unless it's episodic memory because then I remember what happend all of that , not with all the details tho And I don't stay and think much about my future, I don't like thinking in advance what I'm gonna do but I am indifferent towards it. I try to remain on the lookout for possibilities that could help me later or in the moment
• How do you act when others request your help to do something (anything)? If you would decide to help them, why would you do so?
People don't really come to me for help unless they try to use me(and ofc I don't let them) But it would go one of the two ways: either I help them because I feel obligated too, or actually want to show the person I am interested into something of theirs(this sounds wrong lol) or I simply say no and go on about my day
• Do you need logical consistency in your life?
yeah, I don't really like to have things that make no sense around me which is why I try to make sense of everything even including this system of cognitive functions (which I read a bit but ehh not too sure how they apply to me that is why I am here in the first place)
• How important is efficiency and productivity to you?
Not too much , but I do love when I am efficient and productive. Because in free time if I have nothing to work towards I feel pointless, and miserable.. • Do you control others, even if indirectly? How and why do you do that?
• What are your hobbies? Why do you like them? I do karate and play on my pc, that is pretty much it.. I love doing this sport, I want to continue on practicing this sport and maybe become a coach myself + becoming a doctor for a field like kinetotherapy (i hope that is how you call it idk how it is in english)
• What is your learning style? What kind of learning environments do you struggle with most? Why do you like/struggle with these learning styles? Do you prefer classes involving memorization, logic, creativity, or your physical senses?
I see the logic behind things pretty easy, but when I don't then I still try to make sense of everything. But I learn what I need to go further in what I am doing, and prefer classes where physical senses are used a lot followed by logic and creativity. I like to juggle with the logic of the subject in the moment and see how the equasion in front of me could lay out.
• How good are you at strategizing? Do you easily break up projects into manageable tasks? Or do you have a tendency to wing projects and improvise as you go?
Like I said I try to simplify planning so I try to do the same with strategizing, but sometimes a detailed strategy is the best , and even improvising is good because something could happen and set you off course • What are your aspirations in life, professionally and personally?
To be productive, influence others, eventually control others (for their good/our good)
• What are your fears? What makes you uncomfortable? What do you hate? Why?
I get uncomfortable around people who are in a emotional outburst, and look to me for support. I am bad with emotions.. My fear is being rejected, and exploited in a bad way, even if it doesn't happen (which might be because others consider me intimidating and arrogant, which I don't reslly think I am like that) I still know how to manage it, kind of..
• What do the "highs" in your life look like? Really looking forward to everything, actually having something going on in my life. Being overall happy and enthusiastic
• What do the "lows" in your life look like? First thing that I would say is: melancholy, and thinking deeply about life, in a depressing way. Even my friend said that my “miserable” thoughts align with some philoshopies like nihilism and such. But mostly get withdrawn from others, feeling stuck and unable of changing things and maybe more emotional but when alone • How attached are you to reality? Do you daydream often, or do you pay attention to what's around you? If you do daydream, are you aware of your surroundings while you do so? I am pretty attached to it but when alone I do tend to daydream, and think of possible outcomes if I do that, this etc But even daydreaming I am aware of my surroundings
• Imagine you are alone in a blank, empty room. There is nothing for you to do and no one to talk to. What do you think about?
When I have nothing to do I just think of “what if” scenarios, even in real life when I am bored and disengaged from anything
• How long do you take to make an important decision? And do you change your mind once you've made it?
Depends, I usually try to always be decisive, and I may juggle back n forth with options and outcomes but I really get indecisive for personal stuff but decisive for outside stuff
• How long do you take to process your emotions? How important are emotions in your life?
I don't really mess with my emotions, I just supress them because they will make me feel miserable and melancholic and I dislike feeling like that… a lot
• Do you ever catch yourself agreeing with others just to appease them and keep the conversation going? How often? Why?
I tend to do this a lot with people who I don't know , because I don't know how they'll react so I do this but at the same time kind of closing off the room to chat about it more and such
• Do you break rules often? Do you think authority should be challenged, or that they know better? If you do break rules, why? I don't break rules but I also don't really care about them when doing something just as long as it won't get me punished and it won't harm others (ofc), eventually exploiting them. But I don't really care too much about them cause if you gonna do your job good you won't break them. I dislike having limits from others, it's annoying
I took the Michael Caloz test and it said ENTJ, ESTP and ESTJ most likely results
submitted by Loud_Skirt_7421 to MbtiTypeMe [link] [comments]


2024.05.15 13:09 Zhanglixu35 Medical incurable multiple sclerosis was cured by Buddhism (硬化症)

—— Feedback from a 90S Buddhist practitioner who shared her experiences with tears at the Guan Yin Citta Dharma Door Website.
Gratitude to Namo Sakyamuni Buddha!
Gratitude to the Greatly Merciful and Greatly Compassionate Guan Yin Bodhisattva!
Gratitude to all Buddhas and Bodhisattvas from ten directions and three periods of time!
Gratitude to the Dharma protectors!
Gratitude to the benefactor and benevolent father Master Jun Hong Lu!
Gratitude to my fellow Dharma practitioners!
I am very happy to share with you my path to learning Buddhism in a healthy state. I am a post-90s person, and I am also a devout Buddhist. Previously, I just believed in Buddhism, burned incense and worshiped the Buddha, but I did not know I should recite Buddhist scriptures. In my consciousness, reciting Buddhist scriptures is the business of a monk or nun. It was later when I became acquainted with Buddhism formally that I realized that monks, nuns, laymen monks, and laymen nuns can all recite Buddhist scriptures if they are willing to do so.
I came into contact with Buddhism in the summer of 2018, the year I gave birth to 2 children in a row. My physical state was particularly poor. I suffer from insomnia almost every night. I often got to bed around 10:00 p.m. and woke up around 1:00 a.m., and I was then unable to sleep. During the day, I had to take care of the children and do housework. I often felt physically exhausted.
One night, I remembered that my cousin transcribed Buddhist scriptures. I thought that it would be better for me to do so at home so that I would not be wasting sleepless hours. By transcribing Buddhist scriptures I could cultivate my mind and improve my handwriting. Then, I searched the Internet. They said that transcribing Buddhist scriptures disrespects the Bodhisattva, so I gave up this idea. Then I thought of reciting Buddhist scriptures. The several Buddhist scriptures I found online were not suitable for me.
It might be my affinity with Buddha is ripe, or it is the Bodhisattva's compassion for me. Not long after I saw an article online that said reciting Buddhist scriptures could change one's destiny. I just casually left a comment below:“Can reciting Buddhist scriptures really change destiny?”Back and forth in this way, I added that Buddhist practitioner to my friend list.
What impressed me the most was that practicing Buddhism and reciting Buddhist scriptures are free of charge, and there will be no fees. On the Internet, she shared with me a lot of Buddhist scripture information. Later, she mailed me the Dharma Gems. After receiving the Dharma Gems, I began reciting the Buddhist scriptures, and I kept doing so until my children started school. I became very busy after school started. I did not want to recite Buddhist scriptures anymore. I recited a few Little Houses but did not repay my karmic creditors. Perhaps that is why my karma was activated early.
In the winter, I found that I had a high frequency of headaches, and also suffered left migraines. The left side of the body was soft and numb, especially the left toes and the hand. I wondered if it was the same as my mother's disease. Until December, when my mother again went to the provincial capital hospital due to health problems, did I realize this was a genetic condition. Further, the probability of female inheritance is very high. Then, I searched the Internet for primary multiple sclerosis (MS) symptoms and compared them to my own physical condition. I broke down. I was 26 years old at the time, just entering the age of predestined 369 calamity.
I had just been married for 2 years. I didn't dare tell my husband because I was afraid the family would be broken up. Since I had 2 daughters, I was afraid they would inherit the disease. I didn't dare tell my parents either, for fear of causing psychological pressure on my mom. I bear it alone. My spirit was in a state of collapse every day.
One day, I suddenly remembered a cancer case that was cured by practicing Buddhism, which was shared in a WeChat moment. Why not MS? Again, I contacted the Buddhist practitioner who transformed me. I cried and told her what had happened to me. I asked her if reciting Buddhist scriptures could really heal me. I remembered that she replied to me very firmly, saying it would definitely cure me. That's how I returned to the path of reciting Buddhist scriptures. This time I was with hope and determination in practicing Buddhism. MS can't be cured medically, only managed. I have no way out. I want to change my destiny through Dharma.
Since then, I have frantically read the shared presentations and referred to those practitioners’cases. I want to see how to do merits and virtues by making vows and releasing lives. Once, I made a vow to the sky to release fish worth 1,000 CNY and recited a number of Little Houses. Right at that moment, the left side of my body became much lighter and less numb. I thought it was amazing. It gave me a little more confidence in reciting Buddhist scriptures. When I saw people sharing that vegetarian is good, I made a vow to be vegetarian 2 days a month, then 10 days a month, and then a full-time vegetarian.
My physical conditions were not always as good as I wanted them to be, sometimes good and sometimes bad. I often dream of the dead. Once I dreamed that I had caused a car full of people to fall into the river and die. When I woke up, I hurriedly made a vow to ascend them using the Little House. Master Lu enlightened us that everyone comes into this world with karmic obstacles. Only by constantly reciting Buddhist scriptures, performing merits and virtues and repaying debts can these karmic obstacles be dissolved. Therefore, I knew that my karmic obstacle is from my past life, and I either have to repay it with my body or with reciting Buddhist scriptures. I chose the latter, by reciting Buddhist scriptures to repent of my past sins. Thereafter, whenever I dreamed of the deceased, I would make a vow to recite the Little House for them.
I have also deeply repented gossiping behind people's backs, saying too many bad things about them, and doing too many things behind their backs. Due to unknown the cause and effect, I advised people to divorce. I have been obsessed with worldly love and watched too many romance novels and TV dramas, which has led to my blessings loss. I have taken advantage of small gains and committed very petty thefts. I have deeply repented to this now. I am willing to spend the rest of my life cultivating my behavior and mind! I will recite the Buddhist scriptures and recite Little Houses to pay off my karmic debts.
With time, my symptoms improved: from the 24-hour constant numbness in my hands and feet in 2018, to a little bit lighter in 2019, to 2020 when sometimes these symptoms disappeared for a period of time, to 2021 when the symptoms nearly disappeared but the feeling of recurrence still came back at times, and then to 2022 when I had almost forgotten about MS because the softness and numbness in my hands and feet had completely disappeared. It is only now that I dare to stand up bravely and say I am really cured. This is because I have been free of the MS symptoms for >1 year. I am really grateful to the Bodhisattva! Buddhist scriptures have created miracles for me.
Maybe readers will think I have not done diagnosis tests. How can I tell if I have MS? First of all, my physical symptoms are the same as my mom's. Secondly, this disease is divided into hereditary and non-hereditary forms. Unfortunately, my mom's is hereditary, and she has test results for it. Furthermore, I've googled too much information just hoping it's something else and my faulty senses. One article had a message conversation that caused me to fall into the abyss. That person had the same disease and had been diagnosed, and mine was exactly the same. Honestly, I couldn't go to the hospital for a checkup, because I really couldn't face this reality.
Even though I had already practiced Buddhism, any time I thought of having MS it literally broke me down. Sometimes I would wonder why my hands and feet were still numb and weak after reciting Buddhist scriptures for so long and releasing so many lives. Why is it still not healed? This type of thought made me collapse. After collapsing, I decided to continue practicing because of the fact that this disease cannot be cured medically. Reading Buddhist practitioners’ shared presentations is my only motivation. So many rare and intractable diseases were cured, I firmly believe that the Bodhisattva will save me, too. I don't think words can really express my inner world. My heart always experiences breaking down and healing itself over and over again; then breaking down again and healing itself again.
I am grateful to my cousin for accompanying me all the way and listening to me pour out my sufferings. I am also grateful to Buddhist practitioner Liren for always encouraging me and telling me that this is karma and that reciting the scriptures can eliminate karma. It is only by reciting Buddhist scriptures properly and persistently that I have become the person I am now.
I have changed the most in 2022. This year is also the year of the greatest vow power. After I studied Buddhism in Plain Terms, I understood many truths. Before 2022, I used to recite Buddhist scriptures without understanding why. My mind was not cultivated well, and my merits and virtues were leaked. Before 2022, I ate vegetarian food with five pungent spices. In 2022, I made a vow to be a full-time vegetarian without five pungent spices, be one of the hands and eyes of Guan Yin Bodhisattva to widely transform sentient beings, release 100,000 fish, and recite 1,200 Little Houses specifically for my MS.
As my Master taught, the greater the vow, the greater the merits and virtues, and the faster the karmic obstacles are cleared. Today, sitting here and reminiscing, I am fortunate. This is because I met the Dharma before my karmic obstacles fully flared up. As a result, I was able to pass a major calamity in my life.
I hope my sharing will bring hope to more new Buddhist practitioners! Studying Buddhism and reciting Buddhist scriptures is not superstition. It can really help us dissolve all the problems on earth.
My sharing has come to an end. If there is anything that is not rational or in line with the truth in the presentation, I'd like to seek forgiveness from Namo Sakyamuni Buddha, the Greatly Merciful and Greatly Compassionate Guan Yin Bodhisattva, all Buddhas and Bodhisattvas, and Dharma protectors. I’d appreciate my fellow practitioners' critique and correction!
I, not my fellow practitioners, will be responsible for my own karma!
Presenter: Dharma Practitioner LanLan
Posted: 2023-07-27
Translator: Frank
Published: 2023-08-25
Statement by translator
The story was translated from Chinese into English by meaning, not word by word. If there is anything that is not rational or in line with the true meaning of the Chinese version, I pray for forgiveness from the Greatly Merciful and Greatly Compassionate Guan Yin Bodhisattva, all Buddhas and Bodhisattvas, Dharma protectors and Master Jun Hong Lu.
Propagation
It would be greatly appreciated if you would forward this presentation to all sentient beings you know, sick or healthy. You will accumulate immeasurable merits and virtues. Saving a life is more meritorious than building a seven-floor pagoda!
Would you like to change your destiny?
We will show you how to do the Five Golden Buddhist Practices of Guan Yin Citta Dharma Door: (1) making vows, (2) reciting Buddhist scriptures (sutras and mantras), (3) performing life liberation, (4) reading Buddhism in Plain Terms, and (5) repenting. You will personally witness how you and your family can achieve physical and mental stability, relief from illness and grievances, wisdom growth, academic progress, career advancement, and family happiness through Dharma. It’s free of charge.
Contact
Buddhist practitioner: Lily
Email: [sunnypurplelily@gmail.com](mailto:sunnypurplelily@gmail.com)
WeChat: HanJing20210820
原文如下:
90后师兄含泪分享:医学无法治愈的多发性硬化症通过学佛念经彻底痊愈
——心灵法门网友反馈
2023-07-27
感恩南无释迦牟尼佛!
感恩南无大慈大悲救苦救难广大灵感观世音菩萨摩诃萨!
感恩十方三世一切诸佛菩萨!
感恩龙天护法菩萨!
感恩恩师慈父!
感恩师兄们!
很高兴能在身体健康的状态下和大家分享我的学佛之路。我是一名90后,我也是一名虔诚的佛教徒,只不过,我只是信佛,会烧香,会拜佛,却不会读经。在我的意识中,念经是出家师父的事。后面接触佛法才明白,只要愿意,在家出家都可以念经。
我是在2018年暑假的时候接触佛法,那年我是连着生完两个孩子,身体状态特别差,几乎每晚都失眠,经常10点左右睡,1点左右醒,然后就开始失眠。白天又要带孩子做家务,整个人经常觉得体力不支。
有次晚上无意想起表妹会抄经,我想着自己在家没事这样失眠浪费时间还不如也抄经,既可以修心也可以练练字。然后就上网搜索,网上说抄经对菩萨不尊敬,然后又打消了这个念头,又想着读经,结果网上搜索了几种经文,都觉得不适合自己。
也许是佛缘成熟,也许是菩萨慈悲我,没多久我在网上看见一篇文章说念经可以改变命运,我就随缘在下面留言说:念经,真的可以改变命运吗?这样一来二往,我加上了那位师兄。
印象最深的是,学佛念经都是免费的,不会有任何费用。在网上她给我分享了好多经文资料,后面也给我邮寄了法宝,我收到后就开始念经,坚持到孩子开学,孩子开学后每天很忙碌,就不想读经了,经文组合小房子读了几张,也没有烧送,就这样一直放着。也许是这个原因提前激活了业障。
到了冬季,我发现我头痛的频率高了,而且有些奇怪的还出现左偏头痛,还有身体左边有些发软、发麻,特别是左边的脚指头和左边的手,当时也有怀疑是不是和我妈妈的病一样,但也只是怀疑,不敢过多地想。直到12月,我妈又因为身体原因需要去省城住院,结果这次住院的经历让我发现,我妈这个病是遗传病,遗传女性的概率很大,然后我在网上搜索多发性硬化症的初级症状,再对照自己的身体状况。整个人都开始崩溃了,那年我是26周岁,正逢“三六九”关劫。
那会我也刚结婚两年,我不敢告诉我先生,我怕这个家会散,而且我生的是两个女儿,我也怕她们会遗传。我也不敢告诉爸妈,我怕给我妈造成心理压力。就这样一个人扛着,精神每天处于崩溃的状态。
回到家后,我就突然想起师兄朋友圈分享的癌症都能好,我又联系度我的师兄,哭着和她说了我的事,问她我念经真的能好吗,记得她非常坚定地回复我说一定能好。就这样,我又开始了念经的道路,只不过这次带着希望在读,更加坚定了一些,因为这个病在医学上无法解决,只有控制,我没有任何办法,想通过佛法来改变命运。
此后,我疯狂地看分享,参考大家的灵验分享,看大家如何许愿放生做功德。有次我对着天空许愿放生1000元的鱼,念诵多少张经文组合小房子。当时这个左边的身体发软发麻的状态就轻了许多,我当时觉得好神奇,也给我增加了一点念经的信心。此后,我看大家分享吃素好,我就许愿一个月两次,再一个月10天,再后面吃全素。
我许愿吃全素这个过程很短,因为我想早点让自己好。可事情总是不尽人意,时好时坏。在念经这段道路上,我也经常梦见亡人,有一次还梦见自己把一车的人弄得掉进河里死了,醒来后赶紧地许愿给他们读诵经文组合小房子。师父说过,每个人都是带着业障来到这个世界,只有通过不断地念经做功德还债才能化解这些业障。所以,我知道这是我前世的业障,要么用身体还,要么用经文还。我选择后者,用经文去忏悔我的过往。所以此后,只要梦见亡人,我都会许愿读经文组合小房子。
我也深深忏悔,我曾经背后乱嚼舌头,说了太多人家的坏话,做了太多背后阴人的事;曾经不明因果,劝人离婚;曾经迷恋世间的情爱,看了太多的爱情小说和电视剧,导致福报尽损;曾经爱占小便宜,做了很小偷小摸的事;我现在都深深地忏悔,愿意用我的余生好好地修心修行,好好地学佛念经念经文组合小房子还债。
经过我不断地读经消业,我的症状也有所改善,从2018年的24小时手脚持续发麻,到2019年的症状轻了一点,再到2020年有时这些症状会消失一段时间,再到2021年,症状可以说消失,但有时还是会复发的感觉,再到2022年,我几乎把这个病给忘记了,因为手脚那些发麻发软的感觉都消失了。直到现在,我才敢勇敢站出来说,我真的好了,因为我已经有一年多没有这些症状了。真的感恩菩萨!经文的灵验在我这里创造了奇迹。
也许大家会觉得我没有做任何检查,如何判定自己就是这个病呢?首先,是身体的症状和我妈妈的一样;其次,这个病分遗传和不遗传,很不巧,我妈的是遗传,这个是有检测报告的;再者,我上网搜了太多的资料,就希望是其他原因,是我的错感。尤其有一篇文章的留言对话,让我跌入深渊,对方也是这个病,已经确诊,而我的是一模一样,说实话,我真的没法去医院检查,我真的没法面对这个现实。
虽然我已经念经了,但一想到这个问题我真的每次都是崩溃。就这样我抱着念经的信念,坚持了一年,有一点点地改变,有时候也会怀疑,我已经读了这么久的经,我放生这么多了,为啥还是手脚发麻发软?为什么还是不见好转?崩溃之后依旧是继续,因为这个病真的医学上没法解决,看着师兄们的分享,是我唯一的动力。那么多的疑难杂症都能好,我坚信菩萨会救我的。我觉得文字真的无法来表达我的内心世界。内心总是反反复复地崩溃,自愈;再崩溃,再自愈。
这一路感谢我的表姐,一路的陪伴我,听着我倾诉苦水;也感谢丽人师兄,一直鼓励我,告诉我,这个就是业障,读经就能消业障,好好读,坚持读,才成就的现在的我。我在2022年变化最大,这年也是愿力最大,我学习《白话佛法》,明白了很多的道理,以前就是一味地读经,根本不明白,心没修好,功德有漏。我之前吃素都是吃带五辛的,2022年我许愿全素,许了做菩萨的千手千眼广度有缘人,许了余生放生10万条鱼,还针对这个病许愿1200张经文组合小房子,已经烧送了一部分。就像师父说的,愿力越大,功德越大,业障也消得快些。所以今天坐在这里回忆过往,我是幸运的,在业障还没全面爆发,我遇见佛法,让我化解了人生的一道大坎。也希望我的分享能给更多的新人带来希望的光!学佛念经不是迷信,是真的可以帮助我们化解人间所有问题。
我的分享结束了,分享中如有不如理不如法的地方,请南无释迦牟尼佛慈悲原谅,请南无大慈大悲观世音菩萨慈悲原谅,请十方三世一切诸佛菩萨和龙天护法菩萨慈悲原谅,请师兄们批评指正。我自己的业障自己背,不让师兄们背。
分享人:蓝蓝师兄
来自:师父博客
您想改变命运吗?
我们手把手传授您观世音菩萨的心灵法门五大法宝:“许愿”、“放生”、“念经”、“读《白话佛法》、大忏悔”。您将亲自见证如何通过佛法让自己及家人获得身心安定、病苦解除、冤结化解、智慧增长、学业进步、事业提升、家庭幸福。免费学习,免费结缘。
欢迎联络Lily佛友:sunnypurplelily@gmail.com
或者加Lily佛友微信:HanJing20210820
Disclaimer of Liability:
The contents of the presentation and answers, including text, images, and other information obtained from Dharma practitioners, are provided strictly for reference purposes. Due to the unique nature of individual karma, results similar to those experienced by the authors may not be replicated. The experiences and advice shared should not be construed as medical advice or a diagnosis.
In the event of an emergency, it is crucial to promptly contact your doctor or emergency services by dialing 911. Relying on any information found in the answers is done solely at your own risk. The translator and answerer bear no responsibility for the consequences. By using or misusing the contents, you accept liability for any personal injury, including death. It is imperative to exercise caution and seek professional medical guidance for health-related concerns.

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2024.05.15 12:30 NoNotThisPig Convertibility Question re Transamerica Super Trendsetter 15-Year Level Term Plan

Hello,
I am having a heck of a time figuring out my conversion options (term whole) for my current Transamerica Super Trendsetter 15-Year Level Term Plan, and any help about what the boilerplate in this specific plan says would be appreciated. My goal is to convert it as close to the end of the convertibility period as is safely possible, in order to pay the lower term premium while I can, without triggering the need for another medical check-up/physical.
I asked my agent about convertibility and he said that they are typically convertible for 5 years after being written. I wanted to be sure so I called Transamerica and the rep said it's convertible for the whole 15-year term. With this discrepancy, I asked how to request a copy of my policy be emailed to me, since I couldn't find it in the customer portal. Prior to building a relationship with a "real life" agent, I originally bought it online through an online 3rd party broker (PolicyGenius) and never received a physical copy -- I'm a pack rat with vital records, auto/home records, etc.! I requested my policy online and they sent me a confirmation of insurance. Not good! Then I called and they sent me a form that I either needed to fax or mail in with a $25 check. I initially faxed the form in a couple months ago... nothing! Then I mailed it with a physical check about a month ago... nothing again!
So here I am, trying to figure out what my options are because I do *NOT* want to miss my window to convert without a health update, due to certain changes in my health.
Here are some relevant details from my Transamerica portal... Thank you for any help! I'm getting confused/frustrated by the inconsistent answers I'm receiving and the lack of responsiveness from Transamerica.
Policy Information
Policy Number:
xxxxxxxxxxxxxxxxxxx
Policy Type:
TERM LIFE INSURANCE POLICY
Product Name:
SUPER TRENDSETTER 15 YR LEVEL
Policy Date:
AUG 04 2020
Financial Details
Face Amount:
$500,000.00
Paid To Date:
AUG 04 2024
Premiums/Billing
Last Premium Deposit Date:
AUG 14 2023
Annual Premium (next 12 months):
$220.00
Modal Premium Amount:
$220.00
Payment Frequency:
ANNUALLY
Payment Method:
DIRECT BILLING
Coverage Information
Information As Of:
MAY 15 2024
Policy Number:
xxxxxxxxxxxxxxxx
Policy Type:
TERM LIFE INSURANCE POLICY
Kind Code:
N/A
Plan Code:
TD549B
Product Name:
SUPER TRENDSETTER 15 YR LEVEL
Risk Class:
PREFERRED PLUS NON-SMOKER
Face Amount:
$500,000.00
Policy Fee:
$30.00
Issue Date:
JUL 27 2020
Status:
INFORCE PREM PAYING
submitted by NoNotThisPig to LifeInsurance [link] [comments]


2024.05.15 12:01 AutoModerator Introduction and Daily Picture Thread

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2024.05.15 11:07 Simran_Rajput Quick & Easy: Dubai Tourist Visa Processing Time

Quick & Easy: Dubai Tourist Visa Processing Time

https://preview.redd.it/ed7w0ydc3k0d1.jpg?width=1920&format=pjpg&auto=webp&s=9c4f0f286247e2aff52e26f0566a56f83bb803ba
Dubai, with its breathtaking skyscrapers, luxurious shopping malls, and vibrant culture, has become a dream destination for travelers worldwide. Whether you're planning a leisurely holiday or a business trip, obtaining a tourist visa is the first step towards exploring the wonders of this mesmerizing city. Understanding the processing time for a Dubai tourist visa is essential for efficient trip planning.

Different Types of Dubai Tourist Visas

When it comes to visiting Dubai, there are primarily two types of tourist visas:

Short-term Tourist Visa

Ideal for travelers planning a short stay in Dubai, this visa typically allows for a duration of 30 days and can be extended for an additional fee.

Long-term Tourist Visa

For those looking to explore Dubai for a more extended period, the long-term tourist visa provides a stay duration of 90 days, with the option for extension.

Processing Time for Dubai Tourist Visas

The processing time for a Dubai tourist visa can vary based on several factors.

Factors Affecting Processing Time

  • Type of Visa: Short-term visas generally have a quicker processing time compared to long-term visas.
  • Application Volume: During peak travel seasons, such as holidays or special events, processing times may be longer due to increased demand.
  • Completeness of Documentation: Providing all necessary documents accurately can expedite the processing time.
  • Nationality: Processing times may vary based on the applicant's nationality and the diplomatic relations between their country and the UAE.

Average Processing Time

On average, the processing time for a Dubai tourist visa ranges from 3 to 5 working days. However, this timeframe may vary depending on the factors mentioned above.

Expedited Visa Processing Options

To cater to travelers with urgent travel plans, Dubai offers expedited visa processing options.

Premium Processing Service

Travelers can opt for premium processing services offered by authorized visa agencies or directly through the UAE's government portals for faster visa approval. This service usually incurs an additional fee but ensures quicker processing times, often within 1 to 2 working days.

Urgent Visa Processing

In cases of emergency travel, such as medical emergencies or unforeseen business obligations, applicants can request urgent visa processing. While this option is available, it is subject to approval by the immigration authorities and may incur extra charges.

Tips to Expedite Visa Processing

While the standard processing time for a Dubai tourist visa is reasonable, certain steps can help expedite the process further.

Complete Documentation

Ensuring all required documents are provided accurately and in the specified format can prevent delays in processing.

Opt for Premium Services

Investing in premium processing services can significantly reduce the waiting time for visa approval, making it an ideal option for travelers with tight schedules.

Apply Early

Applying for a tourist visa well in advance of your planned travel dates allows ample time for processing and minimizes the risk of last-minute delays.

Common Delays and Solutions

Despite efforts to expedite visa processing, certain issues may cause delays.

Document Verification Issues

Incomplete or inaccurate documentation can lead to delays. Double-checking all documents before submission can mitigate this risk.

Background Checks

In some cases, additional background checks may be required, prolonging the processing time. Cooperating fully with the authorities can help expedite this process.

Technical Glitches

Occasional technical issues with the online application portals may cause delays. Patience and regular follow-ups can help resolve such issues promptly.

Conclusion

Obtaining a Dubai tourist visa is a straightforward process, with standard processing times ranging from 3 to 5 working days. However, travelers with urgent travel plans can opt for expedited processing services to ensure a quick turnaround. By adhering to documentation requirements, exploring premium processing options, and applying early, travelers can streamline the visa application process and embark on their Dubai adventure with ease.

FAQs

How long does it take to process a Dubai tourist visa?

The processing time for a Dubai tourist visa typically ranges from 3 to 5 working days, depending on various factors such as visa type, application volume, and completeness of documentation.

Can I expedite the processing of my Dubai tourist visa?

Yes, travelers can opt for premium processing services or request urgent visa processing for faster approval, usually within 1 to 2 working days, albeit at an additional cost.

What documents are required for a Dubai tourist visa?

Required documents may include a valid passport, completed visa application form, passport-sized photographs, travel itinerary, proof of accommodation, and financial statements, among others.

Are there any additional fees for expedited visa processing?

Yes, expedited visa processing services typically incur additional fees, which vary depending on the chosen service provider and the urgency of the request.

Can I track the status of my Dubai tourist visa application online?

Yes, applicants can track the status of their Dubai tourist visa application online through the UAE's official visa application portals, providing transparency and peace of mind throughout the process.
submitted by Simran_Rajput to u/Simran_Rajput [link] [comments]


2024.05.15 10:52 TangerineJust6591 Cultivating Connections: The Ultimate Guide to Building Your Doctor Email List

In today's digital age, cultivating connections with your audience is essential for success in any industry, and the field of healthcare is no exception. One of the most effective ways to establish and nurture these connections is through email marketing. In this comprehensive guide, we'll explore everything you need to know about building and growing your doctor email list.
Introduction
Building a robust email list of doctors and healthcare professionals is crucial for staying connected with your target audience. Whether you're a pharmaceutical company, medical equipment supplier, or healthcare service provider, having direct access to doctors via email can significantly impact your marketing efforts.
Identifying Your Target Audience
Before you can start building your email list, it's essential to clearly define your target audience. Are you targeting general practitioners, specialists, or a specific medical field? Segmenting your email list based on factors such as specialty, location, and interests will allow you to tailor your messages for maximum impact.
Creating Compelling Opt-In Offers
To entice doctors to subscribe to your email list, you need to offer them something of value in return. This could be exclusive access to industry insights, free resources such as e-books or whitepapers, or special discounts on your products or services. These opt-in offers, also known as lead magnets, should address the pain points of your target audience and provide solutions.
Optimizing Your Website for Sign-Ups
Your website plays a crucial role in attracting new subscribers to your email list. Make sure to design user-friendly opt-in forms and place them strategically on your website where they're easily visible. Experiment with different types of opt-in forms, such as pop-ups, slide-ins, or embedded forms, to see which ones perform best.
Leveraging Social Media for List Growth
Social media platforms are powerful tools for promoting your email list and reaching a broader audience of doctors and healthcare professionals. Share compelling content related to your industry and encourage your followers to subscribe to your email list for more valuable insights and updates.
Implementing Email Marketing Best Practices
Once you've built your email list, it's essential to follow best practices to ensure your campaigns are effective. Personalize your emails based on the recipient's interests and preferences, and send relevant and timely content to keep them engaged. Avoid spammy tactics and focus on providing value to your subscribers.
Tracking and Analyzing Your Email Metrics
Tracking key metrics such as open rates, click-through rates, and conversions will help you measure the success of your email campaigns. Use this data to identify what's working and what's not, and make adjustments accordingly to optimize your email marketing strategy.
Maintaining List Hygiene
Regularly cleaning your email list is essential for maintaining its health and effectiveness. Remove inactive subscribers and avoid spam traps to ensure your emails reach the inbox rather than the spam folder. Pay attention to your sender reputation and take steps to improve it if necessary.
Building Relationships Through Email
Email marketing is not just about sending promotional messages; it's also about building meaningful relationships with your subscribers. Engage with them regularly through personalized emails, and provide value by sharing helpful tips, resources, and industry news.
Offering Exclusive Benefits to Subscribers
Make your email subscribers feel special by offering them exclusive benefits such as discounts, promotions, or early access to new products or services. This will incentivize them to stay subscribed and continue engaging with your emails.
Collaborating with Other Professionals
Consider partnering with other healthcare professionals or organizations to expand your reach and grow your email list. Cross-promote each other's services or products to reach a broader audience of doctors and healthcare professionals.
Staying Compliant with Regulations
It's essential to stay compliant with relevant regulations such as GDPR when building and managing your email list. Obtain explicit consent from subscribers before adding them to your list, and respect their privacy by providing options to unsubscribe and manage their preferences.
Continuously Growing and Nurturing Your List
Building an email list is an ongoing process that requires continuous effort and attention. Experiment with different strategies to attract new subscribers, and regularly engage with your existing audience to keep them interested and invested in your brand.
Measuring Success and Adjusting Your Strategy
Set clear goals for your email marketing efforts and regularly monitor your progress towards achieving them. Analyze your email metrics to identify areas for improvement, and be willing to adjust your strategy based on what's working and what's not.
Conclusion
Building a doctor email list is a powerful way to cultivate connections and engage with healthcare professionals in a meaningful way. By following the strategies outlined in this guide and consistently providing value to your subscribers, you can establish yourself as a trusted authority in your industry and drive meaningful results for your business.
submitted by TangerineJust6591 to u/TangerineJust6591 [link] [comments]


2024.05.15 09:48 red-12monkey Seeking advice

Hello and Good day all,
**Background**
I am an expat. Renting a house for one year. One year payment have been made. I have EJAR contract (all online, absher verifiable). All rental process went through in one real estate agency (lets call it 'Snail'). Few weeks ago, I found Eviction notice pasted outside the main door. Picture attached. I never receive any court notice or any sms regarding any court proceeding. I have conducted some due diligence.
**Due Diligence/What transpired within +- 2 weeks** in chronological order.
• *Snail's Director* : I texted him. According to him, owner have a problem and he is trying to solve the eviction notice. Told me not to worry.
• *Officemate A's cousin* : He is in the real estate industry. He confronted (by phone) Snail's director because he noticed that Snail the company and its director was name as Lessor and Lessor representative respectively. He also asked what happen with the eviction notice because I have valid Ejar contract.
Shocked by the call, snail's director mentioned that he needed to sell the house because his father needed money for treatment. After been pressed futher, Snail director folded and said I can remain until the tenancy end.
• *Officemate B's father* : Hes in the government (unknown department). According to him, aslong Ejar contract is valid. I cannot be evicted.
• *EJAR's office* : Show them the eviction notice. They said its fake. And that my Ejar contract is valid. If i want to lodge a report, go to REGA (real estate general authority).
• *REGA* : Went to the office Rega told me the notice is fake and to lodge complaint online. Complaint file and later the ticket status is 'Closed'. Received call from Rega asking me to lodge police report.
• *Enforcement Officer ('Repoman') : Texted him asking about the notice. I send him my Ejar contract. But he insisted i get out in a week. He also mention I need to talk to court if Im not happy.
• *ETC lawyer friends/district neighbors* : Reiterated, aslong Ejar contract is valid. Cannot be evicted.
**Fast forward to Yesterday**
A man claiming to be real owner (never met him before) said hello and ask me to wait 10 minutes. Later a police sergeant came along with a guy claiming to be officer from the court (his number appear at the bottom of the eviction notice). Three of them threathens me to give vacant possession to them immediately.
I called a local neighbour (lets call him 'Hat' for now) to assist me to speak Arabic with them.
The owner keeps on screaming that my Ejar contract is fake. The police took a hold of my Iqama and keep it with him, he stayed in the car. Repoman kept saying I acknowledged him because Ive texted him before. Hat argued back and forth with them. Hat managed to calm the owner down saying if anything I was a victim too and to give me time to vacate the house.
• *Hat* : Owner said he rented the house to Snail at 20 coins but he never received any rent for 2 years. He then find out that Snail has rented the house to me for 50 coins.
Further, Repoman took copy of my Ejar contract. According to him, he will bring my Ejar to the judge to see if he should proceed with the Eviction notice or seek further instruction.
Hat manage to get the owner to agree in principle after he gotten vacant possession, I could rent it back, at a lower rate. [Safe to say I have my doubt].
• *Snail's Team Member* : Received a call from unknown man claiming to be Snail's team member. According to him, Snail is a broker and owner trying to raise the rental. They had disagreement and hence the eviction notice. He also said that if i leave, Snail will reimburse balance of my rent by this week. I told him, I need time to think of the conpensation because this has caused inconvenience for me and I need to look for a new house. Also, ig we agree he must start the termination process in Ejar because the one who started the termination have to reimburse the other.
**Present**
• *REGA* : Trying to ask rega to verify the eviction notice again because I was ambushed by 3 guys prior. And if what the owner claiming is legit. Is my Ejar contract valid?.
Rega asked me to file new complaint to investigate the Ejar contract. They told me not to worry. I am very worried because I am in a foreign country without family support. Rega ask me to check the validity with the court.
• *Court* : Went to the counter. Was told that the eviction notice is with a judge now. I am not sure if my Ejar contract was attached to the notice or not. Ask me to come back in a week.
**TLDR :** I rent a house through real estate agent. I never known/met the owner. Owner and agent had disagreement. Owner obtained an eviction notice on the house. I was told that I have valid rental agreement and cannot be evicted. Owner bring police and repoman to threathens and evict me. I am clueless and in despair, not sure who to trust. Still not solve. Still finding the truth/answer. Waiting for court solution (if any).
**My question**
  1. Can a property be rented twice using Ejar system?
  2. Can agent rent a house as a broker against the will of the owner? If yes how? He have to fraudulently/knowingly fill the online form wrongly?
  3. How does Ejar verify if the property can be was rented by a rightful Landlord?
  4. Are my right as tenant protected if Snail comitted fraud? (Where i am a 'bona fide' tenant/victims/bystander).
Any advice/suggestions/share similar experience?
Thanks in advance.
submitted by red-12monkey to Riyadh [link] [comments]


2024.05.15 09:33 SuspectWide4924 Dabble (bookie) refusing to payout citing fraud.

EDIT - obviously everyone here is siding that the bookie is allowed to ask these questions, yet they've not cited AML/CTF or any KYC regulations all they've said is "advance customer due diligence" We went back and forth with them for quite a while and all they've cited is Fraud. I asked them to explain the decision they have yet to respond.
"Asking for a friend after recent opinions showed me a different way to deal with these crooks."
They've used dabble on and off for over 6 months. provided all verification upon sign-up and has lost quite a bit since then, withdrawn various amounts but significantly in the red all-time. Never had an issue previously but they've paid out all withdrawals prior, withdrew $515 overnight and woke up in the morning to this:
This is a courtesy email in regards to your account. We are needing to further verify your account, as part of our Advance Customer Due Diligence in relation to accounts with Dabble.
We need you to verify the following:
Asking for sensitive info such as full bank statements, pictures of all credit/debit cards/passport/medicare/ID all with selfies while holding them.
After back and forth they've sent this as the right to withholding winnings.

12. Fraud

12.1 We reserve the right to withhold deposited funds and/or winnings from settled bets should we determine that a deposit or withdrawal has been made fraudulently. Any matters of inappropriate or fraudulent use of any deposit method will be reported to the relevant authority. Your Account may also be closed. 12.2 Dabble Sports may employ third party technologies to track and store technical information on the device that Customers choose to use. Customers accept that this data may be used to reach decisions on investigations where Accounts have been operated in a manner which is contrary to these Rules or applicable laws, including but not limited to Account takeover, bonus or betting abuse, multiple Account operations, and payment fraud. 12.3 Dabble Sports reserves the right to close the Accounts of, and void any or all bets made by any person, group of people or corporation in an attempt to defraud Dabble Sports. 12.4 Dabble Sports may periodically review Accounts to monitor any activity that it might consider unusual. Dabble Sports reserves the right to suspend an Account pending an investigation, without notice. 12.5 Dabble Sports does not permit beneficial owners that are not the registered account holder, or any arrangements or schemes that do or may facilitate this. Where we reasonably suspect a third party beneficial owner, we reserve the right to close the Account and/or void any resulted or pending bets on your Account.12. Fraud
Just wanted to get some clarity about this, is this even enforceable? How can you claim fraud after 6 months of account usage?
TLDR : Blocked account and withdrawal requesting sensitive info, now citing fraud when questioned about it
What does everyone here think? I've suggested my opinions but i'm not a lawyer let alone trained in anything.
submitted by SuspectWide4924 to AusLegal [link] [comments]


2024.05.15 08:04 alittlebitweird__ Raised liver results - Due to gallbladder, or sore throat?

38 Female.
Bit of a boring question but hopefully a quick answer for you :) would really appreciate your opinions.
Recent medical history: gallbladder-like attacks under investigation.
I’ve been having gallbladder like attacks for the last 1-2 years.These are increasing in frequency and severity particularly since January. Normal HIDA scan, normal CT, ultrasound only shows multiple polyps up to 9mm. No stones seen to date. Being reviewed for SOD. So basically, loads of attacks and no medical explanation for what’s causing the pain episodes.
I had a really severe attack on Sunday night. I can handle a fair amount of pain, but this was an easy 10/10 on the pain scale. I took myself to the after-hours doctors and asked them to run bloods. They gave me a form and I did the tests the following day (so, around 18 hours later I guess).
The liver enzymes have come back very mildly raised (my usual for many years has been between 10-16, my result this time was 50. The cut off of normal here is 43). My CRP is also extremely mildly elevated at about 8. More than my usual 0-1, but I know that’s still very low for CRP (I’ve had sepsis and seen massive numbers for CRP before).
Is it more likely the liver result is due to the attack I had the night prior? OR - At the time I was also on day 6 of a virus (sore throat and sinus), is it more likely due to that? I should add I get my bloods taken on a frequent basis and my liver is never elevated even when I’ve been sick in the past. I have little kids so I’m often struggling with a cold of some sort when having my bloods regularly done.
Anyway. I’d appreciate opinions. This has been ongoing for soo long, and it’s getting so bad and I just want some answers of what’s going on. I’d feel a lot better, and relieved, if the liver result was a clear indicator of a gallbladder issue so I have something more concrete to discuss with the doctors.
Thank you
submitted by alittlebitweird__ to AskDocs [link] [comments]


2024.05.15 07:25 Total-Mastodon-6888 Top 10 Mistakes to Avoid in Your Visa Application

The prospect of embarking on a new adventure in a foreign country can be exhilarating. However, the visa application process
can often feel like navigating a complex maze, riddled with potential pitfalls. At Adric Immigration Consultants in Bangalore, we understand the importance of meticulous preparation when applying for a visa. Here, we unveil the top 10 mistakes to avoid, ensuring your application journey is smooth and successful.
1. Incompleteness and Inaccuracy: The Cardinal Sins
Missing Information: Leaving sections blank or failing to provide all the requested documentation is a recipe for application rejection. Always double-check the application form and ensure you have gathered all the necessary documents well in advance.
Inaccuracies and Inconsistencies: Typos, factual errors, or discrepancies between your application form and supporting documents can raise red flags for immigration officers. Proofread your application meticulously and ensure all details are consistent across all documents.
Unrealistic Travel Dates: Be realistic when specifying your intended travel dates. Delays in processing are common, so factor in a buffer period between your application submission and planned travel dates.
2. Applying for the Wrong Visa: Choosing the Right Path
Misunderstanding Visa Categories: Different visa categories cater to specific purposes, such as tourism, work, or studies. Thoroughly research the visa options offered by your target country and choose the one that aligns perfectly with your travel goals. Don’t hesitate to seek professional guidance if you’re unsure about the most suitable visa category.
Ignoring Eligibility Requirements: Each visa category comes with specific eligibility criteria. Failing to meet these requirements can lead to an immediate rejection. Carefully review the eligibility requirements for your chosen visa category and ensure you qualify before initiating the application process.
3. Failing to Disclose All Information: Honesty is the Best Policy
Misrepresenting Information: Tempting as it might be to omit certain information, complete honesty is crucial when applying for a visa. Fabricating facts or failing to disclose past travel history or criminal records can have severe consequences, including permanent visa ineligibility.
Undeclared Financial Resources: Proof of sufficient financial resources is often a mandatory requirement for many visa applications. Underestimating your expenses or failing to provide adequate financial documentation can raise concerns about your ability to support yourself during your stay.
4. Missing Documentation: Leaving Gaps in Your Story
Incomplete Documentation: Every visa application requires specific supporting documents. Missing documents can create delays or lead to rejection. Carefully review the required documents list and ensure you have everything in order before submitting your application.
Outdated Documents: Certain documents like medical certificates or police clearances have expiry dates. Ensure all your supporting documents are valid and current as per the application requirements.
Improper Translations and Authentication: If any of your documents are not in the official language of your target country, ensure they are translated by a certified translator and bear proper apostille seals or legalization if mandated.
5. Neglecting Application Fees: Don’t Forget the Formalities
Missing Fees: Visa applications often come with associated fees. Failing to pay the correct fee at the designated time can delay your application processing or lead to rejection. Research the applicable fees beforehand and ensure timely payment through the designated channels.
Forgetting Additional Costs: Beyond the official application fee, there might be additional costs associated with medical examinations, biometric data collection, or courier services. Factor in all potential costs when planning your visa application budget.
6. Failing to Meet Deadlines: Time is of the Essence
Missing Deadlines: Visa applications have specific filing deadlines. Late submissions can lead to complications, missed opportunities, or even application rejection. Plan ahead, gather your documents well in advance, and submit your application before the deadline.
Improper Scheduling (Interviews): For certain visa categories, a visa interview with a consular officer is mandatory. Treat this interview seriously, schedule it well in advance to avoid last-minute complications, and arrive promptly on the designated date.
7. Inadequate Travel Insurance Coverage: Be Prepared for the Unexpected
Insufficient Coverage: Travel insurance can be a visa requirement for some countries. Ensure your chosen travel insurance plan offers adequate coverage for medical emergencies, trip cancellations, and repatriation costs.
Neglecting Specific Requirements: Some countries might have specific travel insurance coverage requirements. Double-check if your chosen plan fulfills the minimum coverage mandated by the visa category.
8. Underestimating Processing Times: Patience is Key
Unrealistic Expectations: Visa processing times can vary significantly depending on the visa category, workload of the processing center, and individual circumstances. Research the average processing times for your chosen visa and be prepared for potential delays.
8. Underestimating Processing Times: Patience is Key (continued)
Frequent Inquiries: While it’s understandable to be eager about the status of your application, avoid bombarding immigration authorities with inquiries. Most processing centers offer online portals where you can track the progress of your application.
9. Failing to Prepare for the Interview: Opportunity Knocks Once
Lack of Preparation: If a visa interview is required for your application category, thorough preparation is key. Research common interview questions, anticipate potential inquiries related to your travel plans and purpose of visit, and practice your responses beforehand.
Unprofessional Demeanor: Dress appropriately, arrive on time, demonstrate confidence and respect during the interview. First impressions matter, and a professional demeanor can significantly improve your chances of approval.
Unclear Communication: Speak clearly and concisely, answer questions directly, and avoid providing vague or contradictory information. Effective communication can significantly enhance your interview experience.
10. Going it Alone: Seek Expert Guidance
Lack of Knowledge: Immigration laws are intricate and constantly evolving. Navigating the complexities of the visa application process alone can be overwhelming. Partnering with a reputable immigration consultant like Adric Immigration Consultants in Bangalore can provide invaluable support throughout your journey.
Benefits of Professional Guidance:
Your Trusted Partner on the Path to Success
At Adric Immigration Consultants, we understand that the visa application process can be daunting. With our extensive experience and in-depth knowledge of global immigration regulations, we are here to guide you every step of the way.
Contact us today for a free consultation and let us turn your immigration dream into a reality. Together, we can ensure you avoid these common pitfalls and navigate the visa application process with confidence and clarity.
submitted by Total-Mastodon-6888 to u/Total-Mastodon-6888 [link] [comments]


2024.05.15 06:18 bearsbeets-bgalatica Urgent: Process for getting into Basistarif?

Hallo, everyone. I’m having a crisis and am not sure where to turn to, so I am hoping to find some help or guidance from you all here.
I am an American Master’s student studying in Germany and I need to apply for the Basistarif, but I really have no idea how to go about getting it. I have read the Wiki here, the Basistarif Wiki, every article and blog I could find online about it, met with two insurance brokers, gone to TK for help, gone to the international students office at my university, and left messages and emails saying I want to apply for the Basistarif with multiple private health insurance companies.
For background information:
• I am in a dual degree program (a university in Germany and a university in Sweden) and studied in Germany for my first year. I then went to study in Sweden for my second year and moved back to begin and complete my thesis back here in Germany for my third year.
• Upon entry into Germany the first year of my program, my program advisor advised me to opt out of public health insurance and move into private health insurance as she said the coverage was better (she told me about a scary medical issue another student in my program had in the year prior that she framed as something that could have been cared for better with private health insurance) and the cost was lower with private health insurance. I trusted her and signed a document (which was submitted to TK) stating I will be exempted/released from public health insurance for the entire duration of my studies. Therefore, I cannot join public health insurance at any point during my studies now, even if I get a part time job paying me more than 538€ per month. This was not an issue during my first year as my advisor had a connection at an insurance company known for targeting foreigners and they gave me a private insurance plan.
• I moved to Sweden, my German health insurance was cancelled, and had health insurance/coverage there.
• Upon returning to Germany, I reapplied for private health insurance from the same company that I had a contract with previously. However, this time they rejected me due to pre-existing conditions. This was not done my first year so I’m assuming they have become more strict since then. I applied to multiple other private insurance companies and got rejected from all of them.
• I contacted 2 insurance brokers to ask for help in applying for plans of the standard tariffs with pre-existing conditions either being excluded from coverage or being charged a higher premium for them, in hopes of avoiding the Basistarif being my only option. However, the insurance brokers (who work with nearly all of the private insurance companies in Germany) sadly told me/confirmed for me that I am “uninsurable by every private insurance company in Germany”. Therefore, the Basistarif is the only option I have for health insurance while I am studying. I asked the brokers if they could help me begin this process and they said that their firms do not work with the Basistarif as it is not something that results in real benefits for them. They said that the application process will be long and hard with the private insurance companies fighting me along the way because no private insurance company wants any more people to enter into the Basistarif.
This is all very understandable to me, but I just don’t know where to turn to for help now then. Whenever I try to contact private health insurance companies to apply for Basistarif, I don’t get a response. I am so worried about not being to complete my studies here in Germany due to not having health insurance and feel I am running out of ideas of what I can do.
I have some questions (that I fully do not expect Redditors to be able to answer entirely, but thought I’d ask here anyways):
• Has anyone been through the process of applying for and obtaining the Basistarif and can share their experience/advice? Or does anyone know the steps/ways for securing Basistarif from a private insurance company? (I already have the official rejection documents from both public health insurance and private health insurance, which I learned is the first step.)
• Is expat health insurance acceptable for a second study residence permit (for example, expat health insurance from Feather, Ottonova, or Mawista)? I have read that expat health insurance is acceptable for first time residence permit applications, but not for extensions/renewal or second residence permit applications (as expat health insurance is meant for temporary stays or until you can get into public/private health insurance after entering Germany and beginning studies, and an extension or renewal of residence permit would indicate a longer stay). However, if I only have expat health insurance while I am trying to get into the Basistarif, will this be accepted by the immigration authorities for my study residence permit application? I have not been in Germany for 5 years or more yet.
• Is it legally possible to work a minijob with expat health insurance while I am trying to get into the Basistarif?
• Do you have suggestions on who/where I can go to for further help? Should I look for pro bono immigration lawyer? I will visit Caritas in my city soon.
I understand that I made a mistake signing to contract to be released from public health insurance my first year and I wish I hadn’t trusted my advisor in that. I want to study and work a part time job here and contribute to German society so much. What can I do now?
Thank you in advance for reading any of this.
submitted by bearsbeets-bgalatica to germany [link] [comments]


2024.05.15 06:02 Awkward-Juggernaut-4 Benefits from trazadone

I am posting this very cautiously having not put anything on this forum for over two years. This will be a lengthy post and I don’t make it with any claim of cure, or as a recommendation. However, I feel almost duty-bound to share my experience given the impact PSSD has had on my life and the impact it so clearly has had on so many others. I know some people will have had very negative experiences with trazodone and completely respect that. I can only talk about my own recent experience. The headline is that I briefly took trazodone a few weeks ago and have experienced significant benefits. I can’t say strongly enough I am not recommending trying it. I am just relating my own experience. I am happy to reply to comments, but please be aware that I am not prepared to get into any kind of heated debate about the whys and wherefores of this, or any other medication or treatment. At times people can be very confrontational on these forms and I’m not interested in that kind of conversation. Thank you in advance.
Just for context I am a mental health nurse myself although I don’t work in acute mental health and tend to work in more niche areas. However, my employment has been sporadic in the last couple of years in part due to PSSD.
I have had PSSD without out any real improvement (until very recently) since taking sertraline in summer 2019. This manifested itself as lack of sensation, pleasure and associated ED as well as generalised anhedonia. Prior to this, although I had experienced some episodes of anxiety and depression I had no sexual dysfunction whatsoever. I was aware my testosterone level was low as had started to investigate this as a possible cause for my problems with mood. As I say I had no sexual problems so at this point it was not something I had ever really thought about. Over time I tried to accept it and not focus on it as I found this definitely impacted on my quality of life. Like many people I initially spent a lot of time investigating PSSD but found myself becoming increasingly anxious and hopeless doing so.
I have made attempts to find solutions to PSSD. I have been on TRT at points during this time and have also been seen at Imperial College and UCL for the past couple of years. I’ve tried a couple of medications that have been suggested within this community, such as yohimbine and cyproheptadine but did not experience any benefit though equally they did not make things worse. I attempted some lifestyle changes but have struggled to eat as well as I should and, reduce alcohol and caffeine, increase exercise, et cetera due to low mood. Since developing PSSD the existing anxiety and depression which I have managed pretty well for most of my life have become much more prevalent. I have avoided psychotropic medication since the short courses of sertraline in 2019 and mirtazapine in 2020 that in the first case caused PSSD, and in the second case made it worse (after a brief initial improvement). The only PSSD related medication I take is tadalafil 5mg which was prescribed to me by Dr Mears at Imperial to hopefully improve general vascular blood flow.
Last summer my 27 year relationship ended. Before becoming unwell in 2019 and taking sertraline and subsequently developing PSSD, my relationship was solid though of course it had the usual ups and downs. The impact of PSSD was massive and caused many problems. After the first year where I maintained hope that things would improve, the impact on our physical relationship and my mental state began to really caused problems. Associated anxiety resulted in issues with work and increased alcohol consumption. To cut a very long story short in summer last year my wife told me she wanted to divorce and I lost my marriage, my comfortable home and really everything that had kept me together for the past nearly three decades. After initially coping well inevitably my mood deteriorated and I became increasingly depressed and suicidal and found myself sectioned briefly for a couple of weeks in spring this year. Crisis a surprise has a mental health nurse and not an altogether positive experience!
As I say, I’m very reluctant to take psychotropic medication but I did start agomelatine in hospital. On reflection this was somewhat unwise given my history of alcohol use but I asked for it, they prescribed it, and I wasn’t really in a place to logically think it through. In terms of PSSD it wasn’t beneficial but it had a lot of other side-effects that meant I came off it shortly after discharge from hospital whilst under a Crisis Team.
I then started on trazodone 150 mg at night. Like agomelatine it is used as a third line treatment and suggested for people with sexual dysfunction. It is referred to as pro-sexual and is used at times as a treatment for ED. I was given the warnings about priapism when using it. On the first night I took it I woke up with very strong erections on a couple occasions during the night. They were not painful and after a while receded and I returned to sleep so did not take any action. At this point I had had pretty severe ED for months (I think due to poor mental state). This actually wasn’t a significant problem for much of the time I had PSSD, however, the lack of sensation meant that this was somewhat academic. My general health at this time was in a pretty bad way so although concerned about the side effects of psychotropic medication didn’t worry unduly. The same thing happened for the next couple of nights. Of course given this I attempted masturbation and found that I could achieve orgasm and the intensity increased. There was no huge improvement in sensation but the actual orgasm itself was more like normal. The nocturnal erections continued and I started to find that I was having them throughout the day. As I say there was no pain or discomfort and they resolved so I didn’t take any action. However, as I have said I am very reluctant to take psychotropic medication and given this I decided to stop it after a few days. My worry was I would develop full-blown priapism and this can have extremely serious consequences. You are supposed to get immediate medical attention if you have a painful erection that exceeds four hours. I’m not sure what your chances are of being seen the moment you walk through the door in A&E are – it’s more likely you would be there for several hours so I decided this risk was too high as I had started to experience these erections. I have to add I did this without discussing it with the very good Crisis Team I was under. I did discuss this with them subsequently, and they were understanding and supportive but would of course not recommend stopping any medication without seeking advice first. Even though I am a nurse, this isn’t wise.
However, I have now been off trazodone for about three weeks. I have continued to experience strong nocturnal erections but less so, and have some seemingly random erections during the day. After developing PSSD I lost all sense of myself as a sexual being. I wouldn’t experience interest or arousal when seeing someone who was attractive that as did throughout my life beforehand (I was married a long time-don’t judge me!) but this has returned. I have not had sex with anyone since separating from my wife, so can only judge it based on masturbation but as I said above this is easier with much more powerful orgasms. Like I say, there is still a lack of sensation, but it is a vast improvement on how I was before. It may also be coincidence, or possibly a result of this improvement, but over the past couple of weeks my mental state has improved dramatically and in fact I find myself feeling better than I have done in many years. I would give anything to be able to go back in time and not have taken sertraline and not have developed PSSD. Without it I think I would still be in the long and loving marriage I was but I’m on the road to accepting that. That is difficult and it hurts but I have to accept it to move on.
Anyway, I hope this is of help. I’m certainly not advocating taking trazodone and generally speaking feel that the dangers of psychotropic medication outweigh the benefits unless they are absolutely necessary. I would not have taken medication unless if I haven’t found myself in a situation I did. To put it bluntly, I wasn’t going to survive as my suicidal drive was so high had to do something. I appreciate it must seem ironic saying this as a mental health nurse but I am far from alone in this and I have spoken to many nurses and workers, both on a professional and personal level who say the same thing. Something I have noticed in recent time is the huge increase in the knowledge of PSSD in services. The Panorama program broadcast on the BBC last summer seems have made a significant impact. All the best to you all and keep and do your best to remain hopeful though I know how difficult this is.
submitted by Awkward-Juggernaut-4 to PSSD [link] [comments]


2024.05.15 05:53 PlantHerald Almost died from a "pinched nerve"

So about half a year ago while I (27 AFAB at the time) was at work my arm began tingling. It happened while I was crocheting so I attributed it to poor posture but took note of the time (just after 3pm) and continued working until 5pm. By the time I got off work my pinky and ring finger on my right hand became difficult to use. I drove home (hindsight this was really stupid of me to do) and an hour later when it hadn't gotten better I asked my brother to take me to the ER.
While there I told them that given the symptoms I was having (numbness on one side, and partial paralysis) and that I had started a new birth control a month prior that I was worried about the possibility of a stroke. They checked for the more obvious signs of stroke (facial droop, delayed eye dilation, blood tests, etc.) and noted that I had weakness in my right arm as well as tachycardia. They asked my brother about my behavior and if I was acting off, which he said I was not.
When the blood tests came back they informed me that my d-dimer was elevated. I wasn't told how much it was elevated. They referred me to CT to check for a pulmonary embolism. CT showed a normal healthy chest and I was sent home with a diagnosis of pinched ulnar nerve.
Over the next two days I proceeded to be incapable of eating or drinking anything, if I slept it was not for more than an hour at a time and I woke up in a cold sweat. My arm went from tingly and partially paralyzed to dead meat attached to my body. I could not move it, and could only lift at the shoulder. I woke my brother up at 3am to take me back to the ER. I informed them of the new symptoms, as well as the worsening of the previous symptoms.
This time it felt very dismissive. I was not being heard. I got sent to MRI to check again for a pulmonary embolism which again showed nothing. I told them I felt like I had really bad brain fog and my arm felt like it was in ice water. I was told this was normal for a pinched ulnar nerve. They gave me nerve glides to do, a prescription for 600mg of ibuprofen, and a referral to a neurologist. I asked them before I left if it was a good idea to fly as I had a vacation starting the next day, I was told it was fine.
So I went on my vacation, flying from one coast of the US to the other. It was 7hrs after I landed and was picked up from the airport where it started to go downhill and rapidly.
I still couldn't eat, and I knew I wouldn't be able to sleep so I bummed a gummy off a friend and started getting ready to go to bed. After this is a complete haze for me but I will list the events as I was later told:
I dropped on Tuesday night. I remember bits and pieces of Tuesday night, and the following Wednesday, but I was not conscious and aware until Thursday morning. I woke up, realized I had a catheter, and I was PISSED.
In the few hours after the medical staff learned I was actually with it. I was informed not only that I had a stroke, but that I had a rare form of stroke. It was a Cerebral Venous Sinus Thrombosis. They were shocked that the previous hospital had not continued to look for something and dismissed me. I was then informed that my d-dimer was 1.03 (where a 0.50 was the maximum threshold for a normal d-dimer), my glucose upon being admitted was severely elevated, and they didn't know how bad it was because they had not yet been able to get a clear image of my brain.
Throughout my ICU stay I learned I was extremely lucky to be alive, you can't trust every doctor, and to always be accompanied by someone who will advocate for you. Also birth control sucks and my friends are amazing.
I spent my 28th birthday in the ER.
I now live in the state where I was finally diagnosed properly and I am communicating with a lawyer for a malpractice lawsuit. I have had up to 20 appointments a month just for things related to my stroke and am coming to terms with things that just might not get better. I'm taking 4 different medications for the after affects of the stroke, and I might just have to remain on 3 of them as it's possible I now have an epileptic disorder. We wont know for sure until my brain is given more time to heal but my recent EEG still shows abnormal brain activity.
I think overall I have a pretty solid case, especially given the shock of the paralegal as I explained what happened. But sometimes I second guess it and it worries me.
submitted by PlantHerald to MedicalMalpractice [link] [comments]


2024.05.15 05:26 Incman I would love to hear from this subreddit regarding my (actually-this-time-unless-she-changes-) final letter to my nMom.

As the title states, (and despite the existential risk to myself - as I am disabled, impoverished, and my survival is reliant on the room I rent in her attic - given her recent threat to have have me thrown out by the police because she could not handle the feelings she had during the argument that she initiated), I have finally drawn a bright red line in the metaphorical sand regarding her treatment of me. This is the culmination of 8+ years of sustained, one-sided, unreciprocated, and unsuccessful effort on my part to sustain, salvage, repair, or improve our "relationship"
 
I've learned a lot from the stories and people on this subreddit, and I know if anyone can understand the way that I'm feeling about this it's you guys.
 
Any input, commentary, criticism, insight, commiseration, etc, is very welcome, and I appreciate anyone who takes the time to read it.
 
Anyways, enough preamble, here's the letter in all of my ridiculously-verbose inglory (the square-bracketed disclaimers, etc, were part of the letter as delivered to her, since she is selective illiterate whenever there's something she doesn't like):
 
[START]
 
[This document begins with a 382 word AI-generated summary (titled "AI- GENERATED SUMMARY:" below the square-bracketed opening remarks), estimated at 1m23s time required to read. If you are unable or unwilling to make it through even this brief summary, then there is literally nothing else I could possibly do to assist in your comprehension of my positions. The full message following the summary is approximately 2100 words, estimated at approximately 8 minutes to read.]
 
[If you would like assistance in understanding things I've written that you're struggling to interpret or comprehend, you can go to chatgpt.com (no account necessary), or download the ChatGPT app from the Google Play Store on your phone. You can simply interact with the chat in natural language (in other words, type as though you were texting another person) and it will understand what you are saying. If you are struggling to understand how to interact with it effectively, you can simply inform it of that (in any wording you choose) and it will assist you with altering your approach to receive more effective results.]
 
AI-GENERATED SUMMARY:
 
Your son's message is a powerful declaration of his boundaries, grievances, and intentions within your relationship. Here's a breakdown to help you understand:
 
Preface: He advises you to read with an open mind and, if needed, with assistance due to the emotional complexity.
 
Declaration of Disengagement: He firmly states his decision to disengage from any form of interaction or acknowledgment outside of essential landlord-tenant matters.
 
Condemnation of Abuse: He accuses you of perpetuating a cycle of abuse that has deeply impacted his health and stability.
 
Rejection of Coercion: He dismisses the idea that being evicted is a viable solution to the abuse, highlighting the coercive nature of such a choice, and how it leaves him vulnerable to further harm.
 
Criticism of Your Behavior: He unreservedly condemns your actions, particularly your exploitation and manipulation, emphasizing the gravity and effects of your conduct.
 
Challenges to Your Claims: He directly confronts your claims regarding his efforts in the relationship, asserting that he has consistently made extensive attempts to maintain it, despite your accusations to the contrary.
 
Commitment to Compliance: He unequivocally affirms his commitment to compliance with all landlord-related demands, demonstrating his unwavering respect for your authority as the homeowner.
 
Demand for Clarity: He demands clear and unambiguous knowledge of the requisite terms when any changes to living arrangement paradigms are demanded, underscoring his willingness to comply with any directives you may issue.
 
Defense Against Gaslighting: He firmly asserts his unwavering commitment to respecting your property and authority, preemptively refuting any attempts to accuse him otherwise.
 
Insights into Your Behaviour: He offers insights into patterns in your behaviour, linking them to moments of vulnerability or distress in your life.
 
Call for Self-Reflection: He urges you to seek professional help for your narcissism and unresolved childhood traumas.
 
Caution Regarding Gravity: He states that failing to address your responsibilities would be a missed opportunity for both of you to salvage the relationship and resolve underlying issues.
 
Reiteration of Hope: Despite his current stance, he leaves the door open for reconciliation if you undergo necessary personal growth.
 
Closure on Unequal Effort: He firmly states that he can no longer sustain the one-sided effort in the relationship and won't continue to do so.
 
It's evident that he's deeply hurt and demanding acknowledgment, change, and resolution in your relationship.
 
[end of AI-generated summary; my full, non-AI-generated message follows below]
 
[I recommend that you read this in its entirety at a time and capacity level where your literacy and comprehension are at their highest level, and preferably with the interpretational assistance of a knowledgeable and competent support person or technological assistant.]
 
[Presumably, after reading a few sentences or less, your defense mechanisms will be activated and you will eject. However, as with the vast majority of the things I have said to you that have gone unacknowledged, I am completely certain that the contents are cogent and comprehensible, and I believe that with competent support and vulnerable effort you undoubtedly have the raw cognitive capacity necessary for comprehension if you are able to stabilize your emotional reactions and put real effort into the actions necessary for you to understand my words.]
 
I will not talk to you.
I will not look at you.
I will not approach you.
I will not acknowledge you.
 
If you attempt to interact with me on any interpersonal level not related to your role as a landlord, I will reserve the right to express just how fucking despicable it is to treat such a vulnerable person with such utter disregard and abuse for so fucking long.
 
The cycle of abuse you have maintained to destabilize me for your own pathological reasons has caused - and continues to cause - extensive damage to my health, stability, and existence. However, since I know your response to this would likely be some variation of "you're not a victim here [my name], so if I treat you so bad, just leave", I'll preemptively and unequivocally condemn such coercive and abusive tactics, and state again (as I did the other day), that the forced choice between your abuse and life-threatening-homelessness is obviously no choice at all, and leaves me perpetually subject to your coercion and abusive control.
 
Such exploitation by you is absolutely disgusting, and honestly I understand why you run away from yourself at every single instance where you're in danger of having your lifelong house-of-cards ego even slightly threatened. I know if I treated another human being the way you treat me for even a moment, let alone for the literal years you have done so, I would not be able to face myself in the mirror either. You should be fucking ashamed of yourself.
 
You say I "don't want to be your son anymore", as though it has been someone other than me making hundreds and hundreds and hundreds of hours of efforts and attempts in order to try and single-handedly keep our relationship alive, and as though it has been someone other than you who has stonewalled me for years about every single legitimate and valid time I attempted to gain even the slightest foothold as a full human being in the owner-pet relationship you have fought so hard to maintain. You siphon, in fact demand, emotional supply whenever you so choose, and then fucking discard me as soon as it appears that I might do anything that would result in you losing even a fraction of a percent of the 99% to 1% imbalance you believe is an immutable part of our "relationship".
 
I will do my absolute best to be in my room as much as physically possible when you are home, so as to minimize the need to be physically adjacent to you in the course of our respective activities of daily living.
 
I, again, remain unequivocally committed to my position of deference and compliance towards any rules/demands related to my existence, presence, or activities as your tenant.
 
As you refuse to provide any sort of unambiguous guidance or clarification whatsoever regarding your shifting demands affecting my ability to access/perform basic activities of daily living, I will continue to act in good faith with respect to my adherence to all previously-established arrangements and protocols (whether codified or de facto) regarding such activities. To the full extent of my abilities, and to the extent that it is physically possible, I will immediately and unequivocally comply with any alterations, additions, or excisions you choose to impose regarding the nature of our physical coexistence as landlord and tenant, regardless of your disregard or intent for any harm to my stability that will ensue as a result.
 
If you intend to attempt to manipulate or threaten or gaslight me to illegitimately and dishonestly accuse me of failing to comply with your rights and demands as the homeownelandlord, then I can assure you that such efforts will be ineffective and inadvisable. The extensive history of my genuine, documented, and unwavering commitment to absolute respect of your home, property, and landlord-tenant authority is unassailable, and nothing has or will change about the good faith nature of my efforts to simply live peacefully and work on stabilizing my health and continuing to attempt to develop basic protocols that offer me the opportunity to seek the ways and means required to sustainably exist, survive, and seek meaning and fulfilment as a human being.
 
To try and make it a bit more bite-sized (without warranty as to the efficacy of said efforts), since I know when your ego is threatened you conveniently - and dishonestly - become completely unable to read a couple thousand words:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
I love you, and goodbye for now. I hope to see you on the other side, but I cannot force you to undertake the journey.
 
- [name]
 
[/END]
(any edits are fixing formatting/copy&paste errors)
submitted by Incman to raisedbynarcissists [link] [comments]


2024.05.15 04:57 miirshroom Examining Tolkein: Gelmir, Faroth and Beyond

Examining Tolkein: Gelmir, Faroth and Beyond
It has been said that the Lord of the Rings is the origin of the high fantasy genre. I would consider Elden Ring to be something of a deconstruction of high fantasy tropes. A very instructive step of a deconstruction (or of duplicating results) is to look at a thing and examine the elements it is made of. The more general the better - the goal is to find the things that inspired the thing:
  • The setting is inspired by research into many real world mythologies and folk tales. And Tolkein's religious beliefs as a Catholic.
  • Tolkein invented full language systems that were used to add extra significance to the names of people and places
  • The personal history and psychology of the author had an undeniable influence on the themes of the story (when Tolkein writes about the devastation of war it is from a place of sincerity - because he lived it)
So, these are the ingredients of a successful fantasy story that also apply to Elden Ring - draws parallels to previous fantasy stories including mythology, use of bespoke words and naming schemes that are internally consistent as parallel to the real world, and incorporates psychologically-driven themes (in the case of Elden Ring I believe that it is less of the psychology of a person and more about drawing on the psychology of the gaming company FromSoftware...but that is beyond the point of this post).
And regarding the influence of Tolkein there are a few more explicit parallels to be drawn. Which for legal reasons regarding the rights to adapt Tolkein's Legendarium will likely never ever be confirmed by FromSoft. But as I see it getting references under the radar of the copyright lawyers is a time honoured tradition of deconstructive fantasy stories and parodies, so I will attempt to explain these connections as I see them, regardless. Also note that I am writing from the perspective of someone who has been familiar with the Lord of the Rings but never before looked at the extended mythology.
A linguistic connection is formed in the space between two main points that I am aware of: Gelmir of Nargothrond as the possible naming inspiration for Mt. Gelmir, and geographical region "Taur-en-faroth" containing part of the name used for Fort Faroth.

Gelmir

"J.R.R. Tolkien has become a sort of mountain, appearing in all subsequent fantasy in the way that Mt. Fuji appears so often in Japanese prints. Sometimes it's big and up close. Sometimes it's a shape on the horizon. Sometimes it's not there at all, which means that the artist either has made a deliberate decision against the mountain, which is interesting in itself, or is in fact standing on Mt. Fuji." - Terry Pratchett
First addressing Gelmir - literally the volcanic mountain is a reference to Tolkein. As clear of a declaration as possible that Elden Ring intends to stand on Mt. Fiji.
Gelmir in the "canon" version of the Legendarium was an elf of Nargothrond who was captured by the forces of Morgoth at the "Battle of Sudden Flame" which was the fourth great conflict in the War of the Jewels (the war over the 3 silmarils for which "the Silmarillion" is named). He was subsequently blinded and tortured for 17 years until his death - after having his limbs cut off to taunt his brother Gwindor into attacking recklessly - at the start of the fifth great conflict known as "The Battle of Unnumbered Tears". Gwindor himself was captured and held prisoner for an additional 17 years after this battle, before escaping at the expense of having a hand cut off and eventually dying in another battle of the war. He was in love with a golden-haired elf maiden named Finduilas (name meaning "hair of spring leaf") who he also called "Faelivrin" meaning "Gleam of the Sun on the Pools of Ivrin" ("Pools of Ivrin" being a location in the land called Beleriand). She was killed before the end of the war by being nailed to a tree with a spear.
For context, the sixth great conflict was called "The War of Wrath" and was the final one. Morgoth brought dragons to the battle to blast the battlefield with fire and lightning - which had never been done in any previous battle - and the outcomes were that Morgoth was beheaded and kicked through a portal into the void and the northwest corner of the map including almost all of Beleriand (an area equal to the size of the entire Middle Earth map at the time of the Lord of the Rings story!) sunk into the ocean.
There is a lot to work with here already - first being Gelmir's associations with flame and imprisonment and torture that are shared by both Tolkein's and Elden Ring's purposes. Blindness is noteworthy, considering how often this is a theme with Elden Ring characters and even partial blindness is enough to cause madness as indicated by the Prisoner Helmet. Taking a few lateral steps arrives at a golden haired maiden who shares the method of execution used for Marika. And her name meaning "gleam of the sun on the surface of the water" exactly describes the imagery seen in the Elden Ring item "Memory of Grace".
But there's still more to spin from this line! Because Finduilas had another lover named "Turin Turambar" who was a friend of Gwindor and whose family had been cursed by Morgoth. Turin owned a magic helm upon which was perched an image of the Golden Dragon Glaurung - similar to the style of helmet worn by Elden Ring's Banished Knights) - and which allowed him to survive dragon fire. Turin found on the grave of Finduilas a naked woman who he called "Na­niel" or "Maiden of Tears" - because she had lost her memory and was crying - and wed her with neither knowing that they were estranged brother and sister (this is based on the Finnish story of Kullervo, with which Tolkein was especially fascinated). This was revealed to them later to be a machination of Glaurung when Turin was in the midst of slaying the dragon, and subsequently both Turin and Naniel killed themselves. Before meeting his end, Turin also described himself in (probably) poetic terms as having blindness being the curse placed upon him by Morgoth, which is assumed by readers to be more a matter of tunnel vision or short sightedness rather than literal blinding. He is also apparently prophesied to return to life someday in the supplementary materials.
What this means exactly for Elden Ring is up to interpretation. A story could be spun by combining Gelmir, Gwindor, and maybe even Turin into a single character who are motivated by unrequited and/or incestuous love for Finduilas/Naniel also made into a single character - to fill in the empty spaces around the characters of Marika, Radagon, and Godfrey. Or there could be some other purpose for naming the mountain "Gelmir". There is room for more nuance here because there are the alternate Gelmir's to consider.
In one version, Gelmir was king of the gnomes, by which Tolkein was inspired by the Greek "gnome“" meaning "thought" or "intelligence". But this was dropped due to the cultural confusion with gnomes being wrinkly little creatures.
In another version Gelmir was the same character as Finwe, an elf who was born during the "Years of the Trees" that preceded the era called the "Years of the Sun". At this time, the light of the world was confined to the Lands of the Valinor (a pantheon of Creator types) in the west provided by the female golden tree named Laurelin in the south and the male silver tree Telperion in the north. Finwe's wife was a weaver named Mi­riel Therinde and his son Feanor was responsible for forging the Silmarils and jealously guarding them (And also he invented the 7 palanti­ri scrying stones + 1 master stone, and the Tengwar writing system). The grandson of Feanor and last of his line was Celebrimbor, meaning "silver fist". Celebrimbor forged the three rings for the elves (named for air, fire, and water) that were subject to the One Ring but never corrupted by it. So, it's possible that "Gelmir" is selected for being a deceptively niche character who was actually in another lifetime very closely connected to these core events of the history. The appearance of a character named "Miriel" is also interesting in the context of Elden Ring's Miriel, Pastor of Vows.
As a side note, something else of interest from this Tolkein deep dive was regarding the relationship between the silmarils and the world trees of the Valinor. The 3 Silmarils contained the remaining light of the two trees that were destroyed and had the sun and moon forged of their fruits by blacksmith Aule. When the trees were first made they were sung into existence by Yavanna and watered by the tears of Nienna (who was a teacher of the wizard Gandalf and in earlier versions of the Legendarium called "Queen of Shadow"). Nienna again wept healing tears upon the trees to grow the fruits when they were dying. Morgoth stole the Silmarils and set them into his Iron Crown, and upon his defeat the stones were pried out and the crown beaten into a collar for his neck (in the brief period of time before he was kicked into the void anyways). One Silmaril was thrown into the sky where it became the Evening Star. Another was cast into the sea. And the third was cast into a firey pit in the earth along with its possessor.
And as an addition, it is not farfetched that Morgott = Morgoth is an intended spiritual parallel. Considering that Morgoth was indirectly responsible for the blinding and killing of Gelmir (brother of Gwindor) in Tolkein's mythic history. And in Elden Ring this seems expressed in the Shattering War though Morgott pursuing Mt. Gelmir most fiercely. In a more broad sense, Morgoth was the identity taken by Melkor after he was released from the chains made to bind him by Aule, which is somewhat similar to Morgott/Margit using alternate names depending on the circumstance (and Margit's Shackle paralleling Melkor's binding chains).

Faroth

"Faroth" is a Sindarin word meaning "hunters". The "Hills of the Hunters" (Taur-en-faroth) was a location in West Beleriand, the aforementioned western part of the continent that sunk into the ocean at the end of the War of the Jewels. In these hills was hidden the secret elven city of Nargothrond on the Narog River. The same from which Gelmir of Nargothrond is associated. The city began as a Dwarven Hall for the petty dwarfs (exiled and unsociable dwarfs smaller than typical dwarfs), was conquered and ruled by the House of Finarfin (a son of Finwe), and was sacked and turned to the lair of the dragon Glaurung some time after The Battle of Unnumbered Tears. And then fell into the ocean.
At this point there are too many names, which is why I sketched a family tree of all of all these elves that is attached to this post.
Some general trends:
  1. Of the 3 family lines the middle one has significance for being the one to produce the Numenor Kings of Men
  2. The family lines at the two sides have plot significance as discussed in the Gelmir section, but then their lineages die off.
  3. Typically continuity is maintained through the male lines, with sole exception of Idril in the 3rd generation removed from Finwe. The origins of the women spouses are typically left vague (with 3 exceptions near the root of the lineage: Indis has a famous uncle, Nerdanel has a significant blacksmith father, and Earwen's extended family has some substance to it)
If a writer wanted to do a legally distinct take on this mythology while borrowing from it for whatever reason, it would be easy to condense the feats and characterization of these 3 lineages into one truncated one. Maybe fuse Finduilas with Idril - two blonde ladies with minimal character - and also fuse together their lovers and you have a Marika + Godfrey. The narratively satisfying thing about Finduilas being associated to Gwindor (who may as well be made the same character as Gelmir) is that it creates a closed loop for the whole lineage when GwindoGelmir is substituted for Finwe, which is a very attractive proposition for a story like Elden Ring where time is a wheel and return to the origin point is a principle of the Golden Order.
Also this region calls attention to the significance of the river Ringil. That word comes up as: 1) a mountain river through Taur-en-Faroth that is tributary to the Narog river, 2) a sword held by Fingolfin (another son of Finwe), and 3) as the primordial tower - sometimes made of ice - upon which sat the south lamp Ormal (an orb containing the gold light of the world in the First Age that would later pass to the gold tree Laurelin in the Second Age). In an earlier version of the writings. The blacksmith Aule created the lamps at the request of Yavanna, who was herself responsible for the growth of fruits and trees. The end of the "Days before Days" (which preceeded the "Years of the Trees") occurred with the breaking of the lamps by Melkor, after a period of time where he had poisoned the land and caused the things made by Yavanna to rot.
I will note that the early timeline was a bit difficult to follow. I gather that there are spans of time lit only by the stars between the destructions of these various sun/moon light sources, a period of time with Yavanna singing all living life to sleep due to the lack of light. The First Age is also called "The Awakening" but it appears that much of the war between Morgoth and the elves began prior to the beginning of the First Age. There is an aside in which Aule was also responsible for creating the "Seven Fathers of the Dwarves", but he made them too early and they had to go to sleep so that the elves of Iluvatar could be the first sentient mortal life. I found interesting this additional context for the lamps:
"In the middle of Arda, where the light of the lamps mingled, amid the Great Lake lay the Isle of Almaren, where the Valar dwelt." - The One Wiki to Rule them All
"In J.R.R. Tolkien's older writings (not used in the published version of The Silmarillion), the Valar sought peace with Melkor, asking his assistance with fixing the lamps upon Arda. Melkor, still envious and hateful of the rest of the Valar, agreed to give them a strong, sturdy substance. He gave Aule ice. Melkor permitted the Valar to do as they wished until the fateful day when the Lamps' light and heat finally melted the ice. The pillars crashed upon Arda, flooding it with water and darkness." - The One Wiki to Rule them All
I suppose that if I have a point here it is that Radagon's Sore Seal talisman is found at Fort Faroth, which through the winding etymology of words is tied to Mt. Gelmir. Perhaps the blind Radagon was a hunter on a fruitless quest seeking the lost light of the Golden Sun that stood on the ice pillar of Ringil from the days before days - guided by the distant memory of the reflection of it's light on the water. Perhaps there is other meaning to be found. I acknowledge that after a certain point any interpretation found through these linguistics should be cross-referenced with everything that can be learned from all other sources of information in the game.

The Rings of Power

The big brazen choice - in my opinion - was to name the big metaphysical artefact "the Elden Ring"...and then draw actual direct parallel to the Rings of Power. Not the 3 rings granted to the Elf Kings under the sky - I've yet to identify how or if those are expressed in game. Not the 9 rings granted to Kings of Men either - those are seemingly represented in the 9 Night's Cavalry (and possibly the 9 weapon talismans that each feature a ring at the top of the head) . What I find most relevant here are the 7 Great Runes matching "seven for the Dwarf-lords in their halls of stone".
The first critical part of that phrase is the reference to "stone", for I find that the shattering of Marika's Hammer equates to the shattering of the wisdom of stone. But the second point of note is that the dwarf lords of Tolkein received their own curse from holding their rings of power - obsession with gold. A similar obsession is seen in Elden Ring where all of the demigods are corrupted by their great runes and covet the grace of gold.
The arrangement of the Elden Ring also has some synergy with the arrangement of its runes - 6 of the 7 dwarf lords pair nicely through the even numbers. The Seventh Dwarf Lord was the chief among them "Durin the Deathless", who was reincarnated 7 times by being reborn as one of his own descendants. His clan also was generally known to absorb members from all other clans due to his central importance. The first Durin (one of the 7 original fathers of dwarves) built the underground city of Khazad-dum that would later be called Moria after a creature of shadow and flame that may-or-may-not have wings (a Balrog of Morgoth) was uncovered in its depths by Durin VI. Durin III was the one to receive the Ring of Power from Celebrimbor, and Durin IV was contemporary to the first rise and defeat of Sauron. Durin VII is appears to be from the timeframe of the Lord of the Rings and second defeat of Sauron, though he did not participate and seems to be known instead for reclaiming Khazad-dum from the orcs.

Why Examine Tolkein?

So what's the point of the elaborate Tolkein parallel? There may be 7 ring-shaped great runes, but there is also clearly one ring that rules them all - the Elden Ring. Examining Tolkein is one of several avenues of analysis reaching the conclusion that the ring is a dangerous object that corrupts everyone who touches it and must be destroyed. Of the six endings the only one that understands this is Ranni's Age of Stars. And in the Lord of Frenzy Flame ending the Tarnished succumbs to the power of the ring with head becoming a ring of flame matching the firey beacon on top of the Frenzy Flaming Tower - itself visually recalling a depiction of the Eye of Sauron atop the tower of Barad-dur as seen in the 2000's Lord of the Rings trilogy adaptation.
And even more, there's one ring bearer in particular who provides another piece to the puzzle of Radagon and Marika's dual identities. The dissociative identity of Gollum and Smeagol can completely describe the relationship between Marika and Radagon. Two thoughts in one body. With this lens I think that Radagon/Marika were likely not separate entities at the time of their Shattering and may have never had a separate existence. They can appear to hold conversations with each other through reflective surfaces, such as a very shatter-able mirror.
It is quite possible that another Great Rune (or more) will make an appearance in the DLC. If this does happen, I'll re-evaluate Ring of Power theory based on the nature of the added rune.
One last note which, again, is oblique enough for plausible deniability. The end of Patches questline would have the Tarnished deliver the Dancer's Castanets to Tanith, inside the volcano. If you know anything about castanets, they are typically made of hard materials such as wood or ivory (or plastic) and carved into a pear shape. Not so for the Dancer's Castanets. From a visual examination these are made of metal cast in a circular shape and with a ring shaped engraving filled with filigree. A metal ring-shaped object delivered to a volcano, echoing the One Ring delivered to Mt. Doom in the Lord of the Rings.
submitted by miirshroom to EldenRingLoreTalk [link] [comments]


2024.05.15 04:51 Storms_Wrath The Human Artificial Hivemind Part 512: The Pact Of Blades

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Ezeonwha was walking down a long hallway. The dry and plain painted walls and the pure white lighting of the lower levels of the 102nd Visitor Welcome Office helped to frame the dingy realities of those who could only afford these floors. Not even capable of having windows, these were for those who were the cheapest of the cheap or those who mingled with them. He'd passed several Guides on the way in, their claws echoing in the halls as a sign of authority in this lawless land.
Here, mediocrity was king, and he was a loyal servant. He drew his cloak closer about his neck, unwilling to reveal himself to those who weren't already equipped to see through it all. He was famous enough to be an abduction target if he let his guard down. This place was no exception, though Justicar tried to make them such. Too much security on the higher levels and too little on the lower levels. That was the way of things.
Another hallway, this one marked with bullet holes. Two contractors and a Guide were discussing the pricing of the fix project when he turned the corner. Their voices quieted to nothing, the stillness pressing down upon them with the same intensity as the false lighting. Ezeonwha clacked his jaws, giving them a low bow before continuing on his way. He saw the Guide's eyes light up with the sign of his implants getting a reading. It was another impromptu way of tracking via facial recognition, but it was an ancient practice.
Nothing was new about what the Guides did; only how many of them seemed to be on general patrol. Had Justicar hired more of them or actually done full conversions for all of them? Those arm cannons surely weren't cheap or ethical to insert into unwilling participants. And giving a victim a gun they couldn't be disarmed of was a very bad idea, even for Elders. And Justicar was better than most Elders when it came to abject stupidity. He'd likely only been dropped a few hundred times as a child versus the more likely Elder average of a few thousand.
Ezeonwha chuckled at his internal joke, heading deeper underground into the complex. He was going to a certain meeting, and it would be best not to be late. Even if the Guides tracked him, it wouldn't be negative. The group he had been approached by a few days ago wasn't a terror group. He'd looked them up. They dealt in 'freedom and liberation from all chains.'
The Eyes Of Liberty had focused upon Penny as their latest propaganda target and perhaps as a valuable ally in their fight against all tyranny. Though such a flowery message was likely steeped in idealism for the lower ranks, with more pragmatic and likely richer inner circle elites and leaders ensuring the pot would always simmer but never boil or grow cold. That was the way movements such as these managed to skirt the line between inaction and terrorism.
It was a dangerous thing to do. But these were dangerous times. If Penny left, he'd die. Someone with a grudge would kill him. It was a given, and he'd made peace with it now. He needed to get to work, to help others like him and those worse off, with just a small piece of the meager time he had left.
He was in the system as a friend of Penny, so little scrutiny would fall on him as he came and went. He had a new friend, one who was very interested in connecting to Penny.
The offer had come through his communicator, and he'd answered it given its interesting title. After a lengthy discussion about their goals for him and Penny, he'd agreed to at least have a meeting. He didn't tell them that he had a tracker from Phoebe, which would 'be impossible to miss' if things went badly. He knew the value he had, which was why one of the androids was also accompanying him under the guise of being a Sprilnav.
The android was 'walking' on all fours, its mechanical motion entirely silent. It was obscured by a wave of holograms and hard light holograms that would ensure that it wouldn't be considered suspicious beside him. His only guard was a capable one, and Phoebe had all the confidence of an AI who knew that the destruction of her android would only be an inconvenience for her.
Ezeonwha came to an unmarked door with a well-worn door frame. One knock. One pause. Two knocks. Another pause. Four knocks. He waited, and the door swung open. Eight Sprilnav greeted him warily but warmly, their eyes shifting to Phoebe.
The inside of the room was a dull red, coming from a pair of lights in the center of the ceiling that cast dark shadows near the edges. The whole room felt dark and dangerous, and the walls were lined with guns, computers, and several drones. Shelves and drawers were neatly stacked against the wall, as well as five couches and four double beds with ladder access to the top portions.
Bags of food rested atop a trash compactor unit, and the room service button on the inner side of the wall that Ezeonwha could see in the mirror was worn down to the raw metal. No paint jobs here, only grit and business. The room faintly smelled of body odor and assorted foods. Not entirely unpleasant, but also not what he'd expected from a group with sich a flamboyant name. Perhaps they worked in cell-based units. And that was another thing.
Minds were visible in the distance of the mindscape, but the people here were huddled together mentally. They appeared to be haphazard, but Ezeonwha recognized an old army-type defensive formation a mere step from each of their positions. They were more than they appeared. Though based on how their room looked, they probably weren't veterans, just decently trained.
As they walked through the doorway, a scanner activated. One of the Sprilnav, wearing a headset with numbers and letters swirling on the inner side of the visor, called out: "Phoebe android. Commando variant. Risk assessment: Certain Death. Ezeonwha. Carrying two pistols, one hidden in the pack on his left, and the other tucked inside a strap near the lower bottom of his chest."
That made them all pause, sizing each other up. Ezeonwha smiled nervously, failing terribly to break the building tension once again. His nerves started to get to him, but finally, Phoebe spoke. "Well, friends. I, for one, am happy to talk of the business of liberty. Tell us, what do you have in mind for my friend Ezeonwha?"
"It is not about him, AI. It is about the freedom all sentient beings deserve, and which we shall bring to the galaxy no matter if we are alive or dead."
"An honorable goal to strive toward," Phoebe said.
"Thank you. Your words are quite kind for your type."
"I didn't know I had one," Phoebe replied. "But thank you."
Ezeonwha turned his head toward the Sprilnav with all the fancy equipment.
"What is the best way for me and Penny to help in the fight?"
"The best way would be for you to start killing the gang leaders you come across. Barring that, have Penny ignore the graveyards, and continue freeing the slaves as she ought to. The dead have their freedom; the living need her work more."
"I agree with my companion," another of them said. "So far, Penny has done more for the fight for justice than any other on Justicar in generations, so it is a terrible thing to ask more, but we must ask. Even knowing the terrible toll it would have if she loses the Judgment, Sprilnav are at stake."
"People are at stake, you mean," Ezeonwha said. "There is no need to bring species into this."
"There would not be, but it is still a clear factor," another of them said, a female who looked more shifty in her gaze and demeanor. The Eyes of Liberty seemed like one of those groups with too much division.
"Do you disagree with each other often?" Ezeonwha asked innocently.
"Here and there," the tech guy said. "Not often enough to be a problem, and not when what matters is at stake."
"But that is the thing. How can you agree on when something that matters is a stake?"
"Is this a test?"
"Why would it be? Think of it as a genuine concern," Ezeonwha said. "To associate with your group, I have to be certain it will be resilient to change and risks escalating in the future. If the gangs cannot strike at Penny, they will pick the next best targets. Currently, that is me. If I associate with you in a way they can find out, and I assure you they will find out eventually, you all may be at risk as well. And your group's seemingly cell-based design also means large scale mobilization is difficult, ineffective, and risks severe coordination issues which cannot be quickly or safely remedied without changing core security features of it."
"You deduced all of that from context? You are smart, Ezeonwha. And have a good brain in your head. Everlasting knows we need one of those between all of us."
They all shared a laugh.
"I am not as young as I may look," Ezeonwha said. "Penny is not properly learned of the danger that faces us here. I am. The Underground will kill me when this is over. Do you want to die alongside me, all for your beliefs?"
Silence descended again. Ezeonwha kept the pressure on them when one of them stepped forward. "For freedom and liberty? Yes. I would die for that."
"As would I."
"And I."
They all declared the rest in orders that followed the patterns Ezeonwha was noticing. There were variances in their levels of belief and faith in their purpose. Each person had a different level of value difference, which meant that their lives would be worth more or less comparatively.
Cohesion was weaker, too. Not a full defector team, but likely pieces of several. Was that by design from a higher up leader, or was that just circumstance? Another thing to figure out later, that wasn't critical yet, but he would know before he truly went on any missions with them, if he did at all.
He suspected running messages to Penny would be the majority of their tasks. The quality of intelligence the Eyes of Liberty had offered was substantial. Perhaps enough for Penny to turn herself from a major annoyance to the gangs into an actual existential threat. With Justicar's swarming protection of the Fort Court and the 102nd Visitor Welcome Office, there was a limited amount of things that even the gangs could do. And if the rumors were correct, a Progenitor would be partaking in the trial.
"To be clear, if I join up with you, Phoebe would come too."
"Why would we let an AI join us?"
Phoebe smiled. "Without me, you'll die in this fight. You have trained for around 2000 days. You're acceptable combatants, as is Ezeonwha. But you are fighting in a city, and underneath it. You need to know how to keep a low profile. You need to know how to move through a crowd, get in and out. And you need to keep collateral damage to a zero, or the gangs will use you like they have others who had your purpose and were less careful to justify their 'protection' continuing. If you march in there and kill 50 slavers, if you kill a few slaves or a single bystander in the process, your credibility will be smeared. And frankly, with me on your team, you won't get blown up by an IED when you try clearing your first room in a fortress."
"IED?" One of them asked, while the rest digested her statement, going through various levels of offended looks.
"Your translator is too cheap. Improvised explosive device. Here, that can be old engines, reused oil, cracked plastic, frictional fuel bombs, circuit extruders, sodium splash grenades, as well as the more military style attacks they can pack, from small micro rockets all the way up to lower level fission or fusion bombs. Though if you're in a fight with those things involved, you're already dead."
"Why?"
"Because unless you're Elders, or holograms, a nuke will kill you whether you're right next to it or just inside the same shield. They concentrate the thermal pulse, so your bones would be ash before the pain hit your eyes."
"And what protection could you bring against that?"
"Telling you it's there before you start the attack. That is, if you listen to me. I value your lives over that of this android, but also I value Ezeonwha over all of you combined. I will not prevent him from doing this, but I will have you all know the risks involved."
"We are prepared, Phoebe. We have done much of the training you say, though we do not believe the gangs would plant explosive devices in their own fortresses. There is too much risk around that, with betrayals so common. However, the minefields we have scouted are easy to defeat with the right tactics. Perhaps you can give us a briefing on those, too?"
A challenge.
"I can, depending on how long you wish to do this for. But I have the stamina for either hours or weeks, depending on which you choose."
"What of your batteries?"
"They are of sufficient quality," Phoebe assured.
"I hope so."
Their tech guy nodded, more numbers flashing on his visor. Ezeonwha hoped he had a different way of display, like through an implant or something, for the missions in darker areas. The Underground was, by its name, not a place where much natural light was to be found. And the gangs controlled all the power systems in their territory. It was another part of the racket.
"Why aren't you guarding Penny?"
Phoebe's back straightened, a subconscious posture change to make her seem more confident. Ezeonwha caught the tactic for what it was, though without extensive knowledge of bipedal forms, it was less likely the surrounding Sprilnav knew it.
"Penny proved before a trillion eyes she's capable of fighting Elders, Progenitors, and a Dreadnaught Captain. Not to mention her immense power. I can shoot bullets, but she can literally snatch them out of the air and eat them. She has her own way of doing things, and it is a good way."
= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =
Penny landed in the rubble and headed for the Vaquah with a trail of survivors behind her. Many of them, she could recognize the marks of slavery on, with numbers or brands on their skin or just the trauma crouching in their eyes dulled by the pain of a long life in a work camp. Penny went through the wreckage to the shield surrounding the rubble and the defining line between the rest of the city and the destruction. Several news drones flew above her.
More were arriving from various directions. The soft footsteps grew into a constant drumming sound, like a beating heart of doom. Penny marched with them, heading to the spaceport. A large medical operation there quickly rerouted many of its various branches to the most injured freed slaves.
Penny pressed her considerable psychic energy on the entire group, accelerating their healing, slowing bleeding, and generally repairing their bodies and cells from the trauma they'd suffered. But the cloud over their heads did not brighten. The atmosphere remained tense and mournful. Many of them had lost friends, family, and more. She had no right to ask them to feel any different.
She had freed them, that was all. They were not her servants. She was not their ruler.
Several of them came up to her, offering thanks in the small ways they could. Kind words. Attempts at hugs. Even offers of devout prayer and worship, which Penny respectfully declined. She knew, as did most of them, that veneration for her deeds was inevitable. She didn't want to be seen encouraging it at all, since this was a public place where many eyes were upon her.
She knew that it would be misconstrued as a threat if she did. Religions were some of the most major threats entrenched powers could face if not properly co-opted by the state to suit their needs. And here, the 'state' was a military dictatorship billions of years old, ripened with corruption, money, and the immortality of Elders sporting technology beyond any other in the galaxy.
The sky was blue with shields overhead. The Vaquah hung in the distance, its thrusters gently burning to keep it aloft. A trail of shuttles linked the massive ship with several spaceports, including this one. Penny watched the freed Sprilnav get on it one by one, promising themselves to a new life aboard her ship. Technically, they were citizens of the Autonomous Peoples' Stars.
That protection, Penny knew, was why the Vaquah and its innocent inhabitants were still intact. Elders already had hired mercenaries to attack it. They'd failed, thanks to Rimiaha and Penny, but also the defenses of Kashaunta's Grand Fleet when it was in higher orbit. Kashaunta, despite her willingness to use Penny as she would, also had a certain intelligence and empathy. It was highly selective, and only money and power seemed to flip that switch.
But Penny needed the Elder, and Kashaunta only had use for her as an asset. She palmed the new communicator Kashaunta had issued her after the last one's destruction. Kashaunta's hologram appeared. It looked around, noticing the news drones in the air.
"Not here."
"Where?"
"You will know."
In the mindscape, a Sprilnav appeared on Penny's layer. They felt odd to her, almost like the minds of certain humans high up in the hivemind's network. Penny greeted the Sprilnav warmly.
"Hello."
"Queen and Elder Kashaunta requests your presence on her flagship."
"Very well."
In reality, Penny looked around at the crowd. She waited until it dwindled to nothing, and then spoke.
"Displace."
Conceptual energy twisted, and she stood on Kashaunta's flagship, though nearer to the edge than she'd expected. The Elder was waiting for her in an outfit that looked much like pajamas, though they were under a few armor pieces that appeared anything but decorative. Now that Penny noticed it, it was the same sort of armor that Yasihaut had worn to their last encounter, which interfered with conceptual energy. The Sprilnav were highly advanced. She wondered just how far their technology could go. She'd heard mentions of some ships having artificial gravity, and of nanites and programmable matter. But nothing certain.
"Hmm," Kashaunta said, giving Penny a once over. "You have come back. Shall I assume you are still my ally?"
"Nervous, are we?"
"Nervous is what you should be, Penny. The Judgment is coming. Ten days. Indrafabar and Justicar will both be on the court as High Judges. That is not good for us at all. So I figured a bit of prudence was in order. I have thought long and hard about this, and with the great battles of our time so fast approaching, I figure it is time to mend our relationship before the chasm grows any wider."
Kashaunta motioned to a special looking sword sheath on her back. Slowly, she drew a sword. A Soul Blade. Penny began to draw up her armor.
"Oh, I am not wishing for a fight, Penny. I know the damage you could do, even in my sanctum in the sky. Tell me, do you know how Soul Blades are forged?"
"No."
"Good. And tell me, do you know why they draw so much power to swing, even for Elders and beings as capable as us?"
"I have a few theories."
"I am sure you do," Kashaunta said. "But here is the thing. Soul Blades are typically weapons assigned to highly promising Elders, or even Progenitors. Filnatra, undisputed sword master that she is, can wield them as easily as breathing. If I were to swing this blade, there would be no drawback. Why?"
"Because you own that Soul Blade."
"Because this Soul Blade is mine. It is not just something I own. I own around seven or so more Soul Blades, with some weapons nearing their quality lying in my various vaults even now. You did not detect them, because I willed that not to be. I need you to understand this, Penny. You have power. You have might. But you are not invincible. My Soul Blade, if it struck you, would not cutely separate Nilnacrawla or Cardinality from you. Nor would your speeding space entity be able to block this blade with his flesh. If this cut you, it would release unending agony upon you before you exploded in a burst of burnt gore."
Penny sighed. "There is no need to threaten me. Allies do not threaten each other."
"But you do not see me as an ally. You see me as your means to get through the Judgment. You believe I see you as nothing more but a linear singularity maker, and perhaps a passing curiosity I'm backing on a whim. You neglect to imagine that there might be firmer reasons why I back you, and why more Elders are getting drawn into this conflict. You believe I am comfortable with showing you my more pragmatic and ruthless sides because I am comfortable with the fact that you cannot harm me. That you would not dare to do so, when you need my assistance so badly. That I might even be aiming to normalize my 'new' self with you."
"That is hardly my belief alone."
"Is it now."
Kashaunta grinned. There was no warmth in her gaze.
"Nilnacrawla," Kashaunta said. "Cardinality. Exile. Come out and show yourselves. You are being rude as guests."
Exile detached from Penny's head. He grew into the shifting array of fractals and shapes she was more familiar with. What had once grated on her eyes did so no longer. Kashaunta stared at the speeding space entity for ten seconds, then looked back up at Penny.
"He will not work on us. I will cover his form with holograms if he walks through my ship out of courtesy for my workers and crew, if he cannot."
"I am capable, Queen Kashaunta."
"You are quite knowledgable, aren't you?" Kashaunta mused, looking at him hungrily. "Oh, how I wonder what secrets you have in your head. How many of ours do you know?"
"I will not be taken as a hostage," Exile said.
"You will not because I decide not to," Kashaunta said. "Formally, our species are still at war. There is no treaty."
"The Sp'rkial'nova no longer exist."
"Yes, they do," Kashaunta said. "The name was discontinued for use regarding the lesser specimens we created. But I can assure you, Exile, if you wish to go by that name here, that we still do exist. I am a Sp'rkial'nova in the flesh. In the blood. In the mind. In the soul."
"Say what you will, Sprilnav. It changes nothing."
"On that I agree. Though our views on how things are may differ, and yours is wrong, your opinion is not valuable enough to matter."
She turned to Penny. She would have defended Exile, but he gave her a simple shake of his head area.
Nilnacrawla formed out of psychic energy in front of Penny. Cardi did the same beside her. Kashaunta tapped a claw on the ground. Tables and chairs appeared. A chef brought in food that looked passable and a few decent attempts at human cuisine.
"We do not have to eat, though I would expect that all of you at least sit at the table. We will discuss our grievances, and how to solve them before we proceed with the future. We shall first go to the matter of the Alliance. Penny, many in their number wish to establish contact with you. Do you agree to this? If so, I will add their communicator numbers to the translation program I have reserved for your personal use, in case your own device needs another sudden replacement."
"I agree."
"Good. A first step of diplomacy, I would say. Agreement. Now, Nilnacrawla, you look like you have something to say to me. What is it?"
"Free Meridia."
"Meridia was detonated by planet cracker during the 139th Sector 9 Border War. I am sorry more could not be done."
A cold draft of air rushed out of Nilnacrawla's nose. He glared at her. "You let them die."
"I did not. A Grand Fleet was defending that star system, and three came to lay siege. I am many things. A tactician, a queen, an Elder. But I am not a god. I cannot perform miracles. I evacuated 30 billion people from that world and its surrounding stations before the planet crackers hit it. 4 trillion more souls died in that blast. The best I can do is to offer an apology."
"That will never be enough for what you did. If you had never established your nation, they would still be alive."
"They would be slaves. Chattel slaves, not that cute little 'wage slavery' concept privileged people throw around. Perhaps I should remind you just how much darker that reality would have been for your female descendents, specifically. I am a brutal warlord, a dictator with an iron fist. But my claws do not squeeze nearly as tightly as I could. Metrics say that I could extract at least 370% more profit from my people if I simply enslaved them. But despite the shock this may bring to you all, I do have principles. The Autonomous Peoples' Stars are my people. My nation. My empire, if you think I'm imperialist. But I protect them as best I can."
Nilnacrawla's cold anger didn't lessen. Penny placed a calming hand on his front left thigh. He blinked. He let out a long, pained sigh. And he bowed his head to her. Not to Kashaunta, but to Penny.
"There is no need to be cruel."
"My language was accurate, Penny. He is a strong Elder. Everlasting knows he's stronger than most of these fools. Nilnacrawla was and is a hero of the Source war. I respect him enough not to mince words, or to give platitudes. Coddling is for babies. Nilnacrawla is far more mature."
Kashaunta turned to Cardi. "You have been remarkably silent in this, concept."
"I have."
"A wonderfully succinct statement. Perhaps you can shorten it further. But nevertheless, you and I will be working together with Penny much more in the near future. Rest assured, if you refuse to become more independent, you will be nothing more than a crutch for her to rely on before leaving her to fall when you are ripped away."
"When, Elder? I would like to think your protection is sufficient."
"I am sure the truth is quite the opposite, dear. I will now get to the point. Penny needs to move faster, and needs to break out of her shell. She needs to be pushed to do more. She has signed a binding treaty, which shows she is capable of more than barbarian aliens, as some Elders would call her. You, Cardinality, will help her be a high achiever. To do this, you need to learn more about your own history.
That is the theme of the year, after all. History. My history, Penny's history, Sprilnav history, and even Gaia's history, it would seem."
"Gaia? What do they have to do with all of this?" Penny asked.
"Oh, you don't need to worry about that."
"Excuse me? You don't get to decide that, Kashaunta. You will tell me. I refuse to be coddled, like you say. I demand the respect I am owed."
"You forget yourself, Penny."
"I remember myself, actually. I am all I need to be. I can become all I need if I must. You can hold your backing against me all you want, but you won't withdraw it. As you said, more binds you and I than mere money and ideology."
"And if you're wrong?"
"Then I've doomed my species and my nation to war, and this planet to the full power of my wrath."
"Wrath, Penny. Wrath. The Sprilnav have many words for anger, rage, hatred. There is the desire for vengeance, in varying degrees. There is that for justice, which does differ. And that for belonging. I know you believe you are standing up to me as a way to assert your own authority in this relationship of ours. You believe I see you as inferior, and will pull back my help when it is profitable for me. I will not offer you the consequences of what your words could mean.
You already know them, and that argument is as stale as your view on us Elders. I will say this once, Penny. You are the Champion of Humanity. The apex predator of your planet, the only one mostly in charge of an Alliance that does more than merely dream of overthrowing us. It is easy for me to say you are not a threat, though I do not ignore the threat you and your nation are trying to become. Gaia will be a part of your movement, but even my information is not entirely complete. I will not mislead you by claiming I know Gaia's link to this, just that there likely is one.
And I am not unreasonably petty. I am willing to put all our animosity behind us and start anew. Even if you are not willing to do the same, I am willing to make this work for us. You have more people to care for than just the Alliance, now. Do not forget them."
"A lot of words that mean nothing."
"Because you heard, but did not listen. Perhaps it will be easier this way, Penny. I want you to win."
"Explain."
"You wish to overthrow the current Sprilnav led order of the galaxy. Your path to that will likely be through mass slave revolt. A viable strategy that I could spread far beyond just this planet. And I actually agree with you. This Judgment, this utter insanity around the Alliance and your species has shown me the truth. The Elders as a class and a species cannot be trusted to rule any longer. We need new leaders. Better leaders."
"And yourself?"
"As the hypocrite that I am, and the power-hungry ruler of the Sprilnav, I would obviously exclude myself from that number. Let's be realistic. The Sprilnav will never accept a non-Elder ruler. If you wish to see what our insurgencies would be like, imagine the 2090s Struggles of Asia. Expand that to billions of planets, large and small. Countless ships and space stations. We have more collective ships than you have people. And as your military planners know, there is no such thing as an unarmed ship. Without us, without me, your plans are stillborn. Your galactic Alliance or whatever you make will fall to pieces without proper counseling. In essence, my offer to you, and you alone, is this. The galaxy, for the Sprilnav."
"Who backs your offer, with the power to give it?"
Progenitors Lecalicus and Nova appeared in the room.
"I back Kashaunta," Lecalicus wheezed.
"I observe her offer, and wish it a proper outcome," Nova said.
"Thank you, esteemed Progenitors," Kashaunta said, standing just to bow to them. Penny stared at Nova, balling her fists.
"There will be time for battle later," he said. "But not now. Hear out her request. She does not make it lightly."
The Progenitors disappeared.
"If I accept your offer, it will be on a written record."
"No. It will not be, because if that record is written, my nation will be facing war on all sides. A better idea would be for us to keep this under wraps."
"Perfect for betrayal," Nilnacrawla muttered.
"It would be, yes. But consider the second part of this situation, Nilncrawla. If word of this galactic offer, not just the Pact, were to get out, which is why two Progenitors who know the price of interference were called here, it would mean the deaths of Penny and all her kind. Or do you forget what rapidly approaches us?"
Nilnacrawla frowned. "I did. I apologize, Penny."
Kashaunta spoke up again.
"Penny. You believe I will betray you. So I make an offer of collateral. An offer so unbelievably sacred for us Elders that many would recoil at the mere thought of it. Now that you have signed a backed treaty, you are fully qualified."
Kashaunta grabbed her Soul Blade and presented it to Penny.
"What does this mean?"
"Nilnacrawla, tell her," Kashaunta said. "She will trust your mouth more than mine."
"Bonded Soul Blades are priceless artifacts," Nilnacrawla said. "To offer one to another is the ultimate gesture of trust and respect among many martial Sprilnav cultures. It can also allow for a mind bridge, a soul pact, or a proposal for marriage between two great houses, martial families, or Elders of great wealth and power. To offer this to a human... to anyone... is an ultimate sign of backing, and one of trust.
It is a sacrosanct honor, the absolute agreement of speaking truth and respect. The words I can use in any human language are insufficient to describe the weight of this honor. This gesture is one of absolute truth. Family lines with hatred going back millions of years would never dare to violate this honor."
"Only one Elder in history did so, one who once led a group known as the Stannic Resistance. He does so no longer. Penny Balica, Champion of Humanity... if there is nothing else I can give you to prove that I do really back you, there is this."
"...Just how low are my chances in the Judgment for you to resort to this?" Penny asked.
"They are not zero, but your battle with be incredibly difficult even with this boon of mine. The future of the galaxy, I now realize, hinges on the outcome of this. If we do not have enough trust, they will sniff it out, and we will fail."
So she had no choice. But as Nilncrawla continued to explain in her mind, Kashaunta was getting the worse side of the deal. Which meant she was throwing her backing behind Penny for real, beyond all reproach and retraction. Kashaunta, the most powerful Elder in the galaxy.
"And if I reject this gift, or your reasons for it?"
"Circumstances would demand that I kill you and then myself using this blade as a way to cut apart the dishonor, before my remains are dumped into a black hole to be forgotten forever. I would not do this."
"A dark and archaic custom," Penny said. She would have said more, but she looked at Nilnacrawla's face. He was clearly deeply uncomfortable. Her five words had shaken him more than anything she'd ever said to him before.
"You do not understand," Nilnacrawla said. "This is not something to joke or lie about. With a Soul Blade Pact in play, all else must cease. Right now, there is you, and there is her. Accept or decline. The choice, your only choice, is yours."
"How will this look to the Elders in the court? To the Sprilnav, and the people who back me?"
She could see how it would be a boon and a curse.
"You, and I," Kashaunta said. "The whole of the universe between us right now is you and I. No others exist until this one act is done. There will be trust or there will be death. No in between. No middle ground. The nature of this bond will be a Pact of Blades."
Conceptual energy swirled between them. Penny's natural translation, as part of the hivemind, failed for the first time ever. Her communicator likewise did not translate the words Kashaunta spoke.
"Eis nama kaste Penny Balica, sun lanci Dorima Kashaunta. Ko'ri, lanci nupa bes na Dorima'Pecunyanova. Sp'rkial'nova. Sun. Homo Sapiens."
The air grew thick with tension. It was not just emotional, either. Psychic and conceptual energy gathered. The mindscape started to distort as more and more eyes began to view Kashaunta and Penny. But all of them were Sprilnav eyes. All of them were Progenitors. Nova's appeared brightest and largest, nearly six times the size of the next largest pair. They stared at her, sending psychic and conceptual energy down upon her in waves that forced her and Kashaunta to kneel to the ground.
"I apologize for my earlier words," Penny said. "I should not have denigrated this."
Penny stood for an hour, deeply contemplating the Pact. If it was as Nilnacrawla was describing to her, it was a promise that Kashaunta would not break. If she was offering it at all, especially to Penny, it meant she had a level of trust in Penny's capability far above what Penny had previously thought. Apparently, there were even higher agreements than this that were possible, with this Pact being the lowest level of bond and considered unbreakable with the enforcement of consequences coming from the Progenitors themselves.
She thought of her place in Justicar and the wider universe. Hours passed like water. And then, by the end of it, after nearly 19 hours, Penny finally had decided. She gave a short nod to Kashaunta, who had been kneeling to Nova all this time.
Kashaunta gestured at the sword. "Tol, nopa shikai."
Nilnacrawla fed her a few suggestions on what she would need to say.
"I come to this Pact seeking peace, justice, and hope," Penny said. "And a promise not to betray one another, by lies or by treachery."
Nilnacrawla translated Kashaunta's next words to her.
"I come to this seeking trust, understanding, respect, and peace," Kashaunta said. "And a promise not to betray one another, by lies or by treachery. I make this Pact before the gods, those who equal them, and those who surpass them. I bind them to an oath of silence regarding this event, until I directly instruct them otherwise, in a state of a sound mind, body, and soul. Here, we shall step into a future that needs both of us, casting aside that which is unimportant to focus on the ultimate goals we have. I offer my Blade to Penny Balica, of species Homo Sapiens. In this way, we forge a new future, and walk a new path. I accept the Pact."
"I accept the Pact."
Nova and a hundred Progenitors descended. Nova grew larger, and Kashaunta knelt to him. Penny remained standing. His sharp teeth glittered in the light. He pressed his claws to Penny's chest, and to Kashaunta's chest.
"The Pact of Blades is made before the Progenitors. We agree to your vow of silence. The penalty of breaking it will be dismemberment and disposal into a black hole. Penny Balica, Engineer Kashaunta. To break this Pact without mutual agreement is to call down our collective wrath upon yourselves. You both have agreed, and are of sound mind, body, and soul. The Pact is forged. By sword, by word, by action. I, Nova, Everlasting, Lord of the Progenitors, King of all Sp'rkial'nova, Heir to the Mantle of Power, Heir to Narvravarana, Progenitor, Elder, and Sprilnav, declare the deed done, etched in time, space, and Reality."
They winked out of existence one by one, leaving Penny and Kashaunta alone, to ponder the future. Penny's thoughts turned to the Judgment, and her confidence she could win it began to waver. How much worse was this Judgment going to be than before?
Penny stared at Kashaunta's Soul Blade. With careful fingers, she took it. Kashaunta sat up, satisfied.
"Now we can begin. I shall compile all the news about you I can find, and we shall see how to address the questions the High Judges will ask. Now that you trust me, I cannot betray you."
submitted by Storms_Wrath to HFY [link] [comments]


2024.05.15 03:05 Safe-Ad-3696 1WPO second surgery update

Following up on on my latest post TLDR: had failed a hysterectomy in February and second surgery was successful.
34 y/o, high BMI, stage IV endo, suspected adeno, (not confirmed in biopsy)dense adhesions and scarring. Had my LAVH, robotic assisted on May 7th. I found a super compassionate doctor who reassured me and gave me hope after I lost it when my first surgery had to be aborted. Surgery went better than expected, with no complications. It took about 6 hours and took forever for me to wake up. I went home the day of the procedure, only took oxy twice and been managing pain with over the counter meds and gabapentin before bed. Hot water bottles and heating pads. Bloating is annoying, I am lonely and bored but I am happy to be done with it. I felt immediate relief, pain peaked on day 2 - gas pain is no joke. I wanted to thank this community for the advice and support provided, it has been crucial for my journey and I am grateful 💗
My hysterectomy was the culmination of more than 13 years of seeking relief from my discomforts that only worsened over time.
It started with anemia on the verge of blood transfusion that had no explanation other than hypermenorrhea. Each menstrual cycle became more tortuous with the passage of time, heavy bleeding, clots, leg cramps, lumbar pain and chronic fatigue.
I will have seen more than a dozen gynecologists and various doctors.
Blood studies, ultrasounds, resonances, endometrial biopsies, colonoscopy, contraceptives, hormonal IUD that ruined my mental health, I tried absolutely everything. I even went to the middle of the Amazon rainforest to seek relief in the medicine used by the Shipibo people.
I came out of many consultations crying, medical gaslighting and gordophobia were 98% of my experience.
They sent me to the psychiatrist because my pain seemed to have no other explanation than to be psychological.
Since I knew about endometriosis I KNEW that surely it was what happened to me, but finding a doctor who would take me seriously and believe me cost so much. It cost time, money, energy, tears, mental health, putting the body.
First they confirmed fibroids, then suspicion of adenomyosis (waiting confirmation of the biopsy), in February I was operated on for 3 hours without being able to remove my uterus due to the intensity of the adhesions and the advanced endometriosis (phase 4 that was confirmed in said failed surgery)
I had my second operation with a specialist and an interdisciplinary team of gynecologists, urologists and general surgeons.
They took out my uterus, cervix and fallopian tubes. The uterus was attached to the abdominal wall, bladder, intestines and basically everything around it. They drained cysts in the ovaries that I keep. I was cleaned of endometriosis of the sacrous ligaments and mainly of the bladder that was very compromised. They took adhesions from me and I'm sure I forget more.
I feel like I was born again and although this disease is chronic and has no cure, I already hope to see improvements and have a better quality of life, make up for lost time ❤️‍🩹 I can’t wait to see if I can ride a bike again.
Now slowly recovering and feeling very emotional and tired, otherwise happy and excited for my new healing era.
Will include surgery notes, biopsy report and pictures for the curious ones, Hope everyone is having a lovely pre surgery or recovery journey, it’s not easy, but we got this 💪 we are stronger and more resilient than we give ourselves credit for, we fight relentlessly and we show up for each other, our bodies are amazing and can do incredibly things. Sending lots of love your way, internet strangers ✨ 💗
Surgery notes:
Surgery
Findings: Laparoscopy: Smooth diaphragmatic peritoneal surfaces and liver without gross lesion. No injury under site of injury at umbilicus and no umbilical adhesions. Intraabdominal adhesions in the right lower quadrant at the site of prior appendectomy, with bowel and omentum adherent to the right abdominal sidewall. Once this omentum and bowel was taken down, there was a divot with a small amount of fat seen in the RUQ. Dr. Kim evaluated this did not require intervention. Similarly, no clear indirect R inguinal hernia seen without bowel and omentum involved, so Dr. Kim similarly did not recommend intervention. Omentum, bladder adherent to the lower uterine segment anteriorly. Extensive pelvic adhesions and evidence of endometriosis. Thickening of the bladder peritoneum and tacked up to lower uterine segment. Fallopian tubes and ovaries adhered to pelvic side wall, with left hematosalpinx noted in the setting of tortuous left tube. R ovary with small ~1cm functional-appearing cyst. L ovary with hemorrhagic ~2-3cm cyst. Rectum free, no posterior adhesions but extensive serosal endometriosis between the uterosacral ligament and on R posterior serosa overlying R uterosacral. Due to the ICG and use of firefly technology, the course of the ureters were well visualized. Procedure Details: After discussion of risks, benefits and alternatives to the procedure, written consent was obtained. The patient was brought to the operating room. The patient was positioned in the dorsal lithotomy position in yellowfin stirrups with arms padded and tucked at her sides. An exam under anesthesia was performed with findings as noted above. Urology completed a cystoscopy (no endometriosis) and placed ureteral stents with ureteral indocyanine green dye placement. See their operative note for further details. The cervix was dilated with tonsil forceps. Paracervical block was placed. The Rumi uterine manipulator with medium Koh ring was secured to the cervix. A Foley catheter was placed to drain the bladder intraoperatively. A 0.8 cm incision was made at the umbilicus, kocher used to elevate the fascia, and a Veress needle was inserted. Intraperitoneal placement was confirmed. The abdomen was insufflated until an adequate dome was achieved. A 8 mm robotic port was placed and the robotic scope was inserted. Under direct visualization, 3 additional ports were placed, two 8 mm robotic ports to the right of the umbilicus and one 8 mm robotic port to the left of the umbilicus. The patient was placed on steep Trendelenburg and the bowels were swept into the upper abdomen. The Da Vinci robot was then docked in position. The filmy adhesions in the RUQ were taken down with combination of cautery and sharp technique. The omentum was taken down off of the uterine fundus with bipolar and monopolar cautery. The left fallopian tube was followed out to the fimbria. The salpingectomy was then performed, starting at the distal fimbriated end of the tube and sequentially coagulating and transecting the mesosalpinx adjacent to the fallopian tube and well away from the ovary. The fallopian tube was left attached at the cornua. The procedure was repeated on the contralateral side. Good hemostasis was noted. The bladder was noted to be densely scarred to the LUS/cervical junction. The junction was incised with monopolar cautery and the bladder was meticulous dissected off of the underlying uterus/cervix to the level of the KOH ring as marked cephlad traction was placed on the Rumi device. Due to the anterior compartment scarring, round ligaments were not clearly identified. The thickened tissue in this area was grasped, cauterized with bipolar and divided with monopolar. Both ureters were seen using firefly technology. The left utero-ovarian ligament was ligated with bipolar cautery and divided with monopolar. The same procedure was performed on the right side. Marked cephlad traction was applied to the KOH ring. The uterine vessels on either side were skeletonized and ligated with bipolar cautery. The remainder of the cardinal and parametrial attachments were ligated with bipolar and divided with monopolar. The vagina was opened over the Colpo device circumferentially. The fibrotic uterosacral ligaments with overlying endometriosis was incised below the implants and fibrosis, taking care to avoid the ureters. The endometriotic implants over the right uterosacral ligaments were excised. The uterus and fallopian tubes were then removed through the vagina. Given the extensive adhesions and fibrosis, this portion of the surgery took an additional 60 minutes longer than expected. After that, the vaginal occluder was placed into the vagina to maintain the pneumoperitoneum. Dr. Kim then came to assess the inguinal hernia. He deemed no intervention was necessary for the R inguinal hernia or the RUQ divot. The functional ovarian cyst in the R ovary was drained. The 2 cm hemorrhagic ovarian cyst in the L ovary was felt to represent hemorrhagic corpus luteum. Two <1cm nodules on the R uterosacral were excised using cautery, taking care to avoid the right ureter. The vaginal cuff was closed using 0 V-lock in a running fashion in 2 layers . The area was irrigated, and hemostasis was evident. All instruments were then removed under direct visualization. The skin was closed with 4-0 Biosyn . Sterile dressings and Tegaderm were applied to all port sites. The ureteral stents were removed and inspected by urology and noted to be intact. A foley catheter was placed for routine voiding trial in PACU. Sponge and needle counts were correct times x2. The patient tolerated the procedure well and went to the recovery room in stable condition. There were no complications to the case.
Pathology:
Final Diagnosis A) Uterus, cervix, bilateral fallopian tubes, hysterectomy and salpingectomy: - Myometrium with leiomyoma. - Serosal/subserosal endometriosis. - Early secretory endometrium, negative for neoplasm. - Bilateral fallopian tubes and cervix negative for neoplasm. B) Peritoneum, right utero-sacral, biopsy: - Fibrotic squamous epithelium-lined tissue with scattered lymphocytic inflammation. - Negative for neoplasm and no definite endometriosis. Clinical Information Pre-op diagnosis: Adenomyosis [N80.03] Dysmenorrhea [N94.6] Menorrhagia with regular cycle [N92.0] Pelvic peritoneal adhesions, female [N73.6]
Gross Description A. Uterus, with or without tubes and ovaries, other than neoplastic/prolapse. Received fresh labeled; 1)Uterus,cervix,bilateral tubes" is a uterus with attached bilateral fallopian tubes.. The uterus alone is 105 g, 9.5 cm cervix to fundus by 6.0 cm cornu to cornu by 5.0 cm anterior to posterior. The cervix is 3.3 cm long by 3.0 cm diameter with a 0.6 cm diameter os. The ectocervix has punctate areas of hemorrhage. The serosa has scant fibrous adhesions anteriorly and extensive cautery and disruption posteriorly. The endometrium is ragged, hemorrhagic, 0.1-0.4 cm thick. The myometrium is up to 2.6 cm thick and is mildly trabeculated with cysts up to 0.1 cm greatest dimension filled with hemorrhagic material, suggestive of adenomyosis. There is a 0.2 cm diameter intramural well-circumscribed nodule with a whorled cut surface. No areas of softening are identified. The right fallopian tube is slightly serpentine, congested, 5.3 cm long by 0.5-0.6 cm diameter and has attached hemorrhagic fimbria. The left tube is 5.0 cm long by 0.5-0.6 cm diameter, purple-tan with attached hemorrhagic fimbria. Representative sections are submitted: A1-anterior cervix A2-posterior cervix A3-anterior endomyometrium A4-A5-posterior endomyometrium with possible adenomyosis (A4 with leiomyoma) A6-right fallopian tube and entire fimbria A7-left fallopian tube tube, entire fimbria. (MUA) B. Soft tissue, OTHER. Received in formalin labeled, ; 2)right utero-sacral biopsy" are 2 tan red rubbery tissue fragments, 0.7 and 1.0 cm, that are entirely submitted in B1. (AA) Case Report Value Surgical Pathology Report Case: SU24-15696 Authorizing Provider: Chiang, Seine, MD Collected: 05/07/2024 03:42 PM Ordering Location: UWMC Main Operating Room Received: 05/07/2024 05:21 PM Pathologist: Garcia, Rochelle Lorraine, MD Specimens: A) - Uterus, with or without tubes and ovaries, other than neoplastic/prolapse, 1)Uterus,cervix,bilateral tubes B) - Soft tissue, OTHER, 2)right utero-sacral biopsy
Surgery pics
submitted by Safe-Ad-3696 to hysterectomy [link] [comments]


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