Earache accompanied by fatigue and naseau

2 ED attendances and 2 GP appointments and I’m being told “everything is normal” my bloods clearly show I’m starting to get some form of an infection yet no one is willing to treat it or explore the possibility. A bit of context last Friday night I started getting serve palpitations and worsening of my POTS I attended all above as they where accompanied by chest pain, presyncope (worse than normal) breathlessness, fatigue ( again worse than normal) and brain fog (worse than normal), they ruled out any cardiac problems and said it’s probably a flare up go home and rest, I did that no improvement went back to both settings another time was told the same they refused to follow my emergency care plan and sent me home. I’ve tried all recommended “treatment” for a flare up, and genuinely cannot cope anymore I cried at all the HCP that saw me and begged for help and no one will. Any advice on what I can do from here?

Just yesterday I met with a doctor who performed a trans-vaginal ultrasound for concerns of pelvic pain, and everything seemed normal. However, when she asked why I came to see her specifically I told her about my concerns with endo. She said that the only way to diagnose was through a laparoscopy, and that the decision was mine if I wanted to go through with it. My problem is, I don’t know if my symptoms are severe enough to warrant one.
I’ve had thoughts of endo for maybe a year or two now, but only through the last month have I made any forward movement with getting a diagnosis. Below I’m listed some of my symptoms, for reference I’m 20yo and got my first period when I was 12.
Heavy cramping Pelvic pain Back pain Constipation Bloating Need to pee but cant Heavy bleeding Irregular periods Longish periods Pain during sex Fatigue Leg pain Migraines
My symptoms are cyclical, happening when I have my period and roughly around the time I ovulate. For 4-5 years now, my cramps have been so severe I have to take a day off school the first day of my period because I can’t do anything but waste away in pain on the bathroom floor.
My periods have always been irregular, anything from a 28-35 day cycle, and periods lasting either 4 or 10 days. First couple days I typically soak a pad within one to two hours. Last two years, I developed back and pelvic pain with my periods. Additionally, the “I need to pee but cant” feelings accompanied me when I ovulate and when I menstruate. Yes, I’ve gotten test for a uti and yeast infection, they both came back negative.
And since October I developed sciatic pain, which occasionally flares up when I ovulate or menstruate. I read that sciatic pain can be caused by endo, and considering that I haven’t had any real problems with my back or significant injuries, endo might be my only explanation. I bloat after I ingest literally anything, a light snack, some water, or even a full meal. I’m extremely constipated on my period.
And I also experience pain during intercourse. I used to feel like a friction type pain, but my partner and I switched to latex free condoms and that made a difference. However, I still have a like a deep stabbing pain kinda like my bladder is full and it keeps getting punched over and over again. I’m not too sure if that is normal.
All of this to say that I hate being a woman and being on my period is the most painful thing I’ve ever experienced. I’ve talked to my mom and she says a lot of the symptoms are normal, but I’ve read a lot of things and I just feel like what I’m going through isn’t normal. However, I do know I can be a bit of a hypochondriac, and I don’t know if I’m just searching for symptoms or if they’re actually there.
I’m already on birth control, and a lot of people ask why I want a diagnosis when I’m already on treatment. For starters, if something is wrong with me, I’d want to know. But also, I don’t want to be on birth control for the rest of my life if I can avoid it. I also want to have kids, and I want to know if something might interfere with that, if I might be infertile.
I desperately want to get the procedure done, but I’m scared of finding out that I could be wrong about all of this. I’ve made it such a big deal for two years, I’ll be so humiliated if I’m wrong. But I also just want to know. My mom is hesitant, because she doesn’t want me going under general anesthesia if it isn’t necessary. So I’m asking you guys: do you think my symptoms warrant getting a laparoscopy? Am I just being paranoid, and is there anything beneficial with getting an endo diagnosis, or would life be the same even if you didn’t get one?

I guess I’m still young (14F) but recently I’ve realised that I’ve not really expressed any emotion other than just happiness. It’s not that I’m always happy it’s just that I don’t know how to show any other emotion to someone like say family or friends.
It’s not that it started recently but I’ve realised I’ve always been like that. It’s either I look/act really happy or I’m just blank. I struggle with showing gratitude, sadness and saying no to people. I don’t think the fact that my friends are the type to compliment every feature about you everyday partly because I just don’t know how to respond to them. Like yeah, I love them and I’m thankful I just can’t say thank you without seeming awkward so I just go “Hmmm” and seem really ungrateful.
I’m also really bad at comforting people but that’s just normal. I get all awkward when one of my friends come to me crying about something because I just don’t know what I should say.
Another thing is I’ve never cried/seemed upset or sad around anyone other than two times in my life (not counting when I was a baby /toddler /still in primary school). The first time was when I went to Spain with my friends (accompanied by our school) and I’d gotten a text from my mother saying that one of our pets was really ill and might die. The other time I didn’t even notice that I was crying. One of my friends just said “Oh H, you’re crying” and that was when I realised what I was actually crying about and that I was crying. I was crying about how two of our friends got in a fight, stupid things like that.
I’ve only ever cried in front of my parents when I was really angry/frustrated with something they’ve said like punishments and things like that. I’ve only really cried out of sadness on my own like say, locking myself in a bathroom, crying and then washing my face so no one can see.
I’ve cried in front of strangers before though. My local mosque has this thing where on Friday, once a month they hold a youth qiyam for girls. They’d serve either pizza or burgers, do reminders, teach us more about Islam and hold activities. However, whenever I went I’d suffer from panic attacks because there were too many people. They all knew each other, were older than me, and most of them would be whispering and giggling to each other. That made me think they were laughing/talking about me being sat alone in the corner in the fetal position and playing with my abaya. I don’t really wear a hijab or an abaya other than to go to mosque so I’m always adjusting them and wondering if I’m even wearing them right for if my baby hairs or just hair altogether is poking out. Then it’d get too loud for me and I’d start crying. The women who host the qiyam would take me to another room, give me some food and a drink then sit with me. Sometimes in silence and other times they’d talk to me about their kids, school, my options for my GCSEs and stuff. Even then I’d feel awkward and hate the fact I’d cried in front of people. However, this only happens when my friend and her sister don’t go. Sadly, they stopped going and so I did too. My mother thinks I have social anxiety but this hasn’t happened much. Yeah, I’ll panic slightly whenever I have to answer a question in lessons, read out my work in English in front of people or even just sit at the front of the classroom (because of the seating plans my teachers have I’m almost always sat either at the front or close to it) but it’s never a full blown panic attack. I’d only get red in the face, which thankfully isn’t that noticeable as I’ve got dark skin, or my heart will start beating faster than normal. I tend to cover my mouth when I eat or avoid eating in front of people who aren’t my friends altogether (unless I’m in a restaurant, then I just have to deal with it). I’d say I only have tendencies rather than actual social anxiety.
My mother also thinks that I might have really minor ADHD as when she researched some of the tendencies she noticed that I had most of not all of them. I’d be really forgetful, talk too much about random things (of which I get really anxious about as I think that people are sick of me talking but I can’t stop), I fidget a lot either with hair my fingers my clothes or this weird thing that I do with my thumb that I can’t explain, I’ll suddenly get really angry with mainly my brother over little things like who sits in my favourite chair in the corner, I interrupt people a lot or have the urge to, I can’t keep anything organised or tidy, I’m always late to either school or going out with friends. But again I don’t think I really have it because I can do many tasks that are known to be difficult to do for someone with ADHD like say reading a book. I usually read at night particularly quickly and almost never get distracted. I’m not really hyper unless I’m with friends but even that tires me out quickly because of me looking happy when I’m not.
I think the whole being happy thing might be affecting me. For some reason I get really really tired at around 13:30 (when our lunch has ended and we’re in our 5th lesson of the day). It’s like the tired that makes it sort of difficult to breathe or keep your eyes open. I don’t ever fall asleep I just sit in lessons with my eyes shut. I’m still listening it just looks like I’m not. I can manage walking home for a while but when I’m Like 3/4 of the way home I struggle to walk a bit. Not a lot, my leg just buckles a few times and my footsteps get heavy-ish.
Normally it’s not that bad but a few days ago I was really really drained. I was so drained that even though I could keep my eyes open I was just staring at a point in the distance. I couldn’t stand up so even though we were in a lesson where you had to walk around to get all the materials for making the items. It was so bad that at least 3 teachers had to ask if I was okay. They started getting the equipment for me after I said “I’m just tired”.
After that I was walking with a friend to our next lesson because she waited outside my room to walk with me. I noticed that I subconsciously transitioned to happy even though I wasn’t really feeling fine. I was walking normally albeit a bit slower than usual. As soon as she left after walking me to my room I immediately felt even more fatigued than before. And because I didn’t want to have to keep up the happy act with them whilst walking home I decided to run off and walk home really quickly to sleep as quickly as possible. As they weren’t in my previous lesson I didn’t tell them what I was doing.
I was able to walk quite quickly for a while but halfway through I started to feel instantly tired. My leg buckled more than usual and my heavy footsteps could’ve been noticeable to a few people who walked past me. When I got home I couldn’t really sleep so I resorted to sitting in an armchair in the corner of the living room, wrapping myself in a blanket even though it was 20C at the time and staying there for the rest of the day. I’d close my eyes a few times but couldn’t fall asleep.
To be honest I don’t actually know the real reason I get so tired. At first I thought it was because of my iron deficiency and to be honest I wouldn’t be surprised as it makes me really dizzy most of the time. I asked my mother why I’m always getting tired and she thought the same thing until I told her it was after lunch. That made her think it was just a food coma but I only have a sandwich with crisps and some raisins and because it only seems to happen on school days. The emotions thing is something that I’ve only just recently thought of as I’ve just noticed how I’m always acting happy when I’m actually not. I honestly have no idea and while it’s not a major concern, I’d really like to know why I’m always so drained.

I was treated for unipolar depression back in 2020 with SSRI lexapro + amisulpride 50mg and was in remission until 2023 with it.
Then in 2023 I blew a small stressor TOTALLY out of proportion(I think hypomania had already begun then) and got into a really bad or probably even mixed episode (my first one if it was actually mixed). I'd get so restless I'd want to tear off my clothes, attempt to run away, suicidal, get so irritative that I'd say the most wicked shit to my loved ones who were really just trying to help me, lay in bed and cry and shout so loud ALL the time. It was so bad I felt like I was going to die and family members were so worried, I was admitted.
Doctors totally ruled out mania/bipolar disorder because I wasn't impulsively buying stuff, didn't lose control etc bullshit and kept treating me for unipolar depression but they did add lamictal with the 20mg Lexapro to address the aggression etc it was titrate to 200mg and put me in remission for a whole year.
But now in 2024 January I relapsed again and this time it was so bad that doctors were continuosly suggesting ECT. I was admitted for over 3 weeks. Same symptoms- agitation, restlessness etc being treated for MDD and borderline personality disorder Bullshit.
Finally, I saw this miracle doc who said I might actually be bipolar and experiencing mixed episodes. Both the combination of hypomania and depression were making me restless. He said he often sees his patients who're hypomanic get so restless they wanted to crawl out of their skin.
SSRI lexapro would only fuel both so it must be stopped immediately and suggested me to try ketamine (because my symptoms were mostly depressive) and started lithium 600mg/day. They worked like a CHARM. I loved ketamine so much and it put me in remission for 3 months.
But then I relapsed again 3 months later and doc now said it is now time to try the big guns aka antipsychotics and continue ketamine. He said he's willing to prescribe either Vraylar or Latuda which work great for mixed episodes.
TLDR : So, do you have any of my symptoms especially the restlessness during your depressive/hypomanic episodes and which antipsychotic of the two worked the best for you without fueling the restlessness. Personally leaning more towards Vraylar (it has amazing reviews and doesn't cause weight gain)
Symptoms list optionally if anyone wants to read that my son made :
What's your go to treatment plan for mixed states? Is this a mixed state rather than unipolar

• Agitation/Inner restlessness: Unable to remain calm/sit still. Blaming all of her symptoms on this restlessness. When this comes the other symptoms which I'll mention come along too:
  
• Crying and shouting loudly (simply can not control this to sorta escape)
  
• Excessive anger and snapping at/blaming others for no reason: Involuntarily blame people for the most random and petty things who've been the most helpful and kind.
  
• Very Irritable.
  
• Suicidality (to escape the restlessness). Suicidal attempts in aggression where she had to be stopped with a lot of physical force.
  
• Racing negative thoughts leading to Guilt and worthlessness
  
• Irrational/Questionable decisions and behaviors were almost always noted by my family members during these periods accompanied with extreme impatience.
  
• Energy: Being fatigued and unmotivated that she can't even move or do stuff. But at the same time having so much Energy to shout so loud and rip her chest open to escape the "agitation".
  
• Pupils get dilated.
  

I was treated for unipolar depression back in 2020 with SSRI lexapro + amisulpride 50mg and was in remission until 2023 with it.
Then in 2023 I blew a small stressor TOTALLY out of proportion(I think hypomania had already begun then) and got into a really bad or probably even mixed episode (my first one if it was actually mixed). I'd get so restless I'd want to tear off my clothes, attempt to run away, suicidal, get so irritative that I'd say the most wicked shit to my loved ones who were really just trying to help me, lay in bed and cry and shout so loud ALL the time. It was so bad I felt like I was going to die and family members were so worried, I was admitted.
Doctors totally ruled out mania/bipolar disorder because I wasn't impulsively buying stuff, didn't lose control etc bullshit and kept treating me for unipolar depression but they did add lamictal with the 20mg Lexapro to address the aggression etc it was titrate to 200mg and put me in remission for a whole year.
But now in 2024 January I relapsed again and this time it was so bad that doctors were continuosly suggesting ECT. I was admitted for over 3 weeks. Same symptoms- agitation, restlessness etc being treated for MDD and borderline personality disorder Bullshit.
Finally, I saw this miracle doc who said I might actually be bipolar and experiencing mixed episodes. Both the combination of hypomania and depression were making me restless. He said he often sees his patients who're hypomanic get so restless they wanted to crawl out of their skin.
SSRI lexapro would only fuel both so it must be stopped immediately and suggested me to try ketamine (because my symptoms were mostly depressive) and started lithium 600mg/day. They worked like a CHARM. I loved ketamine so much and it put me in remission for 3 months.
But then I relapsed again 3 months later and doc now said it is now time to try the big guns aka antipsychotics and continue ketamine. He said he's willing to prescribe either Vraylar or Latuda which work great for mixed episodes.
TLDR : So, do you have any of my symptoms especially the restlessness during your depressive/hypomanic episodes and which antipsychotic of the two worked the best for you without fueling the restlessness. Personally leaning more towards Vraylar (it has amazing reviews and doesn't cause weight gain)
Symptoms list optionally if anyone wants to read that my son made :
What's your go to treatment plan for mixed states? Is this a mixed state rather than unipolar

• Agitation/Inner restlessness: Unable to remain calm/sit still. Blaming all of her symptoms on this restlessness. When this comes the other symptoms which I'll mention come along too:
  
• Crying and shouting loudly (simply can not control this to sorta escape)
  
• Excessive anger and snapping at/blaming others for no reason: Involuntarily blame people for the most random and petty things who've been the most helpful and kind.
  
• Very Irritable.
  
• Suicidality (to escape the restlessness). Suicidal attempts in aggression where she had to be stopped with a lot of physical force.
  
• Racing negative thoughts leading to Guilt and worthlessness
  
• Irrational/Questionable decisions and behaviors were almost always noted by my family members during these periods accompanied with extreme impatience.
  
• Energy: Being fatigued and unmotivated that she can't even move or do stuff. But at the same time having so much Energy to shout so loud and rip her chest open to escape the "agitation".
  
• Pupils get dilated.
  

Playing By Ear
Bloodhound Saga
Wakeup Super
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First Prev Next
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Memory transcription subject: Bonti, Yotul Pre-Med Student (Second Term) White Hill University
Date [standardized human time]: November 5th, 2136
My eyes felt dry as I stared at my pad. Once more, I read over the words in front of me, and once more, I felt lost.
I just don’t understand what it’s saying here. It’s reverse osmosis, but which part of the cell is undergoing the reaction here? They could have phrased this better.
I flipped between the virtual textbook and my notes. My brain was starting to feel like mush after everything I'd put it through over the last claw. I didn’t expect the work to be so extensive, and I regretted putting it off with each new thing I jotted down.
At least I made sure she was alright. It was worth the inconvenience.
I'd stayed with Lanyd for a couple paws after the broadcast, waiting for everything outside to calm down. It was a little strange to be back on her couch again. I couldn’t help but feel like I spent just as much time sleeping there as I did in my own bed. It wasn’t my intention to impose on her so much; I had an apartment of my own, but, unfortunately, crazy shit seemed to just pop up like clockwork.
I probably should have gone home sooner, but she got nervous when I suggested it was safe enough for me to leave…
We passed the time listening to Human music, trying to push the chaos of the reveal to the back of our minds. I wished that I had my guitar to play along, but I'd brought nothing but my pad along with me. Instead, I listened as Lanyd accompanied with both her flytser and her keyboard. Her skills never ceased to amaze me, and I found myself distracted more often than not…ignoring my responsibilities…
Enlek certainly didn't slow down even a little. Not that I really expected him to. That old bastard really doesn't waste any time.
All my other classes had dialed the workload back after the broadcast, giving the students a chance to process everything. It wasn't just my classes either. Lanyd’s courses were the same. Professor Haeli recorded some mini-lectures, but that was all she did.
Professor Enlek, however, took the world-shattering news in stride, and he seemed to expect everyone else to do the same.
That man won’t let a single damn thing get in the way of his teaching process.
So, after being less than productive during all the chaos, I now had catching up to do. Finally, I was starting to near the end of Enlek’s assignments. Or, rather, I was trying. The last few chapters were a slog, and when I messaged the prof to ask for clarification on certain topics, he only repeated that it was already covered in the reading.
Ah, yes, of course. I simply forgot to try and comprehend what I was reading! Silly me. I was just letting the words imprint themselves on my eyeballs.
Then again, my sarcasm was probably pretty damn close to reality. I doubted the subject was as complex as I made it out to be, but, by that point, my brain was barely functional. The fatigue was no doubt obscuring the obvious. I’d been going at it pretty much nonstop since I got back to my apartment, no time for breaks.
It was a shame, too. Brad was in town just the paw before, but I couldn’t make the time to see him without putting off my schoolwork even longer than I already had. I knew there would be more opportunities to see him in the future, but I still kicked myself for missing that one.
I wouldn’t be so behind if I’d kept track of my work. Lanyd was fine, but I was focused on her the entire time instead of my assignments…
Of course, I didn’t blame Lanyd for my predicament. It was my own decision to go check on her, my own decision to stay, and my own decision to fret over her when she was actually okay. In truth, I was glad that my worrying wasn’t needed. She’d been a little out of sorts lately, and I was afraid that the broadcast would make things worse. All was well, however, and I should’ve focused on my own responsibilities sooner.
I continued to stare at the text in front of me. I’d been wall-eyed at it for the last few minutes, yet I hadn’t processed any of it.
Honestly, this whole chapter has felt like gibberish to me. I didn’t expect molecular biology to be easy by any means, but sheesh. Is it fatigue, or am I just not understanding it? An extra pair of eyes on this would be nice…
Just then, I realized how stupid I was. There was an extra set of eyes I could use. I swiped the virtual textbook away and looked for Tenseli's contact. The Zurulian was supposed to be my study buddy, but I hadn't talked to him at all since the broadcast. The whole thing had me more frazzled than Lanyd I supposed.
I found Tenseli’s contact and tapped to give him a call. Part of me wondered if he’d even pick up. I had no idea how he might have taken the news. To be honest, I didn’t really know much about the guy. He seemed nice enough, but he kind of approached me out of nowhere.
Thankfully, I didn’t have to speculate for long. The Zurulian’s face appeared on my pad. His ears were perked up and he seemed in high spirits.
“Hey, Tenseli,” I greeted. “What’s up?”
“Nothing much with all the lectures still canceled,” he chuckled. “I finished trudging through Enlek’s assignments last paw, though I’m guessing you haven’t?”
“Nope,” I admitted. “I was keeping tabs on a friend after the broadcast and…I might have put off my schoolwork.”
“I can’t really blame you. Do you need a helping paw?”
“Yeah, I’m feeling stumped here on chapter six. I get the process with the cells’ reverse osmosis, but I don’t really get the phrasing on this part. Which compound is undergoing the reaction?”
“Hold on. Let me get the text pulled up. Which section are you looking at?”
“Section 6.1.2.”
There was a pause as Tenseli moved to the specified text. Once he got there, understanding flashed through his features.
“Oh yeah. This part felt unclear to me as well. I ended up sending a message to Professor Enlek about it. He was able to explain it better.”
That gave me a bit of pause.
“Really? When I messaged him, he just told me it was in the text. You actually got some clarification out of him?”
Telensi gave me a look of confusion.
“Yes, he was quite thorough. Enlek has been very helpful in my experience. I’ve been asking him to elaborate on topics since the course began. He’s always given me an in-depth answer.”
“Huh. Well, this is the first time I’ve contacted him. Maybe I just caught him at a bad time. If both of us were confused by that part, I bet a lot of others were too. He probably got tired of answering the same questions over and over again.”
“That makes sense,” Telensi agreed. “Especially since you’re likely one of the last ones to ask.”
Once again, I internally kicked myself for not starting on my assignments sooner.
Damn my procrastination.
“Well, it’s a good thing I have you,” I chuckled. “Think you could walk me through this?”
“Of course! But…it might be kind of hard to do it over a call like this. Do you want to meet up in person? I can show you some of the diagrams I drew.”
“That works,” I replied. “I’ll send you my address.”
I tapped out a message and waited to make sure he received it. After a moment, I heard the ping of his pad, and his ears perked up in response.
“Got it. Alright, I’ll head right over.”
“Sweet. Sorry to drag you out for this.”
“Ah, it’s no issue. It’s not like I have anything worthwhile to do right now anyway. Not with so many businesses still closed. See you in a bit.”
With that, the call disconnected and I set my pad back down on the table. Hopefully, with Tenseli’s help, I could finally get through this roadblock in my work. Since I had to wait for him anyway, I decided it would be a good time for a break. I’d have an easier time learning if I was fully present when he arrived.
With a tired sigh, I stood up from my seat and started stretching each part of my body.
Ugh, I’ve been sitting too long. I’m so stiff. Maybe I should do something a little more tactile.
I turned my attention to the case that held my new guitar. I’d barely had a chance to play it since Kila gave it to me. Between the start of my classes, the campus tours, and, most recently, Cilany’s broadcast, I was extremely short on free time.
Even now, I couldn’t play it for long, but it was better than sitting there doing nothing.
I picked the case up, placed it on the table, flipped up the latches, and slowly opened it wide. The matte black body of the instrument stared up at me from inside. Light glistened off the silver pickups. It was a beautiful instrument, and I once again found myself impressed with Kila’s craftsmanship.
I pulled the guitar out of the case and tossed the strap over my shoulder. It handled a little differently from a plehr, but it was actually very similar to the Yotul glesta as well as the Letian yilik. The former was actually fretted like a guitar, but it pertained to the thirty-one tone division of the ‘octave’, unlike the Human’s twelve tone system or the Venlil’s twenty-four tone system. The yilik was fretless, but it had an almost identical body shape to the guitar. I had both a glesta and yilik in my collection, though neither were as well-built as what Kila had made.
I plucked out a few notes, just one at a time to get my claws moving. Once they were loose, I ran up and down a few scales, then started switching between chord shapes.
Without the instrument being plugged into the amp, it wasn’t very loud or imposing, but I could still hear the distorted sound in my mind. My claws moved up and down the fretboard, ‘calibrating’ themselves to the space between each fret. After learning so many similar instruments, I always took a moment during my warmup to acclimate myself to the way everything was spaced out.
Once I felt loose, I started picking my way through some simple songs, passing the time until Tenseli arrived.
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Memory transcription subject: Lanyd, Venlil Music Student (Second Term) White Hill University
Date [standardized human time]: November 5th, 2136
I tapped at the keys of my keyboard, feeling my claws gradually acclimate to the device. It felt familiar to the flytser, yet different. When I played them in close succession, it was like stepping into an anti-grav chamber, as though my whole way of thinking had to adjust.
That wasn't the only thing making me feel that way.
It felt quiet without Bonti around. Actually, it seemed that way ever since he stayed with me over the break. But, now that he'd stayed here again, the feeling returned in full.
What's more, that weird sensation of off-ness hadn't gone away either. It wasn't any more prominent than before, nor was it lessened. The same void continued to haunt me all the same.
Oddly enough, Cilany’s broadcast seemed almost unimportant to me. All my distractions came from within. And yet, they weren't the kind of thoughts that left me quivering with anxiety. everything just felt…confusing…
It's like a piece is missing, but I just can't tell what it is.
I cringed as I struck a wrong tone and sighed. My next session with Dr. Jacobson was about to begin, but I didn't really know what to say to him. We'd talked about this feeling the last time, as well as the time before, yet we never came any closer to determining the cause.
My anxious spirals were much easier to recognize. At least, they became more recognizable once I started writing down my experiences. I could tell where they originated from, and I could follow them back to the source. Sometimes the bad thoughts still got the better of me, but at least I was more aware of them.
This feeling, on the other paw, was more of an absence. There was a gap somewhere, and I couldn't figure out what was supposed to fill it. It nagged at me no matter where I was or who I was with. Some part of me was always unfulfilled.
I wish my brain came with an instruction manual. It shouldn't be this difficult to process my own thoughts.
As if to reply to reassure me, my pad began to ring. I knew it was Dr. Jacobson before I even looked at the screen. The time for our session had finally rolled around. The human therapist wasn’t a brain instruction manual, but he did give me more direction than I’d ever had before. I owed him a lot, much more than what he charged monetarily.
Maybe I could ship him a gift at some point, just something to show my appreciation.
I tapped to accept the call and Dr. Jacobson’s face appeared on the screen.
“Good paw, Lanyd,” he greeted. “It seems a lot has happened since our last session.”
I supposed that was an understatement. We hadn’t spoken since Cilany’s broadcast, and that was large enough that even Humans on Earth knew what had transpired.
“It’s certainly been eventful,” I agreed. “Though, to be honest, it…didn’t really affect me much. Something has always felt wrong to me, so I guess I wasn’t all that surprised. Things still feel wrong, but I know that’s just how I normally think anyway.”
“Ideally, we’ll be able to remedy that,” Dr. Jacobson replied. “We can at least make the doubt feel less everpresent. Though, by the sounds of things, you’re still feeling that emptiness?”
“I don’t know if I can even call it that,” I sighed. “There’s something lacking, but…I don’t know. Can I even call it emptiness if there’s never been anything there before? I d-don’t know what to make of m-my own thoughts and feelings. I just know that s-something’s missing.”
I focused on the feeling of my paws on the keyboard. It was slowly becoming as effective as the flytser in anchoring me. I liked to think that it meant I was getting comfortable with the instrument, one positive in the sea of unsurity.
“There’s been no recent changes then?” Dr. Jacobson asked.
“No.”
“Hmmm…Is there a chance it might be a physical ailment? I’m unfamiliar with Venlil biology. Perhaps your body expresses problems in a way that doesn’t pertain to Humans?”
“Well…” I pondered the question. “I could probably stand to eat better, but Bonti cooked when he stayed here for a short while. Those meals were plenty nutritious, and I still felt the same way then. Maybe it could be all the walking from the tours? I would think that would improve my health though. I don’t have shortlung…”
“You may want to undergo a physical checkup just in case,” Dr. Jacobson suggested. “At least we can rule it out then.”
I flicked my ears in agreement. His practical approach always surprised me with its simplicity. In times where I got wrapped up in my internal struggles, he had a way of focusing me on present action. Truth be told, I didn’t think the problem stemmed from my physical health, but I hadn’t even considered it until he mentioned it.
That’s the difference, the motion that keeps me from stagnating.
“Is there anything else on your mind?” Dr. Jacobson snapped me from my introspection.
“Well…I agreed to p-play at the new jazz lounge. I’m a little n-nervous about it.”
“Oh? That sounds quite nice, actually! Why don’t you tell me about it?”
And so, the session continued on…
-
Memory transcription subject: Bonti, Yotul Pre-Med Student (Second Term) White Hill University
Date [standardized human time]: November 5th, 2136
My song was interrupted by a knock on the door. As much as I dreaded throwing myself back to my schoolwork, I was equally happy to know Tenseli had arrived. Hopefully, I could get past the trouble areas and catch back up before lectures resumed.
I set my guitar to the side and moved to open the door. As it swung open, I had to tilt my head down to look at the Zurulian.
I swear, I always expect them to be just a little taller.
“I’m here!” he gave a little hop in place. “Sorry for the wait!”
“No problem. I’m just glad you were available. Come on in.”
Tenseli obliged, zipping inside without hesitation.
“The campus is starting to get more active,” he slung his bag off of his shoulder. “It’s still kind of eerie though. Those first few paws after the broadcast were just…”
He shuddered in place of that last word.
“Yeah,” I agreed. “I’ve never seen White Hill so…dead, even during the break.”
“Well, classes are starting again soon. Hopefully it breathes life back into this-.”
Tenseli stopped as he rounded the edge of the couch, one eye focused on the guitar seated upon it.
“This is a guitar,” his voice was softer. “A Human instrument…”
“Yeah, I’ve been learning,” I replied. “A Human friend of mine has been teaching me. You know, the woman that played guitar and sang in the concert last term? I’m a bit of a nerd when it comes to string instruments. Plucked strings, anyway.”
Tenseli’s focus remained on the instrument, unwavering.
“I actually thought about getting one of these from that engineering club, but I don’t know that I could even reach my way down the whole neck. It would be nice to see for myself though.”
“You can try your paw at playing that one,” I offered. “We should study first, of course, but you can totally take a crack at it after the fact.”
“I think I’ll take you up on that,” Tenseli signed agreement. “We’ll consider it payment for me coming over here to help you.”
I scoffed and shook my head.
“You didn’t mention a need for payment before!”
“I didn’t know you had a guitar before!”
“Pfft, whatever. Study first, music later.”
“Right!” the Zurulian unzipped his bag and drew his pad from within. “Let’s get started then!”
-
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Knight Captain Shaw barked orders at his men like a rabid dog. His voice was hoarse and edged with panic as exhaustion gnawed at his already frayed mind. His body became heavy, and his thoughts became a haze of fatigue, but he continued to push his men and himself relentlessly throughout the night.
"Pick up the damned pace!" he roared, his spittle flying. “I’ll flog any ye fucks that think to dally!”
That foul Dark Elf had said they'd have an entire day to rest, but Shaw wasn’t going to trust the word of some knife-eared prick that gobbled down a bigwig Noble’s dick as far as he could the devious bastard. However, his men were weary and weren’t keen on complying. Shaw could understand the sentiment, but they didn’t know what he knew. They haven’t experienced the backstabbing nature and the insidious double-speak that came with upper society.
He hand to make them comply through any means necessary, even if it meant taking a head or two.
Shaw's eyes darted nervously between the men scurrying around and the eastern night sky, searching for any sign of that damned dragon. The sudden appearance and subsequent disappearance had left him unnerved. Usually, something that big and that old was accompanied by entire cities being put to the torch just to make a point, and the fact that Shaw’s Lord was executed and labeled as a traitor didn’t bode well. The feathered bitch wasn’t fucking around, and she was out for blood.
"But Capt'n Shaw, the Dark Elf, said we had an entire day to rest," a young, newly anointed knight ventured. His voice was barely above a whisper, heavy with the unspoken fear they all felt.
"Are ye an imbecile, lad!?" Shaw snapped, grabbing the man by the collar of his shirt and yanking him closer. "Do ye trust a snake with yer neck!?" He jabbed a calloused finger at the knight's chest, spraying him with spittle. "That dark-skinned bastard will sell us out the moment it suits him! We march NOW, or that piece of shite will label us as traitors as well and have that damned monster breathing fire upon us before dawn!”
Shaw released the young knight with a final shove, sending him stumbling backward. Paranoia flickered in the Knight Captain’s eyes as his hand twitched toward the hilt of his sword, itching for the comfort of solid steel in a world gone mad. Every rustle of leaves, every distant animal cry, sent shivers down his spine, and his gaze darted back to the horizon with a desperate intensity.
"MOVE!" he bellowed, his voice cracking with strain. "We cannot afford to linger here another moment! Get those wagons loaded and those supplies packed! We must be gone before dawn breaks!"
The men and women of the camp scrambled to obey, and as Shaw watched them, his jaw set, his body thrumming with restless energy. This was no longer simply a means to collect tribute and supply the war effort – it was a desperate flight for survival.
He cast a glance over his shoulder, half-expecting that Dark Elf and his shadows to be watching them with their dark eyes gleaming with cold amusement. To Shaw’s relief, the bastard and his minions were nowhere to be seen. But after seeing just how long it was taking for their departure to take shape, an uneasy feeling formed in the pit of his stomach.
Wagons were being overloaded with barrels of grain, crates of hardy fruits and vegetables, and cages of squawking chickens. Larger, bulkier beasts like the lean, razor-fanged worgs used as war mounts were being prepped by riders, and the plump, docile, shaggy horned beasts that were bred for burden – were not even ready. The first light of the morning was coming soon, and they were nowhere near ready for departure.
"By the Emperor's balls..." Shaw swore under his breath. At this rate, they'd be lucky to move more than a kilometer before the afternoon. Fury surged through him like a wildfire. This was no army, no fighting unit – it was a disorganized mob.
With a snarl, he stomped towards a group of soldiers struggling to hoist a massive crate of chickens, clucking away, onto the back of a groaning wagon. "Leave it!" The Knight Captain barked, his voice a whipcrack across the hushed camp. "Leave all of it! Gods damn it all!"
The soldiers stopped, their eyes wide with shock. "B-But Captain," one stammered, "The Count–."
"The Counts DEAD ya fool!!" Shaw roared, kicking the crate. It slid with a thud, spilling its precious contents across the dirt. "We're leaving this wrong shit behind if we want to see another sunrise!"
And just as those words left the good Knight Captain’s mouth, dawn's first rays painted the eastern horizon, causing his face to fall. They were nowhere near ready. Yet, even as panic began to gnaw at him, a screeching cry pierced the air as a chorus of shrieks echoed from the skies.
Shaw spun around, his heart pounding in horror, thinking it was a dragon, but instead, a flock of wyverns graced his vision. Dozens upon dozens of the smaller Dragon-like beings soared across the skies, their leathery wings blotting out the rising sun. It was a sight both awe-inspiring and terrifying. It was a reminder of the monstrous power the Count held as a breeder.
A surge of relief crashed over Shaw. The messages had reached Count’s Wyvernic nesting grounds, and the message he'd sent just after that damned dark elf played his bloody theatrical games made it. One Wyvern and its rider and a woman donning a dark gambeson reinforced by chain mail assessed the situation below before descending for a landing.
"Finally!" He breathed, a flicker of hope rekindling in his chest as he walked towards the woman and saw she had steel hair with the weathered face of a seasoned rider.
Grabbing her blade staff, the woman dismounted and casted a quick protection spell as her Wyvern snarled and snapped at a few workers who had gotten to close. "Captain Shaw, I take it?" she said warily, peering around the camp to spot any sign of deception. "I'm Commander Eira, of the Barbed Talon. We received the Lord Harmswid’s message… What in all the Abyss is going on?"
Shaw swallowed, trying to keep the desperation from seeping into his tone. "A change of plans, Commander. The Duchess," he lowered his voice, "has decided to… consolidate our Lord’s forces…"
Eira frowned, her eyes narrowing as she surveyed the camp before pulling off her riding cap, exposing her pointed ears, and eyed Shaw in disbelief. “And our Lord… agreed? To this?” She replied incredulously, her hand tightening around her staff.
Shaw hesitated, a thousand half-truths and evasions flashing through his mind. The reality they just experienced was so convoluted, so insane, that it would likely sound like the ramblings of a lunatic. Yet, lying to one like Commander Eira's gaze, with an entire wing of Wyverns, seemed an even worse idea than telling the truth.
He took a deep breath, steeling himself. "No, Commander," he admitted, his voice surprisingly steady. "The Count is... dead. Executed. By the Duchess' hand."
"Executed!? Over what!?" Eira recoiled in surprise as the grip on her blade staff loosened ever so slightly.
"Treason," Shaw said, the word heavy on his tongue. "That dark elf, Tharivol, accused Lord Harmswid of defiance in the Duchess and took his head…."
A storm brewed in Elira’s silver eyes as her expression darkened. Her wyvern, sensing the shift in her mood, let out a low, menacing growl, its eyes flickering with a fire mirroring its rider's anger. The air around them seemed to chill, and the morning's light did little to dispel the growing tension.
"Treason?" she echoed, her voice sharp as the blade of her staff. "And you let this happen? You didn't think to stop them?"
Shaw flinched under her gaze, the weight of his decisions—and their consequences—bearing down on him. "We couldn't," he protested, his voice strained. "They had a dragon! An elder, or perhaps even an ancient one! It was unlike anything I ever did see! We wouldn't even been able to make the monster sneeze, let alone stop ‘em!!"
The fire in Eira’s Wyvern’s mouth started to billow with a raise of her hand as her frustration reached a boiling point. "So, you chose to let the murderer of our Lord walk away unscathed and seize his Wyverns under false pretenses!?" Her tone was icy, and each word stabbed at the Knight Captain like a dagger.
As the wyvern crept closer with its jaw parting slightly letting Shaw see the vortex of flame building within its maw, the knight captain backed away with fear in his eyes. “W-What could I have done against such a monster!?” He pleaded with a voice cracking with strain. “Even with yer entire wing, we all woulda been done in! We gone do nothin’ but annoy it!”
Eira sneered dismissively, flicking her hand in a quick gesture that caused her Wyvern to calm down. "Bah!" she exclaimed in frustration. She hated it, but she knew this coward had a point. Fighting even a senior dragon, let alone a young, teenage dragon, would have been suicide for this lot.
With the Wyvern glaring menacingly at the Knight Captain, Eira's eyes narrowed as she surveyed the ragtag group of soldiers and mages. Her mind started to race through scenarios, each one ending in disaster if they were to face such a beast head-on. "Feel grateful that I show you mercy, plebian," she finally said, her voice laced with disdain before turning around and rubbing the snout of her Wyvern.
“It’s okay, precious… I’ll feed you something more delicious than a dickless coward…” Eira cooed and soothed her bestial companion and scratched under its chin. “I don’t even know what Count Harmswid was thinking when giving a lowly knave like him hereditary peerage.”
The knight captain gritted his teeth at the insult as Eira let out a derisive sigh. Without another word, the wing commander turned and mounted her Wyvern before looking down at her so-called counterpart with a contemptuous look in her eyes. Shaw, despite his anger and frustration, couldn't meet her gaze, feeling the sting of her shaming.
With a harrumph that echoed throughout camp, Eira squeezed her thighs against the wyvern's flanks. The language of pressure was all the creature needed, recognizing its rider's keen desire to take flight. In response, the beast’s mighty wings beat the air, and a whirlwind of power kicked up dust and debris. The force of the takeoff was a visceral thrill, propelling Eira and her mount skyward, leaving awestruck faces below.
As they ascended, the wyvern flock fell into formation behind their leader forming a disciplined wedge, cleaving through the air. They flew eastward, bound for Aldenshore, the rising sun painting long shadows across the land.
Looking around him, The knight captain worse an expression that told of humiliation. The man clenched his fist as his eyes darted across each face, accusing them of also mocking him before violently swinging his arm to the side and barking orders. “WHAT THE HELL ARE YE ALL LOOKIN’ AT!? GET BACK TO WORK!!” In his anger, the knight captain’s hand went to his sword.
“WE’RE LEAVIN’ IN AN HOUR!” With a final bellow, Shaw stormed back towards his tent, obscenities trailing behind him. His men, startled into action, scurried about, the camp abuzz with renewed purpose.
Meanwhile, still hidden in the foliage with their eyes trained on the chaotic scene, Coleman and his ODA team exchanged glances.
"That's a lotta lizards," Bennett whispered with awe evident in his voice.
"Yaaaa," Lister drawled, "All headed east, following that big-ass bitch."
Coleman's brows furrowed, a contemplative hum escaping his lips. "I think this camp is getting ready to move too."
"Whatcha think they're running from?" Bennett asked, turning to Coleman and lifting his eyebrow. “Us?”
Offering a simple shrug in reply, Coleman pressed his face back into his specialized surveillance equipment. "Who knows? Maybe they got spooked by the rangers when they raided." He paused, a predatory glint in his eyes. "Regardless, we're gonna be hitting this place once they piss off."
Elijah watched the retreating wyverns, his gaze focused on the lead rider. "That shiny one riding on the flyer… she's a problem," he muttered, his voice laced with a hint of menace. "Got the feel of someone actually competent."
Coleman nodded slowly, his own gaze fixed on the departing figures. "This the main reason why I want to wait till their long gone. They’re already unloading livestock and what I think is vegetables.” He looked over to Elijah as he spoke. “We can slip in, grab what we need, and bug out before anyone knows we’re there.”
“Ehhh…. I’d still like to snatch one of them up,” Elijah replied, rubbing the back of his neck and wearing a complicated expression. “There’s a mass exodus heading east, and any information we can get our hands on would be worth its weight in gold." He finished before ripping a piece of jerky in half and sharing it with his patron, who was happily munching away on his shoulder.
A deep breath of air left Coleman’s mouth as he sat back and thought for a moment. “I don’t know… There’s a lot of the bastards in there.” His gaze turned to Kwon, the team’s sergeant, in the hopes that he might have some kind of tactical insight. “Any ideas?”
Folding his arms and looking up at the sky, Kwon let out a contemplative groan and crossed his arms. “Well… I have a few ideas…" he drawled. "Why don't we turn this into a three-pronged attack? We've got those Poles further up the road to the east.” Kwon’s head gestured towards one of two dirt roads leading into the place.“ and the Aussies are somewhat near us, right?"
"We could coordinate an ambush," Kwon continued. "The Poles brought heavier gear with ‘em and could cause some serious ruckus in the middle of that convoy.” He said, standing up and grabbing a stick.
Kwon then started drawing a line in the dirt to represent the convey and then drew an arrow interdiction its midsection. “They can Get 'em good and riled up, draw the majority attention away from us while we and the Aussies hit the rear, nabbing anything and anyone worth taking."
Coleman stroked his chin thoughtfully. "The Commandos would buy us time... and if we just focus on just snatching shit, the rest of the convoy wouldn’t even realize the tail was getting shwacked." He added, nodding thoughtfully. "I like it."
"Ya, not bad," Elijah joined in with a wolfish grin, "It's the kind of chaos that just... feels right, y'know?"
“Didn’t we bring mortars? We could just start dropping shit on them while the Poles rough them up.” Bennett chimed in.
A thought hum left Coleman’s voice as he wore a face that said he was deliberating on parting with something precious. "Ya, however..." he started with a cautious note in his voice, "We don't exactly have that many rounds, so we should only use those them for a special occasion."
Elijah cocked his head, munching on his bit of jerky. "Sure, but... isn’t this pretty much a special occasion? If we're gonna use 'em, this is the scenario for it."
Kwon nodded in agreement. "The two goons got a point. Dropping a few surprises in the middle of their convoy while the Poles stir up trouble would pretty much ensure our success.” He added while kicking his makeshift battle plan to break it up. “It’s apparent they don’t know how to deal with indirect fire yet, so we should take advantage of it while we can."
Coleman sighed dreadfully as he hung his head and capitulated to his men. The idea of raining a bit of death and destruction definitely held an undeniable appeal, especially with the fact that it would significantly reduce the chance of casualties. He needed to stop being a miser and use what they had to its fullest extent. "Alright, we’ll use the mortars,” he declared, standing up, “We’ll zero for a predesignated spot where the Commandos will engage them, drop a shit load of mortars, and scare the hell outta 'em.”
“However…” The team leader murmured as he still felt like there were some glaring flaws in the plan. “These shitheads still use magic to augment their physical abilities, so it's still gonna get dicey… Any idea on how to subdue one of them?” Coleman asked, looking around.
The team fell into a heavy silence, with each member becoming lost in their own thoughts. They had always engaged the enemy from a distance or at least had enough space between them to riddle each prospective warrior with bullets. The question of subduing someone, especially those using magic to enhance themselves, seemed incredibly unwise. Everyone exchanged uncertain looks and collectively shrugged as they acknowledged their lack of a solid plan for non-lethal engagement.
A heavy silence descended upon the team as everyone looked at each other with eyes the kind laden with uncertainty. They'd always fought these magic users with the buffer of distance. But close up? That was a another question they weren’t too keen on finding out.
Ever the one to think outside the box, Elijah hummed in interest. "Hey, Yana,” he called out tapping the bag of beef jerky that had her little legs sticking out of it. “Do you have any way to drop some dude without, ya know, turning them into crispy a critter?" he asked as her legs kicked angrily at the sudden smack.
Suddenly her legs sunk into the bag and her tuny head popped out, narrowing her eyes at her insufferable human. “Haahhhh!?!?” An irritated and confused look clouded the little fairy’s face, clearly taken aback by the question.
“Why would I do something so nonsensical and stupid as that!?” she retorted, her tone dripping with disdain. “And why are you so insolent all of the time!?”
Unfazed by Yana's outburst, Elijah met her annoyed gaze with a mischievous and calculating look that flashed across his face for a moment. "Oh, if you can't do it, then don't worry about it," he said, his voice dripping with a challenge that insinuated the task was out of her capabilities. He continued, adding fuel to the fire, "If it's beyond your means, then don't worry about it. We'll figure something out."
Yana stared at him blankly for a few moment. She couldn’t believe the words that left her apostle’s mouth wand was clearly unable to process what was just said. The very implication that something might be beyond her capabilities was not just an affront to her pride, but an insult that couldn’t be left unasnwered. Then, suddenly, her hair billowed like a raging flame, a physical manifestation of her indignation.
Her reaction was instantaneous and intense. In a blur of motion that caught everyone off guard, she zipped out of the bag of jerky and grabbed a fist full of Elijah's long hair, yanking on it as she brought her face close to his, her eyes ablaze with a fiery fury. "What do you mean by 'can't' and 'beyond my means'!? I am a goddess!" she yelled, her voice a mix of anger and wounded pride. “You insolent little man! You idiot! You dummy!”
Elijah couldn’t help but wince at the deceptively powerful tug. His tactic of provoking Yana into action had worked a little too well. “Ow, ow, ow! Yana, chill!” He yelped as she pulled harder, growling at him. “I’m sorry! Relax! I believe you’re capable of anything!”
“Hmph!” Yana harrumphed as she released her human. "Well, of course I am!" She huffed, crossing her arms and spinning around in annoyance. “The mere fact you questioned my ability is not only unacceptable! But rude! Rude, rude, rude, rude, rude!”
As everyone stared at the two as if they lost their minds, Elijah rubbed his head where Yana had yanked his hair, wincing slightly from the unexpected fierceness of her grip. "God damn..." he muttered under his breath, but a grin still formed on his face. She had taken the bait, but now he had to see if he could reel her in.
Looking up at the tiny goddess, who was now floating with an air of indignation, Elijah decided to shift gears and aimed to appease her wounded pride. "Well, I just never seen you in action, you know? Maybe you could give your favorite human a demonstration of how magnificent you can be?" His tone was a mix of genuine curiosity and a dash of flattery, hoping to smooth over the ruffled feathers. “Maybe stretch your arms out and test the new strength you’ve been gaining?”
Still hovering with her arms crossed, Yana paused at the request. Her anger momentarily gave way to intrigue. The idea of showcasing her abilities, particularly after having them doubted, was an appealing opportunity to reassert her divine prowess, especially since she had taken a small slice of power from the few souls she had helped pass. Her expression softened slightly, and the flames in her hair dimmed as she considered Elijah's proposal.
"A demonstration, you say?" Yana mused, her voice losing some of its earlier sharpness. "I suppose it wouldn't hurt to remind you mortals of the extent of my power.”
Elijah gave a cheeky grin to the rest of his team, who just stared at him as if he were a madman. “We just need you to make the person I point out squeal in pain while we tie ‘em up.”

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Chapter 21: Reborn
Gribble sitting alongside his grandfather, Gorp, at a serene lake nestled in the heart of a lush forest. The gentle lapping of the water against the shore and the melodic chirping of birds create a peaceful atmosphere. Gribble's small, green hands grip a fishing rod, his eyes fixed on the unmoving line, frustration etched across his youthful face as time passes without a single catch. The sun's warm rays dance upon the lake's surface, casting a golden glow on the tranquil scene, yet Gribble remains oblivious to the beauty surrounding him, consumed by his growing impatience.
Gorp, a wise and patient goblin with a wrinkled face and kind, knowing eyes, notices his grandson's mounting frustration and offers a reassuring smile. With a gentle touch, Gorp places his weathered hand on Gribble's shoulder, his presence alone seeming to calm the young goblin's restless spirit. In a voice filled with wisdom and understanding, Gorp imparts a profound piece of advice that will forever shape Gribble's perspective: "Patience, my dear Gribble, is the bridge to success; when coupled with an unwavering belief in oneself, it becomes an unstoppable force, capable of overcoming even the most daunting of challenges."
As these words resonate deep within Gribble's mind, the peaceful scene begins to fade, the colors blurring and the sounds growing distant. The harsh reality of the present situation comes crashing back, and Gribble finds himself torn from the comforting memory, thrust once more into the dangerous reality of the cave and the looming threat of the Thundercat
Gribble lies on the cold, hard ground of the cave, his small body battered and bruised from the Thundercat's relentless assault. The air is thick with the scent of blood and the tang of fear, as Gribble struggles to catch his breath, each inhalation sending shockwaves of pain through his weakened frame. The Thundercat looms over him, its massive form casting a sinister shadow across the cavern floor, its electric blue fur crackling with barely contained energy. The creature's eyes gleam with a predatory hunger, its gaze fixed upon the helpless goblin, as if savoring the moment before delivering the final, fatal blow.
Gribble's heart races, his pulse pounding in his ears like a frantic drum, as he stares into the face of death itself. The Thundercat's hot breath washes over him, carrying with it the stench of primal ferocity and unbridled power. Gribble's own breath comes in short, desperate gasps, his lungs burning with the effort of drawing in the damp, musty air of the cave. The cold tendrils of fear wrap around his soul, threatening to suffocate him with their icy grip, as he confronts the terrifying realization that his life hangs in the balance, dependent upon the whims of the savage creature that towers above him.
In this moment of absolute horror, Gribble's mind races, desperately searching for a way out, for some glimmer of hope amidst the overwhelming darkness. He knows that he must act quickly, that hesitation will surely spell his doom, but his body feels leaden, weighed down by the burden of his injuries and the paralyzing fear that grips his heart.
In a last-ditch effort to save himself from the Thundercat's impending attack, Gribble musters the remnants of his strength, drawing upon the very last reserves of his power. He calls out to the earth, seeking to summon the dormant life that lies beneath the cave floor, hoping against hope that his earth vine powers will answer his desperate plea. Gribble's mind races as he focuses all of his energy on this single, crucial task, his brow furrowed in concentration, his eyes squeezed shut as he wills the vines to burst forth from the unyielding ground.
The thick green vine is sluggish in its movements, its progress hindered by the unnatural environment of the cave, but still, it inches forward, guided by Gribble's unwavering determination.
Gribble's heart leaps with a sudden surge of hope as he watches the vine snake its way towards the Thundercat, a small, defiant spark igniting within his chest. He knows that this is his only chance, that the success of his plan hinges upon the strength and speed of the vine, and he pours every last ounce of his will into the endeavor. The vine quivers and strains, as if struggling against an invisible barrier, but Gribble refuses to yield, his mind locked in a silent battle of wills with the very earth itself.
As Gribble watches the vine's sluggish progress, a sudden flash of inspiration illuminates his mind, and a daring plan takes shape. With renewed focus and determination, he directs the vine's growth, shaping and molding it with his earth magic, willing it to take on a new, more deadly form. Slowly, the tender green tendril begins to elongate and narrow, its tip sharpening into a wicked point, until it resembles a crude but effective spear, poised to strike at the heart of the Thundercat.
Gribble's eyes narrow as he concentrates on the newly-formed vine spear, his body trembling with the effort of maintaining his mental grip on the volatile plant matter. The spear quivers in the air, its tip aimed squarely at the Thundercat's broad, muscular chest, as if seeking out the creature's vital organs with a hunter's precision. Gribble's breathing grows shallow and rapid, his heart pounding against his ribcage as he prepares to unleash the improvised weapon, knowing that this single strike may well determine the outcome of the battle, and perhaps, the very course of his life.
With a final, desperate surge of energy, Gribble thrusts his hand forward, his fingers splayed wide as he channels every last ounce of his power into the vine spear. Time seems to slow to a crawl as Gribble watches the spear's progress, his heart in his throat, his eyes wide with a mixture of hope and fear, as he silently prays for the success of his gambit
The vine spear’s sharpened tip finding its mark with a sickening thud as it pierces the Thundercat's muscular chest. The creature lets out a deafening roar of pain and surprise, its voice reverberating through the cave like a clap of thunder, as it staggers backward, its electric blue fur standing on end. The Thundercat's eyes widen in shock and disbelief, its gaze fixed upon the slender green tendril that protrudes from its body, as if struggling to comprehend the reality of its own vulnerability.
Gribble watches in stunned amazement as the mighty Thundercat, the very embodiment of primal power and ferocity, begins to falter, its movements growing sluggish and uncoordinated. The creature's massive frame shudders and convulses, its muscles rippling beneath its fur as it fights to remove the vine. The Thundercat's breaths come in short, ragged gasps, its eyes growing dim and unfocused as the life slowly drains from its body, until at last, it collapses to the ground, a final, shuddering sigh escaping its lips.
The cave falls silent, the only sound the steady patter of the rain outside and Gribble's own labored breathing, as he struggles to come to terms with the magnitude of his victory. He stares at the Thundercat's lifeless form, scarcely daring to believe that he, a small, unassuming goblin, could have felled such a formidable beast. A mixture of relief and exhaustion washes over Gribble, his limbs trembling with the aftershocks of the intense battle, as he slowly begins to process the implications of his triumph.
Gribble crawls towards the fallen Thundercat, his movements slow and painful, each breath sending a fresh wave of agony through his battered body. As he nears the creature's lifeless form, an inexplicable urge takes hold of him, a primal desire that he can neither explain nor resist. Before he can question the impulse, Gribble finds himself drawn to the Thundercat's still-warm chest, his hands moving of their own accord as they seek out the beast's most vital organ.
With trembling fingers, Gribble carefully parts the Thundercat's thick fur, revealing the smooth, blue skin beneath. He hesitates for a moment, his mind reeling at the thought of what he is about to do, but the compulsion proves too strong to ignore. With a deep breath and a quick, decisive movement, Gribble plunges his hand into the Thundercat's chest, his fingers closing around the creature's still-beating heart. The organ pulses in his grasp, its rhythm slowing as he carefully extracts it from the Thundercat's body, a faint crackle of residual electricity dancing across its surface.
Gribble brings the heart to his lips, his eyes wide with a mixture of fear and anticipation, as he contemplates the enormity of the act he is about to commit. The coppery scent of blood fills his nostrils, mingling with the damp, earthy smell of the cave, as he parts his lips and takes a tentative bite of the Thundercat's essence. The taste is overwhelming, a flood of rich, primal flavors that dance upon his tongue, setting his senses alight with a rush of power and vitality unlike anything he has ever experienced. The world narrows to a single, focus point, as if the universe itself is holding its breath, waiting to see what awestriking abilities Gribble will gain from this bold act of consumption.
As Gribble swallows the last morsel of the Thundercat's heart, an electrifying surge of power courses through his veins, setting every nerve ending alight with a tingling, almost painful sensation. The goblin's small frame begins to tremble and convulse, his muscles twitching and spasming as the creature's essence merges with his own life force. Gribble gasps as he feels his body start to change, subtle shifts taking place throughout his musculature and skeleton that quickly escalate into all-consuming physical transformations as the potent powers from the heart take hold.
Gribble's once small, wiry muscles begin to bulge and swell, expanding with newfound strength and vitality, as if the Thundercat's raw power is being transmuted directly into his own cells and sinews. His scrawny limbs thicken and lengthen, the sudden growth of his body accompanied by shooting pains and cramps, as he undergoes an accelerated metamorphosis. The goblin's stature increases rapidly, his height multiplying at an astonishing rate, until he towers over his former self, a new, imposing figure of raw power and potential.
But the changes do not stop with his musculature alone. Gribble's senses sharpen to a degree he would never have thought possible, his eyes able to penetrate the thick darkness of the cave without hindrance, every detail of his surroundings now clear and sharp as if bathed in the bright light of day. The goblin's ears twitch and thrum with a newfound sensitivity, able to pick up the tiniest sounds and vibrations from the depths of the cave. Most astonishing of all, sparks of brilliant blue electricity emerge through the hairs on Gribble's arms, dancing and pulsing with a life force that both fascinates and terrifies him. He has been reborn, a product of the powers that now surge within, his body and mind irrevocably altered by the essence of the Thundercat.
As the initial shock of the transformation begins to subside, Gribble becomes aware of a soothing warmth spreading throughout his body, a sensation that stands in stark contrast to the pain and exhaustion that had plagued him mere moments before. The goblin looks down at his battered and bruised form, his eyes widening in astonishment as he watches the myriad wounds and gashes that mar his skin begin to knit together before his very eyes, the flesh mending itself at an impossible rate.
Deep lacerations seal shut, leaving behind only faint, silvery scars that quickly fade into nothingness, as if erased by an unseen hand. Ugly purple bruises that had blossomed across Gribble's body, testaments to the savage beating he had endured at the claws and fangs of the Thundercat, now rapidly diminish in size and color, until they vanish entirely, leaving his skin unmarked and pristine. Even the bone-deep aches and pains that had settled into Gribble's joints and muscles dissipate, replaced by a newfound sense of strength and vitality that courses through his veins like liquid fire.
As the healing process nears its completion, Gribble slowly rises to his feet, marveling at the ease with which he can now move, his body no longer weighed down by the burdens of injury and fatigue. He flexes his fingers experimentally, feeling the raw power that thrums just beneath the surface of his skin, a barely contained energy that whispers tantalizing of limitless potential. A sense of invincibility washes over the goblin, the knowledge that he has not only survived the brutal encounter with the Thundercat but emerged stronger and more powerful than ever before. Gribble's gaze hardens with a newfound sense of purpose, steadied by the certainty that he can now overcome any obstacle that dares to stand in his path.
Even as Gribble revels in the rush of power and the exhilaration of his miraculous recovery, a faint shadow begins to creep across the edges of his consciousness, an unsettling presence that lurks just beyond the reach of his newfound senses. It is a darkness that seems to emanate from deep within his own being, a nebulous entity that tugs at the corner of his thoughts, whispering of hidden costs and unspoken dangers.
The goblin tries to shake off the growing sense of unease, pushing the troubling thoughts aside as he focuses instead on the incredible changes that have taken place within his body, marveling at the raw strength and vitality that now course through his veins. Yet, even as he seeks to bask in the glow of his transformation, the darkness persists, hovering at the edge of his awareness like a silent, watchful specter.
As Gribble moves through the cave, his steps imbued with newfound purpose and power, he cannot escape the nagging feeling that something fundamental has shifted within him, a subtle alteration that goes beyond the physical changes he has undergone. It is as if the essence of the Thundercat, now intertwined with his own lifeforce, has brought with it a touch of something primal and untamed, a wildness that threatens to consume him from within. The goblin's heart begins to race, a sense of trepidation rising in his chest as he ponders the implications of this strange, unsettling presence, wondering what price he may ultimately pay for the powers he has so eagerly embraced.
Driven by an instinctive need to escape the confines of the cave and the lingering presence of the fallen Thundercat, Gribble makes his way towards the entrance, his steps steady and purposeful, imbued with a newfound sense of strength and determination. As he nears the mouth of the cave, the sound of the pouring rain grows louder, the steady patter of droplets against stone echoing through the cavernous space like a ghostly drumbeat.
Gribble steps out into the downpour, his body immediately assaulted by the cold, stinging droplets that fall from the sky in an unrelenting torrent. The water sluices over his skin, running in rivulets through his hair and down his face, yet the goblin barely registers the sensation, his body thrumming with the power of the Thundercat, the electricity that courses through his veins keeping him warm and insulated against the chill of the rain.
He tilts his face upwards, his eyes closed as he allows the water to wash over him, a silent, almost meditative gesture that speaks of a desperate need for cleansing and renewal. The rain beats down upon Gribble's body, as if seeking to purge him of the darkness that has taken root within his soul, to wash away the lingering traces of the Thundercat's essence that now mingle with his own. Yet, even as the water pours over him in an unending stream, the goblin knows that some stains are too deep to be cleansed by mere rain alone, that the changes that have been wrought within him are irrevocable and permanent.
As Gribble stands there in the pouring rain, he catches a glimpse of his reflection in a nearby puddle, the image distorted and rippling with each falling droplet. The face that stares back at him is at once familiar and utterly alien, a strange amalgamation of the goblin he once was and the creature he has become. Gone is the scrawny, unassuming figure that had entered the cave, replaced now by a being of raw power and untamed potential.
Gribble's once wiry frame is now corded with muscle, his body honed and sculpted by the Thundercat's essence, every sinew and fiber imbued with a strength that defies belief. His eyes, once a dull, unremarkable shade, now glint with a predatory intensity, the pupils narrowed to vertical slits that seem to pierce the very darkness itself. The goblin's skin, too, has undergone a transformation, the surface now alive with tiny bolts of blue electricity that dance and crackle with each movement, a testament to the power that flows through his veins.
As he stares at his altered reflection, Gribble is struck by the realization that he is no longer the same goblin he was before, that the experiences he has undergone and the powers he has absorbed have changed him in ways that go far beyond the physical. He senses a new hardness within himself, a steely resolve that was absent before, tempered by the trials he has faced and the darkness he has embraced. The goblin knows that he has crossed a threshold, stepped into a realm of power and potential that few of his kind have ever dared to tread, and that there can be no turning back from the path he has chosen.
As the initial rush of adrenaline and euphoria begins to fade, Gribble is struck by a profound and unsettling realization, a truth that settles over him like a leaden weight upon his soul. The powers he now possesses, the incredible abilities granted to him by the consumption of the Thundercat's heart, have come at a terrible cost, a price that he is only now beginning to comprehend.
Gribble senses that a part of himself has been lost, consumed by the very darkness that now resides within him, a fundamental piece of his being that has been forever altered by the merging of his essence with that of the Thundercat. It is as if a shadow has fallen over his spirit, a veil of darkness that threatens to engulf the very core of his identity, to erode the values and beliefs that once defined him.
The goblin's mind reels as he ponders the implications of this realization, the knowledge that he has willingly embraced a power that may ultimately consume him, body and soul. He wonders what challenges lie ahead, what trials he will face as he navigates this new and uncharted realm of existence, and whether the strength he has gained will be enough to see him through the darkness that surely awaits.
As Gribble stands there in the pouring rain, his body thrumming with power, his mind haunted by the specter of an uncertain future, he knows that he has set foot upon a path from which there can be no retreat. The goblin steels himself, his jaw set with grim determination, as he prepares to embark upon a journey that will test the very limits of his newfound abilities, and perhaps, the very essence of his being. With a final, lingering glance at the cave that has borne witness to his transformation, Gribble turns his face to the storm and steps forward into the unknown, ready to embrace the challenges and dangers that lie ahead.

i’m not diagnosed with any autoimmune disorders but i have a fair amount of markers / symptoms that are apparently related to / in the realm of an autoimmune disorder. i wanted to reach out here to see if y’all had any advice on how to seek out treatment / how to get tested / any other advice given the set of symptoms i have.
for the past 3ish years i’ve been exhausted, extreme fatigue that isn’t remedied with any amount of sleep and makes getting through any day a very difficult task. i get blood pooling in my legs when i stand still and upright for a few minutes, which leads to me getting light headed and seeing spots / fainting (this is remedied by wearing compression socks). irregular heartbeat occasionally, typically accompanied by the blood pooling / dizziness. i never have “normal” bowl movements, nor consistent ones. some days i’ll go 7 times, others it’ll just be once. they’re never the staple “healthy” looking stools. i get frequent debilitating stomach cramps that encompass my entire abdomen and last all day, sometimes spanning more than a day, and make me unable to stand up straight without severe pain. i also have psoriasis in some parts of my body. i get hot red splotches on my face, chest, arms and stomach a couple of times a month. i am frequently nauseous (almost daily) and have a sensitivity to gluten. three years ago i was throwing up multiple times a week till the point that i threw up blood and got an endoscopy done. it showed my stomach lining being very torn up and bloody and unhealthy, but i never followed up (i haven’t had an episode like that since).
i’ve been told to look into pots which i tested negative for. i’ve been told to look into possible thyroid issues, lupus and chrons, but i’m honestly really lost and confused. it’s been something dragging me down for the past 3 years and it’s been too overwhelming to try to go to the doctor to figure it out since i have no sense of direction. it’s obvious it’s not getting any better, so any words of advice / guidance on what threads i should follow or steps to take would be amazing. thank you for your time!

The really long sentences are mine and the separated ones is chatgpt. PLease comment what you think.
But all this peace and tranguility was about to change, with the arrival of the UES Safe Travels. The ship was tasked by the government to retake the lost cargo of the Contact Light, unaware of the horrors of petrichor 5. Making landing zones at spots with the most cargo, they were immediately attacked by the wildlife. The denizens of the planet were infuriated at the death of Providence, and knew that it was the humans fault. They attacked all of the camps, outnumbering the humans by the hundreds they easily won against some of them but some camps stood the test. Our focus must now deviate from the main group of humans, to a specific one, a mechanic named Tohm.
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In the chaos that ensued after the arrival of the UES Safe Travels, the once-peaceful Petrichor 5 transformed into a battleground. The denizens of the planet, enraged by the perceived affront to Providence and the disruption of their sanctuary, launched attacks on the human camps established for the retrieval of the lost cargo.
As the wildlife descended upon the landing zones, the humans found themselves outnumbered and ill-prepared for the ferocity of the planet's defenders. The initial skirmishes were swift, with some camps easily overwhelmed by the sheer numbers and hostility of the native creatures. However, a few resilient camps managed to stand their ground against the onslaught.
Amidst the chaos, our focus turns to a specific individual—Tohm, a mechanic among the crew of the UES Safe Travels. As the attacks unfolded, Tohm, with his mechanical expertise, found himself playing a crucial role in the defense efforts. With makeshift barricades and jury-rigged defenses, he worked tirelessly to fortify the camp against the relentless assaults.
Tohm's hands, accustomed to the intricacies of machinery, now wielded tools and devices crafted for survival. The screams of the wildlife and the clashes of combat echoed around him as he repaired damaged structures and repurposed salvaged technology to fend off the planet's vengeful defenders.
The mechanic's determination and resourcefulness caught the attention of his fellow survivors. Tohm emerged as a beacon of hope amidst the chaos, a symbol of resilience in the face of an unforeseen and hostile environment. His skills not only kept the camp standing but also inspired those around him to fight against the fury of Petrichor 5.
As the battle raged on, Tohm's mechanical ingenuity became a vital asset in the struggle for survival. The fate of the UES Safe Travels crew hung in the balance, and in the heart of the battleground, the mechanic stood as a testament to the indomitable spirit of those who dared to venture into the unknown depths of the cosmos.
After the attrition had stopped all the survivors returned to their duties and it was Tohm's turn on watch duty. While he sat in the little foldable chair he brought, he noticed a strange crab like creature wandering the plains. It crawled around looking at the ground and every decent size rock, inspecting it. When it noticed Tohm he jumped and readied his gun but thats what he thought he did, instead he just stood there perplexed. Then, he heard words, no memories, surface in his brain then go silent like they were vanishing.
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Tohm, weary from the recent battles, took his turn on watch duty as the survivors regrouped and resumed their duties. Seated in a small, foldable chair he had brought, he scanned the plains around the camp, vigilant for any signs of the native creatures that had attacked earlier.
In the quiet moments of his watch, Tohm's attention was drawn to a peculiar crab-like creature. It wandered the plains with a purpose, inspecting the ground and examining rocks. When the creature noticed Tohm, he instinctively reached for his gun, only to find himself frozen in a state of perplexity.
As Tohm stood there, trying to make sense of the situation, he heard words—fragmented memories that surfaced in his brain. The words were fleeting, like whispers on the edge of his consciousness, slipping away before he could grasp their meaning. It was as if the very fabric of his thoughts was unraveling, replaced by a sense of disorientation.
The crab-like creature, seemingly unfazed by Tohm's presence, continued its inspection of the surroundings. Tohm, still grappling with the strange mental phenomenon, watched as the creature moved with a deliberate and almost methodical intent.
In a moment of cautious curiosity, Tohm approached the creature. As he drew closer, the whispers in his mind grew louder, fragments of memories teasing the edges of his understanding. The crab-like creature, aware of Tohm's presence, turned its attention toward him, its gaze locking onto his eyes.
Then, unexpectedly, the creature emitted a series of rhythmic clicks and whirrs. Tohm felt a peculiar resonance with the sounds, as if they were unlocking something within him. The memories that had eluded him began to coalesce, revealing fragments of a forgotten past, a history intertwined with the mysteries of Petrichor 5.
Tohm, standing on the plains under the alien sky, found himself at the crossroads of memory and discovery. The crab-like creature, an enigmatic guide in this cosmic puzzle, continued its inspection, leaving Tohm to grapple with the echoes of his own forgotten narrative in the heart of Providence's sanctuary.
As Tohm walked towards it the creature tensed up and looked at a stone golem approaching it. The golems laser started to line up with the creature, until the creature started to stretch its spine, revealing a black hole that started to grow bigger and bigger until it incased tohm and the golem. Feeling sick he tried to stand put was already standing, actually floating through what looked like space but had a purple light at the end like a tunnel
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In an unexpected turn of events, as Tohm approached the crab-like creature, a stone golem emerged on the scene. The golem's laser aimed directly at the creature, creating a tense atmosphere on the plains. However, the creature responded in a manner that defied understanding.
As the creature stretched its spine, an astonishing revelation unfolded. A black hole began to form, growing larger and larger until it enveloped both Tohm and the stone golem. In an instant, the familiar landscape of Petrichor 5 dissolved, replaced by an otherworldly space that seemed to stretch into infinity.
Tohm, initially disoriented and feeling a wave of nausea, realized that he was not standing but rather floating through this cosmic void. The purple light at the end of the tunnel beckoned, drawing him closer with an ethereal allure.
The space around him felt both vast and intimate, a surreal dreamscape that defied the laws of the known universe. Tohm's senses were overwhelmed by the cosmic beauty that surrounded him, and the echoes of the black hole's creation lingered in the air.
As he floated through this surreal journey, Tohm couldn't shake the feeling that he was traversing the very fabric of existence. The purple light at the end of the tunnel pulsed with an enigmatic energy, inviting him to venture further into the cosmic unknown.
Amidst the kaleidoscope of colors and the absence of gravity, Tohm grappled with the profound realization that he had been transported to a realm beyond the constraints of Petrichor 5. The cosmic journey, initiated by the mysterious actions of the crab-like creature, unfolded like a celestial tapestry, and Tohm found himself suspended in the cosmic dance of design and soul.
But he snapped out of his gaze after he heard a whale cry and shaking stones. Looking behind him he saw a whale that was purple and had multiple white eyes with a pinkish clear underbelly. As he tried to move out of the way the whale moved over him revealing what the shaking sound was coming from. When the whale passed over Tohm he could see inside its belly, he was expecting organs but what he found was the golem that had tried to attack the crab and wisps plus a couple lumerians. As he thought he was in the clear he got hit by the fin of the whale sending him hurling deeper into the abyss. As he traveled through the dark he felt a presence watching him with hungering eyes.
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Tohm's cosmic journey took an unexpected turn as he heard a distant whale cry echoing through the void. The shaking stones around him hinted at the colossal presence approaching. Turning around, he beheld a massive purple whale with multiple white eyes and a pinkish clear underbelly.
The whale's ethereal form moved with a majestic grace, and as it passed over Tohm, he witnessed a surreal scene within its belly. Instead of biological organs, the interior harbored unexpected inhabitants—the stone golem, the wisps, and a couple of lumerians. The creatures seemed unharmed, suspended in a strange symbiosis within the whale's cosmic embrace.
Thinking he was in the clear, Tohm attempted to move out of the way, but the colossal fin of the whale struck him, sending him hurtling deeper into the abyss. As he tumbled through the dark expanse, a disorienting sense of weightlessness surrounded him.
In the cosmic depths, Tohm felt a strange presence watching him with hungering eyes. The void seemed to pulsate with an otherworldly energy, and the sensation of being observed intensified. The eyes, unseen yet keenly felt, bore into his very essence, raising questions about the nature of this cosmic journey.
The journey through the abyss continued, and Tohm found himself propelled further into the unknown. The surreal encounters with the cosmic entities of Petrichor 5 left him with more questions than answers. As he hurtled through the darkness, guided by the purple light in the distance, the mysteries of this cosmic realm unfolded like a cosmic tapestry, revealing layers of existence beyond the comprehension of mortal minds.
As he traveled Tohm started to feel heavy and realized he was going into an island of strange appearance. Crashing into the rock with some force he got up and observed his surroundings. he looked around and was absolutely astonised with what he was seeing it was a stone coil laid down with it ferrying random objects to the left side of the island and beyond. He felt the ground, it was like sea grass it waved the same way and grew about the same height but was pink, the dirt under it was white with black specks. Ignoring the coil he could see upright seaweed but it was a pale white and he saw galaxy looking purple growths under an overhang that he swore he saw his galaxy in these starry purple blobs.
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Tohm, heavy and disoriented, found himself on an island of surreal and otherworldly appearance after crashing into a rock. As he gathered himself and looked around, astonishment washed over him at the bizarre sights that greeted his eyes.
The island featured a massive stone coil, curving and ferrying random objects to the left side and beyond. The coil seemed to be a peculiar force of nature, its purpose shrouded in cosmic mystery. As Tohm observed, he couldn't help but marvel at the intricate dance of the stone coil, its movements defying the conventional laws of the natural world.
Turning his attention away from the coil, Tohm noticed the ground beneath him. It resembled sea grass in its waviness and height, but it had a distinct pink hue. When he touched it, it responded like real sea grass, adding to the surreal nature of the environment. The soil beneath the pink sea grass was a striking contrast—white with black specks, creating a stark and captivating landscape.
Moving further, Tohm discovered upright seaweed, but this seaweed was an otherworldly pale white. The galaxy-looking purple growths beneath an overhang captured his attention, their starry patterns resembling galaxies in the cosmic expanse. Tohm felt a strange connection with these celestial-like blobs, as if they held the echoes of his own galaxy within their mysterious depths.
As he explored the island, each discovery unveiled a new layer of cosmic wonder. The environment, a harmonious blend of familiar and alien elements, spoke to the intricate design that defined Petrichor 5. Tohm, amidst the strangeness, felt a sense of awe and reverence for the cosmic tapestry that unfolded before him—an island that seemed to exist at the intersection of reality and dreams.
He looked more around the island till he saw a little hut that looked like it belonged to something he moved closer, then realizing he had no weapons just clothes. But still further he aproached starting to hear and smell, a fire! Mabye it was his pals, but then he heard a old voice say "I know you are there, please come in.". Astonished by what he just heard Tohm obliged, going into the door way he noticed pieces of art that looked like paintings of the purple whales. Going down the stairs he saw a purple and black shelled creature sitting near a fire, he walked over to the dirt seat across from it.
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Tohm, curious and cautiously intrigued, approached the little hut on the island. The absence of weapons dawned on him, leaving him with only his clothes as he ventured further. As he neared the hut, the scent of a fire reached his senses, and he started to hear the crackling flames within.
The realization that this could be a gathering place for his companions filled him with hope. Yet, as he reached the doorway, a voice, weathered by time, reached his ears, saying, "I know you are there, please come in." Astonished by the unexpected invitation, Tohm obliged, stepping through the doorway.
Inside, he found a space adorned with pieces of art that resembled paintings of the purple whales, mirroring the cosmic wonders he had encountered on his journey. Descending a set of stairs, he discovered a room with a fire, where a purple and black-shelled creature sat, bathed in the warm glow.
Tohm approached, choosing a dirt seat across from the creature. The air was filled with a mixture of curiosity and anticipation. The creature looked up, its eyes holding both wisdom and a sense of mystery. The firelight danced across the room, casting shadows on the walls adorned with depictions of the enigmatic purple whales.
As Tohm settled into his seat, he couldn't help but wonder about the nature of this encounter. The old voice that had welcomed him, the paintings on the walls, and the presence of the purple and black-shelled creature all hinted at a deeper connection to the cosmic mysteries of Petrichor 5. Seated across from the creature, Tohm awaited the next chapter of his journey, guided by the inexplicable forces that had brought him to this island sanctuary.
"So whats your story, soldier" said the humanoid armored creature. Tohm, explained his story and what he was doing before ending up here. The creature chuckled, then started to remove its head revealing an aged man with purple markings on his face. He said "Thats cute they sent a team to recover the Contact Light, speaking of whats the number of crew alive now?" "0 living, all MIA." A tear started emerge from the mans eyes. he wiped it with a gloved hand and said "My name is Arthur Creed, captain of the Contact Light" Tohm replied "Tohm mechanics division."
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"So, what's your story, soldier?" inquired the humanoid armored creature, its voice echoing within the confines of the hut. Tohm began recounting his tale, explaining the expedition, the battles on Petrichor 5, and the mysterious journey that led him to this island sanctuary.
The creature chuckled, a sound that resonated with a mix of understanding and amusement. To Tohm's surprise, the creature then started to remove its head, revealing beneath it the visage of an aged man with purple markings on his face. The transformation from armored being to a human caught Tohm off guard.
With a warm smile, the man introduced himself, saying, "That's cute they sent a team to recover the Contact Light. Speaking of, what's the number of crew alive now?" Tohm hesitated for a moment, then replied, "0 living, all MIA." A tear welled up in the man's eyes. He wiped it away with a gloved hand and spoke again, "My name is Arthur Creed, captain of the Contact Light."
Tohm, still processing the revelation, responded with a nod of acknowledgment. "Tohm, mechanics division," he introduced himself. The hut, adorned with paintings of the purple whales and surrounded by the mysteries of Petrichor 5, felt like a meeting place of past and present.
As Tohm and Captain Arthur Creed exchanged glances, a profound connection formed between them. The cosmic dance that had brought them together on this island sanctuary now bound them through shared experiences and the weight of lost comrades.
Seated across from the aged captain, Tohm prepared to delve into the untold chapters of Petrichor 5's mysteries. The journey, which had started with cosmic anomalies and surreal encounters, now extended into the heart of the Contact Light's story—a tale that intertwined with the very fabric of Providence's sanctuary.
"So, captain where are we? It dosen't look like a planet to me." Arthur sighed "We're in the void an expanse that goes infinitely down and never out. A place of horrors that make the interplanetary wars look like a joke." Tohm kept asking questions that the captain would answer with ease. The captain told Tohm that the whales ferry things to the voidling and other places in this abyss. The captain also told Tohm about the void monsters that roam islands, lesser beings serving the higher minds of this realm. Then Tohm asked "I felt something watch me as I floated to the island, do you know what it is?" the captain pausing for the first time in hours looked dead ahead at a painting of an island. "It is The Leviathan a consumer of all that tries to pass through the layers without using the gravity wells.".
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"So, Captain, where are we? It doesn't look like a planet to me," Tohm inquired, his curiosity undeterred by the surreal surroundings. Arthur Creed sighed, the weight of untold stories and cosmic mysteries evident in his expression. "We're in the void, an expanse that goes infinitely down and never out. A place of horrors that make the interplanetary wars look like a joke."
Tohm continued to ask questions, and the captain, with the ease of one who had traversed the cosmic expanse for years, shared his knowledge. He spoke of the whales ferrying things to the Voidling and other places in this abyss. Captain Creed recounted tales of void monsters that roamed the islands, lesser beings serving the higher minds of this realm.
As the conversation unfolded, Tohm couldn't help but feel a mixture of awe and trepidation. The cosmic tapestry of the void seemed to extend beyond the limits of comprehension, revealing layers of existence that challenged the very nature of reality.
Then, Tohm brought up a lingering sensation he had experienced during his journey. "I felt something watch me as I floated to the island. Do you know what it is?" The captain, pausing for the first time in hours, looked dead ahead at a painting of an island. "It is The Leviathan, a consumer of all that tries to pass through the layers without using the gravity wells."
Tohm absorbed this revelation, the name "The Leviathan" resonating with a profound sense of danger and power. The layers of the void, the creatures that dwelled within, and the enigmatic nature of this cosmic realm unfolded before him like chapters in a vast, untold epic.
Seated in the hut adorned with paintings, Tohm and Captain Arthur Creed delved deeper into the mysteries of the void, their words echoing in the cosmic silence that enveloped Providence's sanctuary. The island, suspended in the cosmic dance, held the echoes of a tale that transcended the boundaries of space and time—a tale that Tohm was now a part of, bound by the threads of fate that connected the living and the abyss.
As the pair of humans settled to sleep, they heard a otherworldly noise then a clicking and tapping after that a sound of a portal closing. The captain packed all the things in the room in a hurry then woke up Tohm saying "They are here.". Tohm jumped up grabbing what little he had and following the Captain out the door. He sprinted towards the kelp grove after Arthur. After they took cover hiding in the kelp, Tohm noticed that same creature that supposedly got him here, except there were more. Followed by a strange bipedal, black and purple lobster that towered over a creature an already tall creature. Arthur pointed out that when he first got here they sent the lobsters after him. He also knows that they act as some sort of jailer for the minor things that arrive in the void. After some time Arthur whispered "They'll search the whole island, we have to get out of here or we're dead meat, we'll have to take the gravity well.". Tohm replied "Where will that leave us?" "No idea but they've never came with this much force." They agreed that they would make a run for it, jump into the gravity well and see where it takes them. So they ran. Sprinting out of the kelp the void creatures immediately noticed them the lobster like creature firing void orbs at them. They jump and feel a tugging sensation floating them away deeper into darkness.
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As the pair of humans settled down to sleep, the eerie quiet of the void surrounded them. Suddenly, an otherworldly noise filled the air, accompanied by clicking and tapping sounds. A portal closed, signaling the arrival of beings from the cosmic expanse. Captain Arthur Creed, reacting swiftly, packed their belongings in a hurry and woke up Tohm, urgently whispering, "They are here."
Tohm, roused from sleep, grabbed what little he had and followed the captain out of the room. They sprinted towards the kelp grove, seeking cover amidst the alien vegetation. As they hid, Tohm observed the arrival of the creatures, including the one that had supposedly brought him to this place. The eerie atmosphere intensified as strange bipedal, black and purple lobsters joined the group, towering over the other creatures.
Arthur pointed out that the lobsters acted as jailers for the minor entities that arrived in the void. The situation became tense as the creatures began searching the island. Arthur, whispering to Tohm, realized the urgency of their predicament, saying, "They'll search the whole island; we have to get out of here, or we're dead meat. We'll have to take the gravity well."
Tohm, uncertain but trusting the captain's experience, asked, "Where will that leave us?" Arthur admitted, "No idea, but they've never come with this much force." With a silent understanding, they decided to make a run for it, sprinting towards the gravity well in a desperate attempt to escape the impending threat.
As they emerged from the kelp, the void creatures immediately noticed them. The lobster-like creature fired void orbs, and in a desperate sprint, Tohm and Arthur jumped into the gravity well, feeling a tugging sensation that whisked them away deeper into the darkness of the void. The unknown destination awaited, and the two humans plunged into the cosmic currents, leaving the island sanctuary behind, shrouded in the enigma of the void.
As they travelled through the void the pair of survivors looked into the deep expanse wondering what could be at the bottom or the top. "I'm going to sleep through the trip, I suggest you do to." Arthur said. "Noted." Tohm replied. While they were floating Tohm felt uneasy like he was being hunted and his suspicions were confirmed when the void started to move. "As you struggle against the void, you may find that every path you take just brings you deeper, deeper, yet deeper." "Who's there?" "Deeper into curiosity, deeper into hubris, and deeper into creation." The void replied. And then Tohm saw it The Leviathan, a massive creature with eyes that resembled the stars in a night sky and scales as black as it's surroundings. Then it spoke some more "You will never find your way out mortal, nothing ever comes out. I have seen creatures of monumental power go through this void and to think you have chance of making it out. You are a fool." Tohm was in awe at the massive creature it was mythical in size and appearence, and to think this being was sparing his life he couldnt comprehend it.
ChatGPT
As Tohm and Arthur floated through the void, their thoughts filled with uncertainty about their destination, the deep expanse around them seemed to hold secrets that defied comprehension. Arthur, expressing fatigue, decided to sleep through the journey, and Tohm, acknowledging the suggestion, prepared to do the same.
However, a sudden uneasiness gripped Tohm. It was as if the void itself was alive and watching, and his suspicions were confirmed when the void started to move. A mysterious voice echoed through the cosmic currents, speaking of struggle, curiosity, hubris, and creation. Tohm, bewildered, asked, "Who's there?"
The voice responded, "Deeper into curiosity, deeper into hubris, and deeper into creation," leaving Tohm with an eerie sense of foreboding. As the voice continued, an awe-inspiring sight unfolded before him—the Leviathan, a colossal creature with eyes resembling the stars and scales as black as the surrounding void.
"You will never find your way out, mortal. Nothing ever comes out. I have seen creatures of monumental power go through this void, and to think you have a chance of making it out. You are a fool," the Leviathan declared. Tohm, in the presence of this mythical being, was both humbled and astonished. The Leviathan's words resonated with a truth that transcended mortal understanding, and Tohm struggled to comprehend the magnitude of the encounter.
The Leviathan, a creature of immense power, spared Tohm's life, leaving him in a state of profound awe. As they continued their journey through the cosmic currents, the Leviathan's presence lingered, a reminder of the vast mysteries that unfolded in the depths of the void—an expanse where mortal beings grappled with forces beyond their comprehension.
The Leviathan was speaking but wasn't moving it's mouth, it followed the humans observing them repeating phrases and sometimes responding to some of the things Tohm said. "There is one who has escaped a creature silenced by the void but as loud as rolling thunder. It's purpose is vengeance and it will not stop." The Leviathan muttered. Tohm wondered how long this godlike being had lived for and what it had seen while existing in this realm between space and logic.ChatGPT
As Tohm and Arthur continued their journey through the void, the Leviathan, a creature of cosmic magnitude, accompanied them with its haunting words. The Leviathan's presence transcended mere physicality; it spoke without moving its mouth, and its eyes, resembling the stars, followed the humans' every move.
"There is one who has escaped, a creature silenced by the void but as loud as rolling thunder. Its purpose is vengeance, and it will not stop," the Leviathan muttered, its words echoing in the cosmic currents. Tohm pondered the enigmatic message, wondering about the identity of this escaped creature and the tales it carried within the timeless expanse of the void.
The Leviathan, a being that seemed to exist beyond the constraints of mortal understanding, continued to observe the humans, responding to Tohm's thoughts and words. As Tohm considered the vastness of the Leviathan's existence, he couldn't help but wonder about the timeless wisdom and the cosmic stories the Leviathan held within its mythical form.
In the realm between space and logic, where the Leviathan reigned as a godlike entity, Tohm found himself immersed in a journey that transcended the boundaries of mortal comprehension. The Leviathan, a silent witness to the eons that passed in the void, guided them through the cosmic currents, leaving Tohm to ponder the mysteries that unfolded in the company of this enigmatic and ancient being.
After what seemed like an eternity they had spotted a quite large island with a large twisting structure in the middle. The Leviathan had delved back into the infinite depths of the void leaving Tohm in utter silence. As they got closer Tohm woke up the Captain and they observed this new island, it was strange it had this wierd ramp to an oval frame and a gravity well like system snaking around the island. This island was much larger than the previous one it had rock spires, a larger void kelp forest, plus a middle island that had a strange form.
ChatGPT
As the journey through the void stretched on, Tohm and Arthur eventually spotted a sizable island with a large twisting structure at its center. The Leviathan, having retreated into the infinite depths of the void, left them in silence. As they approached the island, Tohm woke up the Captain, and together, they observed the strange features of this newfound land.
The island was peculiar, featuring a weird ramp leading to an oval frame and a gravity well-like system snaking around its perimeter. It dwarfed the previous island in size, showcasing towering rock spires, an expansive void kelp forest, and a central structure with an unfamiliar form.
Tohm and Arthur, having left behind the cosmic currents and the enigmatic company of the Leviathan, now faced a new set of mysteries on this uncharted island. As they drew nearer, the details of the landscape became clearer, inviting them to explore the secrets that awaited within the depths of this cosmic sanctuary. The island, with its peculiar architecture and unique features, beckoned them to uncover the untold tales hidden within its rocky spires and swirling void kelp forest.
When they arrived they swam out of the well and landed on the island, looking around Tohm was eager to find some rations or even better a real meal. Arthur walked to the central island using a stone bridge covered in pink moss like it was ancient, he then walked up the ramp to the crumbling oval frame and pondered what it could be for. Tohm was still looking for food when he found a large stone plate that had a purple liquid in it, Tohm being to hungry to care what it is cupped some up in his hand and drank it. It was nourishing but tasted like seafood, that made alot of sense in his mind.ChatGPT
As Tohm and Arthur arrived on the new island, their immediate priorities diverged. Tohm, driven by the urgency of hunger, began searching for rations or any semblance of a real meal. Meanwhile, Arthur walked toward the central island, using a stone bridge covered in pink moss that seemed to carry the weight of ages. He ascended the ramp leading to a crumbling oval frame, his thoughts consumed by the mysteries it held.
Tohm's quest for sustenance led him to a surprising discovery—a large stone plate containing a purple liquid. Driven by hunger and a willingness to take risks, Tohm cupped some of the liquid in his hand and drank it. The taste was unmistakably seafood, fitting for the alien environment they found themselves in.
Arthur, lost in thought by the oval frame, speculated on its purpose. The island, with its ancient structures and intriguing features, seemed to hold a myriad of untold tales. As Tohm sated his immediate hunger, the exploration of the island's mysteries awaited, inviting the two survivors to uncover the secrets that lingered within its enigmatic landscapes. The convergence of their individual journeys on this cosmic sanctuary hinted at a narrative yet to unfold—a tale woven from the threads of the void and the echoes of ancient mysteries.
As time went on the pair began to settle down, and wander the island mapping it out and using the not so natural utilities to their best known extent. They found carvings that told a story of an innocent trapped in the void, held against it's will it became spiteful and seeked an unstoppable vengeance. It was accidently let out by a stranger who wandered into and then out of this strange land helped by bobbles and trinkets. "Strange story, wonder who carved it?" Tohm remarked. "Whoever it was it was recent and awfully detailed." the Captain replied. They wandered to the front of the island and came into view of the hole in the sky that the whales went back and forth into. They sat down talked and Tohm took thought about the Leviathans words, they might be true he thought but this isnt so bad. And they watched the void the starry space like it was once in a lullaby.
ChatGPT
As time passed, Tohm and Captain Arthur Creed settled into a routine on the mysterious island, mapping its features and utilizing the not-so-natural utilities to their best extent. They discovered carvings that told a captivating story—an innocent entity trapped in the void, driven to vengeance after being held against its will. The tale unfolded with the accidental release of this being by a stranger who wandered into and then out of the strange land, aided by bobbles and trinkets.
"Strange story. Wonder who carved it?" Tohm remarked, examining the intricate details etched into the rock. Captain Arthur Creed pondered the same, noting, "Whoever it was, it was recent and awfully detailed."
As they explored further, they reached the front of the island and beheld the hole in the sky where the whales went back and forth. Sitting down, they engaged in conversation, and Tohm reflected on the Leviathan's words. Despite the potential dangers that lay ahead, the tranquility of the island offered a respite, a moment to appreciate the starry expanse of the void.
Tohm, Captain Arthur, and the island itself became intertwined in a cosmic dance—one that unfolded with each passing moment, revealing the mysteries of the void and the echoes of ancient tales. As they watched the void, the starry space seemed to lull them into a contemplative state, inviting them to ponder the enigma of their existence within the timeless expanse of Petrichor 5.

Age 22
Sex Female
Height 5’9
Weight 180ish
Race Black
Duration of complaint Two or so weeks
Location MI, US
Any existing relevant medical issues high blood pressure
Current medications none I for some reason have been urinating much more often than usual, sometimes it is cleaalmost clear. I thought it was due to my consumption of liquids more often but it is being accompanied by a bit of fatigue lately and every once in a while some slight pains in my stomach region as well as muscle spasms. I have been trying to drink more water than anything else (i usually drink mainly juices and water, once in a while a soda). The most exercise I get as of late is walking/lots of moving around at my job at walmart. I have a history of high blood pressure and used to take amlodipine for it but haven’t had my medicine refilled in some time. Looking into getting more soon

(For posting reasons: Age:35 / Male / Malta EU / 163cm 72.5kg / Non smoker for 3 years, started again 4 days ago)
Hi all - I felt I need to talk to someone - I have posted numerous times about needed help regarding a left sided swelling and full body flushing. Some replied and some ignored and I understand completely.
Im 35 Malta, 5foot 4- now 73kg from 61kg due to Predisone(Steroid) and I've just been released from our local hospital. I've done all the tests possible including MRI's, CT's, US's and almost 30 pages of blood tests which all show no real "abnormality".
This all started with a slight left swelling in my Jaw February 2023 and a red rash plus extreme ants under skin. Now May 2024 - My whole left side is swollen, and now accompanied by pain. Was rushed to hospital 2 days ago due to both feet and ankles swelling, and hands and fingers swelling. Multiple tests and nothing abnormal.
Looked at my Rheumatologist, spoke to my Immunologist and even if they didn't say it clearly - this is where this ride will end. I have tried everything in my power and they have done all there is to do. But the swelling keeps increasing, the fatigue keeps gaining on me and the pain well - is not helping at all.
I have kept my job, and I thank my boss for his patience. I have tried to deal with my youngsters and wife best I can. Now I start preparing for the inevitable. Can't say Im happy - but I think deep down I always knew since they always stated that its an unknown disease. Gonna try to enjoy this summer fishing and going out with the family and see how long we can stretch this out.
Were going to try one last medicine, should be here in a week. baricitinib 2mg daily - like a last resort - but still there's no guarantee it will work and odds are slim.
Felt I needed to vent somewhere - and well maybe read some feedback.
Thanks all -

My brother got mono from EBV about 2 months ago. It was a fairly normal mono experience (sore/swollen throat, muscle pain, fatigue, fevers), but it got out of hand about a month ago. The muscle pain turned into severe, deep pains in his arms and hands that comes in waves; a rash showed up on his palms accompanied by tingling/pain; he is incredibly fatigued; he cannot walk without extreme calf pain; his fevers continue unless he is on a high does of oral steroid. Inflammatory markers (ESR, CRP) are very high still. Unfortunately, neurology and rheumatology are passing us back and forth. We did an SFN biopsy today but it'll probably take some time to come back. He's taking Lyrica, dexamethasone, and failed Tramadol today. Nothing really seems to help. Anyone seen something like this before and have any experiences to share? Doesn't seem possible to get into a good doc in any short timeframe. For reference my immune system is also screwed up and I have a ridiculous number of issues (dysautonomia, craniocervical instability, SFN, spondyloarthritis...) so we seem to have lucked out on the genetic lottery. Thanks everyone

Understanding Solar Flares

Solar flares are intense bursts of radiation emanating from the sun's surface. These energetic events can disrupt satellite communications, affect power grids, and even influence our planet's magnetic field. For many, solar flares can also bring about heightened emotions, fatigue, and other physical symptoms due to their impact on our energetic fields.

The Role of Crystals

Crystals have been used for centuries to support physical, emotional, and spiritual well-being. Each crystal carries its unique vibration, making it beneficial for different purposes. During periods of solar flares, certain crystals can help shield your energy, promote grounding, and maintain emotional balance.

Top Crystals for Solar Flare Protection

1. Black Tourmaline

• Properties: Known for its powerful grounding and protective qualities.
• Benefits: Helps to shield against electromagnetic radiation and negative energies. It can also stabilize your energy, reducing the impact of solar flares on your emotional and physical well-being.

2. Labradorite

• Properties: A stone of transformation and protection.
• Benefits: Balances and protects the aura, raises consciousness, and grounds spiritual energies. It helps deflect unwanted energies from the aura and prevents energy leakage.

3. Shungite

• Properties: Known for its strong protective and detoxifying properties.
• Benefits: Shields against EMFs (electromagnetic frequencies) and is known to purify, ground, and protect. Shungite can help mitigate the energetic disturbances caused by solar flares.

4. Hematite

• Properties: A grounding stone that promotes stability and protection.
• Benefits: Helps to absorb negative energy and calms in times of stress or worry. Hematite is also effective in grounding one's energy during the turbulent times of solar flares.

5. Amethyst

• Properties: A powerful and protective stone with a high spiritual vibration.
• Benefits: Enhances intuition, promotes calmness, and protects against psychic attack. Amethyst can help manage the emotional upheaval and stress that can accompany solar flares.

How to Use These Crystals

Carry Them With You

Keep a small piece of your chosen crystal in your pocket or wear it as jewelry. This way, you can benefit from its protective and grounding energies throughout the day.

Create a Crystal Grid

Set up a crystal grid in your home or workspace. Place the crystals in a geometric pattern, with the intention of creating a shield of protection and grounding energy.

Meditate with Crystals

Spend a few minutes each day meditating with your crystals. Hold them in your hands, place them on your body, or surround yourself with them to enhance your meditation practice.

Place Them in Your Environment

Position crystals around your living space, especially near electronic devices, to help mitigate the effects of electromagnetic pollution.

Final Thoughts

Solar flares, while a natural part of our sun's activity, can have significant impacts on our well-being. Utilizing crystals such as Black Tourmaline, Labradorite, Shungite, Hematite, and Amethyst can provide much-needed protection, grounding, and emotional stability during these energetic events. By incorporating these crystals into your daily routine, you can better navigate the challenges posed by solar flares and maintain a balanced state of being.
Love and Light,
Dia Thomas, CRMT www.thecrystalandhealingcollective.com

So, my partner has a serious chronic illness, and has been signed off work long term. Some of the symptoms of this are chronic nerve pain, severe fatigue, veritgo, difficulty with walking/co-ordination, memory issues etc., because of this she is on some pretty hardcore infusions akin to chemo.
Every 8 weeks or so there is a CNS appointment essentially to verify she is 'still' sick., which is IMO ridiculous, but whatever - my point here is, during these appointments the 'doctor' essentially plays the role of a court prosecutor and attempts to prove that my partner is some sort of charlatan.
This is fucking shit for numerous reasons, firstly because being a young person and having to *prove* you are ill, despite having your life destroyed by an illness is a psychologically awful experience - she doesnt want to be sick, she wants to work, she just isnt able to at the moment. Secondly because for me this is in clear violation of the ethics of medicine and patient care - whenever these meetings come up it creates a huge amount of anxiety and stress (which then makes her symptoms worse), and then she leaves feeling terrible after having to beg and cry and convince someone of her (ALREADY DIGANOSED AND DOCUMENTED!) illness, and then goes through a period where she tries to force herself back into work which is dangeorus for her health and risks further relapses.
What makes this worse is *despite this being a doctors appointment* I am never allowed to accompany her - which as far as I have seen at every doctor I have ever visisted, is a patient right, so I am unable to provide her moral or emotional support or stop her from being bullied in these meetings and made to feel like a fraud merely for having an illness she has zero fucking control over,
So my question is: has anyone encouted this issue before? Am I legally allowed to ensure that I am present for these meetings? Is there anything else that can be done?

I want to develop a character who has DID derived from PTSD, which in turn arose from a four-day period of suffering different atrocities. The character has no explicit memories of this four-day period, but their subconscious locks it away to avoid the pain of trauma and develops disorders as a defense mechanism. In addition to the mentioned disorders, the character has developed a refusal to eat food due to an apparently irrational line of thought and sensation that if they eat, they would be hypocritical for something, and therefore, more guilty. The character has 5 personalities. So far, I've only been able to conceptualize 3: the assistant, the machine, and the monster.
The monster is the murderous and harmful personality. It's what the character most instinctively tries to avoid manifesting, even if they don't know exactly why. It's the embodiment of their potential evil, and its appearances are always accompanied by tension and suspense. Even if not actually manifested (or is it?), the mere fact of appearing in nightmares and hallucinations already triggers panic attacks in the character. This is the most mysterious personality because the character has doubts about the nature of this personality that doesn't offer many explanations beyond the simple fact that it knows everything about him and is playing and affecting him; Is it a personality or a distinct demon? Is it a delusion or is it real? Is it himself or a separate being pretending to be him to scare him? Is it capable of killing the personalities, and if so, why doesn't it do it immediately instead of leaving the personalities unharmed? Why psychologically torture him if the function of fragmented personalities is to help in self-preservation? If it's real, why does it let him escape at the end of its ''games''? This personality (or not) is physically the largest, the most technological, the most inhuman, and presents more feats of strength despite appearing less, all geared towards psychological torture mainly, a literal kind of haunting like Pennywise's. It wreaks psychological havoc on the character in each of its personalities, and the most sensitive one, which is the one the other personalities most try to avoid being impacted by the monster, is the assistant personality, the personality that personifies human essence and, being based on the Superego and Ego and reflecting the distant past spent with his deceased good mother whose values were transmitted in his childhood and adolescence, is the personality that tries to maintain order, predominate, and reunite the fragmented personalities, although this self-imposed role is not easy and it is difficult to deal with the fear of what could happen if people found out that he and the other four 'people' are actually the same person who has DID; it is difficult to represent order while his other parts are more inclined to chaos and there is no direct interaction between the personalities. The assistant personality has blindness, whose degree varies depending nuancemente on the external and internal security situation it feels, but is always present because it results from an unresolved trauma. Glasses are used, the only one who does this. Blindness is more present in the assistant personality and less manifested in the other personalities because they are more detached from humanity. The assistant personality is the most divergent from what the character was before DID. Its form is more human, shorter, and less cybernetic, precisely because it reflects a distant period from the current one of the character. (A side note: the character is, in a way, a shapeshifter, so its personalities have a distinct form, some more similar to each other and others less similar, and vice versa. The metamorphosis is restricted to the forms the character has already had in its life and afterlife, and those forms it did not have are a more adapted version of the personality concept). The assistant is the most sensitive personality and the one that most tries to be virtuous, and because of these characteristics, it is the most vulnerable to the monster.
The machine personality is the psychological barrier. A wall for any emotions. An internal shield for trauma. It looks like a robot, like a machine, both for sentimental and behavioral issues. It does not feel emotions, is extremely rational, and is very connected to technology. Indeed, it is the most technological personality in the purest sense of the word, while the monster personality is the most technological in the most monstrous sense. Its function is to offer a more impartial view of situations and, because of the monster, to be the most solid shield for the assistant personality not to be haunted directly (and possibly killed) by the monster.
There are 2 more personalities to develop, and I'm working on it since it's a new idea I had.
The character is Vox.
The conceptual ideas for this fanfic that I intend to create, combined with my hobby of self-studying psychology/psychoanalysis/psychiatry, made me realize that I attribute four disorders to Vox:
• DID: According to the DSM-5 criteria, to be considered DID it is necessary: ▪︎Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self. ▪︎Amnesia must occur, defined as gaps in the recall of everyday events, important personal information, and/or traumatic events. ▪︎The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder. ▪︎The disturbance is not part of normal cultural or religious practices. ▪︎The symptoms cannot be due to the direct physiological effects of a substance (such as blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (such as complex partial seizures).
• PTSD: Symptoms of PTSD fall into the following four categories. Specific symptoms can vary in severity.
Intrusion: Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are reliving the traumatic experience or seeing it before their eyes. Avoidance: Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that may trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it. Alterations in cognition and mood: Inability to remember important aspects of the traumatic event, negative thoughts and feelings leading to ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); distorted thoughts about the cause or consequences of the event leading to wrongly blaming self or other; ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; feeling detached or estranged from others; or being unable to experience positive emotions (a void of happiness or satisfaction). Alterations in arousal and reactivity: Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being overly watchful of one's surroundings in a suspecting way; being easily startled; or having problems concentrating or sleeping. Many people who are exposed to a traumatic event experience symptoms similar to those described above in the days following the event. For a person to be diagnosed with PTSD, however, symptoms must last for more than a month and must cause significant distress or problems in the individual's daily functioning. Many individuals develop symptoms within three months of the trauma, but symptoms may appear later and often persist for months and sometimes years. PTSD often occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems.
The four tabs below provide brief descriptions of four conditions related to PTSD: acute stress disorder, adjustment disorder, disinhibited social engagement disorder, and reactive attachment disorder. Source: https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd • Psychotic Depression: Psychotic depression Some people who have severe depression may also experience hallucinations and delusional thinking, the symptoms of psychosis.
Depression with psychosis is known as psychotic depression.
Symptoms of depression Someone with depression feels sad and hopeless for most of the day, practically every day, and has no interest in anything. Getting through the day feels almost impossible.
Other typical symptoms of depression may include:
fatigue (exhaustion) disturbed sleep changes in appetite feeling worthless and guilty being unable to concentrate or being indecisive thoughts of death or suicide Doctors describe depression as mild, moderate or severe depending on your symptoms, how long it lasts and how much it affects your daily life.
Read more about the psychological, physical and social symptoms of clinical depression
Symptoms of psychosis Having moments of psychosis (when people lose some contact with reality) means experiencing:
delusions – thoughts or beliefs that are unlikely to be true hallucinations – hearing and, in some cases, feeling, smelling, seeing or tasting things that are not there; hearing voices is a common hallucination The delusions and hallucinations almost always reflect the person's deeply depressed mood – for example, they may become convinced they're to blame for something, or that they've committed a crime.
"Psychomotor agitation" is also common. This means not being able to relax or sit still, and constantly fidgeting.
At the other extreme, a person with psychotic depression may have "psychomotor retardation", where both their thoughts and physical movements slow down.
People with psychotic depression have an increased risk of thinking about suicide. Source for more information: https://www.nhs.uk/mental-health/conditions/psychotic-depression/
• An as-yet unidentified eating disorder: This is the only one in which I do not know which exact diagnosis it fits into. It is a consequence of the trauma from the four-day period - including this period being one of the biggest mysteries in history and a great source of theories for readers, as it is the root of Vox's psychological mess, the divergence point that originated the entire fanfic and which the protagonist DOES NOT want to remember - that resulted in the trauma of eating. He does not feel like eating, not even the SIN OF GLUTTONY is able to make him eat - he is immune to her powers - and feels an apparently inexplicable instinct of guilt and hypocrisy when trying to eat, as if he were the worst being in the universe if he ate a food and a huge hypocrite; why and what exactly this innate thought of judging himself as a hypocrite is another mystery in the plot.
In this story, at least in the initial arcs, no one associates all five as being the same person, at most they associate only one/two of them with Vox. With the climaxes (yes, it's in the plural) throughout the story, the characters will find evidence and suspect and associate more and more of the other alters (as I call Vox's fragmented personalities) with the same person, which increases the narrative tension. Being the assistant personality the last to be accurately associated by the other characters, although she was the one that had the most tension and care in NOT being associated throughout the story because she is the human essence of Vox, reflects more the fragility of his soul state and is not ready to deal with the harsh social consequences that the actions of the other alters and Vox before DID caused, needing solid support and not wanting to lose all the friendly social relationships, although fragile, that he built as a separate being from Vox and the other alters. It is easier to hate than to love. The assistant personality does not want to risk losing the little support he has built. These relationships are extremely valuable to him. He doesn't want to have this taken away from him anymore. The relationships he built are based on the inhabitants of Hazbin Hotel.
All alters have Vox's trademark: the TV as
a head. All... except the assistant personality. This alter is the ONLY one that has a human head and is the smallest, being even a few centimeters smaller than Lucifer. The size of his hair goes up to just above his shoulders, but he ties them in a professional hairstyle. His clothes are similar to those of an assistant, and they have a palette of blue, black, and white colors. The color of his hair, influenced by his powers as a Media Demon, is black with dark blue streaks and tips.
His human appearance reflects a period when Vox was human. In my story Vox is a trans man, which means he was born female and went through a transition at some point in his adolescence or adulthood. The appearance of the assistant personality reflects an episode during his 13/14 years. In this episode, he did a special show for his father's assistant at a fancy restaurant. It was her last night in his life as she would unfortunately be sent away without a chance to return, and he was aware of this. He also knew that his father was responsible for her being sent away, although his innocence at the time made him not immediately detect that she would be KILLED by a hired hitman hired by the father and mother. The assistant was a loved one by the teenage Vox. She was a loving mother he never had, and because of the emotional attachment to her, he decided to do a musical show, showing for the first and last time to anyone his talent for piano and violin. He, at the time still not going through the transition, dressed more masculinely, used the best appearance he could, and used a pseudonym to enter the restaurant and make the presentation without being detected by the family. He did not explicitly specify for whom the music was intended, but the assistant, secretly his true biological mother, knew it was for her. That was the last time he would see her, and he made every second of that night count.
Vox's human female name was Elizabeth. I chose this name because it is a beautiful name, it was the name of the former queen of the United Kingdom, and it was the name of one of Jack the Ripper's victims, Elizabeth Stride.
Vox, during his adult life as a man and even post-death, buried his past as a woman. It was not a source of pride, especially for the family abuses suffered and the transphobia of the time. If the Vees, the people closest to him currently, do not have a deep understanding of Vox's human life as a man, imagine their knowledge of the initial part of his life before the transition!
That's why being called "Elizabeth" during the direct and indirect appearances of the monster personality already causes genuine and unmasked panic in him. It is an indication of knowledge of his deepest layers.
The story has a suspenseful atmosphere, with some horror scenes. We follow the alters individually, and as the story progresses, we realize along with the protagonist some strange, wrong things. The alters do not communicate directly with each other and, therefore, the character does not immediately perceive the signs of having multiple personalities. It was as if there were four people in one body and none of them noticed, according to the perspective of the assistant personality, the alter that we slowly follow discovering the huge web of the situation he's in. There's something very wrong with Vox, more specifically his soul. But there's an invisible barrier that prevents the character from investigating further, like an elephant in the middle of the room. Each alter has its own course, all acting as if they were distinct people and not associating with each other. This is bad socially speaking in the long run, because sooner or later the clash of beliefs and values built among the alters will come into conflict and the individual consequences of their actions will negatively impact each other. The monster personality served to add more salt to the wound. It is by far the most harmful, appearing little but causing a huge mess in return. Don't think of it as a kind of Hulk, because Hulk is a destructive monster that his counterpart, Bruce, can try to control and turn into a hero, and everyone is aware of Hulk's nature, which is easy to understand and try to contain; whereas the monster personality is an enigma at the same time as it is a nightmare, there is no discussion with it, it causes psychological terror in Vox's alters, its apparently internal actions affect the external world of the alters, it is unpredictable, it is the literal meaning of hell. The monster personality has already caused physical harm to the alters, although they did not exactly remember, mainly the assistant personality, the most oblivious of all for a reason. I want to relate the monster personality to Roo.

Hi! I'm a male, 46 yo, 1.68 meters tall, 65 kg. In 2000, while preparing for a corneal transplant due to rapidly declining vision acuity caused by keratoconus I was feeling bad (pulsating pain in left arm, headaches, numb small finger on left arm). Going through different doctors, I was diagnosed with diabetes (marked as "probably MODY"), and put on a diet. Each time I ate too much, I started feeling bad again, but my blood sugar remained normal. In 2003 I was hospitalized again in the endocrinology ward, and again discharged on diet with 'diabetes', despite normal sugars; also was sent to geneticists, but they found nothing.
In 2010, while studying at courses (preparation for an institute), I went off the diet and ate more, because I was feeling tired; basically it was not overeating in normal person's terms; my blood sugars were okay. This overeating caused a kind of stressed stuporous state, but I persisted; I started having weird sensations in my left arm again.
After some days I had a "stroke-like episode" with dizziness and a kind of numbness in the left half of the lips, left arm, left foot. I was afraid and went back to my strict diet, took some cardio aspirin, resumed taking an ACE inhibitor, despite normal pressure. This was when I first had an MRI scan of the brain, and it revealed only an unrelated tumor of the trigeminal nerve (1 by 2 cm, invading a bit into the left orbital cavity), described as "probably a schwannoma" - this tumor has not grown a bit ever since, it has the same size on all scans since 2010. Except this tumor, located in the left cavernous sinus, nothing was found.
After this stroke-like episode, I could not properly read texts - upon reading, I was having attacks of dizziness and sudden strong ear blockage, a kind of 'airplane ear', and sensations of heaviness in my left arm. The same happened upon starting each meal. I was afraid of subsequent episodes, so I went on a really strict diet.
I then had myself hospitalized in the same endocrinology ward and asked the docs there to finally discover what this so-called "diabetes" was, with neurological symptoms and with normal blood sugars. They instead decided to put me on insulin therapy, on tiny doses, only 3 units of ultra-fast Apidra insulin per meal, with no long-acting insulin. Their reasoning was that I was having "anorexia nervosa" and that the insulin would "make me eat more". No amount of describing my neurological symptoms would dissuade them.
I signed an informed refusal to start on insulin, and they discharged me with a diagnosis of "diabetes, probably MODY" again. I then nearly starved myself, being afraid of overeating and having a new stroke-like episode. I could not read, so I spent time listening to audiobooks. Then, half-starved, I had myself voluntarily hospitalized there again and consented to start on this microdosing insulin treatment in November 2011.
Surprizingly, on this microdosing insulin regimen my strange left-sided sensations gradually diminished, over the course of the next 6 months, and I could read again without sudden attacks of "airplane ear" and dizziness and feelings of "my left arm is weirdly heavy/stiff all of a sudden". By the end of 2012, I was working as a translator, studying for a university again, jogging and bicycling.
On 20 April 2018 I had an attack of lower back pain after a bicycle ride in the cold; had some etorixocib prescribed for it; the pain went away in mere days, and bouts of severe fatigue set in. After each bicycle ride, however light, I was having 2 to 3 days of not being able to do anything. I could not translate, I was mentally too slow. My total urinary 24h cortisol was constantly at about 150% of the upper range and my blood potassium was slightly elevated. Doctors found nothing, I went to the psychiatry hospital and they found "sub-depression" (their tests showed that I was 1 point short of being in "light depression). We decided to try out escitalopram, and it worked - my cortisol normalized, I could work again.
In November 2020 I started having bouts of heavy feeling in my left flank some 1 hour after each meal, accompanied with extreme fatigue which lasted for many hours, until the food went completely through the GI tract. I could not work again: slow thinking, tiredness. In the summer 2023 I was hospitalized in the gastro ward of the same hospital, but they found nothing.
While in the gastro ward, I was asked to undergo a planned hospitalization for my diabetes, since they noticed that I had no such hospitalization ever since 2011. I said that I would only consent to that if during my stay I would be re-tested for the presence of diabetes, because I was highly suspicious on whether I actually had it. They agreed, and during my stay in the endo ward, I had a glucose tolerance test accompanied with two measurements of C-peptide. This revealed that my pancreas was producing insulin and I had no diabetes.
I still had several days to remain in the endo ward, so the doc and me decided that I would eat a lot of carb-rich food, and track my blood sugars with the Bluetooth sensor they put on my upper arm. I treated myself to cookies and honey and stuff, and my sugars were just fine - but I suddenly had the same neurological feelings that had vanished in 2012 upon starting on the microdose insulin regimen.
So I was discharged from that unit for the fifth time since 2000, only this time with "no diabetes" in my discharge paper instead of "diabetes, probably MODY" -- but I go on injecting micro-doses of insulin before meals, because otherwise the 'airplane ear' and 'heavy left arm' and 'numb left part of lips/external fingers on left foot/hand' reemerge. Stopping insulin increases these sensations, restarting insulin brings them gradually down.
I was sent to the geneticists again, and as a condition for seeing me they had me take another MRI scan. This time, to my amazement, the radiologist's impression contained a mention of a "lesion in the right part of the corpora quadrigemina area, probably an area of gliosis". The geneticists did some dry blood spot testing and found nothing.
I went to my neurosurgeon and asked what this lesion in the tectum (corpora quadrigemina) could be. She took all the MRI scans dating back to 2015 which I had with me, and after perusing them for a long time said that the same spot is visible on all previous scans; and that she has no idea what it is, but the spot is of the same size, so she indends to pursue watchful waiting, with follow-up MRI scans every 2 years.
I went home and managed to find the rest of the MRI scans dating back to February 2010, shortly after my "stroke-like episode". I can see the lesion there.
I have these questions: 1) Why would radiologists not mention a midbrain lesion in their impression papers for years? Is it clinically insignificant? 2) Could a lesion there be somehow related to my odd sensations? 3) What could have caused the lesion to arise there in the first place, while I was only 32 years old, or even 22 years old (if it arose there in 2000)? 4) Why insulin treatment diminishes these sensations, while going off insulin and eating a lot of carbs makes them worse?
What can I do to research my condition further? I have little confidence in local doctors in Russia, having been treated for a non-existent diabetes for 23 years. Recently I had some stress at work (my attention is flagging, so I had to go from being a translator to being a food delivery person), and my left arm is feeling heavy sometimes, despite the insulin, and I have weird sensations of being a little clumsy, despite not being clumsy in reality.
I'm ready to provide additional information. I'm currently taking 150 mg venlafaxine, 75 mcg thyroxine, 5 mg rosuvastatin, and 1600 to 2000 mcg methylfolate daily. I visit a psychiatrist for a follow up and to renew drug prescriptions. I'm trying to save for a psychotherapist, but my salary is peanuts, so I haven't been able thus far.
I have MRI scans from 2010, 2012, 2013, 2015, 2016, 2018, 2022 and 2024 - the lesion is visible on each of them, but is described only on the radiologist's impression from the spring of 2024. I can upload the scans somewhere if necessary. The lesion is described as "a T2-enhancing area, 6 by 6 by 8 mm in size, with no mass effect".

I’ve had migraine without aura since I was a teenager. I discovered sumatriptan in my mid-twenties, which helped curb the attacks most of the time, but last few years (I’m 40F), migraine episodes became more frequent and sumatriptan started giving me. scary side effects (chest pain). After having me try a bunch of other triptans, my insurance approved Ubrelvy, which has no side effects, but doesn’t help every single time. And then back in January I had a migraine and it just never went away… I had daily headaches for 3 months!!! They weren’t all level red migraines, 2/10-4/10 most days, but exhausting and accompanied by fatigue and brain fog. A migraine cocktail didn’t help, a short steroid taper didn’t help. They even did an MRI and a temporal artery biopsy - all clear. Finally, they gave me like a 3-week steroid taper which helped. 3 weeks free of pain with only an occasional attack. And then, 2 weeks later, a migraine came and never left. Again!! The migraine cocktail didn’t work - again!! I had an SPG block this morning - no joy! The worst thing about status migrainosus (aside from daily headaches that is and being permanently exhausted) is that my normal abortive medication does not work, so when the pain reach high levels, there’s nothing I can do. I’m on propanalol for prevention, I do acupuncture weekly, take magnesium glycinate, ginger supplement, I am seeing a therapist and I’m scheduled for Botox later this month. What helped you knock status migrainosus out? Have you ever find a reason/trigger? I just need to have some hope.

Hello, diagnosed with erosive antral gastritis since 2019. Recently I fell into a relapse of the worst symptoms again.
As the title says, do any of you here experience POTS-like symptoms when doing sudden movements/physical activity? I've tested for POTS but my doctor can't find anything.
It's usually a trigger for my gastritis too, when I stand up or climb a flight of stairs, I can feel my stomach and somehow palpitations would follow. Other times I'd take a walk outside or do groceries and I don't feel anything at all. It totally happens on random times, but I'd say it's pretty frequent. Along these symptoms are accompanied by extreme fatigue, physically and mentally.
I'll be going back to my doctor soon and prolly undergo EGD. Right now I'm just really holding on and trying to find ways to cope with my current situation. Though I can say that every day is a progress of healing, as the pain have reduced by a lot.
Thank you for anyone who would share their insights, and I hope we all heal well!

A new patient(F45) mildly obese was brought in who was planned for ECT in a week. Though she might actually be bipolar (atleast on the spectrum). She was terrified of ECT.
She had severe depression including suicidality and severe agitation.
She was on Lithium 600mg/day (Started recently), Lamotrigine 200mg, Lexapro 20mg and clonazepam 1mg with quietiapine 50mg for sleep.
Since 2023 she'd been experiencing strange episodes according to her family.
Here's all the history and symptoms provided about these episodes since 2023 :

• Agitation/Inner restlessness: Unable to remain calm/sit still. Blaming all of her symptoms on this restlessness. When this comes the other symptoms which I'll mention come along too:
  
• Crying and shouting loudly (simply can not control this to sorta escape)
  
• Excessive anger and snapping at/blaming others for no reason: Involuntarily blame people for the most random and petty things who've been the most helpful and kind.
  
• Very Irritable.
  
• Suicidality (to escape the restlessness). Suicidal attempts in aggression where she had to be stopped with a lot of physical force.
  
• Guilt and worthlessness
  
• Irrational/Questionable decisions and behaviors were almost always noted by family members during these periods accompanied with extreme impatience.
  
• Energy: Being fatigued and unmotivated that she can't even move or do stuff. But at the same time having so much Energy to shout so loud and rip her chest open to escape the "agitation".
  
• Pupils were dilated when I saw her.
  

After her lexapro was increased to 20MG her symptoms have been just worsening and worsening including suicidality.
Benzos would do nothing even injectable ones for the agitation.
Then today when she came to me during the severe agitation I immediately thought of a mixed state. Gave her zyprexa and asked to taper down the lexapro.
After she took the zyprexa (sublingual) in about 2 hours experienced tremendous relief - felt calm, brain went silent and took a long nap quite refreshing. She wasn't bothered by people talking. She wasn't irritated. She just felt normal. The relief seemed never-ending.
It makes sense now how being put on lamictal back in 2023 put her into remission and it kept masking Lexapro's rebound effect(in bipolar)
I'm honestly unsure why high dose Lexapro was continued over a year (even though there was a clear worsening of symptoms with dosage increase) and why high dose benzodiazepines were constantly being used to control the agitation despite having little to no effect. Even effexor was started in cross-titration with Lexapro which further worsened her suicidality etc?
Sorta leaning towards ECT and later on adjusting the medications because it does seem to be severe and ECT it is quite effective though the patient wants to try the no-ssri approach.
If we do go with the latter approach, I plan on : - Switch to Vraylar for its good evidence in mixed states. Cariprazine is dirt cheap here.

• Stick to Lamotrigine and increase Lithium/ Switch to Valproate(Good evidence in mixed features).
  
• Wellbutrin for depression if it does not or only partially responds to psychotherapy.
  
• Gabapentin.
  
• Low dose Trazodone for insomnia.
  

Perhaps the increased energy from the (hypo)mania and the activation from the SSRI is resulting in the restlessness which explains the relief from Olanzapine. I've seen many hypomanic patients who'd get so restless that they wanted to crawl out of their own skin.
What's your go to treatment for mixed states? What about the efficacy of Lithium in mixed bipolarity? Which mood stabilizers seem to work best?

A new patient was brought in who was planned for ECT in a week. Though she might actually be bipolar (atleast on the spectrum). She was terrified of ECT.
She had severe depression including suicidality and severe agitation.
She was on Lithium 600mg/day (Started recently), Lamotrigine 200mg, Lexapro 20mg and clonazepam 1mg with quietiapine 50mg for sleep.
Since 2023 she'd been experiencing strange episodes according to her family.
Here's all the history and symptoms provided about these episodes since 2023 :

• Inner restlessness:Getting EXTREMELY restless (CAN NOT sit still). Inner restlessness that makes her want to slap /kill herself just to escape it. She'd beg her family to kill her so she can escape this.This comes and goes daily during these episodes and is the main symptom. When this comes the other symptoms which I'll mention come along too:
  
• Crying and shouting loudly (simply can not control this to sorta escape)
  
• Excessive anger and snapping at/blaming others for no reason: Involuntarily blame people for the most random and petty things who've been the most helpful and kind.
  
• Very Irritable.
  
• Suicidality (to escape the restlessness)
  
• Guilt and worthlessness
  
• Irrational/Questionable decisions were almost always noted by family members during these periods accompanied with extreme impatience.
  
• Energy: Being fatigued and unmotivated that she can't even move or do stuff. But at the same time having so much Energy to shout so loud and rip her chest open to escape the "agitation".
  

After her lexapro was increased to 20MG her symptoms have been just worsening and worsening including suicidality.
Benzos would do nothing even injectable ones for the agitation.
Then today when she came to me during the severe agitation I immediately thought of a mixed state. Gave her zyprexa and asked to taper down the lexapro.
After she took the zyprexa (sublingual) experienced tremendous relief - felt calm, brain went silent and took a long nap quite refreshing. She wasn't bothered by people talking. She wasn't irritated. She just felt normal. The relief was long lasting.
It makes sense now how being put on lamictal back in 2023 put her into remission and it kept masking Lexapro's rebound effect(in bipolar)
I'm honestly unsure why high dose Lexapro was continued over a year and why high dose benzodiazepines were being used to control the agitation despite having little to no effect.
Sorta leaning towards ECT and later on adjusting the medications because it does seem to be severe and ECT it is quite effective though the patient wants to try the no-ssri approach.
If we do go with the latter approach, I plan on : - Using either VraylaLatuda for their good results in mixed states. Cariprazine is dirt cheap here.

• Stick to Lamotrigine and increase Lithium.
  
• Wellbutrin for depression if it does not or only partially responds to psychotherapy.
  
• Gabapentin.
  

What's your go to treatment plan for mixed states? Is this a mixed state rather than unipolar depression?
A new patient was brought in who was planned for ECT in a week. Though she might actually be bipolar (atleast on the spectrum). She was terrified of ECT.
She had severe depression including suicidality and severe agitation.
She was on Lithium 600mg/day (Started recently), Lamotrigine 200mg, Lexapro 20mg and clonazepam 1mg with quietiapine 50mg for sleep.
Since 2023 she'd been experiencing strange episodes according to her family.
Here's all the history and symptoms provided about these episodes since 2023 :

• Inner restlessness:Getting EXTREMELY restless (CAN NOT sit still). Inner restlessness that makes her want to slap /kill herself just to escape it. She'd beg her family to kill her so she can escape this.This comes and goes daily during these episodes and is the main symptom. When this comes the other symptoms which I'll mention come along too:
  
• Crying and shouting loudly (simply can not control this to sorta escape)
  
• Excessive anger and snapping at/blaming others for no reason: Involuntarily blame people for the most random and petty things who've been the most helpful and kind.
  
• Very Irritable.
  
• Suicidality (to escape the restlessness)
  
• Guilt and worthlessness
  
• Irrational/Questionable decisions were almost always noted by family members during these periods accompanied with extreme impatience.
  
• Energy: Being fatigued and unmotivated that she can't even move or do stuff. But at the same time having so much Energy to shout so loud and rip her chest open to escape the "agitation".
  

After her lexapro was increased to 20MG her symptoms have been just worsening and worsening including suicidality.
Benzos would do nothing even injectable ones for the agitation.
Then today when she came to me during the severe agitation I immediately thought of a mixed state. Gave her zyprexa and asked to taper down the lexapro.
After she took the zyprexa (sublingual) in about 2 hours experienced tremendous relief - felt calm, brain went silent and took a long nap quite refreshing. She wasn't bothered by people talking. She wasn't irritated. She just felt normal. The relief seemed never-ending.
It makes sense now how being put on lamictal back in 2023 put her into remission and it kept masking Lexapro's rebound effect(in bipolar)
I'm honestly unsure why high dose Lexapro was continued over a year and why high dose benzodiazepines were constantly being used to control the agitation despite having little to no effect. Even effexor was started in cross-titration with Lexapro which further worsened her suicidality etc?
Sorta leaning towards ECT and later on adjusting the medications because it does seem to be severe and ECT it is quite effective though the patient wants to try the no-ssri approach.
If we do go with the latter approach, I plan on : - Switch to Vraylar for its good evidence in mixed states. Cariprazine is dirt cheap here.

• Stick to Lamotrigine and increase Lithium.
  
• Wellbutrin for depression if it does not or only partially responds to psychotherapy.
  
• Gabapentin.
  
• Low dose Trazodone for insomnia.
  

What's your go to treatment for mixed states? What about the efficacy of Lithium in mixed bipolarity? Which mood stabilizers seem to work best?