Ankle Mri results
Bad fall over a year ago..physio for 9 months..slight pain still but nothing crazy. Pain returned with swelling a month ago and now very sore at night
Here are the findings
There is no acute bony injury, aggressive bone lesion or malalignment deformity demonstrated. There are features most in keeping with a small avulsion fracture from the anterior aspect of tip of lateral malleolus with subtle underlying bony oedema. Plain x-ray correlation might confirm The articular surfaces of the hind foot joints are unremarkable. Ankle tendons are well maintained with no current evidence of tendonitis or tear. There is a grade II tear of the fibular attachment of ATFL, and possibly also calcaneofibular ligament. The PT FL, syndesmotic ligaments and medial ligament complex all appear intact. Proximal plantar fascia appears normal. No mass lesion or ganglion formation is seen around the hind foot. Summary: Abnormality at the tip of lateral malleolus as
Female 28 Bad fall a year ago Clear x-ray No medical history

Findings: Female 29 70kg No medical history except a fall a year ago. X-ray at time was clear
Bad fall over a year ago..physio for 9 months..slight pain still but nothing crazy. Pain returned with swelling a month ago and now very sore at night
Here are the findings
There is no acute bony injury, aggressive bone lesion or malalignment deformity demonstrated. There are features most in keeping with a small avulsion fracture from the anterior aspect of tip of lateral malleolus with subtle underlying bony oedema. Plain x-ray correlation might confirm The articular surfaces of the hind foot joints are unremarkable. Ankle tendons are well maintained with no current evidence of tendonitis or tear. There is a grade II tear of the fibular attachment of ATFL, and possibly also calcaneofibular ligament. The PT FL, syndesmotic ligaments and medial ligament complex all appear intact. Proximal plantar fascia appears normal. No mass lesion or ganglion formation is seen around the hind foot. Summary: Abnormality at the tip of lateral malleolus as described these are my MRI results..I had a bad fall last year and on and off pain. I have had pain and swelling return suddenly after the 9 months of physio and I requested an MRI
These are the findings. GP seemed to think the avulsion fracture isn't recent but why is the pain so bad recently

It just feels like a good day for this post.
Let's talk about The Lady from Old Holly

In the beginning, there was the wood.
It was strong wood, and old. And it grew beside a stream, by a tower all of stone.
There was warm sun, which was good. There were climbing vines, which were bad. There was wind, which was neither. It merely made leaves turn and branches sway.
There was also the lady. She was neither. She came to the tower. She turned the earth and made a garden. She cut the other trees and burned them in the tower.
But the holly tree she did not cut. The holly grew and spread its branches in the open space. And that was good.

What should stand out to you here (but so many of us have skimmed right past it, including myself) is that last line.

She cut the other trees and burned them in the tower.

I laid this part out in a previous comment, but it goes much deeper.

The Lady pricked her hands upon his thorns, and that was bad. She sucked the bright bead from her thumb, and slipped, and screamed, and fell.
And holly bent. And holly bent. And Holly bent his boughs to catch her.
And the Lady smiled, and that was beautiful. But there was blood upon her hands, and that was bad. But then the Lady looked upon her blood, and laughed, and sang. And there were berries bright as blood, and that was good.

The Holly Tree represents the world, and it bends its branches for the Lady. For the Lady and her burning tower, the blood on her hands.

Auri stood, and in the circle of her golden hair she grinned and brought the weight of her desire down full upon the world. And all things shook. And all things knew her will. And all things bent to please her."
“No.” [Auri] gave her head a tiny, firm shake. “You are my Ciridae, and thus above reproach.” She reached out to touch the center of my bloody chest with a finger. “Ivare enim euge.”

So here is another story that I hope will help click this into place for a few of you. It's a story about a Lady in a Tree, called the Miracle of the Sun. The following quotes are from a book written in 1975 called The Invisible College, where the author was investigating the "miracle" by reviewing the records of the Catholic Church. The Lady / Angel appeared in a tree and spoke to three children, a girl and two boys.

The first apparition of the woman took place on May 13, 1917. Three children were watching their sheep when a bright flash surprised them, and they walked toward the large hollow pasture called Cova da Iria (literally: the Cave of St. Irene, an old sacred spot) to see what had happened. They found themselves caught in a glowing light that almost blinded them, and in the center of the light they perceived a little woman, who spoke to them, begging them to return every month to the same spot.
The oldest child, Lucia, who was 10 at the time, addressed an unseen entity whose answers were not heard by others in the group. One spectator, however, reported perceiving a very faint voice or the buzzing of a bee

The children keep returning to the spot, and the crowd grows larger on each occasion. Then came the Miracle of the Sun

On September 13 the crowd numbered thirty thousand... two priests were absolutely skeptical and had come specifically to establish the falsity of the much-heralded “miracles.” The site of the apparitions was a wide amphitheater where most of the crowd had gathered to be close to the tree of the apparitions. However, the two skeptical priests had chosen a spot on the higher ground from which they could observe everything. The following is based on their report
Noon. The sun got dimmer, although no clouds were seen in the sky. Thousands cried: “There She is … look!” A globe of light was seen by all, advancing slowly down the valley, from east to west, toward the children. It came to rest on the tree. A white cloud formed and out of the empty sky, shiny white “petals” began to fall. Let us ponder this description of the phenomenon by a witness:
As the people stare at this strange sight they soon notice that the falling, glistening globules, contrary to the laws of perspective, grow smaller and smaller as they near them. And when they reach out their hands and hats to catch them they find that they have somehow melted away.
At Fatima there was a wind which “moved across the mountain without touching the trees.” The Lady consistently appeared in the top branches of a small tree, whose center shoots were found bent toward the east, as though tilted in that direction when the apparition departed. Lucia, of Fatima, was closely questioned on this point and stated that “our Lady’s feet rested lightly on the top of the leaves.”

So here's where this ties in to the rest of the books, plus a lot of mythology. The people at Fatima thought "the Lady" was the Blessed Virgin Mary. You may have heard of her, she's featured in a pretty popular story about an immaculate conception, where she gives birth to a son that is the son of himself.
As it so happens, Perial / Princess Ariel is also a pretty popular figure in KKC for the same reason. Immaculate conception, followed by the birth of the son of himself.
So let's talk about the popularity of "the son of himself" in mythology. Because it isn't just Christianity, you see it in the Norse mythos too. Odin "The Terrible", the son of himself who tears out his eye in exchange for knowledge. You see it in the story of Horus, whose eyes were torn out by Set. You see it in the tragedy of King Oedipus, who tears out his eyes after he realizes he married his mother.

Little Oedipus was named after the swelling from the injuries to his feet and ankles ("swollen foot"). The word "oedema" (British English) or "edema" (American English) is from this same Greek word for swelling: οἴδημα, or oedēma.

So let's talk about that dynamic. Because Menda-who-is-Tehlu wouldn't just be Perial's son then, would he? He is the son of himself. Meaning he'd be both husband, and son. The same as Oedipus.
So look at the story of Lanre and Lyra again. Really look at it.

Lanre paused. “My wife is dead. Deceit and treachery brought me to it, but her death is on my hands.” He swallowed and turned to look out over the land.
“Lord Tehlu, I am not Encanis.” For that brief moment the demon’s voice was pitiful, and all who heard it were moved to sorrow.
“Aethe lived forty years after that, and it is said he never killed again. In the years that followed, he was often heard to say, ‘I won the only duel I ever lost.’
At the very end of things, covered in blood amid a field of corpses, Lanre stood alone against a terrible foe. It was a great beast with scales of black iron, whose breath was a darkness that smothered men. Lanre fought the beast and killed it. Lanre brought victory to his side, but he bought it with his life.
“To ash all things return, so too this flesh will burn. But I am Tehlu. Son of myself. Father of myself. I was before, and I will be after. If I am a sacrifice then it is to myself alone. And if I am needed and called in the proper ways then I will come again to judge and punish.”
“Will you kill me to cure me, old friend?” Lanre laughed again, terrible and wild. Then he looked at Selitos with sudden, desperate hope in his hollow eyes. “Can you?” he asked. “Can you kill me, old friend?”
The one called Cinder sheathed his sword with the sound of a tree cracking under the weight of winter ice. Keeping his distance, he knelt. Again I was reminded of the way mercury moved. Now on eye level with me, his expression grew concerned behind his matte-black eyes. “What’s your name, boy?”
Cinder sighed and dropped his gaze to the ground for a moment. When he looked back up at me I saw pity staring at me with hollow eyes.
Menda looked to be a young man of seventeen. He stood proud and tall, with coal-black hair and eyes.

But there's even more going on here with Perial / Auri. The Blessed Virgin Mary is always, always depicted with a halo. Auri's hair is used to depict both the halo, and that she is velificans

Velificatio is a stylistic device used in ancient Roman art to frame a deity by means of a billowing garment. It represents "vigorous movement," an epiphany, or "the vault of heaven," often appearing with celestial, weather, or sea deities. It is characteristic of the iconography of the Aurae, the Breezes personified, and one of the elements which distinguish representations of Luna, the Roman goddess of the Moon, alluding to her astral course.
The device continued to be used in later Western art, in which it is sometimes described as an aura, "a breeze that blows from either without or from within that lifts the veil to reveal the face of an otherwise invisible being."
Auri stood, and in the circle of her golden hair she grinned and brought the weight of her desire down full upon the world. And all things shook. And all things knew her will. And all things bent to please her."

Now for the last part, a part I covered awhile back. Auri's soap. When Auri creates her soap in Slow Regard, she adds selas perfume so her soap smells like flowers. Flowers that smell like ashes, and tallow, and pine, and nutmeg. Or in other words, they are flowers that smell like smoke, and leather, and citrus, and spice.
So look to the Lady and the Miracle of the Sun again. Standing on the leaves high in the tree, unseen, her golden halo, the shiny white "petals" falling that grow smaller, contrary to the laws of perspective.
That particular phenomenon of the melting white petals is known as angel hair.

I came around a corner and saw Auri sitting on a chimney, her long, fine hair floating around her head as if she were underwater. She was staring up at the moon and swinging her bare feet.
“Why Auri?” Elodin asked.
“Ah,” I said, embarrassed. “Because she’s so bright and sweet. She doesn’t have any reason to be, but she is. Auri means sunny.”

My mom is in her 60's, Height = 5'5 / Weight 93kg / 205 Pounds, white and is complaining about pain in her feet prodominantly in her achiles tendon. She also has ostio-arthiritus in her thumbs (not sure if relevant). She has been to a physiotherapist who has mentioned that she has oedema in her ankles and also that she experiences pronation in her feet. She averages around 25,000 - 27,000 steps a day and has been suggested to reduce this number of steps but that is just her daily routine.
She has been advised to stretch her tendons by the physiotherapist but finds this exercise very painful. She is also due a checkup where her feet will be assessed for specially made shoes (to help with pain) by the end of this month - she has been in pain for the last 2 years which has had an effect on her walking especially in the evenings.
Im just wondering if anyone knows of any ways of helping to reduce this pain / possibly improve her situation - hoping the shoes will do the job but still looking for any other solutions in case they dont.
​
Sorry if im lacking detail - first time posting here and thanks in advance for any advice.

Just looking to have this explained a bit more to me as my doctor said "no tendons torn, just rest" and I would like to work on a plan to get back to running and riding :) thanks so much!

Lipedema is often confused with obesity or Lymphedema, but it possesses distinct features that set it apart. Here's what to look for:

• Disproportion: Noticeable enlargement of soft tissue in hips, buttocks, legs, and sometimes arms, often symmetrically.
• Skin: Lipedema fat feels soft, cool, and dimpled, differing from regular fat. No oedema present, unlike Lymphedema.
• Ankle Cuff: 'Cuffing' or ‘braceleting’ at ankles or wrists, with loss of ankle definition, termed ‘cankles.’
• Family History: Often inherited, exacerbated by hormonal factors like puberty or pregnancy.
• Pain and Discomfort: Lipedema fat can be tender, heavy, and painful, not directly correlated with size.
• Heaviness: Legs feel heavy and swollen, especially in latter stages.
• Bruising: Easy bruising on affected limbs, often without clear cause.
• Swelling: Uncomfortable swelling worsens with activity or in hot weather.
• Varicose Veins: Common in Lipedema tissue due to lymphatic system issues.
• No Response to Diet and Exercise: Traditional weight loss methods are generally ineffective; liposuction may be necessary to completely remove the tissue.
• Physical Activity: Impaired movement and joint pain hinder exercise and daily activities.
• Mental Health: Restrictions in mobility can lead to low self-esteem, body dysmorphia and mental health issues.

Understanding these symptoms can aid in early diagnosis and proper management of Lipedema, which can help slow the progression of the disease.

Unsure if anyone here specialises in ankles.
6 months ppst injury. - full rupture of atfl - extensive oedema within the deltoid ligament without evidence of significant tear in keeping with a grade 1 strain -Fluid effusion surrounding the flexor digitorium and tibialis posterior tendency - Cortical defects at the distal aspect of the tibia.
WHAT THE FLIP
I've been doing basic gym stuff since 4 weeks after the injury. No weight bearing issues but can't jump on it without pain. I'm a boxer so this is a problem. Did the injury at volleyball. If anyone has experience in sustained ankle injuries please check out the results from the MRI and let me know!!
Booked into seeing a specialist but always interested in other that may have had similar problems or specialists online.

Part 3
Part 2
Part 1
Welcome back! Once again I am updating progress to Part 3 with a new thread, to try and keep the information fresh.
Our latest installment confirmed the diagnosis of Q Fever (Coxiella burnetii) in our young Australian gentleman. He is currently deteriorating in ICU despite improvement in his clinical features of sepsis - he now has anuric renal failure, profound hyperbilirubinaemia, declining cognitive status, and appears to be bleeding while thrombocytopoenic.
I'm going to amalgamate the gamut of interventions and investigations requested by commenters from the previous Part 3 post, as they were many. We will end this thread with further clinical progress, before concluding in a final Part 4 with an overview and outcome, as well as some education around Q Fever.
Immediate management
Step 1 must be haemostatic resuscitation. Melaena is ongoing, our most recent Hb was 64 despite 2 units of PRBCs. Platelets were 40-ish and INR 1.5. It is reasonable to throw things empirically at this gentleman, but TEG/Rotem-guided resuscitation is also appropriate. You decide to give 3 units of blood, 2 pools of platelets, IV vitamin K empirically over the next 90 minutes, and your thromboelastogram afterwards is surprisingly not too sad - no further products are needed at this stage. More blood is available and thought likely to be required.
Step 2 must address the cause. A transfusion-resistant Hb suggests active bleeding, and active bleeding more often than not requires procedural intervention of some kind. A discussion with gastro yields a tentative plan to scope the patient (between appreciatively curious non-verbal acknowledgements of the intrigue of the case, you detect a certain wariness to become involved). They agree to do this tomorrow morning (it is still PM of Day 4 in ICU). To facilitate this, as quite rightly suggested by some, it is supremely sensible to secure the airway and intubate.
Step 3 therefore must be temporisation and optimisation. Although no stonkingly high, the urea of 40 is very acute, and it is reasonable to attribute some of the encephalopathy and bleeding tendency to this. You chuck a vascath in the groin (see below) and get some dialysis-du-jour up and running. Anticoagulation is probably not necessary - I would run the first filter without, but citrate would be a very sensible choice either way. There is no need to broaden antibiotic coverage - Coxiella is blessedly sensitive to doxycycline in its acute phase.
His haemodynamics become very unpredictable, with the onset of peripheral oedema complicating your fluid management. Nevertheless, with dialysis initiated, this is less of a worry. You crank the noradrenaline and soon have to add vasopressin (terlipressin would also be reasonable). Distributive shock predominates, but you suspect some septic cardiomyopathy in addition.
Lastly, a PPI infusion makes everyone feel much better. You hold off Octreotide at this stage, as there is no evidence of cirrhosis or portal hypertension in the investigations to date.
The discussion re: aHUS is a valid one and one that was held at the real case. The renal and haem team both agree that sepsis alone is enough to cause this clinical picture. Review of the films suggests, while schistocytes are present, they are not in numbers consistent with proper TMA. Sepsis, hyperthermia and splenomegaly are blamed, and the wallet is not opened for eculizumab.
Further investigations/examinations
Let's start with a bit of an examination. Our patient is yellow, GCS 12-13, with tender hepatosplenomegaly, asterixis and dry mucous membranes. His invasive monitoring continues to show a wide pulse pressure with systolic and diastolic hypotension (supported by your squeezy potions). He is on HFNO2 at 30L/min at 30% oxygen, sort of just because - some nurses thought the humidification would help. His chest is clear, though, and all you hear of note is an unsurprising flow murmur. There is half a centimeter of pitting oedema to his ankles. There are 2-3 spider naevi on his chest, but no other features of a more chronic process. There are no stigmata of IE. The entire room smells of melaena.
His complement levels are normal. ADAMTS-13 is negative. He does not have cold or warm agglutinins. He has 5% reticulocytes and a raised haptoglobin, with LDH 600. His D-dimer is moderately elevated and your senior colleague slaps you. His entire coag panel is otherwise mildly deranged, with a slightly low fibrinogen, slightly prolonged APTT and echis time. His albumin is 29 (and heavily supplemented at this stage). Coombs test is negative.
His ABG shows a pH 7.42 with a lactate of 3-4 (pre-dialysis), pCO2 26 (mmHg with apologies), pO2 85 and HCO3 16. His chloride is 115, K+ 5 and Na+ 144.
TTE (TOE is not yet deemed worth the risk) shows a globally hypokinetic LV with an estimated EF ~40-45%, no significant valvular pathology and an RV which appears to be quite happy. There is a 3-4mm global pericardial effusion.
CVL/Vascath insertion
There is no one way to approach this, but here is what I did.
I gave DDAVP and a pool of platelets as I prepped the site. I was less worried by the INR of 1.5. the right femoral site already harboured the CVL, so I prepped the left femoral. My thinking re: site is that most bleeding from instrumentation occurs from the vessel puncture site, and is therefore most easily and safely compressible in the leg. If you end up rogering the vessel distally and causing a retroperitoneal haematoma, well, that would only have been a haemothorax if you'd gone for the neck. Both of those risks are low, though.
In my coagulopathic patients, I do not use a scalpel prior to dilation - it will bleed for hours, ruin the dressings (and therefore sterility), and most importantly the nurses will nag me to do something about it. Even for a vascath, it is perfectly possible to slowly dilate a tract without an incision, taking extra care not to kink your guidewire. There's a decent argument to be made that a scalpel is never worth bothering with... but I'm lazy.
Progress
Having negotiated to scope electively in the morning, you fight fires into the evening - the nurses inform you that the patient is now on 40% oxygen... 50% oxygen... meanwhile you have had to commence adrenaline as your third vasoactive agent to maintain a perfusing MAP. He is now GCS 11 and his head lolls on his chest, bobbing with significant respiratory effort. "Fuck this," you tell the nurse, "we are intubating him".
You get some control, ventilate him quite hard on 60% oxygen, and get some imaging to reveal new bilateral interstitial infiltrates with small pleural effusions. Having survived induction, his haemodynamics stabilise, though he remains in need of triple agents. RRT ticks along and you cautiously take 50ml off per hour, in the hopes of reassuring the morning team they can try harder. His ABG normalises somewhat with good ventilation and RRT. At the very least, his fevers have settled.
In the morning, he is transfusion-dependent, and still has melaena. Gastro agree to scope him in ICU, and raise an 'I told you so' eyebrow as they reveal only generalised erosive gastritis. They spray some adrenaline around half-heartedly, but nothing much is achieved. They advise to continue supporting his bleeding medically, but continue slow NG feeding.
His sepsis appears to be controlled, you think, but he has stumbled his way into an unfortunate host of secondary insults.
This is now the whole clinical picture.
What do you think has happened?

As always, I recommend Reddit Enhancement Suite and old.reddit (dark mode in settings) to read these long posts. Gives it an ebook-ish format, much easier on the eyes.
Spoilers. You've been warned.
I wrote this post last year that goes more in-depth regarding Oedipus, but it isn't necessary reading it's just for those who are curious: Edema Ruach
But this is the main thing you need to know

The infant Oedipus eventually came to the house of Polybus, king of Corinth, and his queen, Merope, who adopted him, as they were without children of their own. Little Oedipus was named after the swelling from the injuries to his feet and ankles ("swollen foot"). The word "oedema" (British English) or "edema" (American English) is from this same Greek word for swelling: οἴδημα, or oedēma.

The old man in the cave, Trapis, Auri, even Kvothe. A barefoot character means descendant of the great people Shehyn talks about, those who sang songs of power and fought as well as the Adem. The people who the Adem were before they became the Adem. It means Ruach.
In a nutshell, Oedipus' story goes like this: Oedipus was a prince, but due to a prophecy of tragedy his birth parents gave him away. Oedipus doesn't know he's adopted, so when he grows up and learns about the prophesied death of his parents, Oedipus leaves home to protect them (not knowing that they were his adoptive parents).
On the way to a city, he meets an old man and they fought. Oedipus kills the man and continues to the city, which is beset by a great beast. A sphinx. Oedipus defeats the sphinx, and he marries the Queen because the King had died during the siege. Oedipus becomes King.
Oedipus had unknowingly killed his birth father on his way to the city, the King. Then Oedipus had married his birth mother, the Queen. When they realize the truth, she kills herself and Oedipus stabs out his eyes.
That's what it means to be Edema Ruh. The unknowing death of the father, and "marriage" to the mother. Folly. Tragedy.
But the first Edema Ruh had no father. He was the son of himself... or rather, the son of Aleph.

“In the beginning, as far as I know, the world was spun out of the nameless void by Aleph, who gave everything a name. Or, depending on the version of the tale, found the names all things already possessed.”

This first Ruach had only a mother, The Cosmic World Soul.

Hecate is a goddess in ancient Greek religion and mythology, most often shown holding a pair of torches, a key, or snakes, or accompanied by dogs, and in later periods depicted as three-formed or triple-bodied. She is variously associated with crossroads, entrance-ways, night, light, magic, witchcraft, the Moon, knowledge of herbs and poisonous plants, graves, ghosts, necromancy, and sorcery.

Mother of the "Chaldeans".

In the post-Christian writings of the Chaldean Oracles (2nd–3rd century CE) she was also regarded with (some) rulership over earth, sea, and sky, as well as a more universal role as Savior (Soteira), Mother of Angels and the Cosmic World Soul.

The Mother of the Angels.

Felurian turned over my hand and examined my palm and fingers closely. “you are not a fighter,” she mused softly to herself. “yet you are all ironbitten. you are a sweet bird that cannot fly. no bow. no knife. no chain.”
Her hand moved to my foot, running thoughtfully along the calluses and scars from my years on the streets of Tarbean. “you are a long walker. you find me in the wild at night. you are a deep knower. and bold. and young. and trouble finds you.”

The first of the Edema Ruh was able to see her. He was a long walker, bold and young.

Jax had no trouble following the moon because in those days the moon was always full. She hung in the sky, round as a cup, bright as a candle, all unchanging.
Jax walked for days and days until his feet grew sore. He walked for months and months and his back grew tired beneath his packs. He walked for years and years and grew up tall and lean and hard and hungry.

This Edema Ruach, like Oedipus, defeated a great beast and saved the city, but he had unknowingly killed his father and "married" the Mother of Angels.
Jax went up to the highest peak

I made my way to the top of the wheel, and from there pulled myself onto the flat peak of the highest roof in town. The fires were still dark for the most part, and most of the shouting had died down to sobs and a low murmur of urgent, hurried talk. I took the piece of shingle out of my mouth and blew on it until it was flaming again. Then I concentrated, muttered another binding, and held the oak twig above the flame. I looked out over the town and saw the glimmering coals dim even further.

and he burned his father, Aleph.

The oak tree below burst into sudden, brilliant flame. It flared brighter than a thousand torches as all its leaves caught fire at the same time.

Jax had stopped chasing the moon. Jax made the moon come to him.

I let go of the loden-stone. It shot toward the iron scale. Below my feet was an explosion of stone as the great iron wheel tore free from the church wall.
A ton of wrought iron fell. If anyone had been watching, they would have noticed that the wheel fell faster than gravity could account for. They would have noticed that it fell at an angle, almost as if it were drawn to the draccus. Almost as if Tehlu himself steered it toward the beast with a vengeful hand.
But there was no one there to see the truth of things. And there was no God guiding it. Only me.

Jax had trapped the Mother of Angels.

Lifting the smooth stone to the sky, Felurian carefully closed one eye. She tilted her head as if trying to fit the curve of the stone into the empty arms of the crescent moon above us. “that was the breaking point. the old knowers realized no talk would ever stop the shapers.” Her hand dropped back into the water. “he stole the moon and with it came the war.”
Felurian took my hand and nestled the stone between our palms again. “this shaper of the dark and changing eye stretched out his hand against the pure black sky. he pulled the moon, but could not make her stay. so now she moves ’twixt mortal and the fae.”

The First Silence was his, the emptiest thing you've ever heard. Meant for keeping things inside.

“And the box?” Jax reached out and picked it up. It was dark, and cold, and small enough that he could close his hand around it.
The old man shivered and looked away from the box. “It’s empty.”
“How can you tell without seeing inside?”
“By listening,” he said. “I’m amazed you can’t hear it yourself. It’s the emptiest thing I’ve ever heard. It echoes. It’s meant for keeping things inside.”

Jax, the first and greatest of the Edema. All of their oldest songs are his, and he had trapped the moon with his crowning achievement. He had bound her with kisses and cords of chorded song, robbed her of her virtue and stole her away.

My parents sang “The Lay of Sir Savien Traliard.” Like most of the great songs, Sir Savien was written by Illien, and generally considered to be his crowning work.
My father played an Encanis so convincing you’d think we’d conjured him. Most importantly, he could be frightening and careful at the same time. No one was ever hurt when our troupe was in charge.
“So you think there is an original story all the others stem from?” Ben asked. “A historical basis for Lanre?”
“All the signs point to it,” my father said. “It’s like looking at a dozen grandchildren and seeing ten of them have blue eyes. You know the grandmother had blue eyes, too. I’ve done this before, I’m good at it. I wrote “Below the Walls” the same way. But…” I heard him sigh.
“What’s the problem then?”
“The story’s older,” my mother explained. “It’s more like he’s looking at great-great-grandchildren.”
“And they’re scattered to the four corners,” my father groused.

The reason Arliden found Lanre's story was because he was researching the genealogy of the Edema Ruh.

Bonus

But I was brought up as Kvothe. My father once told me it meant “to know.”

A golem, a clay man, is jewish folklore.

the word emét (אמת, "truth" in Hebrew) written on its forehead. The golem could then be deactivated by removing the aleph (א) in emét, thus changing the inscription from "truth" to "death" (mét מת, meaning "dead").

Imet killed swiftly and without tears. He never sang... but he played something more than songs. He did not have knives for hands. He burned the oak tree, and removed Aleph. Truth became Death.

“You were counted among the best of us. We considered you beyond reproach.”
“Yet I did this.”
Selitos could not bring himself to look upon his ruined city. “Yet you did this,” he agreed. “Why?”

The reason the Cthaeh cannot lie is because it is sitting on the "chair", the tree. The Throne.

I am no tree. No more than is a man a chair. I am the Cthaeh.

With Aleph, Death becomes Truth.

She shook her head slowly, “the Cthaeh does not lie. it has the gift of seeing, but it only tells things to hurt men. only a dennerling would speak to the Cthaeh.”

That's what Kvothe is, what the Edema Ruh are. The Form of Aleph. Truth. "to know.". They are spears of Holly.

The Lady turned her foot upon a stone, and that was bad. She leaned against his trunk and frowned, and that was bad. The Lady sang a song to holly. Holly listened. Holly bent. The Lady sang and branch became a walking stick, and that was good.
The Lady climbed into the highest reaches of his branches, looking into nests, and that was good. The Lady pricked her hands upon his thorns, and that was bad. She sucked the bright bead from her thumb, and slipped, and screamed, and fell.
And holly bent. And holly bent. And Holly bent his boughs to catch her

“Four days ago I turned my foot on that loose flagstone,” [Denna] said softly. “Remember? We were walking on Mincet Lane. My foot slipped and you caught me almost before I knew that I was stumbling. It made me wonder how closely you must be watching me to see something like that.”

As always, I recommend Reddit Enhancement Suite and old.reddit (dark mode in settings) to read these long posts. Gives it an ebook-ish format, much easier on the eyes.
Spoilers. You've been warned.
I wrote this post last year that goes more in-depth regarding Oedipus, but it isn't necessary reading it's just for those who are curious: Edema Ruach
But this is the main thing you need to know

The infant Oedipus eventually came to the house of Polybus, king of Corinth, and his queen, Merope, who adopted him, as they were without children of their own. Little Oedipus was named after the swelling from the injuries to his feet and ankles ("swollen foot"). The word "oedema" (British English) or "edema" (American English) is from this same Greek word for swelling: οἴδημα, or oedēma.

The old man in the cave, Trapis, Auri, even Kvothe. A barefoot character means descendant of the great people Shehyn talks about, those who sang songs of power and fought as well as the Adem. The people who the Adem were before they became the Adem. It means Ruach.
In a nutshell, Oedipus' story goes like this: Oedipus was a prince, but due to a prophecy of tragedy his birth parents gave him away. Oedipus doesn't know he's adopted, so when he grows up and learns about the prophesied death of his parents, Oedipus leaves home to protect them (not knowing that they were his adoptive parents).
On the way to a city, he meets an old man and they fought. Oedipus kills the man and continues to the city, which is beset by a great beast. A sphinx. Oedipus defeats the sphinx, and he marries the Queen because the King had died during the siege. Oedipus becomes King.
Oedipus had unknowingly killed his birth father on his way to the city, the King. Then Oedipus had married his birth mother, the Queen. When they realize the truth, she kills herself and Oedipus stabs out his eyes.
That's what it means to be Edema Ruh. The unknowing death of the father, and "marriage" to the mother. Folly. Tragedy.
But the first Edema Ruh had no father. He was the son of himself... or rather, the son of Aleph.

“In the beginning, as far as I know, the world was spun out of the nameless void by Aleph, who gave everything a name. Or, depending on the version of the tale, found the names all things already possessed.”

This first Ruach had only a mother, The Cosmic World Soul.

Hecate is a goddess in ancient Greek religion and mythology, most often shown holding a pair of torches, a key, or snakes, or accompanied by dogs, and in later periods depicted as three-formed or triple-bodied. She is variously associated with crossroads, entrance-ways, night, light, magic, witchcraft, the Moon, knowledge of herbs and poisonous plants, graves, ghosts, necromancy, and sorcery.

Mother of the "Chaldeans".

In the post-Christian writings of the Chaldean Oracles (2nd–3rd century CE) she was also regarded with (some) rulership over earth, sea, and sky, as well as a more universal role as Savior (Soteira), Mother of Angels and the Cosmic World Soul.

The Mother of the Angels.

Felurian turned over my hand and examined my palm and fingers closely. “you are not a fighter,” she mused softly to herself. “yet you are all ironbitten. you are a sweet bird that cannot fly. no bow. no knife. no chain.”
Her hand moved to my foot, running thoughtfully along the calluses and scars from my years on the streets of Tarbean. “you are a long walker. you find me in the wild at night. you are a deep knower. and bold. and young. and trouble finds you.”

The first of the Edema Ruh was able to see her. He was a long walker, bold and young.

Jax had no trouble following the moon because in those days the moon was always full. She hung in the sky, round as a cup, bright as a candle, all unchanging.
Jax walked for days and days until his feet grew sore. He walked for months and months and his back grew tired beneath his packs. He walked for years and years and grew up tall and lean and hard and hungry.

This Edema Ruach, like Oedipus, defeated a great beast and saved the city, but he had unknowingly killed his father and "married" the Mother of Angels.
Jax went up to the highest peak

I made my way to the top of the wheel, and from there pulled myself onto the flat peak of the highest roof in town. The fires were still dark for the most part, and most of the shouting had died down to sobs and a low murmur of urgent, hurried talk. I took the piece of shingle out of my mouth and blew on it until it was flaming again. Then I concentrated, muttered another binding, and held the oak twig above the flame. I looked out over the town and saw the glimmering coals dim even further.

and he burned his father, Aleph.

The oak tree below burst into sudden, brilliant flame. It flared brighter than a thousand torches as all its leaves caught fire at the same time.

Jax had stopped chasing the moon. Jax made the moon come to him.

I let go of the loden-stone. It shot toward the iron scale. Below my feet was an explosion of stone as the great iron wheel tore free from the church wall.
A ton of wrought iron fell. If anyone had been watching, they would have noticed that the wheel fell faster than gravity could account for. They would have noticed that it fell at an angle, almost as if it were drawn to the draccus. Almost as if Tehlu himself steered it toward the beast with a vengeful hand.
But there was no one there to see the truth of things. And there was no God guiding it. Only me.

Jax had trapped the Mother of Angels.

Lifting the smooth stone to the sky, Felurian carefully closed one eye. She tilted her head as if trying to fit the curve of the stone into the empty arms of the crescent moon above us. “that was the breaking point. the old knowers realized no talk would ever stop the shapers.” Her hand dropped back into the water. “he stole the moon and with it came the war.”
Felurian took my hand and nestled the stone between our palms again. “this shaper of the dark and changing eye stretched out his hand against the pure black sky. he pulled the moon, but could not make her stay. so now she moves ’twixt mortal and the fae.”

The First Silence was his, the emptiest thing you've ever heard. Meant for keeping things inside.

“And the box?” Jax reached out and picked it up. It was dark, and cold, and small enough that he could close his hand around it.
The old man shivered and looked away from the box. “It’s empty.”
“How can you tell without seeing inside?”
“By listening,” he said. “I’m amazed you can’t hear it yourself. It’s the emptiest thing I’ve ever heard. It echoes. It’s meant for keeping things inside.”

Jax, the first and greatest of the Edema. All of their oldest songs are his, and he had trapped the moon with his crowning achievement. He had bound her with kisses and cords of chorded song, robbed her of her virtue and stole her away.

My parents sang “The Lay of Sir Savien Traliard.” Like most of the great songs, Sir Savien was written by Illien, and generally considered to be his crowning work.
My father played an Encanis so convincing you’d think we’d conjured him. Most importantly, he could be frightening and careful at the same time. No one was ever hurt when our troupe was in charge.
“So you think there is an original story all the others stem from?” Ben asked. “A historical basis for Lanre?”
“All the signs point to it,” my father said. “It’s like looking at a dozen grandchildren and seeing ten of them have blue eyes. You know the grandmother had blue eyes, too. I’ve done this before, I’m good at it. I wrote “Below the Walls” the same way. But…” I heard him sigh.
“What’s the problem then?”
“The story’s older,” my mother explained. “It’s more like he’s looking at great-great-grandchildren.”
“And they’re scattered to the four corners,” my father groused.

The reason Arliden found Lanre's story was because he was researching the genealogy of the Edema Ruh.

Bonus

But I was brought up as Kvothe. My father once told me it meant “to know.”

A golem, a clay man, is jewish folklore.

the word emét (אמת, "truth" in Hebrew) written on its forehead. The golem could then be deactivated by removing the aleph (א) in emét, thus changing the inscription from "truth" to "death" (mét מת, meaning "dead").

Imet killed swiftly and without tears. He never sang... but he played something more than songs. He did not have knives for hands. He burned the oak tree, and removed Aleph. Truth became Death.

“You were counted among the best of us. We considered you beyond reproach.”
“Yet I did this.”
Selitos could not bring himself to look upon his ruined city. “Yet you did this,” he agreed. “Why?”

The reason the Cthaeh cannot lie is because it is sitting on the "chair", the tree. The Throne.

I am no tree. No more than is a man a chair. I am the Cthaeh.

With Aleph, Death becomes Truth.

She shook her head slowly, “the Cthaeh does not lie. it has the gift of seeing, but it only tells things to hurt men. only a dennerling would speak to the Cthaeh.”

That's what Kvothe is, what the Edema Ruh are. The Form of Aleph. Truth. "to know.". They are spears of Holly.

The Lady turned her foot upon a stone, and that was bad. She leaned against his trunk and frowned, and that was bad. The Lady sang a song to holly. Holly listened. Holly bent. The Lady sang and branch became a walking stick, and that was good.
The Lady climbed into the highest reaches of his branches, looking into nests, and that was good. The Lady pricked her hands upon his thorns, and that was bad. She sucked the bright bead from her thumb, and slipped, and screamed, and fell.
And holly bent. And holly bent. And Holly bent his boughs to catch her

“Four days ago I turned my foot on that loose flagstone,” [Denna] said softly. “Remember? We were walking on Mincet Lane. My foot slipped and you caught me almost before I knew that I was stumbling. It made me wonder how closely you must be watching me to see something like that.”

I am currently in the hospital with preeclampsia. I delivered my twins via c-section early in the morning on December 31st, so today is Day 6 post birth. I was admitted on the evening of the 29th after a 6+ week battle with my blood pressure. Prior to my pregnancy I had what my family doctor called “borderline” high blood pressure because it would be high but would decrease after a few readings. I also have generalized anxiety disorder so she knew it was possible that could make some readings high.
My OB had me begin checking my blood pressure at home around 27 weeks after she noticed it was consistently going up at our visits. At 30+0 weeks I went to triage for the first time with two readings of nearly 180/120. I was diagnosed with gestational hypertension and prescribed labetalol 200mg 3x a day but it was clearly too low a dose as I was back just three days later when it was raised to 300mg 3x a day. At my third visit at 32+0 weeks, I was also prescribed atalat 30mg once a day and this seemed to work well for a long time. At 34+6 I was admitted overnight and left with the official diagnosis of preeclampsia, though my medication actually didn’t change that day. At 35+4 (I believe), my OB increased the adalat dose to 30mg twice a day, and honestly at some point the adalat became 30mg in the morning and 60mg in the evening but this was right before I eventually gave birth. It’s all a blur.
I ended up giving birth nearly two days after the decision to admit and induce me, but I was on magnesium sulfate both before and after I gave birth - for 24 hours after for sure, and for some period before I can’t remember.
It’s worth noting I never had any other symptoms besides the high blood pressure. The diagnosis at 34+6 was due to protein in my urine and since then there’s been some elevated liver enzymes but it looks like they’re slowly coming down.
Since then it has been a struggle to control my blood pressure here at the hospital, and I have been in the absolute worst mental state of my life. My thoughts the first few days went back and forth from “am I ever going to get out of here?” to “if they let me leave am I going to die?” I barely slept until my husband and I were able to get in a private room yesterday.
Medication wise - I’m on labetalol 400mg 2x per day, atalat 30mg… once or twice per day? Methyldopa (sp?) twice a day I think, and 250mg each? Twice they’ve had to use hydralazine as a “rescue” medication in the afternoons when my blood pressure seems at its highest. I’ve been given lasix 20mg three days because the swelling in my ankles and feet is so bad. They also give me a blood thinner injection in my belly every day because they think I’m immobile as a long term patient but I might speak up about that one tomorrow as no one with twin newborns is immobile. I’m also of course taking pain medication, but now just Tylenol (or just Advil?) because one might be making my blood pressure worse. After speaking with an OB resident yesterday I was given the option to take Ativan to sleep and I did last night - my husband took one shift totally to himself so I was able to sleep 4+ hours and definitely needed it!!
I have to say the care here has been incredible overall - nurses and doctors. The OB who saw me yesterday really took the time to explain what was happening to me and how it was out of my control. I needed that, as I’d been playing the game of “if I eat really healthy I can fix it faster” and trying so hard to stay calm for the many, many blood pressure readings each day.
After needing a “rescue” yesterday, last night and tonight my readings had been good and really good, with the exception of one an hour or so ago now where all the readings came in around almost 160/almost 100. I was due for adalat and methyldopa, and that seemed to fix it as the second reading just now was 138/93. The same OB from yesterday came by today to let me know that the plan now is to try to wean me off of some of the medications so I don’t have to go home on so many, she mentioned maybe tomorrow I’d go home (I’m doubting that now) but more likely Sunday. She said the longest stay she’d seen here for preeclampsia was 9 days post-birth, and I’d really like to let that record be kept by its current owner.
I guess what I’m looking for is any similar experiences/signs of hope. My twins were discharged yesterday, so it’s been tough navigating getting supplies for them and protocols that say they have to be seen outside of the hospital two days after leaving. I know now that I got sicker every day so they could get healthier and so I can’t regret anything or be hard on myself - that’s a damn good Mom. But I’m sitting here wiping tears as I write this. I’m scared, my husband is scared (he hates trying for a better reading, he feels it’s going to result in something awful happening to me), and we’re just two new parents to twin newborns trying to find our stride in the hospital where I’m constantly being woken up/taken out of feedings (including breastfeeding, I am trying and pumping a lot). I’m definitely sobbing less than I was day 3/4 but I’ve already decided I need to speak with my family doctor about longer term medication for my anxiety. My babies need a healthy Mom.
If you read all of this, thank you. It was cathartic to type it all out. If you have any words of encouragement or advice, thank you even more.

For new years eve i cheated, three time in a week. Now even though i'm back into carnivore for 4days now, my blood pressure is still higher than it was before, by like 20pts.
I know about glycophilic hypertension, and i imagine that getting back into ketosis might be a chore. But shouldn't it be back to normal now?
Update: Well i thought of googling something...
Prednizone... Since i cheated i had a stiff achiles and achy ankle. It does raise BP. It also makes us retain water and sodium, which i'm deficient in and started adding more and more, as my urine was getting clearer and clearer.
I'd say it's the prednisone, oedema from the carbs and the extra sodium that are at play!
Thank MOST of you for your answers!

Greetings, friends.
28M from Brazil, 176 cm and roughly 60 kilos. I do not drink nor smoke.
I've been experiecing severe ankle/feet oedema. My ultrasound has come back negative, no thrombosis, nothing.
https://imgur.com/AGgD1RY
https://imgur.com/bOWpqJx
Doctor told me to move around, as I've been rather sedentary for the previous year, and to take diosmin daily, but it's getting worse and worse.
For what it's worth, I genereally have very high homocysteine (40+ mmol), probably due to a MTHFR gene mutation. I also suffer from hemorrhoids. (But again, ultrasound show no obstruction or thrombosis.)
Also perhaps worthy of note, because of the hemorrhoids, I've been taking osmotic laxatives for a while now.
So I don't know whether it's a thrombotic/blood flow issue, or something, I don't know, kidney- related. I just don't know what to do, honestly, as doctor's advice didn't solve the problem.
Any thoughts will be much appreciated.
Many many thanks!
​

Like many folks I feel like I’m on a magical mystery tour of Rheumatology! I’ve received notes my new Rheumatologist to Dermatology asking for their opinion because she couldn’t work out what was going on with me. Not gonna lie, it was pretty disheartening to see that. The Rheum did make some notes around a recent rash looking similar to Sweet’s Syndrome, but she was unsure. I started reading more about this, and it led me to Bechets..
I would just like to understand if others’ experiences maybe feel similar, so I can have better discussions with my doctors.
I am currently dx with Sjogrens, hypermobility and associated issues related to them. I was also HSV2 positive in 2015 which was the beginning of being unwell. I was initially antibody positive for ANA and SSB, with borderline lip biopsy, and lots of dry eye / gynae issues.
However, since around 2019 there have been ‘flares’ of increasing severity which Rheum doctors can’t attribute to Sjogrens, and I am now wondering if it could be Bechets? My bloods generally are good, CRP is always high, ESR is occasionally high, with only just high C1, C4 and Fibrinogen.

• Cycles of rashes, swelling / oedema, breathlessness / coughing, fatigue, pain
• Rashes seem to range from malar-type facial rash, to raised / defined red-purple nodules on my fingers and toes, and red-lace rashes from the sun
• Oedema is mostly my face, but fingers and ankles too
• Breathlessness and dry coughing with a horrid squeaky wheeze. Earlier this year I was sent to A&E with a suspected pulmonary embolism (it wasn’t) but the doctors couldn’t work out why I was gasping for breath, tachycardia but great o2% and no sign of any infections
• Livedo reticularis on arms and legs, with ‘poor capillary refill’ in my feet
• Headaches, migraines, pressure in my head feelings, and apparently an MRA showed CSF distension on both optic nerves in 2018.. I also have lights in peripheral vision lots
• Nerve pain which gives me electric shocks all over, strange tremors of arms and legs, so much joint pain but no rheumatological findings like synovitis or erosion
• Lots of mouth ulcers, gynae sores, skin tearing etc

The consultants keep noting ‘very systemically symptomatic, no serological evidence of active connective tissue disease’ which means I’m given no treatment other than hydroxy. But I’m getting more sick as months go by, and I’m struggling so much with losing my quality of life in my early 30s.
And if you got this far, thank you 🙏 Any thoughts on things I could discuss with my doctors I’d really welcome, I just want to start feeling better ✨

Primary idiopathic Membranous Nephropathy treated with Rituximab Part 1
I decided that I would like to share the story of my journey from the time I first knew that I had a medical problem to the completion of treatment . The story will be in part 1 up to and including my first Infusion and the aftermath, and part 2 covering the second infusion and recovery period. I am British and although the article objectively points out a few failings, I am eternally grateful for the medical service that we have freely available in the UK courtesy of the NHS. My decision to put pen to paper was made for 2 reasons. Firstly- before diagnosis the best resource for information was online-and Reddit made it possible to network with real people who have shared similar experiences. Nephrotic syndrome covers many different diagnoses .My illness is caused by auto antibodies and affects only 2-3 per million population – my GP has never had a patient with the condition, but there are experts on this community who have insider knowledge and they were easy to find through kidney disease. Secondly I have had symptoms that do not reflect typical symptoms listed online and if even one person reads and identifies with these it was worth the time taken to share. The history.... In June 22 I found during home blood pressure monitoring that my blood pressure was very variable – and too high. I contacted my GP. The practice was still restricting access based on complications from Covid, but following a telephone conversation prescribed blood pressure medication and a diuretic. Blood work and urine analysis were normal. There was no follow up but I slowly developed ankle swelling and contacted the surgery . I was reassured that ankle swelling was a side effect of the blood pressure medication and of no risk . Over the year that followed I spoke to the practice seveal times as the blood pressure remained high and doses were adjusted upwards – I always mentioned the swelling but it was discounted as drug induced. In March 2023 9 months after treatment started, I insisted that the ankle swelling was unnacceptable and I would like an alternative medication. This was agreed – still without physical examination and I was given Ramipril and indapamide with the assurance that the swelling would go. Blood and urine were taken and I was called back for a repeat test because the results were anomalous but the second set of results were accepted and filed as normal. This was infact a missed opportunity because the urine showed protein and the blood showed low albumin – I only found this 3 months later. I had developed by this time other health issues with what I thought was some form of food or medication intolerance which I was trying to work out. Lots of gastric gurgling daily with sporadic nausea or diarrhoea an hour after going to bed or in the early morning before normal wake up time. Both blood pressure medications and my statin listed side effects that could account for these symptoms as the dosing was increased. In May we holidayed abroad, 3 nights out of the week I was unwell with nocturnal sickness , reflux and diarrhoea, on the flight home I could not get my shoes on at Heathrow airport to disembark –my feet were too large! I rang my GP who suggested an eyes on physical examination! At physical examination the Dr knew immediately that my oedema was not related to medication, his suspicion was heart failure – which as a healthy 57 year old was unwelcome news. Blood work was taken and showed elevated BNP which is a marker for cardiac failure (but the result is not specific ). Echo cardiography however showed a healthy heart. Further blood work showed anaemia , elevated ESR (.>100) a multitude of ionic imbalances , hypoalbuminaria and urine showed heavy protein loss. My eGFR which was 90 when my blood pressure was first flagged to the GP had dropped to 60 by this point . My GP said this was outside his experience and referred me to a nephrologist who I first saw in August 2023 . Multiple additional blood tests were taken and an ultrasound of kidneys was arranged prior to review at the end of September. At review in September I was delivered the diagnosis. Blood tests had demonstrated the presence of auto antibodies and the diagnosis was primary idiopathic membranous nephropathy. There was still a need to exclude further pathology and to that end I now needed a full abdominal ultrasound to demonstrate health of liver and biliary system and and chest xray. Both Colonic cancer and Lung cancer can also cause nephrotic syndrome and these had to be ecluded. Once further pathology had been ruled out, the consultant decided to delay the first rituximab infusion until I got the latest vaccinations forCovid and influenza. EGFR was now 40. The vaccination had to be arranged by my GP surgery and this introduced another delay – 2 weeks to access the jab and 30 days after receipt of the vaccine before infusion can be safeely delivered. Which took us to November. A little more about my symptoms . During the first year of treatment for blood pressure I had noted reduced urinary flow ( but both blood pressure meds and diuretics had warned this may happen) -I was not concerned . I had worsening fatigue - as a lifelong insomniac I was finding it difficult to stay awake after 10 pm , I was struggling by the 15th hole on the golf course . By the time of diagnosis I was finding it difficult to get up in the morning. Habitually I was and early riser – up by 6-30am but struggle with anything before 8am now. Approximately 6 months before diagnosis I noted reduced taste and smell sensation . It was easy to explain this away in the age of Covid. By the time of diagnosis I had developed a problem with certain food smells – internet research shows it is called parosmia, A number of foods that I have loved for years had developed the same acrid/ putrid smell - ironically coffee, tuna fish , hot toast , red wine (sad) all have the same smell and its not nice. I can find nothing much in the literature but this is my ongoing experience. These and other similar foods have had to be eliminated from my diet. I had also developed nocturnal nasal congestion March 23 which changed over a month or so to be a permanent post nasal drip that starts without fail in the late evning / early hours and keeps me awake gulping without ever managing to clear my throat. This stops mid morning the following day .I suspect this is either part of the autoimmune disease or a drug induced reaction to ramipril. I have mentioned both taste /smell issues and post nasal drip to my GP and nephrologist but drawn blanks! Finally the gurgling stomach – at first diagnosis I still felt generally well ,but within a few weeks I was clearly unwell .Suddenly developing dramatically foaming urine – the proper onset of proteinuria . I had abdominal discomfort with 24 hour discomfort , and light nausea . Headaches which I have never had before and oedema from feet to knees, sacral oedema and abdominal ascites. With my symptoms as they were I had decided initially that my problem must be gastro intestinal and had been seen out of hours with acute abdominal pain , nausea and diarrhoea – caused by ischemia of the bowel which has blood flow reduced by abdominal ascites and generalised oedema of the bowel walls. My nephrologist in October started me on 80Mg daily of furosemide -this worked wonders and within 3 weeks I had lost 2 stone . Much of the abdominal discomfort had gone , sleep patterns were improved , urinary habits were normalised .Even though I still had the disease frying my kidneys practically all symptoms were resolved by simple a cheap medicine to eliminate water . Why this is not a priority is a mystery as quality of life was improved dramatically. We have now arrived in November 2023 , 6 months after investigations began. My first infusion commenced at 8-30 am . I was infused with Saline, Predniolone, benadryl , given 1000gm paracetomol and then rituximab over a period of 8 hours in total. The infusion was carried out by an infusion nurse in a destination unrelated to the renal consultant. The infusion nurse thought that I was being infused because I had Rheumatoid arthtitis. When I asked to visit the toilet half way through the day she tried to arrange a recovery tem to take me. I suggested I could manage the 10 yard walk and back. "what about your joints " she said? I enlightened her that I was recieving the infusion for kidney failure not rheumatoid arthritis , and she then understood! As did I! Having read the multitude of adverse reactions and side effects online I was fairly certain at the beginning of the day that there would probably be a fatal outcome, and my blood pressure at 8-30 am reflected that! At 180/106 . However, I was unaware of any change in wellbeing through the day- My vital signs were monitored every 15 mins in early stages and every 30 mins later as the infusion speed increased .My blood pressurewas reduced to 135/79 by the end of treatment and 120/70 24hours later. I was discharged and went home . At about 10pm I felt ropey and took another 500 mg paracetomol, and went to bed. I had insomnia – which is a reported side effect and developed painful cramping of both feet with them contracting into claw position and getting stuck there ! It was painful but not enough to get me worried. The following morning I was sleep deprived but felt well, had a 6km walk and was enjoying life. Early days but thats where the story has got so far. My next infusion is 29th November and I fear it less – and that is another purpose of this article . It is difficult to rationally work through fear of medical procedure when information always contains the very worst scenario . You are more likely to focus on the possibility of the 1/100000 infusions that go wrong than the 99000 that deliver positive news . But my own experience so far is positive.

- Age - 36 - Sex/Gender - Born female, taking testosterone injections for gender transition for 9 months. - Height and weight - 175cm, 110kg - Race/Ethnicity - Australian - Pre-existing medical issues (if any) - High BP, anxiety and depression, psoriasis. - Current medications (if any) - Prednisolone (25mg), Advil + Panadol for pain and inflammation. - Duration of complaint (how long has this been happening) - 4+ months now Hello everyone, this is a bit of a long one. Throwaway account for privacy. I've had an ongoing pain in my right ankle for 4+ months now. I originally went to my GP. The initial concern was blood clots. I was given a CT scan and x-ray to check. CT showed an old fracture in my distal fibula (broken when I was 16). Venous Doppler CT found there was no overlying soft tissue swelling. CT was done in early August. My GP then put me on Prednisolone, 25mg for 3 days. This helped with the pain and I felt great. Once I stopped taking it, the pain returned. My GP then started investigating gout as my blood tests showed my uric acid levels slightly elevated. I was given Allopurinol to help with the uric acid levels, but I wasn't able to actually take this, at the same time I was also referred to a rheumatologist. After my initial appointment, the rheumatologist ordered an MRI scan to investigate psoriatic arthritis. The MRI results did not indicate gout or psoriatic arthritis. The results mention "Extensive dorsolateral subcutaneous oedema overlying the midfoot. There is also subcutaneous oedema of the medial and lateral distal tibia". The rheumatologist ended my appointment with "Your leg is swollen but we don't know why", ordered more blood tests and told me to see him again in 2 weeks. Album: https://imgur.com/a/C7eBdzZ There are multiple shots of my ankle, across 2 months. Also my MRI report with more detailed information (No personal information, of course) Prior to this, there was only pain and no marks. I would consider this a 10/10 pain, I have never felt anything so awful. If anyone has any advice or has experienced something similar, please let me know. If you'd like any more info, feel free to ask or send me a DM. Thank you everyone.

• Age - 36
• Sex/Gender - Born female, taking testosterone injections for gender transition for 9 months.
• Height and weight - 175cm, 110kg
• Race/Ethnicity - Australian
• Pre-existing medical issues (if any) - High BP, anxiety and depression, psoriasis.
• Current medications (if any) - Prednisolone (25mg), Advil + Panadol for pain and inflammation.
• Duration of complaint (how long has this been happening) - 4+ months now

​
Hello everyone, this is a bit of a long one. Throwaway account for privacy. I've had an ongoing pain in my right ankle for 4+ months now. I originally went to my GP.
The initial concern was blood clots. I was given a CT scan and x-ray to check. CT showed an old fracture in my distal fibula (broken when I was 16). Venous Doppler CT found there was no overlying soft tissue swelling. CT was done in early August. My GP then put me on Prednisolone, 25mg for 3 days. This helped with the pain and I felt great. Once I stopped taking it, the pain returned.
My GP then started investigating gout as my blood tests showed my uric acid levels slightly elevated. I was given Allopurinol to help with the uric acid levels, but I wasn't able to actually take this, at the same time I was also referred to a rheumatologist. After my initial appointment, the rheumatologist ordered an MRI scan to investigate psoriatic arthritis.
The MRI results did not indicate gout or psoriatic arthritis. The results mention "Extensive dorsolateral subcutaneous oedema overlying the midfoot. There is also subcutaneous oedema of the medial and lateral distal tibia". The rheumatologist ended my appointment with "your leg is swollen but we don't know why", ordered more blood tests and told me to see him again in 2 weeks.
Album: https://imgur.com/a/C7eBdzZ
There are multiple shots of my ankle, across 2 months. Also my MRI report with more detailed information (No personal information, of course) Prior to this, there was only pain and no marks. I would consider this a 10/10 pain, I have never felt anything so awful.
If anyone has any advice or has experienced something similar, please let me know. If you'd like any more info, feel free to ask or send me a DM.
Thank you everyone.