According to Valve, I'm in the bottom 1% of the game by skill. Here's a clip of me.
https://allstar.gg/clip?clip=663820e2725ee5000c0def12
Now, am I the top 1%, nope. Top 20%, doubtful, but bottom 1% (where I've been for the last 4 years)...
Um? I am a Solo-Q player and there is no way to actual rank up. My win rate is 35-40% and there's really nothing I can do to change that rate, even though I grind and grind and pull of clutches at a statistically higher percentage than most of my peers (according to scope.gg).
So, this is my main problem with the game. There's no way a player who's played for 25 years with 4.2k hours on CSGO/CS2 (was once an MG) is stuck in the bottom of the bottom.
Isnt the point of competitive to be able to have at least a chance of ranking up as a Solo-Q?

Hello, I been playing with this idea for a while, but here is a video that gives a small idea of what we are doing.
https://youtu.be/hFBBXOlZnJ8?si=VNonTemep5J6WBdF
The tools will be:
55 gallon copper drum, which can hold 173,000 grams of the salts, but under compression and due to thermal expansion we will say it can hold 150,000 grams. Large screw going through entire drum. Just enough that water to saturate. 80,000 grams Rochelle Salt. 40,000 grams Epsom Salt. 20,000 grams white sugar. Unspecified amount of Pyrite filings, but the rest should be filled, so around 10,000 grams.
Recipe: Mix all the substances together. Add enough water to saturate. Heat the mixture till there are no air bubbles and its like puddy. Pour mixture into drum. Put screw into center of mixture in drum before it solidifies. Measure volts after the mixture solidifies.
Results: the battery he showed gave an output of 0.7 volts with 7 grams of material. We can then do the math and see that 150,000 grams of material should produce 1,500 Volts by dividing the grams by 10, because of the 0.1 Volts per grams, then divide it by 10 again, which gets the 1,500 Volts. According to some sources, this battery should last 25,000 years, but I doubt it. If you take into consideration thermal expansion enough, it could be possible.
Some flaws in other experiments show that over the course of a few years the copper cracks and falls apart due to the vast pressure.

Prescribed 20 mg once per day. Can I split it and take twice a day instead?

Race information

• What? 3 Days at the Fair 50K
• When? May 18, 2024 ‡
• How far? 31.1mi
• Where? Augusta, NJ
• Website: https://sites.google.com/site/njtrailseries/fair
• Strava activity: https://www.strava.com/activities/11441314526
• Finish time: 4:40:46

Goals

Goal	Description	Completed?
A	4:30:00	No
B	< 5 hours	Yes

Splits

Mile	Time
1	0:39 *
2	7:33
3	7:31
4	8:01
5	7:45
6	7:56
7	8:08
8	8:00
9	8:00
10	8:27
11	8:04
12	8:11
13	8:08
14	8:10
15	8:06
16	8:10
17	8:43
18	8:09
19	8:40
20	8:21
21	8:38
22	8:39
23	9:06
24	9:05
25	9:56
26	9:45
27	9:40
28	10:16
29	11:07
30	10:20
31	11:46
32	11:00
33	6:30 **

• "Lap 1" was from the 50K start to the timing mat. ** "Lap 33" was the remainder from my GPS watch auto-split to the end of the lap/race. ‡ "3 Days at the Fair" went from 13 May to 19 May 2024 (yep!). I was there 18 May.

Training

This was a spring full of sharp turns and hard knocks. The original training went towards the Cheap Marathon in Derry, NH. (That race was reported upon by flocculus here.) Training then consisted of maintaining 30-40 weekly miles, with a weekly long run adding two miles from the prior week, with some fluctuation. My hometown is quite hilly, so I foregone specific hill training as all of my runs were not near flat. My final long run was 21.5 miles March 6 before tapering down my weekly long runs.
A freak snowstorm delayed the Cheap Marathon from 4/6 to 4/20, however on 4/9 I fell in my gym shower. Either a rib contusion or hairline fracture paused any running or training for nearly two weeks. Scrambling for some sort of race to scratch the itch and not toss away months of prior training, I found 3 Days at the Fair online – a six day affair featuring ultramarathon categories from 50K to 144H races. They offered a marathon category, with an alluring 50K at similar start times. Naturally, I signed up for shy of 5 more miles than a marathon. One of my running mates gave me the best advice that "ultra running is more of an eating contest than anything else." Considering that during prior marathons I had salt tabs and 3 or 4 GU packets, I thought more about this statement. Hoping my ribs and legs would stand up, I went for the race.
Note: If registering for this race, you can choose the specific date and time you wish to start it. Just stick to that time. I would end up toeing the line with three other 50K runners who opted for the Saturday 9AM start. One could have theoretically started their run any day between Monday and Saturday, at 9AM or 6PM.

Pre-race

The Sussex County NJ fairgrounds were easy enough for me to get to. Those who were not running longer ultra races had plenty of parking mere steps from the registration/food/starting line. (Those running longer races have opportunities to park campers, tents, and so forth.) Weather was gray and cool, at 58˚F/14˚C -ish. I ended up playing with how I'd pack for the run, before noticing racks set up after the start line into which you could place your water bottle so as to not hold it the entire time.

Race

For check-in, I picked up my swag (a plush bathrobe) and timing ankle chip. No bibs here! At 8:50, marathoners and 50K'ers were brought to the respective start lines, 0.1 and 0.2 miles after the timing mat. At 9AM, we would run against the sea of all other runners back to the starting mat, turn around, and continue in the anti-clockwise 1 mile loop course. This is why marathons are 27 laps and 50K is 32 laps – that quarter lap registered as "lap 1 completed," so 31.1 miles registers as 32 at the end. I'm getting ahead of myself!
I found the course compelling enough to follow. After the timing mat, there is a short uphill that weaves past the toilet and shower area, and toward a hairpin. While the 'pin itself was set wide, most of the time I would walk it because of traffic or weakening knees. This continued straight past a Camper's Row of sorts with mild downhill. The second half runs a long arch around the grounds, with a gradual gentle uphill. The course is paved except for a 200m segment of packed gravel – if it had rained, this part could've been muddy. The course completed after a shot down a causeway, and left turning back to the mat. It's this area where registration, fuel/food/catering, and timing is displayed. Overall, no real potholes to be concerned about, just 31 total laps of this!
Hydration and food – tons of everything including Impossible Burgers, PB&J, cola, and sports vitamins – was supplied after the timing mat. I kept track of which lap I was on with a big-screen projection. My name, lap number, prior lap time, and total time appeared. Every 30 minutes or so I decided to take in calories. This included GU Rocktane, GU Vanilla (sooooo good), two stroopwaffels, two ice pops, and a few salt tabs. It was roughly 400 or so more calories than I would have consumed during a race. Hydration was also a factor, that the course was completely uncovered made me feel hotter and "drier" than normal. I might have taken on about 50 fl oz / 1.5 liters of water. My stomach tolerated this!
The main causeway/timing mat area is where I stopped for water and stowed my foods so I didn't have to carry it around. Early on, I didn't understand where the timing screen was, so took minor detours in the registration area. These factors are why my paces seem inconsistent by 30-odd seconds per mile at points.
The people here are amazing! Other runners were highly supportive, chatty, upbeat. One person was dressed up like a chicken (the race logo featured one), and another person blasted some pretty appropriate and popular tunes. It would be a game for me to guess the artist or song on every lap – we had a great banter going! Another group had a dry-erase board and changed it every few minutes or so with a new dad joke. Naturally, I had to stop to retort with another. For example, they wrote, "3.14% of sailors are pi-rates!" I replied, "if it's $4.50 in Jamaica for a beef patty, $3.50 in DR, and $2 in Trinidad, are those the pie rates of the Caribbean?" Sorry, not sorry.
The lack of proper training began to present itself around mile 22. Pacing was targeted at 8:00-8:15 per mile, with goal half-marathon splits at 1h45m or so. After mile 26, I was 3h40m44s, ten minutes off goal pace. Around that point I slowed, taking more walk breaks but promising myself to run at least half every lap. Landmarks were mentally set to designate where walking and running would occur. When I crossed the line I was done.

Post-race

From a mental standpoint, the concept of so many laps did not bother me. My daily runs more often than not are laps in my parking lot, and I've completed a few half marathons on traditional 400m tracks a few times prior – especially during the Global Pandemilovato of '20. Physically, my legs did not feel any worse than they would have after 26.2 miles. My stomach was actually doing quite alright – nausea and headache would set in within a few minutes of finishing other marathons, but not today. My buddy's advice is making me rethink my marathon strategy.
As the event is ultra-marathon focused, finishers of marathon and 50K received a coin. The longer the distance, the larger the coin, with special awards for those who have invested 100+ miles with the organization. (A paver brick [!] stamped with the runner's name is awarded after 1,500 miles with the organization.) Either way, I circled back to the registration area to press my luck at burger availability. Unfortunately they were out, yet making more. While at the beginning of the race the smell of bacon and pancakes wafted onto the line, the sweet smell of success – naturally, manifest as deliciously greasy burgers – greeted us at the end.
Post-race nutriton in my car included Gatorlyte electrolytes, SiS Rego Rapid recovery, and 1.5 liters of water. I opted against the on-site showers and made the long ride home for one which was far more satisfying.
EDIT: Added info about registration. EDIT 2: Grammar.

Just something I did for fun. Having played a stupid amount of this game, these are changes I believe will make each gun good but most importantly fun to use. All weapons are currently "viable" but most don't feel good to use despite this fact.
Primary Weapons:
AR-23 Liberator:

• Damage 60 70

(breakpoint for 2 hit kill in Devastator head)
AR-23P Liberator Penetrator

• Damage 45 60

(should feel like current Liberator but with worse mag capacity)
AR-23C Liberator Concussive

• Recoil 28 20
• Fire rate 320 475

(same fire rate as SMG 72P with a recoil reduction to make it feel similar to currently)
AR-61 Tenderizer

• Damage 60 80

(hits better breakpoints vs bugs but very similar to base Lib vs Bots)
BR-14 Adjudicator

• Recoil: horizontal recoil reduced by 80%
• Capacity: Extra mags increased 8 9

(with effective mouse/stick drag the recoil can now be controlled. The extra mag brings the total ammo capacity near to that of the other AR's.)
R-63 Diligence

• Damage: 125 128

(allows for 1 tap headshots sub 25m on Devastators. Further cements this as the close range battle rifle compared to the R-63CS.)
R-63CS Diligence Counter Sniper

• Damage: 140 175

(unchanged vs Bots, allows for consistent 1 taps vs bugs.)
MP-98 Knight

• Damage: 50 60
• Recoil: 20 10
• Bug fix: Receives full ammo back on resupply.

(fix the legacy errors and make it controllable in 3rd person. Also makes it more ammo efficient)
SMG-37 Defender

• Unchanged

(gold standard for an SMG)
SMG-72 Pummeler

• Unchanged

(effective side grade to both SMG-37 and Lib-C)
SG-8 Punisher

• Unchanged

(gold standard for a shotgun)
SG-8S Slugger

• Heavy stagger added back.
• Projectile velocity reduced 25%
• Projectile drop increased 25%

(Much better close up but less able to function as a marksman rifle.)
SG-225 Breaker

• Capacity: 13 16

(game has been power crept enough, the nerf is no longer required much like the Railgun)
SG-225SP Breaker Spray&Pray

• Ergonomics: Improved to match other Breaker variants.
• Capacity: 26 30
• Recoil 45 28

(easier to control and better at quickly spraying down light hordes)
SG-225IE Breaker Incendiary

• Unchanged

(gold standard for Breaker family)
CB-9 Exploding Crossbow

• Damage: 420 550
• AOE: increased to original value.

(550 is the breakpoint to be able to 1 hit Devastators in the weak point or 2 hit otherwise. 2 hit kill Brood Commanders. Can now clear chaff as well while dealing with elites.)
JAR-5 Dominator

• Unchanged

(gold standard of explosive primaries)
R-36 Eruptor

• Damage: 420 650
• AOE: Restored to post AOE nerf value but before the shrapnel was removed.

(A large but fair AOE paired with the ability to 1 shot Brood Commanders/ Devastators like before. Importantly it won't be able to 1 shot chargers due to the shrapnel bug. Despite claims it was +100 shrapnel was much closer to +300 to 500)
SG-8P Punisher Plasma

• Unchanged

(Gold standard for AOE weapon)
ARC-12 Blitzer

• Unchanged

(Already strong but one bug fix for arc weapons away from becoming a monster. May need to be adjusted down once this fix happens depending.)
LAS-5 Scythe

• Scope: Changed to Sickle/Liberator scope
• Damage 350 400

(now able to beam heads with a good scope vs Bots and higher DPS will help vs bugs.)
LAS-16 Sickle

• Unchanged

(with almost 100 shots per mag and the ability to run forever, the lower damage and worse breakpoints is a fair trade vs kinetic AR's.)
Plas-1 Scorcher

• Unchanged

(Gold standard of Plasma weapons)
Plas-101 Purifier

• Rework: 3 tiers of charge up.
• Tier 1: Trigger pull 200 damage 80 fire rate. (no splash)
• Tier 2: Trigger hold 1.25 second 300 damage.(small splash)
• Tier 3: Trigger hold 1.75 seconds 400 damage. (large AOE splash like currently)

(better matches the description of the weapon. High incentive to hold your fire for longer but allows for it to be used as a weaker Plas-1 when required)
Stratagem Weapons
The following are pseudo primaries and so will be looked at as well.
M-105 Stalwart

• Ergonomics: Improved by 25%

(Often struggles to feel competitive with top tier primaries but should blow them out of the water if you are giving up your stratagem slot. Will hit more shots and clean hordes easier.)
MG-43 Machine Gun

• Capacity: reserve mags 2 3
• Reload: able to reload while moving.
• Damage: 80 90

(Very little reason to give up a stratagem slot for a Adjudicator damage equivalent with low max ammo and a stationary reload. With more ammo and the ability to move and shoot this will be a good choice.)
MG-206 Heavy Machine Gun

• Rework: Backpack fed weapon. Does not require reload.
• Capacity: Total ammo 225 250
• Damage: 102 128

(Will have cleaner breakpoints vs Bots allowing for 1 shot headshot kills up close and won't have its current ammo problems. Will still be hard to handle and consumes a backpack slot but worth it)
Bonus:
Recoilless / Quasar Cannon

• Damage: +10%

(Currently both launchers do not 1 shot Hulks or Tanks in their rear weak spot. Both survive on a tiny amount of HP. This change will fix that making launchers viable vs Hulk backs and the backs of tanks)

• Projectile: Hitbox size increased by 25%, projectile has priority on weak spots.

(if the projectile contacts a Hulks front plate and it would have hit the head but instead touches the body armour first it counts as a headshot. Simulates penetration of the round. Also the headshot hitbox is larger and more forgiving. Currently the launchers are completely outclassed by the AMR and Autocannon vs Bot armour, requiring the same level of precision for a headshot but not being versatile weapons or having fast follow up potential.)
SPEAR

• Projectile: Hitbox size increased by 25%, projectile has priority on weak spots.
• AH studios makes a daily sacrifice to the machine god to appease it and fix the SPEAR lock.

(shooting a hulk from the front should always award a headshot kill but currently it's random chance. This change will fix that.)
Extra Wish list:
Bot Trooper Infantry:

• Rework: Hp increased 100 400
• Rework: Appear in higher frequency alongside Devastators at higher difficulties.
• Rework: Accuracy improved

(currently Bot infantry pose 0 actual threat outside of calling in drops. They can be ignored almost indefinitely and they wont kill you. This change makes them more like the terminators they are suppose to be. Taking a decent amount of fire to go down while still being a fodder tier enemy. This is also a massive indirect buff to AR's as dealing continuous damage to low armour targets is where they shine.)
Feel free to offer feedback. and don't forget to downvote.

I really enjoy actively countering enemy attacks in almost every game that has that, but for some reason no arpg I've played has a skill like that.
LE has already brought plenty of innovation to the genre, so I could see it pulling this off aswell with a cool skill tree for a counter skill.
It would probably make the most sense on a Bladedancer, where the Counter would put you in a parry pose with a sword and when an enemy hits you during that period, you react with a counter attack of some sort.
I think a skill like that could add an actual use case for the 2 reflected dmg to attackers affixes beside the very few niche cases that exist right now.
By default it could last like 1s and be a basic melee slash attack in a 180° cone, triggering after a hit is parried, cooldown of 10s, 100% dmg absorption by default, meaning you take 0 dmg by parried skills. Requires 1h sword. Flat reflected dmg to attackers is applied with 500% effectiveness to the counter attack.
I feel like % reflected dmg should get reworked to apply as an %increase to the flat reflected dmg to attackers stat.
Possible skill nodes I could imagine:

• Reduce cooldown to ~1s to make it viable as a main skill, but instead of a 1s duration it's a very small time window, so you need to learn monsters' attack patterns to get the timing right. Time frame slightly scales with increases to attack speed.
  
• Reduce the cone to 45°, but make it shoot a wave of energy like that Rive Node (which is in need of rebalancing btw)
  
• Every hit you parry during that stance extends the duration by 1s, up to 10s, but -2% dmg absorption for every hit parried. Counter attack no longer triggers when parrying something, but at the end of the duration, 50% more dmg per parried hit.
  
• Change the 180° slash into a Shadow Cascade cast with 200% increased area.
  
• Throw a piercing dagger per 20 reflected dmg to attackers when counter attacking.
  
• Change into a channelling skill and you can turn around freely while channelling, but lose dmg absorption at an accelerating pace until reaching 0
  
• Using another attack shortly after parrying enhances that attack in a unique way: -> Flurry (400% increased area) -> Puncture (300% extended range) -> Cinder Strike (+100% fire penetration) -> Shadow Cascade (cast 2 additional shadows)
  
• Taunt enemies around you during the duration, but -10% dmg absorption.
  

Potential unique item ideas:

• Remote Tracker Gloves (any existing Decoy's are violently flung at the enemy you parried with counter attack)
  
• Wolf's Focus 1h Katana (Successfully parrying a hit makes you flash briefly and with a well timed Shift cast you dash forward with increased range and cast another counter attack (just the attack part, not the parry) at the end of the dash. Only works when Shift is not on cooldown.)
  
• Reckless Rage Helmet (You counter with 3 quick attacks instead of 1, but -50% dmg absorption during Counter attack.)
  
• Zerrick's Shell Body Armour (1% more armour per 10 reflected dmg to attackers, 1% endurance per 20% reflected dmg. Cannot regenerate or leech hp during Counter attack.)
  

This is just me brainstorming and I'm no balance expert, so take any numbers here with a grain of salt, but I think this would be a very fun (although likely niche) skill to add to the game. Do others here enjoy reflect/counter type of playstyles aswell?

It's really simple if you follow basic rules, or at least it significantly reduces any problems related to nutritional availability or temperature, and humidity. 18 to 26c . 40-70% ph 6.0 to 6.3 Feed a fully complete 13 minimum required mineral solution N P K Ca Mg S Fe Mn Zn Mo Cu B Cl . 600ppm feed and up to 900 ppm runoff in carbon media 850ppm feed and up to 1300ppm runoff in inert media like water , rockwool, or gravel . 10k to 15k / lux seedling 15k to 35k veg 25k to 45k bloom When feeding, apply a 20% runoff to try to keep Salts from building up in the media. When your media dries out about one-third, apply another watering feeding two twenty percent runoff. When the bulk of the plant is as wide as your pot. This is when you can apply once a day. Feeding and that will allow the plant to continue to grow widthways, whereas normally, it would stop when it hits the edge of the pot. That is called the drip line. Keep track as this will be a pattern from now on. so: -water to 20% runoff - when pot dries out 1/3 from saturated to 2/3 wet watefeed to 20% runoff monitoring ph/ec to above levels. - when plants bulk width is as big as pot ie: 8" pot and 8" bulk of plant Not just the tips of the biggest leaves You can Start at least one watering daily. End follow the same rules about increasing frequency of watering. bigger pots = less watering smaller pots = more watering Both will equal roughly the same product. but the more water there is In the media, the more buffer you have in case of watering issues such as pump failure or you not being there. Smaller media with more watering is just more economical and less wasteful. The plant will take up the exact same water and nutrients per pound, no matter how you feed it. I usually choose a happy medium of around free 3>5 gal again following the common sense rules.
That's pretty much it these are the environmental conditions you need to try to get as close to as you can within reason. If it's eg 27c, do NOT buy an AC to get it to 25 or 26c . ( the within reason part ) All the other stuff like mold and pest control and stuff mostly happens when you lose control of your environmental conditions but these are the basic environmental and feed conditions that will allow you to focus on all the rest of the things above and beyond basic environmental and feed conditions.
THESE ARE EXCELLENT STARTING POINTS I RECORDED OVER 20 YEARS FULL TIME PRODUCTION. YOU MAY FIND YOUR PLANT LIKES A BIT MORE , A BIT LESS BUT WILL BE IN A REASONABLE RANGE .
This covers 99% of plant growth. Follow these basic rules within reason, and you will get 99% of your potential. Always make sure you have got a basic yield number. a yield with just proper technique and basic 13 mineral solution. Then, if you do add a new product, you will know whether it does anything or not. You will NEVER be unhappy with cannabis grown using just these basic parameters. DO NORMAL THINGS , EXPECT EXTRAORDINARY RESULTS 🙂 John ( always read, reason & then read some more) cannabis GROWERS SCIENCE group fb growersscience

I'm 2nd grade material science student, and I have a homework about, a car's brake system is broken, I have to use characterization techniques to figure out why it broke.
I'm thinking TGA, light microscopy analysis, TEM (or SEM) analysis to see microstructure, I don't think EDS, XRD or XRF needed for this example, should I include them too?
And for sample preparation for TGA, how can I analyse broken brake system, I know how to prepare sample for light microscopy, SEM and TEM but for TGA, the broken part is large and I need just 5-20 mg of sample, so I don't know how to prepare a bulk metal sample from a broken system.

34 AFAB 183lbs 5'4"
For the past 6-7 weeks, I've been dealing with what my PCP diagnosed as Candida Albicans infection. It started around the anal area. It has now moved to the entire genital area (vaginal and anal), under both arms, inside and outside my right ear, my stomach, neck, and face [also, both forearms, top of the right hand, , and moving down both upper thighs]. I've taken 4 doses of Fluconazole and treat with Nystatin cream twice a day. I'm taking daily showers or a 15-20 minute bath with Domeboro soak. Nothing is working, I'm in extreme pain, and I would appreciate some guidance.
Other relevant information:
Pregnancy w/ vaginal birth 12 years ago.
PCOS w/ metabolic syndrome and insulin resistance 7 years ago. Taking 1500 MG Metformin daily.
GSHV2 9 years ago. Taking 500 MG Valtrex daily.
Depression/Anxiety. Taking Lexapro.
ADHD-Inattentive. Taking 40 MG Vyvanse.
Other supplements: Magnesium glyconate (sleep), prenatal multivitamin (low Vitamin D and Iron in the past).
Former cigarette smoker. Current vape user.
No new sexual partners in the last 5 years. No new soaps, detergents, etc.
The amount of pain I'm in is just miserable. I've been trying to follow my PCP's instructions to the letter, but nothing is working. I can barely walk around my house at this point and it's interfering with my job and being able to take care of my kid who was diagnosed with Type 1 Diabetes this past year and may have celiac's disease. I may just be impatient to have this clear up and I know my PCP has given what's considered the gold standard for Candida skin infections. I'll be talking to her on Monday about seeing a dermatologist.
My questions:
Has anyone seen this situation in their practice before?
What are the next steps usually taken?
How can I stop it from spreading further?
Is there any possibility the infection could have gotten into my bloodstream (I started having headaches, chills, fatigue, abnormal amount of gas, and dizziness w/in the last 3 days)?
Is there some way to get some relief or speed up the healing process?
Are there any best practices for this type of infection besides keeping it clean, dry, and medicated?
Would anything described warrant a trip to the ER (asking bc my partner has been very worried about me and has mentioned it several times)?
Thank you for any feedback.
Edit: Formatting since I'm on mobile and additional observations from tonight's bathing and applying medicated cream included in [ ].

I first started noticing that something was wrong around 3 months ago. At the time, I was working from home and would usually light a scented candle while I worked, which usually helped me relax and stay focused on my work. I would usually burn through a candle a week, but over time, the candles started to take less time to fully burn up. At first, I thought that this was because of a change in ingredients the company that made the candles used, but the problem persisted after I switched candle brands, which I once again blamed on the candle manufacturers.
I kept this belief for another week until the first incident. While getting up from my computer desk, which faces away from the candle, to take a quick bathroom break, I caught a glimpse of the lit candle. A two-inch layer of molten wax rested on another three-inch layer of solid wax, the wicks rising out at first and being somewhat visible through the molten layer, finally breaking the surface and being slowly burned away. The flames flickered as I swung the door open and walked out of the room. When I returned 10 minutes later, the molten layer was gone, and the wicks had been shortened so that the flames rested right above the solid layer of the wax. At first, I thought that the glass jar that contained the candle was leaking, but after a short inspection, I was only able to find two small drops of candle wax that had solidified right next to the candle on the bedside table. I still had 2 hours of work left to do, but I was too lost in thought and was unable to do any work for the rest of the day.
Every night before I go to sleep, I like to read for at least 30 minutes, and while reading, I usually light a candle. Around 4 days later, I had mostly forgotten about the incident and went back to using candles. Due to my naivety, it returned.
I fell asleep while reading with a candle lit on my bedside table. I woke up to loud slurping noises. As I opened my eyes, the brightness of the light I had not turned off almost blinded me. As my eyes tried to readjust to the light and focus on what was in front of me, I saw a somewhat humanoid dark gray to light blue blur that contrasted with the white paint on the walls behind it. Another gray line stretched from the shape's head to the candle on my bedside table. I could feel my heart skip five consecutive beats. I opened my mouth and tried to force out a scream for help, but the pressure I applied to my throat was way beyond what it was able to handle, leading me to only produce a light wheezing sound. I tried to sit up or to at least prop myself up, but my muscles failed me. Trying to push myself up with my arms felt impossible. As I stared at the figure that had suddenly appeared in my room, my eyes finally managed to focus, making it possible for me to see the intruder who was now staring at me. The figure was a man at least 7 feet tall, fully naked; he looked bloated; his eyes were bloodshot and looked like they would pop out of their sockets; at any point, his skin was a grayish light blue.
HIS LIPS
His lips extended from his mouth like an elephant's trunk, which had been split in half. The lips extended from the man's face to the candle; the flames had been put out. He was using his lips as a makeshift straw, slowly sucking up all the molten wax from the candle, which had fully liquified while I was asleep. I laid in bed, unable to move, unable to scream for help, staring until he emptied the jar. His lips retracted back to his face, the molten wax solidifying on their tips and cracking, flakes of wax falling off the man's lips and falling to the floor. The man grinned, staring at me. The ridges and gaps between the teeth were filled in with wax, making it impossible to make out where one tooth ended and the next one began. The man opened the door he was standing next to, but instead of walking out of the room, he stepped behind it. His face peered at me from above the door, and then once again, like he had done to drink the wax, the man puckered his lips, which stretched from his mouth and floated to me. I shook and tried to roll over away from him. I wanted to get up and run, but my fear had taken over my body. Tears flowed from my eyes. He kissed me on the cheek, leaving flakes of wax and light moisture. He retracted his lips and lowered his head behind the door.
I don't remember falling asleep, but when I woke up, I saw the empty glass jar, which at one point contained the candle. Even though I had hoped that what had happened was a dream, it wasn't. I still had flakes of wax on my cheek, and on my bedroom floor, the wax in the jar had disappeared. I called the police, but they were unable to find anyone in my apartment; they also could not find any evidence of a break-in.
After the break-in, I started looking for a new apartment to move to, thinking that the man was tied to the building I was in, but even though I had thrown out all of my candles, I could not stomach spending another hour in my apartment, constantly looking over my shoulder or walking around with my back pressed up against the wall to not allow it to creep up on me. Thankfully, my friend Emma was able to let me stay over at her apartment while I looked for a new one for myself.
Me and Emma have been friends since we were 8, and we've been there to support each other when times get rough. This isn’t the first time I've had to stay over at her house for an extended amount of time; in fact, I have had to stay over at Emma’s as many times as she has had to stay over at my apartment, whether it was because of evictions after losing a job, breakups, or a candle wax drinking squatter. I didn't even know if it was human. I mean, sure, it looked like one, but human lips are not supposed to do what his did, and somehow it didn't have a reaction to molten wax being poured down its esophagus. I didn't tell Emma about what happened—the details at least—I just told her that a man had broken into my house and was watching me sleep. The only people I told the truth to were my therapist and the cops, and all of them disregarded what I told them as my mind making things up after a traumatic event.
For a while, I believed what they said—I mean, why wouldn’t I?—but then I started seeing him again. For a few days, I thought it was my mind playing tricks on me again like it had done during the night of the incident. For split seconds out of the corner of my eye, I would see the outline of a tall, bloated figure. At first, they were hours apart, but after a while, it became constant. He was standing in each room I passed, in every single dark corner I glanced past, and then he spoke.
“FeeD MeEeee”
It stood in the kitchen, peering over from a small gap between the fridge and the sink, where the trash can that had been knocked over onto its side usually stood. His voice was raspy, and every word that came out of his mouth was distorted as if he were gargling water, but still, I could somehow clearly make out each word he said from over 15 feet away.
“Please just leave me alone I… why are you following me?”
I shouted at the figure, the same fear that had taken over my body during the night I saw him for the first time paralyzing me, making it impossible for me to move anything other than my eyes, eyelids, and mouth.
“i’M sTarviNg, I nEEd You To FeEd ME”
It replied again. Now, stepping out from behind the fridge, he stepped directly onto a rotten banana. Its mushy brown content’s seeping out of the peel under the pressure of his decomposing foot, which was covered in scabs, and took up the same grayish light blue color as the rest of his body. He mostly looked the same; his bloodshot eyes bulged from their sockets, but now his tongue was swollen. It peeked out from between his bloated, cracked gray lips; it stared at me, waiting for an answer.
“Ok, I’ll.. I’ll feed you, but please just... leave me alone.”
I replied, the tone of my voice shifting into high-pitched squeals with every quick breath I took. He looked satisfied by my response. He somehow squeezed his bloated body back into the gap that was at least four times smaller than him. After peering over at me from above the fridge, he bent over backwards, his spine releasing a series of sickening cracks until he was fully obscured by the fridge, and then he vanished.
Still barely in control of my body, I limped over to the couch tucked away in the back corner of the living room, it took me at least 10 minutes to steady my breathing and 20 more to fully regain control of my body again but as soon as I did I ran out the house and to the nearest store, during the 15-minute walk he stared at me through dark windows and the backs of cars, peered out at me from gaps between leaves in the trees and bushes, he even followed me into the store staring at me from the middle of deserted isles before disappearing right before my eyes were able to fully catch him, once I finally got the candles I randomly picked four off of the shelves and rushed to the self checkout.
When I arrived home, I had 2 hours before Emma got off work. I didn't want to feed it while she was home, and I didn't want her to see it. I pulled out two of the candles from the black plastic bag and placed them on the kitchen table, the first a light blue candle named “Garden Rain” and the second a red candle named “Juicy Watermelon." I pulled out a lighter from one of the drawers Emma used after her stove stopped lighting on its own and lit each of the 6 wicks on the candles. As soon as I started seeing the wax melt under the heat of the burning wicks, I dropped the lighter onto the table next to the candles and ran out of the room. I could not stomach seeing that thing again; even just thinking about it made me shudder and hyperventilate. The paralyzing fear that seeing him caused me made me want to vomit.
At least 30 minutes later I started to hear it drink even though the living room and kitchen were separated by a wall, even though I had closed the door I could still hear what at first started as slurping sounds which were followed up by loud gulps, then it stopped, and once again 30 minutes later it started drinking, as the slurping started once again I heard the door to the apartment crack open, it was Emma, as she stepped through the door I saw her carrying two large brown paper bags of groceries in her hands, she was headed to the kitchen.
“Hey let me grab those for you”
I said running over to her, my voice shaking.
“Oh, thanks. Are you… okay, you look scared?”
My eyes shot wide open in a mixture of fear and surprise. I said the first thing that came to mind.
“Yeah just umm… I didn't expect you to come home so early and I got a bit spooked”
“shit sorry, I know I should have called you, work let me off early today,”
I started to turn away from her walking to the kitchen.
Trying to keep her away from the kitchen I told her to wait for me in the living room because I wanted to talk to her about something. I didn't know what I would talk to her about but that was a problem for future me to resolve, somehow it worked.
“What's that sound?”
She called out to me while walking towards the living room couch. It took me a few seconds to come up with an excuse.
“I think it’s the sink, or the pipes at least”
I opened the door to the kitchen with my eyes closed at first hesitant to look knowing what would be greeting me. slowly prying my eyes open I started to see its outline, my muscles started to lose strength as the details of the man came into my view, I felt the grocery bags start to slip from my arms, my knees buckled, face first I fell onto the kitchen floor scattering the groceries all over the floor, I mixture of a light scream and a yelp escaped from my mouth as my body made contact with the floor, Emma concerned for my safety ran into the kitchen, she didn't scream, using all of the strength and mobility I had left in my muscles I rolled over expecting to see her face drenched in terror, her body frozen still unable to move just like my body had done the first time that I saw him, but Emma looked concerned, the man was gone, she crouched down beside me.
“Oh my god are you ok? What happened?”
I looked around observing my surroundings.
“I um… I… I tripped on the little thing at the bottom of the doorframe”
I finally managed to blurt out another excuse, not being able to remember what the name of a door sill was. I started to sit up using a part of the energy that had returned to my body, pain pulsed through my chest and arms, Emma looked at me with a concerned face.
“You've been acting really weird since I got home, are you sure you're ok?”
“Yeah… I think I’m just having one of those days you know”
The confusion on Emma’s face said that she didn’t know and to be honest I didn't either, I guess my luck of pulling random excuses out of my ass ran out, Emma thought that she triggered some sort of PTSD response after barging into the house unannounced at first apologizing then trying to change the subject to stop my trembling which I was still unsuccessfully trying to hide from her.
“Did you buy candles?”
Emma asked picking the groceries apart from the garbage that spilled out the can that the man had knocked over, placing them on the table next to the now half-empty glass jars, the flames flickered above the inch or so of molten wax the man was unable to finish drinking.
“Yeah I’ve been struggling with work lately, they usually help me focus”
“Huh Interesting combination you’ve got going on here”
She looked at me and smiled slightly, I smiled back and chuckled to seem normal.
“Yeah even I don't know what I was trying to accomplish here, to be honest”
I tried to help Emma clean up the spilled groceries but she did not let me, she told me that I needed to recover like I had been in a car crash instead of having taken a little tumble. After a few seconds of silence, Emma spoke again.
“Anyway, what did you want to talk to me about earlier?”
A quick jolt of stress shot through my body, in a jumbled mess of lies and fear I had forgotten what I had told Emma, I sat there in silence for a few seconds unable to come up with an excuse
“I…umm… I don’t remember, it wasn't anything serious though”
“Damn did you hit your head too?”
She said once again proudly smiling at her joke.
At this point Emma picked up the last bag of potato chips from the floor and placed it on the table, then she opened the fridge and started loading the groceries into it.
“Anyway I gotta go get back to work’’
I blurted out after a few more seconds of awkward silence.
“Alright well good luck”
I walked over into the living room and sat down in front of my workstation, which now consisted of a laptop sitting on a small foldable TV tray that had just barely enough room left on it to fit a small USB mouse.
The last thing I remember, before I fell asleep, was me mindlessly scrolling through apartment listings while Emma watched a random 90’s horror movie I’m positive only had a budget of $500.
I woke up with a light stinging pain shooting through my dry throat, and a dim hissing sound caused by thousands of water drops striking the ground outside filled the room. I pressed the spacebar on my laptop, the brightness of the screen blinding me temporarily, after taking a few seconds to let my eyes readjust I managed to make out the time, 3:45 AM. A strong smell I was unable to make out the origin of assaulted my nostrils. Lavender.
The smell hitting my nose had the same effect on me that I would expect smelling salts would have on a weightlifter right before they set a world record. Before I knew it my legs were moving on their own at an almost uncontrollable pace, fighting back against my mind which was telling them to slow down after years of being used to navigating both mine and Emma’s apartment as steadily as possible to not bother the neighbors.
Finally, after what felt like an eternity I stood before Emma’s bedroom door, a faint, yellow, pulsating light radiated from a lamp and snuck out of a small gap between the door and the doorframe, reluctantly I pushed my left hand up against the door, my right hand grasping onto the door frame for a sense of stability, once the door was fully agape I scanned the inside of the room my heart skipping a beat for every humanoid shadow cast up onto the wall by the lights from the wicks which were set ablaze and were being slowly burnt away.
I walked into Emma’s room and made my way over to her bedside table to put out the candle, as I stepped closer towards her, her face became more defined, I could finally make out her features, she was awake, but no she could not have been, even though her eyes were wide open they never blinked, she didn't even move slightly, as I moved closer I finally managed to fully make out the expression of pure terror on her face, her mouth wide agape as if she was about to release a deafening screach, but she could not have, a single drop of solidified wax dribbled out of the corner of her mouth and clung to her cheek, my eyes traced the cream colored path back towards her mouth, first up her cheek then between the corner of her mouth and finally behind her teeth, there instead of her tongue or the roof of her mouth I saw a wall of wax which had filled in the entirety of her mouth.
I fell to my knees and hunched forward supporting my body weight with my arms, I was too late, I resisted the urge to vomit and got back up onto my feet, a mixture of tears and snot slid down my face and onto my lips, shaking now I slowly started limping over towards my phone which I had left on the couch next to where I had awoken just minutes before, just minutes before my life was destroyed because of my lies if I had just told Emma what I had gone through, if I had just told her what had happened on the night of the incident which now seemed trivial, even if she thought that I was crazy, I know that she would have complied just to make me feel comfortable.
It took me at least 30 seconds of repeated attempts to stabilize my hands enough to properly dial 911. “Someone broke into my apartment and hurt my friend” was the only reasonable explanation I could come up with that would not get the operator to hang up on me thinking that this was a prank call.
I sat there in the living room for an agonizing 10 minutes, crying, my sadness slowly transformed into anger towards myself, and my mind raced thinking of all the lies I’d told, I kept thinking that if I had just told her the truth she would not have been laying there in her bed, her body bloated, “every single orifice has signs of forced penetration and has been filled with what seems to be candle wax” is what was written on her autopsy report.
For a few days I was the main suspect in Emma’s murder, but due to the almost unstoppable crying and the unresponsive state that I was in when the police arrived, mixed with the lack of evidence of me having a way to produce 30 pounds of candle wax led to me being released out of police custody, but because I was the main suspect I was not told any details about what had fully happened to Emma, for days all I had to work off of was the image of her face frozen in terror, and a short glance I caught of her bloated body as she was being carted out on a stretcher.
I recounted every single word of our last conversations over and over again until they became permanently etched into my brain.
Emma’s parents originally wanted to cremate her, as that is what she had somewhat jokingly asked for whenever the topic of funerals came up, well she had joked about wanting to have had unpopped popcorn shoved down her throat before she was sent off to “scare the shit out of the guy cremating me” but due to all the wax which would have been impossible to get out of her body they were forced to bury her.
A few days before Emma’s funeral her body disappeared.
After Emma’s death, her parents took me into their home, after reading the autopsy reports and seeing her corpse they had thrown out every single candle they owned which made their home the safest choice I had, still, this did not stop me from buying a machete and keeping it under my bed, just in case.
I was laying on the bed in their guest bedroom The day that the police informed Emma’s parents about her disappearance, the bedroom is right above the front porch of the house, at first I heard them ring the doorbell which was followed up by 3 powerful knocks on the door, for about a minute I laid there on the bed listening to muffled voices exchanging distorted words I was barely able to make out which slowly transformed into distorted weeps, curious I lifted myself up from the bed, made my way over to the window and carefully lifted the bottom panel making Shure to not make too much noise, the distorted muffled sounds started forming into coherent words “We checked the security footage but the only strange thing we could see was a 5 second time jump” one of the officers spoke in a serious and almost monotone voice “which meant that the security guard who was the only person in the building had to climb down 2 flights of stairs walk through a 40 foot long hallway and then drag her body back up stairs and out of the building in 5 seconds” Emma’s mom let out yelp “ but don’t worry ma'am that’s actually good news because we know that her corpse is still somewhere within the building and was probably brought to the wrong floor by an intern, we’ve already warned all of the staff at the hospital to keep an eye out, and we also sent 5 officers to search the hospital”
I could not believe what I was hearing, my breathing quickened, but this time instead of fear I felt anger, that fucker stole her corpse and was probably in the weird separate plane of existence he always went back to after terrorizing me, cutting off chunks of her body, melting her, and drinking her.
I closed the window Emma’s mom's cries once again turned into a muffled rumble which was only possible to make out if you knew what to look for, I took a few steps back away from the window planning to lay back down, not wanting to bother Emma’s parents. I bumped into something, not something, someone, its fleshy towering form as solid as a wall sent me tumbling forward, I knew it was him, he had returned to take me too, to stretch his swollen cracked lips, push them down my esophagus, fill my lungs and stomach with wax. But despite all of that this time I was not scared, I was angry, and I was not going to stand there in terror like I had the last time I saw him.
I fell forward onto my knees my face missing the window sill just by mere inches, I put my hands onto the floor, lifted one of my knees, and rotated 180 degrees now facing the monster, to the right of him pushed up against the wall was the bed, light from the sun reflected off of the metallic button which kept my machete in it’s sheathe, the man started to stretch his lips, they were moving towards me, waving a wiggling through the air like a snake slithering towards me.
I dove towards the bed one of my feet pushing off of the floor and the other pushing against the wall which creaked under the pressure applied to it, I flew for a few moments before slamming down onto the carpet and sliding forward, the heat generated by my skin brushing against the carpet released a sharp stinging pain throughout my body, my outstretched arm landed just a few inches short of the machete, I quickly bent my arms, pushing my body up and crawled towards the machete. my fingers wrapped around the handle I spun around, my back pushed up against the bedside table, once again facing the man, he was still facing the window but his lips faced me and were just a few feet away from me, for what felt like minutes but was most likely no longer than a second, I struggled to hook my finger under the strap securing the machete into its sheath, as the lips inched towards me the man started producing gurgling noises, he was regurgitation wax.
I finally pulled the machete out of its sheath, I swung the blade at the man's lips, the blade was not met with any resistance as it sliced through the man’s lips which landed on the carpeted floor with an audible thud, the man did not have a physical reaction to my counter-attack, his lips kept creeping towards me, once again I slashed at the lips, still no reaction, I repeated this at least 3 more times.
I wanted to kill him, I wanted to take revenge for what he had done to Emma, but fighting back was pointless. I realized that no matter how much I tried to hurt it, I could not kill him, I could not get rid of him.
My rage dissipated and a mixture of fear and sadness crept in, and soon took over my body, I screamed for help, I screamed in fear, in agony, tears streamed down my face as the man's lips finally reached my face, he wasn’t met with any resistance as his lips snuck between mine, pried my jaw open and finally started to slide down my esophagus.
I heard the cops run up the stairs, they started banging on the door asking if I was okay only to have been met with muffled screams, hot wax started to pour down inside of me, the stinging pain of the heat made me want to plunge the machete which I had dropped onto the ground next to me into my stomach to create a gaping wound that the wax would hopefully funnel out of, the texture of the man's slippery, oily lips matched with the poison like flavor of the wax caused me to start gagging, I felt my insides bulging like at any moment my intestines would have been filled to the point where they would pop, I wanted to vomit, the drain myself of the filth I was filled with, but his lips had plugged my throat not allowing anything to get out.
Hearing my muffled screams the cops started kicking the door down, the man retracted his lips, the suction aided my attempts at cleansing my insides, I got onto my hands and knees streams of molten wax pouring out of me, solidifying on the the carpet, with another loud thud the door swung open slamming into the wall, the man was gone.
That’s the last thing I remember before I passed out, but according to one of the doctors who was in the ambulance that brought me to the hospital, I was still semi-responsive during the first 10 minutes of the ride to the hospital.
Approximately 13.4 pounds of wax were removed from my body, the doctors said that I was in a critical condition and some of them did not expect me to make it.
One of the officers who was there the day the man attacked me took a report of what had happened to me, due to the unmistakable evidence of what had happened to both me and Emma, and the fact that this was the 3rd instance of me reporting something like this the police finally started investigating who this man might have been.
Around a month later I was discharged from the hospital and once again have been staying in the living room of Emma’s parent's house.
I’ve been seeing the man again, candles were not allowed in the hospital I stayed at, which means that he’s probably very hungry, he’s close to attacking me again, I know it, he wants to finish what he started and I don't know if I have the power to fight back, I’m not sure if defeating him is even possible, I’m tired.
I’ve been seeing Emma too, her bloated, reanimated corpse often appears to be standing next to the man. If I let him take me will I get to join them? I’ve tried asking but they don’t answer, they just stare, I can’t keep living in constant fear, always looking over my shoulder, I miss Emma.

34F, 160 cm, 65 kg
Treatment resistant depression, Bipolar II. Medication: venlafaxine 300 mg once a day, lamictal 100 mg twice a day.
Last week I went in for the first consult and mapping to start TMS. Once the strength was determined and the coil was placed on my head, I fainted probably 20 seconds into the treatment. I was out for only a few seconds. After regaining consciousness, I felt extremely nauseous, weak and sweaty, and it took a few hours for me to feel better.
The psychiatrist and the technician said vasovagal syncope at the first session is not a contraindication to continue TMS. I am now hesitant to continue TMS, since I find fainting and it's aftermath very unpleasant. Also, it's been almost a week since the mapping session and I still have headaches and nausea every day.
I fainted several times in the past. Once it was just out of nowhere, and the other two times at the start of an infection, before developing other symptoms.
Is there a way to prevent vasovagal syncope if I was to give TMS a go? Is there a reason why fainting can happen during TMS? I tried looking it up on the Internet but I didn't find much info - just some case reports

Hello everyone,
I'm reaching out to this community for advice and information regarding my wife's ongoing medical condition. I hope I can explain this correctly – my wife has a gastrointestinal enterocutaneous fistula.
Here's a bit of background: In December 2023, my wife underwent surgery to correct a long-overdue hernia. During the procedure, the surgeon discovered part of her colon had died, necessitating its removal. An ostomy was installed, and she was fitted with a wound vac to aid in healing.
After her initial hospital stay, she was discharged with instructions to visit the wound care center twice a week. On our first visit, the nurses (at the wound care center) noticed a fistula forming and sent us back to the ER. We were re-admitted, and she stayed in the hospital for about 70 days. During that time, the wound care team found an appliance (Coloplast ref 14050) to manage the GI fluid from the fistula, which had formed a pseudo stoma. A J-Tube was placed through the fistula for feeding.
Additionally, it's worth noting that my wife had gastric bypass surgery between 15 to 20 years ago. The doctor informed us that this previous surgery has also contributed to the current issues with her stomach.
Several concerns have arisen since she was discharged:

1. **Diet and Healing**: The surgeon mentioned the fistula wouldn’t heal on its own and would require surgery after a year due to inflammation. She was advised to resume a regular diet, but is this typical advice?
   
2. **GI Fluid and Output**: There is a lot of bile coming from the fistula, and the ileostomy output is white and watery. Is this normal?
   
3. **Pain Management**: My wife is in constant pain but was not prescribed any pain medication. Should she have been given pain relief?
   
4. **J-Tube Issues**: The J-Tube frequently clogs, necessitating hospital visits to unclog it. Is this a common issue? Also, the bumper on the J-Tube, which prevents it from slipping into the fistula, was trimmed by the wound care nurses, causing jagged edges that have seemingly worsened the fistula. Any advice on managing this would be appreciated.
   
5. **Energy and Infusions**: She has very low energy, is bedridden most of the time, and requires twice-weekly infusions and salt pills. Is there anything we can do to improve her energy levels and overall well-being?
   
6. **Cost and Supplies**: The Coloplast ref 14050 pouches are quite expensive ($800-$1200 per box). Does anyone know where we might find them cheaper? Additionally, any tips on managing the other necessary supplies (barrier rings, paste, powder, etc.)?
   

It currently takes my daughters and me 2-4 hours to install the ostomy bag and the fistula pouch each time. Any advice on making this process more efficient would be greatly appreciated.
We are seeking any guidance, tips, or experiences that could help us manage this condition better and improve my wife's quality of life until she can have the corrective surgery.

Hello everyone,
I'm reaching out to this community for advice and information regarding my wife's ongoing medical condition. I hope I can explain this correctly – my wife has a gastrointestinal enterocutaneous fistula.
Here's a bit of background: In December 2023, my wife underwent surgery to correct a long-overdue hernia. During the procedure, the surgeon discovered part of her colon had died, necessitating its removal. An ostomy was installed, and she was fitted with a wound vac to aid in healing.
After her initial hospital stay, she was discharged with instructions to visit the wound care center twice a week. On our first visit, the nurses (at the wound care center) noticed a fistula forming and sent us back to the ER. We were re-admitted, and she stayed in the hospital for about 70 days. During that time, the wound care team found an appliance (Coloplast ref 14050) to manage the GI fluid from the fistula, which had formed a pseudo stoma. A J-Tube was placed through the fistula for feeding.
Additionally, it's worth noting that my wife had gastric bypass surgery between 15 to 20 years ago. The doctor informed us that this previous surgery has also contributed to the current issues with her stomach.
Several concerns have arisen since she was discharged:

1. **Diet and Healing**: The surgeon mentioned the fistula wouldn’t heal on its own and would require surgery after a year due to inflammation. She was advised to resume a regular diet, but is this typical advice?
   
2. **GI Fluid and Output**: There is a lot of bile coming from the fistula, and the ileostomy output is white and watery. Is this normal?
   
3. **Pain Management**: My wife is in constant pain but was not prescribed any pain medication. Should she have been given pain relief?
   
4. **J-Tube Issues**: The J-Tube frequently clogs, necessitating hospital visits to unclog it. Is this a common issue? Also, the bumper on the J-Tube, which prevents it from slipping into the fistula, was trimmed by the wound care nurses, causing jagged edges that have seemingly worsened the fistula. Any advice on managing this would be appreciated.
   
5. **Energy and Infusions**: She has very low energy, is bedridden most of the time, and requires twice-weekly infusions and salt pills. Is there anything we can do to improve her energy levels and overall well-being?
   
6. **Cost and Supplies**: The Coloplast ref 14050 pouches are quite expensive ($800-$1200 per box). Does anyone know where we might find them cheaper? Additionally, any tips on managing the other necessary supplies (barrier rings, paste, powder, etc.)?
   

It currently takes my daughters and me 2-4 hours to install the ostomy bag and the fistula pouch each time. Any advice on making this process more efficient would be greatly appreciated.
We are seeking any guidance, tips, or experiences that could help us manage this condition better and improve my wife's quality of life until she can have the corrective surgery.

Timestamp: https://imgur.com/a/m2sZtlS

Howdy y'all, please buy my damn stuff.

x5 P&S Picatinny Rail Covers - $7/ea or all 5 for $20 SOLD

• NOS, unused

PSA FDE Sabre AR10 grips - $15 each or take both for $25 $20

• Brand new pulled of the same PA-10 build as the rail covers.
• Include grip screw and washer (hence the blue painters tape so they don't fall out)

PRi Mini Red Dot Base For 1" Tube, RMR footprint - $40 $30

• Red dot base shows slight salt from mounting when screwdriver hit the side of it.

x2 Bushnell TRS-25 red dot with UTG .83" picatinny riser - $40 each

• Serial No 1
• Serial No 2
• Catch and release
• In very good shape with little if any salt
• One has orange marker on the screws on the optic and riser that can be removed if wanted

Rules:

• All prices include shipping and are open to negotiation - shoot your shot homie! The worst I can say is No.
• PP FF preferred (if you want to use G&S you cover the 3%) but I also have Venmo.
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I DO NOT GIVE OUT PASSWORDS! I USE 2FA & YOU SHOULD TOO! ALWAYS BE WEARY OF PEOPLE PHISHING FOR YOUR PASSWORD OR CLAIMING YOU ARE BANNED!
PAYMENT: Zelle (strongly preferred), Venmo, CashApp, or Paypal FF. High value orders and new to the sub Zelle only.
SHIPPING: USPS $6 less than 10oz. $10 over 10oz. $100 insurance and tracking included. Free shipping on orders over $500. Additional insurance over $100 is optional at buyers liability. Additional insurance $0.80/$100 coverage. I can ship other methods at buyers' request.
AUTHENTICITY: All of these items have been verified for authenticity using acid tests or a sigma. I offer a full money back guarantee on the authenticity of all items listed. I am happy to send a video of an acid / magnet test if requested.
If you need more pictures or info don’t hesitate to ask.
ORDERS SHIP THE FOLLOWING BUSINESS DAY!
PROOF: https://i.imgur.com/L3dDIAR.jpg
All Prices rounded up to the nearest $0.25
Coins:
Mexican Gold 2 Peso 1945 Restrike (2x) - $133ea
Gold Jewelry (ALL 5% BELOW SPOT):
14K Gold 18.5" 3mm Omega Chain / Necklace 22.514g Signed 14K Italy & MI - $968.55 https://imgur.com/a/KA3iKzo
14K Yellow & White Gold Two-Tone Ring Size 6-3/4 Signed 14K Makers Mark 5.267g - $226.50
https://imgur.com/a/1APzy8K
10K Harley Davidson Heart Pendant 3.75mm x 1.5mm bail 1.682g - $51.75 https://imgur.com/a/Qr9uNdV
10K White Gold Fuchsia CZ Heart Necklace and Earrings Set with 18” Rope Chain Signed 10K 4.39g - $135
https://imgur.com/a/6K5i5E7
40g of 14K scrap @ 95% spot - $43.02/gram (Abunch of cheap Walmart Jewelry & a broken necklace)
5.4g of 10K scrap @ 95% spot - $30.72/gram (Abunch of cheap Walmart Necklaces)
Sterling Silver Necklaces:
20” x ½” HEAVY Figaro Chain 238g - $425
https://imgur.com/a/Y5zO5TV
30” x 6.5mm Italian Curb Chain - 54.47g - $109
https://imgur.com/a/ChMAGwi
16” Italian San Marco Chain with 7” San Marco Bracelet 62.3g - $115
https://imgur.com/a/9IS5uhF
31” Puff Heart Necklace with Italy Rope Chain 15.4g - $35
https://imgur.com/a/LXEXGG5
30.5” Box Chain with Owl Pendant / Brooch (has attachments for both) 11.63g - $33
https://imgur.com/a/pTaT52q
18” Italian Byzantine Chain / Necklace 12.21g - $27.50 (Sold)
19” Italian Square Herringbone Style Sterling Chain with Czech Pendant - 6.28g - $20
https://imgur.com/a/ANY2KWM
18” Italian Sterling Box Chain with Ross Simon Cross Pendant 2.61g - $20
https://imgur.com/a/L8DjEYl
20” Italian Gold Vermeil Fancy Rope Chain 5.34g - $20 (Sold)
17.5” Lotus Studio Aventurine Sterling Necklace 2.11g - $12 (Sold)
16” Sterling Abstract Glass Pendant Necklace 15.96g - $25
https://imgur.com/a/c2X7Ykq
18” 925 Box Chain with Synthetic 14x10mm Sapphire Pendant & Matching Earrings with 10x8mm Sapphires 8.12g - $30
https://imgur.com/a/8WAi9jl
18” 925 Gold Vermeil Box Chain with Pear Cut Ceylon Sapphire Pendant & Matching Triangle CZ Earrings 12.13g - $30
https://imgur.com/a/DbenkRb
20” Italian Millefiori Necklace with Circular Glass Pendant 3.18g - $25
https://imgur.com/a/UxC0pBf
15.5” Italian Millefiori Bead Necklace 3.98g - $20
https://imgur.com/a/OXOxnYk
15.5” Italian Murano Style Necklace (Note the wire is ferrous for strength, clasp and non-stone charms are sterling) - $15
https://imgur.com/a/UoyGHPq
15” Native American Fetish Necklace (Note the wire is elastic material for strength, beads and pendants are sterling) - $30
https://imgur.com/a/4OQKVFr
17” Sterling Bead / Clasp Turquoise Nugget Necklace (Note the wire is ferrous material for strength, beads and clasp are sterling) - $15
https://imgur.com/a/5ikva93
Sterling Silver Bracelets & Pendants: https://imgur.com/a/UZ3M9PR
8.5” x ½” Heavy Curb Bracelet 53.6g - $105
Taxco 7.5” Juan Luis Flores 70s Vintage Bracelet 43.49g - $87
Sterling Flower Filigree Bracelet 8” 10.19g - $30
Sterling Rose & Garnet Tennis Bracelet 7.5” 13.43g - $35
Ross Simon Sterling Rose Quartz Aventurine Tennis Bracelet 7” 9.50g - $30
Sterling Native American Bear Bracelet (Note the wire is ferrous for strength, clasp and non-stone charms are sterling) - $40
Sterling Silver 2-Strand Malachite Bracelet 7” 2.32g - $20
Sterling Clasp Faceted AB Crystal Bracelet with amazing sparkle (Note the wire is ferrous for strength, only clasp is sterling) 7” - $15
Taxco Hummingbird Pendant / Brooch (has both attachments) 11.95g - $24
Sterling Pink CZ Butterfly Bracelet 7.25” 7.5g - $27.50
Sterling Silver Earrings: https://imgur.com/a/rTrTKTE
Larimar Dangle Earrings 1g - $12
Dolphin Jumping through Hoop Drop Earrings 6.86g - $15
Taxco Sterling Half Circle Bohemian Hoop Earrings 9.24g - $20
Taxco Sterling Triangle Drop Earrings 9.43g - $18
Taxco Sterling Shell / Feather Drop Earrings 6.01g - $15
Taxco Sterling Triangle / Bead Drop Earrings 21.79g - $25
Flower Drop Earrings with Aquamarine Stones 9.28g - $25
Teardrop Shaped Earring with Black Beads 5.13g - $15
Concentric Oval Earrings 2.05g - $12
Leaf / White Opal Studs (Brilliant Luster on these) 2.22g - $40
Vintage Filigree Sterling Drop Earrings (Super intricate) 14.33g - $20
Vintage Sterling Dragonfly Earrings 12.39g - $20
Heart Shaped Drop Earrings with Lapis Stones 5.22g - $15
Sterling Silver Rings: https://imgur.com/gallery/65jVHip
Bali Swirl Design Sterling Ring Size 7-1/2 11.06g - $27.50
Large 925 Ring with CZ Size 6 5.97g - $18
Large 925 Ring with CZ and Flower Engraving Size 6 9.28g - $18
925 Ring with Bands of CZ Size 6 5.9g - $18
Wedding Band Style 925 Ring with Moissanite Size 6 2.41g - $18
Shablool Didae Israeli Filigree Style Ring Size 7.5 One-of-a-kind 8g - $25
Sterling Silver Kitchen / Dining (MOST @ 95%): https://imgur.com/a/QW6x0ot
Porter Blanchard Sterling Tea Pot 612g - $543.25 (95% of SPOT)
Gorham Sterling Footed Bowl 619g - $549.50 (95% of SPOT)
Sterling Coasters (2) 86g - $76.50 (95% of SPOT)
Pimaral Peru Sterling Serving Set 311g - $276 (95% of SPOT)
Gorham Sterling Etruscan Spoon & Butter Pick 71g - $63 (95% of SPOT)
International Sterling Joan of Arc 5 Piece Set 204g - $181 (95% of SPOT)
Assorted Sterling Spoons (Unmarked and the smaller two are thin) 44g - $39 (95% of SPOT)
English Shell by Lunt Sterling Silver Soup Spoons (4) 135g - $119.75 (95% of SPOT)
La Touraine by Reed & Barton Sterling Tea Spoon 30.34g - $27 (95% of SPOT)
Lunt Lus60 Sterling Silver Salt Spoon 2.94g - $10
51.15g of Sterling Scrap @ 90% - $43
https://i.imgur.com/nHVssYc.jpg

~RIGL Thesis – 5/18/2024~
Outstanding Shares 175M
131 Institutional Holders
111,129,461 Total Shares Held
63.36% Institutional Ownership
Total Cash on Hand 3/31/2024 = $49.6M
Total Debt: $101.5M
Cash Burn Approximate = $8M per quarter (6 quarters of cash without any increases in revenue)
Q12023 REV = $26M
Q22023 REV = $26.8M
Q32023 REV = $28.1M
Q42023 REV = $35.8M
Q12024 REV = $29.5M (Decline from Q4 likely from end of year versus new-year tracking of Rx and shipments of drugs, resetting of Copays)
Most Recent EPS -$0.05 per share
May 22, 2024 - Vote on S will take place, caution
~Statistics Applicable To Thesis~
333.3 million US Population (2022)
8,109,679,892 Global Population (2024)
~Drugs On Market~
~Tavalisse – Treatment for ITP, FDA Approved April 17, 2018~
~What is ITP?~
Immune thrombocytopenia (ITP) is an illness that can lead to bruising and bleeding. Low levels of the cells that help blood clot, also known as platelets, most often cause the bleeding.
Once known as idiopathic thrombocytopenic purpura, ITP can cause purple bruises. It also can cause tiny reddish-purple dots on the skin that look like a rash.
Children can get ITP after a virus. They most often get better without treatment. In adults, the illness often lasts months or years. People with ITP who aren't bleeding and whose platelet count isn't too low might not need treatment. For worse symptoms, treatment might include medicines to raise platelet count or surgery to remove the spleen. Immune thrombocytopenia (ITP) - Symptoms and causes - Mayo Clinic
~What is Tavalisse?~
TAVALISSE is a prescription medication used to treat adults with low platelet counts due to chronic immune thrombocytopenia (ITP) when a prior treatment for ITP has not worked well enough. It is not known if TAVALISSE is safe and effective in children.
The cost for Tavalisse oral tablet 100 mg is around $15,404 for a supply of 60 tablets, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.
Tavalisse Prices, Coupons, Copay & Patient Assistance - Drugs.com
TAVALISSE IS AN ORAL MEDICATION TAKEN TWICE DAILY WITH OR WITHOUT FOOD¹
A 12-week evaluation period is recommended
60 tablets = 1 month supply, evaluation period = 3 months, Cost for 3 months = $46,212 Cash, assuming cheaper through wholesale, insurance, discount cards, etc.
Dosing TAVALISSE® (fostamatinib disodium hexahydrate) tablets (tavalissehcp.com)
~Addressable Market~
“Our findings suggest that nearly 20,000 children and adults are newly diagnosed with ITP each year in the US, substantially higher than previously reported. Among patients requiring formal medical care, the economic burden during the first 12 months following diagnosis is high, with estimated US expenditures totaling over $400 million.”
Primary immune thrombocytopenia in US clinical practice: incidence and healthcare burden in first 12 months following diagnosis - PubMed (nih.gov)
The estimated prevalence of ITP in the United States is 9.5 per 100,000 people, with a global prevalence of over 200,000 people at any given time [1].
Immune thrombocytopenia. [ Oct; 2022 ]. 2022. https://rarediseases.org/rare-diseases/immune-thrombocytopenia
~Author Calculations/Estimates~
ITP estimated cases based on measured statistics 31,635 cases a year in the US and 770,355 cases globally each year.
~Rezlidhia – R Acute Myeloid Leukemia, FDA Approved December, 22, 2022~
~What is Relapsed or Refractory Acute Myeloid Leukemia?~
Relapsed, or recurrent, acute myeloid leukemia (AML) means the leukemia has come back after treatment and remission.
Refractory AML means the leukemia did not respond to treatment. Complete remission has not been reached because the chemotherapy drugs did not kill enough leukemia cells.
Both relapsed and refractory AML need more treatment to reach complete remission.
Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. Some factors considered for your treatment include:
your age
your health
how long the leukemia was in remission
treatments you had before
where the leukemia comes back
Treatment options usually include chemotherapy and a stem cell transplant if possible. Targeted therapy may also be used.
Treatments for relapsed or refractory acute myeloid leukemia Canadian Cancer Society
~What is IDH1?~
Somatic mutations in isocitrate dehydrogenase (IDH) genes occur frequently in adult Acute myeloid leukemia (AML) and less commonly in pediatric AML… Enhanced genomic and epigenomic profiling of acute myeloid leukemia (AML) has led to identification of recurrent mutations that are prognostic and are candidates for targeted therapy. Somatic mutations in isocitrate dehydrogenase (IDH) genes, IDH1 and IDH2, occur in ∼6% to 16% and ∼8% to 19% of adult patients with AML, respectively.^1-5 In pediatric AML, IDH mutations are rare, occurring in <4% of patients.^6-11
Characteristics and prognostic impact of IDH mutations in AML: a COG, SWOG, and ECOG analysis Blood Advances American Society of Hematology (ashpublications.org)
~What is Rezlidhia?~
REZLIDHIA is a prescription medicine used to treat adults with acute myeloid leukemia (AML) with an isocitrate dehydrogenase-1 (IDH1) mutation when the disease has come back or has not improved after previous treatment(s).
Targeted Treatment REZLIDHIA® (olutasidenib) capsules
The cost for Rezlidhia oral capsule 150 mg is around $17,468 for a supply of 30 capsules, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.
Rezlidhia Prices, Coupons, Copay & Patient Assistance - Drugs.com%20is%20a%20member,on%20the%20pharmacy%20you%20visit.)
~Addressable Market~
The annual incidence of new cases in both men and women is approximately 4.3 per 100,000 population, totaling over 20,000 cases per year in the United States alone.[13] The median age at the time of diagnosis is about 68, with a higher prevalence observed among non-Hispanic Whites. Furthermore, males exhibit a higher incidence compared to females, with a ratio of 5:3.
Acute Myeloid Leukemia - StatPearls - NCBI Bookshelf (nih.gov)
~Author Calculations/Estimates~
Cases of AML with IDH1 would be 11% based on the median of statistics above (6% to 16%) leaving approximately 1500 to 2000 cases a year in the US. Appling the same calculations to world population would amount to approximately 38,500 cases a year globally.
~Gavreto – Treats RET+ Non-Small Cell Lung Cancer In Adults and RET+ Thyroid Cancer in Kids and Adults, FDA Approved August 9, 2023~
For the sake of common ground, I am going to assume these types of cancers do not need to be elaborated on as we all likely have a basic understanding of what they are. The medical conditions treated by Tavalisse and Rezlidhia I felt needed a more in-depth explanation because they are not common. I will elaborate on RET+ a little later in this writing.
~What is Gavreto?~
GAVRETO is an oral once daily prescription medicine used to treat certain cancers caused by abnormal rearranged during transfection ~(RET+)~ genes in:
Adults with non-small cell lung cancer (NSCLC) that has spread
Adults and children 12 years of age and older with advanced thyroid cancer or thyroid cancer that has spread who require a medicine by mouth or injection (systemic therapy) and who have received radioactive iodine and it did not work or is no longer working*
It is not known if GAVRETO is safe and effective when used to treat cancers caused by abnormal RET genes in children for the treatment of NSCLC or in children younger than 12 years of age for the treatment of thyroid cancer.
Home GAVRETO® (pralsetinib)
The cost for Gavreto oral capsule 100 mg is around $11,745 for a supply of 60 capsules, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.
The recommended dosage for adults and children 12 and over is 400mg orally once daily. Each capsule is 100mg, which means you will take 4 capsules. Gavreto should be taken on an empty stomach, at least 1 hour before or 2 hours after a meal.
Gavreto Prices, Coupons, Copay & Patient Assistance - Drugs.com
~What is Rearranged During Transfection Positive (RET+)?~
RET-positive cancer is caused by a mutation or abnormal re-arrangement of the RET gene. It occurs most commonly in lung cancer and several types of inherited and sporadic thyroid cancers. RET alterations also occur in an estimated 1-2% of multiple other cancers, including ovarian, pancreatic, salivary, breast, and colorectal cancers.
RETpositive Empowering Patients and Driving Research
Rearranged during transfection (RET) rearrangements were first identified as oncogenic drivers in NSCLC in 2012. The proportion of patients with NSCLC who have RET rearrangements (ie, fusion-positive disease) is approximately 1%-2%.
RET Fusion-Positive Non-small Cell Lung Cancer: The Evolving Treatment Landscape The Oncologist Oxford Academic (oup.com)
RET alterations occur most commonly in lung cancer (non-small cell lung cancer (NSCLC)) and the number of new cases diagnosed each year is considerable, accounting for approximately 37,500 [IG1] cases worldwide and 4,000 cases in the US (2% of NSCLC) (2,3). RET alterations are also common in several types of inherited and sporadic thyroid cancers and can occur in other types of cancers like ovarian, breast, pancreatic, and colorectal cancers, among others (4-8) adding >110,000 cases yearly worldwide (9).
What is RET Positive Lung Cancer? - The Happy Lungs Project
(2) Although medullary thyroid carcinoma represents 5-10% of all thyroid cancers, activating RET gene abnormalities occur in over 90% of hereditary and approximately 40%-60% of sporadic medullary thyroid carcinoma cases.
Patients – RETpositive%20Although%20medullary%20thyroid%20carcinoma,sporadic%20medullary%20thyroid%20carcinoma%20cases.)
~Prevalence of Non-Small Cell Lung Cancer~
Most lung cancer statistics include both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). In general, about 10% to 15% of all lung cancers are SCLC, and about 80% to 85% are NSCLC.
Lung cancer (both small cell and non-small cell) is the second most common cancer in both men and women in the United States (not counting skin cancer). In men, prostate cancer is more common, while breast cancer is more common in women.
The American Cancer Society’s estimates for lung cancer in the US for 2024 are:
About 234,580 new cases of lung cancer (116,310 in men and 118,270 in women)
About 125,070 deaths from lung cancer (65,790 in men and 59,280 in women)
Lung Cancer Statistics How Common is Lung Cancer? American Cancer Society
Worldwide, an estimated 2,206,771 people were diagnosed with lung cancer in 2020. These statistics include both small cell lung cancer and NSCLC.
Lung Cancer - Non-Small Cell: Statistics Cancer.Net
~Author Calculations/Estimates~
Approximately 187,664 cases of NSCLC in the US based on an 80% factor.
Approximately 1,765,416 cases of NSCLC worldwide based on an 80% factor.
~Prevalence of Thyroid Cancer~
Rate of New Cases and Deaths per 100,000: The rate of new cases of thyroid cancer was 13.5 per 100,000 men and women per year. The death rate was 0.5 per 100,000 men and women per year. These rates are age-adjusted and based on 2017–2021 cases and 2018–2022 deaths.
Lifetime Risk of Developing Cancer: Approximately 1.2 percent of men and women will be diagnosed with thyroid cancer at some point during their lifetime, based on 2017–2019 data. Lifetime risk based on data through 2022 will available soon.
Prevalence of This Cancer: In 2021, there were an estimated 979,295 people living with thyroid cancer in the United States.
Thyroid Cancer — Cancer Stat Facts
About 44,020 new cases of thyroid cancer (12,500 in men and 31,520 in women)
About 2,170 deaths from thyroid cancer (990 in men and 1,180 in women)
Thyroid cancer is often diagnosed at a younger age than most other adult cancers. The average age when a person is diagnosed with thyroid cancer is 51.
This cancer is about 3 times more common in women than in men. It is about 40% to 50% less common in Black people than in any other racial or ethnic group.
Key Statistics for Thyroid Cancer American Cancer Society)
Addressable Market
Given Gavreto’s dual treatment capacity, the total amount of potential patients with NSCLC with RET+ indications would be approximately 2,800 cases in the US and approximately 26,500 cases worldwide each year using a factor of 1.5% of total NSCLC cases. The total amount of treatable cases for Thyroid Cancer would be approximately 650 in the US and 16,500 cases worldwide respectively each year applying the same 1.5% RET+ percentage rate. DOUBLE CHECK MATH…
~Rigel Pharmaceuticals Pipeline~
~IRAK/4 – Clinical Trials~
Rigel’s investigational candidate, R289, is an oral, potent and selective inhibitor of interleukin receptor-associated kinases 1 and 4 (IRAK1/4).
Toll like receptors (TLRs) and the interleukin 1 receptor family (IL-1Rs) play a critical role in the innate immune response and dysregulation of these pathways can lead to a variety of inflammatory conditions such as psoriasis, rheumatoid arthritis, and inflammatory bowel disease. Chronic stimulation of both receptor systems has also been implicated in causing a pro-inflammatory bone marrow environment leading to persistent cytopenias in lower-risk myelodysplastic syndrome (LR-MDS) patients1.
R835 is a selective dual inhibitor of IRAK1/4 that blocks TLR4 and IL-1R-dependent systemic cytokine release. In preclinical studies, R835 demonstrated activity in multiple animal models of inflammatory disease2,3 and showed that dual inhibition of IRAK1 and IRAK4 provided more complete suppression of inflammatory cytokines when compared to an IRAK4-selective inhibitor4.
Development of R289:
In a Phase 1 clinical trial, R835 was well tolerated and inhibited LPS-induced inflammatory cytokine production in healthy volunteers, demonstrating proof-of-mechanism.5 Phase 1 clinical studies of R289 (an oral prodrug that is rapidly converted to R835 in the gut) are also complete.
A Phase 1b open-label, multicenter trial of R289 in patients with relapsed/refractory lower-risk MDS is currently enrolling (NCT05308264). The primary endpoint for this trial is safety with key secondary endpoints including preliminary efficacy and evaluation of pharmacokinetic properties.
~Bemcentinib – Bergenbio Partnership~
In June 2011, Rigel entered into an exclusive, worldwide research, development and commercialization agreement with BerGenBio for its investigational AXL receptor tyrosine kinase (AXL) inhibitor, R428 (now referred to as bemcentinib).
Bemcentinib is a potent, selective and orally bioavailable AXL inhibitor and the furthest along in clinical trials. In preclinical studies, bemcentinib was shown to have an effect as a single agent therapeutic in the prevention and reversal of acquired resistance to standard of care cytotoxics and targeted therapies and may also slow or prevent tumor metastasis.
Rigel received an upfront payment and is eligible for milestone payments and potential sublicensing revenue, as well as tiered royalty payments on any future net sales of products emerging from the collaboration.
~R552 Systemic – Eli Lilly Partnership~
Rigel’s investigational candidates are oral, potent and selective inhibitors of receptor-interacting serine/threonine-protein kinase 1 (RIPK1).
RIPK1 is a critical signaling protein implicated in a broad range of key inflammatory cellular processes including necroptosis, a type of regulated cell death, and cytokine production. In necroptosis, cells rupture leading to the dispersion of cell contents, which can trigger an immune response and enhance inflammation. RIPK1 inhibition has therapeutic potential in treating autoimmune, inflammatory, and neurodegenerative disorders.
Rigel’s RIPK1 inhibitor program includes R552, a systemic molecule being developed for the treatment of autoimmune and inflammatory disorders, and brain penetrating RIPK1 inhibitors for central nervous system (CNS) diseases. In preclinical studies, R552 demonstrated prevention of joint and skin inflammation in a RIPK1-mediated murine model of inflammation and tissue damage.
Development of R552:
In Q2 2023, the initial Phase 2a trial (NCT05848258) in moderately to severely active rheumatoid arthritis (RA) was initiated by partner Eli Lilly.
Development CNS-penetrating RIPK1 inhibitors:
Currently in preclinical studies.
~Milademetan – Daiichi Sankyo Partnership~
Rigel has a long-standing collaboration with Daiichi-Sankyo for developing murine double minute 2 (MDM2) protein inhibitors in cancer, which were discovered in Rigel’s laboratories.
Preliminary safety and efficacy data from an early Phase 1 study of milademetan (formerly DS-3032), an oral selective MDM2 inhibitor, in hematological malignancies suggests that it may be a promising potential treatment for oncology indications.
Rigel received an upfront payment and is eligible for milestone payments, as well as tiered royalty payments on any future net sales of any products emerging from the collaboration.
~Rxxx (CNS Penetrant) – Eli Lilly Partnership~
Rigel’s investigational candidates are oral, potent and selective inhibitors of receptor-interacting serine/threonine-protein kinase 1 (RIPK1).
RIPK1 is a critical signaling protein implicated in a broad range of key inflammatory cellular processes including necroptosis, a type of regulated cell death, and cytokine production. In necroptosis, cells rupture leading to the dispersion of cell contents, which can trigger an immune response and enhance inflammation. RIPK1 inhibition has therapeutic potential in treating autoimmune, inflammatory, and neurodegenerative disorders.
Rigel’s RIPK1 inhibitor program includes R552, a systemic molecule being developed for the treatment of autoimmune and inflammatory disorders, and brain penetrating RIPK1 inhibitors for central nervous system (CNS) diseases. In preclinical studies, R552 demonstrated prevention of joint and skin inflammation in a RIPK1-mediated murine model of inflammation and tissue damage.
Development of R552:
In Q2 2023, the initial Phase 2a trial (NCT05848258) in moderately to severely active rheumatoid arthritis (RA) was initiated by partner Eli Lilly.
Development CNS-penetrating RIPK1 inhibitors:
Currently in preclinical studies. Pipeline :: Rigel Pharmaceuticals, Inc. (RIGL)
~Summary and Prediction~
The current share price of sub $1 does not feel justified. I would anticipate financial breakeven by the end of 2024 or potentially in Q1 or Q2 of 2025. The robust pipeline, progress, and expected revenue growth are enough to justify a much higher valuation. The debt load is manageable, but the potential for S is concerning. I believe that the S is not necessary and revenue growth and progress should speak for itself. I am not as bullish as the analysts at HC Wainright for a $15 PT, but the valuation should be at least 3x to 5x from the current value. This thesis does not highlight the patents surrounding their drugs either which some extend into 2035 and beyond. Perhaps what Wall Street is discounting is the fact that most of the drugs are very niche. However, the currently available drugs have an addressable market, albeit less universal than some, but you should value it in the sense of multiple facets (a 1000 headed snake is the phrase I wanted to use). I believe the company should be valued with specialty drugs in mind which would command a higher PE ratio. At the current day and time of writing, the value should be at least $1.50 to $1.75 ~at a minimum~ with a 12 month price target of $3 to $5+. I will be looking for continued revenue growth in each quarter this year and realization of revenue from Gavreto in Q2 or Q3 this year. The partnerships should not be discounted either and the current share price if it lingers here perhaps may attract a merger or acquisition. I initially began the research thinking that perhaps the drugs were too niche, but given the multiple drugs they are working with, I believe their revenue sources will continue to grow if you do not focus on one particular drug as the main performer. With the most recent inflation report being cooler than expected, I would suspect larger funds and institutions will be circling back to riskier assets.

Had went into urgent care last November for sinus infection and had a BP in the high 160s. Always have had white coat syndrome, but they directed me to my primary for further testing. I’m a male, 46 who was lax for the previous 6 months on exercise and mild drinking. Doc got me on Olmesartan, had some adjustments on mg’s and added the diuretic version of it and immediately started to see my BP improve as you can see. Started taking my BP at home every other day. Cut down my drinking and salt intake, but not completely. Went completely dry for the month of Feb. Ensured at least a 30min ride on the Peloton 5-6 days a week and now consistently under 120. Thanks to this subreddit for all the great advice. I thought I was dying at the start of this journey, but with a little work and motivation, you can better yourself.

Top of the Day for 19/05/2024

^{[FAQ](https://www.reddit.com/TopOfThe/comments/dtlta2/mod_post_info_and_faq/} Discord GitHub)
^{Times shown are in UTC and dates are formatted as Day/Month/Year.
On mobile you can scroll and slide the tables to reveal more info.}

Most Upvoted Posts of the Day

Place	Title	Author	Subreddit	Score	Posted
1st	This is how a sex scene was filmed.	u/RayanSrivastav	interestingasfuck	64,984 Upvotes	18/05/2024 08:13 UTC
2nd	Welcome to Australia	u/Rd28T	pics	63,445 Upvotes	18/05/2024 05:08 UTC
3rd	This pedophile was identified when police uncovered his identity by reversing the 'swirl' effect he used online	u/okhahmm	facepalm	58,242 Upvotes	18/05/2024 06:24 UTC
4th	Name a greater victory than that	u/NormanFreeman67	memes	52,457 Upvotes	18/05/2024 00:18 UTC
5th	Owner pretends to be drowning to test whether his dog would save him	u/ImadeJesusLaugh	Damnthatsinteresting	45,280 Upvotes	18/05/2024 06:55 UTC

Most Upvoted Comments of the Day

^{Note: These may not be entirely accurate. Currently these are out of the comments taken from the top 5 submissions.}

Place	Body	Author	Subreddit	Score	Posted
1st	Relevant:(...)	u/The_Glus	interestingasfuck	15,826 Upvotes	18/05/2024 09:01 UTC
2nd	Camera man wasnt expecting a leg rubs outta the star that day	u/Gooliez	interestingasfuck	15,398 Upvotes	18/05/2024 08:20 UTC
3rd	Most actors hate sex scenes and I imagine this is just one reason.	u/Hoosier_Daddy68	interestingasfuck	14,167 Upvotes	18/05/2024 10:05 UTC
4th	Zoom and enhance, also unswirl	u/Holiday_Pea8576	facepalm	9,814 Upvotes	18/05/2024 07:50 UTC
5th	What the police should’ve done is not released this information and planted articles about pedos doing this and it being completely irreversible.	u/ENaC2	facepalm	8,157 Upvotes	18/05/2024 09:28 UTC