#(atypical occurrence part... 3?)

[suddencolds]

of painkillers and lenience

...hello! 😭 I wrote this way back in April; it's been sitting in my drafts ever since. Chronologically, it takes place shortly following Atypical Occurrence.

I wasn't sure if I was ever going to post this. I suppose it's more a character study than a proper romantic installment :') but it's an exchange I'd been wanting to write for a long time.

you can find everything I've written in this universe here!

—

Summary: Yves comes down with something. His best friend wonders where Vincent is, in all of this.

—

Perhaps it’s merciful that it’s on a Sunday that Yves wakes up with the slightest tickle in his throat.

Yves has an idea what it means. He’s had the flu enough times in his life to know that it comes on quickly. Maybe if he attempts to sleep it off, he’ll have a better time over the next few days.

Or maybe not. He cancels his Sunday plans, goes through his itinerary. There’s a slew of emails he’ll have to send off, a handful of meetings he’ll probably have to reschedule for this coming work week. He’ll need groceries, too, to last him the week—ideally something that won’t take too much effort to make. Resting now seems like it’d be a waste of time. Best to get everything over with before the illness has a chance to properly settle, he thinks. 

He really does mean to stop by the grocery store. It’s perhaps just the timing that doesn’t work out as planned. Between figuring out how to reschedule everything that’s coming up with work—figuring out who he can ask if he needs to reallocate any of his assignments to anyone else, rearranging things for clients, and getting all the paperwork in order—all of it takes him nearly two hours. He wanders into the kitchen to make himself a cup of tea, finds himself having to turn aside to cough, notes the unpleasant sting in his throat when he turns back around. 

It’s not terrible yet, but he feels distinctly off. His head feels a little heavy, and everything he does feels strangely—sluggish, maybe. Like he can’t quite manage to be as efficient as usual. Judging by past experience, he’s probably going to crash in a few hours.

He can already feel a headache brewing. Staring at his computer screen probably hasn’t helped with that. If he takes something for it, it’ll probably be at least tolerable when it gets worse.

He opens the medicine cabinet, rifles through the couple bottles and the first aid kit he has stashed in there.

Right. He’s out of Advil.

It’s no matter. Just a quick grocery trip, then—he can grab the rest of his groceries while he’s at it. Yves shuts the bathroom cabinet, grabs his wallet and keys, and makes it all the way to the doorstep outside when the wave of dizziness hits him.

All of a sudden, he feels a little lightheaded. Heat crawls up under his skin, prickling and unpleasant, as if something in him has cranked up the heat generation to the max—but that can’t be right, because he’s shivering inexplicably in the wake of it. He leans his weight back against the wall, squeezes his eyes shut.

Fuck. He probably should have gotten groceries first, before sorting out everything for work. Perhaps going out on his own now would not be the wisest.

He heads back in, locks the door, and—after some thought—calls Mikhail.

Mikhail picks up on the second ring. “To what do I owe the pleasure?”

“Are you busy?” Yves starts, but the words catch on his throat, and he has to stop immediately to muffle a cough into his elbow. 

There’s a moment of silence on the other end. “It depends what you’re about to ask me for,” Mikhail says.

Yves swallows. Shuts his eyes. He doesn’t like asking for help, but he doesn’t think he’ll be in any state to be doing this on his own over the next few days. “It’s not that urgent. Just if you have time,” he says. 

He can almost feel Mikhail rolling his eyes on the other end. “You’d say that even if you were bleeding out.”

Yves laughs, startled. “I promise I’m not bleeding out. Just—do you think you could run to the store and get me some Advil?”

There’s another, longer pause on the other end. “Any time is fine,” Yves says. A part of him already regrets this. “If you’re busy right now—”

“I’ll be over in a few,” Mikhail says. Then the line goes dead.

—

He doesn’t remember drifting off, but when he wakes, it’s to a knock on the front door.

The knock is just for courtesy, of course. Mikhail is one of a few people whom he’s permitted the privilege—or the burden, perhaps—of having a spare copy of his apartment key.

Yves opens the door anyways.

There, in the windy April weather, Mikhail shuts an umbrella and leaves it dripping at his feet. “You look even worse than you sounded over call,” is the first thing he says.

Yves blinks at him, surprised. “Did I really sound that bad?”

In lieu of answering, Mikhail just looks at him, scrutinizing, the corner of his lip ticking downward. “What is it? An injury? A migraine?” When Yves shakes his head, Mikhail presses forward to pick a stray lint ball off of Yves’s shirt. His hand makes contact with Yves’s shoulder, and he frowns.

Before Yves has a chance to explain, he feels a tickle—not the first, today, and certainly not the last—surface. It’s irritatingly difficult to ignore, more irritating still when he finds himself forced to turn away, to duck into one arm—

“hHehh-!’ hEHh’yyiISCHh-HHEEW!”

The sneeze is rough enough to scrape against his throat. He coughs tightly into his raised arm.

“A cold,” Mikhail says, with a frown. “But usually you don’t take Advil for colds. Wait—don’t tell me this is something worse?”

Yves winces. What is he supposed to say to that? “The Advil was all I needed,” he says. “Thanks for making the trip. I owe you one.”

“No, I’m sure of it now,” Mikhail says. “If it were only a cold, you would’ve driven out to get this yourself.”

“It probably isn’t,” Yves says, neglecting to mention that he knows exactly where he caught this. “Thanks for bringing these. I’ll take the next couple days off. I—”

The next sneeze sneaks up on him. He ducks into his sleeve again, taking another step back.

“hHhEH’iiDzzsCHH-yYew!” The sneeze sends a burst of pain through his temples, and for a moment, he’s glad his face is too deeply buried into his sleeve for Mikhail to see.

“Does Vincent know?” Mikhail asks.

The question catches him off guard. “What?”

“That you’re apparently unwell enough to ask me to pick up Advil for you.”

Yves doesn’t like where this conversation is going. “I told you not to come if you were busy.”

“It’s not a problem,” Mikhail says. “But if you’re sick, shouldn’t he be over here, taking care of you?”

 “He’s had a really busy few weeks,” Yves says, which is true, but simultaneously might be true at any point during the year. He clears his throat. “I - coughcough - wouldn’t want him to catch this.”

“So he doesn’t even know,” Mikhail says.

…Perhaps Yves should’ve thought of a more convincing excuse. Mikhail isn’t the type of person to drop an issue after he’s raised it, and Yves had, perhaps, neglected to think about how—for all Mikhail does to appear casually disaffected—he’s one of the most perceptive people Yves has ever met. “He doesn’t have to know.”

“What are you talking about? He’s your partner. I’ll text him,” Mikhail says. It’s then when Yves recalls that Mikhail probably does have Vincent’s contact—exchanged before their trip to France, so that he could text them all to coordinate the rides to and from the airport.

“Wait,” Yves says, unable to keep the panic out of his voice. “Don’t. If you text him, he’ll - snf-! - feel obligated to come.”

Mikhail doesn’t lower his phone. “I’ll just ask him to drop by,” he says. “You can talk to him about it when he gets there.”

But that won’t happen—can’t happen—because Yves knows that if Vincent were to see him like this… 

I’d feel terrible if you caught this, he’d said. He’d sounded so upset over it. How can Yves, after all his reassurances last week, admit to him now that he’s faring badly enough to need someone to look after him? 

Besides, Vincent probably has enough on his plate already. Yves knows enough to know that in their line of work, taking time off almost always means being swamped with assignments upon return. 

“Please don’t ask him anything,” Yves says.

Mikhail looks long and hard at him. He looks as though he’s trying to puzzle something out. “Did you guys get into a fight, or something?”

“No,” Yves says. “It’s nothing like that.”

“Then, if you’re on good terms, why are you so resistant to the idea of him coming over?”

Yves squeezes his eyes shut, and then opens them. He can think of a dozen more excuses to field away the questions—that isn’t the hard part. Mikhail has always been good at seeing through his bullshit, but if Yves has to steer this conversation to a close through sheer willpower, he thinks he can do it. But then again—

Maybe it’s fine, he thinks, if Mikhail knows. For better or for worse, Mikhail is his best friend. Yves knows that if he asks him to keep his mouth shut about this, he will. 

“Vincent is my coworker,” he says, slowly.

Mikhail’s eyebrows creep up. “Yes, I’m aware.”

“That’s not what I meant,” Yves says, with a cough. “He is just my coworker. Nothing else.”

The alarm that flashes across Mikhail’s face is unmissable. “You two broke up?”

And there it is—another crossroads, where Yves thinks the easiest course of action would be to reshape the current lie into a simpler one, to keep the trappings of their fake relationship intact. With anyone else, it would be easier, that is.

Yves says, honestly, “We were never together in the first place.”

“But you went with him to France,” Mikhail says, confused. “Not to mention, to Margot’s new year party, and then to Joel and Cherie’s housewarming. Are you telling me—”

“That was all an act,” Yves tells him, and waits for this information to register. “There is nothing between us that’s real. That’s the reason I haven’t called him.”

The recognition settles on Mikhail’s face. Then he laughs, a little disbelieving. “You’re really not dating him? Why would you lie about that?”

“Do you remember Margot’s party?” Yves asks. It seems like the right place to start, after everything. “Erika was there with Brendon. And I was bitter, and—to be honest, jealous—and I wanted to show her I was fine. So I asked Vincent to go with me.”

“That was months ago,” Mikhail says.

“It was easier to just keep up the act, after that.” Yves says. “Easier to have him accompany me once a month than it would have been to stage a proper breakup. But obviously, this is all temporary. I just haven’t figured out when it’s going to end.”

Mikhail is quiet for a moment. Yves looks past him, at the staircase that leads down to the first floor.

“You’ll be fine, then,” he asks. “If you two break it off.”

“Of course,” Yves says. “I know it’s going to happen someday.”

“You won’t be upset at all?”

“What is there to be upset over?”

“From the way you spoke to him, I really thought there was something there,” Mikhail says.

“He is a good liar,” Yves says.

“Maybe so,” Mikhail agrees. “But you are not.”

He says it so calmly, it barely registers as an accusation. But Yves hears it, loud and clear.

“Vincent is attractive,” Yves says. “Anyone with eyes can see that. That’s all there is to it.” it feels wrong, even as he says it. Yves has always known Vincent to be attractive—that much hasn’t changed. But he knows that the feeling in his chest when he sees him at work, in the break room, or at lunch—the unusual ache—is a little more than that. 

“Margot’s party was at the end of December,” Mikhail says. “It’s April, now. Margot wouldn’t tell you this, but since I don’t like withholding my feelings from you, I will.”

Yves waits—waits for Mikhail to tell him how all of this has been unduly dishonest, how Mikhail doesn’t appreciate having been lied to.

But Mikhail doesn’t say any of that. Instead, he says: “If you’re still intent on keeping this fake relationship up…” Here, he meets Yves’s eyes, a little sternly. “You should think about who you’re really doing it for.”

It’s only for convenience, Yves wants to say. Now that we’ve set things up already, it’s merely the path of least resistance. But that isn’t quite right, is it?

“Don’t worry about me,” Yves says, trying a smile. “Vincent and I have talked this through already. Whatever happens with our arrangement, I’ll be fine.”

“Okay,” Mikhail says. He pockets his phone, and then hands Yves the bottle of Advil. “Sorry for the interrogation, then. If you believe it to be fine, I trust you.” Perhaps that’s the worst part of it. Mikhail has never been the type of person to stay quiet about any foreseeable problems, but Yves knows that his agreement now is not a tactical retreat, nor is it an acknowledgment that it’s not worth arguing over something they won’t agree on. Mikhail is dropping the subject because he really trusts him.

Yves just doesn’t know if that trust is justified.

Mikhail turns on his heels, steps delicately past the hinge at the bottom of the doorframe. 

Yves clears his throat. “Thanks for stopping by.”

Mikhail nods. “Feel better soon. If you need anything other than Advil, just give me a call.”

Then he’s gone. Yves shuts the front door behind him and wonders just what exactly he’s gotten himself into.

[ushidoux]

Be My Last - Iwaizumi x  Reader (Pt. 3)

Summary: You have trouble getting over a past relationship and it’s preventing you from moving forward. (~2.5k words)

Warnings: again poor communication!!! angst, no sex in this chapter

A/N: Let me know what you think!

Part 1|| Part 2 || Part 3 || Part 4 || Part 5

---

“Oi, you fucking bastard, you knew!”

Iwa losing his temper over the phone wasn’t exactly atypical, even if it had become a less frequent occurrence, but for once Oikawa was actually genuinely surprised to hear his friend this angry over the phone. Especially given that it was almost 2pm in San Juan, which made it the very early AM in Tokyo, so whatever had worked him up had also kept him up way past his bedtime, given that Iwa was now extremely careful about his sleep hygiene. 

Oikawa took enough time to properly swallow the bite he’d just taken of his choripan before answering.

“What did I know, Iwa-chan?” He finally inquired, setting down his sandwich in the wrapper spread across his lap before leaning back into the park bench on which he was sitting. It was a wonderful sunny day, the type of day where it was a shame you were being yelled at, he mused briefly.

“About ___ and Ushijima.”

Oikawa’s eyebrows furrowed, not that Iwa could see the confusion on his face. There was a short pause which Oikawa broke eventually.

“Am I missing something or…?” His genuinely confused tone didn’t serve in any way to make Iwa less irritated.

“You didn’t say anything!” He hissed loudly enough that Oikawa winced, holding his cellphone a good distance from his ear before answering. “You used to tell me about that motherfucker’s every move, and now that it’s useful information, you have nothing to say?”

Oikawa frowned.

“Why are you blaming me for your communication issues, Iwa-chan?!” He all but whined.

When Iwa’s voice grew silent on the other line, Oikawa grew slightly nervous. But he was right. This was a particularly severe lapse in communication between Iwa and you that he was now projecting onto him, severe because clearly it had ended up being a bigger deal than it should have been in the first place.

As much as Iwa didn’t want to admit it, yesterday evening was evidence that something was very, very wrong in his relationship with you, or at the very least a residual tangled web of feelings to sort out, and it wasn’t exactly something he could easily fix or improve on his own. 

Not that he wouldn’t try. 

“What happened?” Oikawa finally asked, and Iwa retreated.

“Nothing. I’ll… talk to you later.”

The phone cut off on Iwa’s end and Oikawa sighed with mild irritation before returning to his lunch thousands of miles away.

On the other side of the globe, Iwa made his way from the balcony to the bedroom, setting his phone down on the nightstand and taking a glance at you who had appeared to be finally sleeping soundly, but betrayed by the intermittent soft hiccups of someone who had been crying just moments earlier. 

He hadn’t meant to make you cry. In fact, he hadn’t even meant to force another discussion at all, but hours after the last guests had filed out, none the wiser about the fight that had just transpired earlier (even if Hinata had made a single innocent comment about the bruise blooming on Ushijima’s cheek), the elephant in the room had grown entirely too large for him to bear. Unfortunately, the simple demand for clarification had spiraled out of control and ended up with a shouting match which had culminated in you bursting into tears.

It wasn’t a good look for him to behave like this. 

Even so, Iwa couldn’t stop thinking about how the subject of your argument had replied to his grumbled apology with the admission that he probably deserved the hit for all he’d done. Somehow, the persistent remorse in his voice made Iwa consider hitting him a second time for good measure. 

That wouldn’t be the right move either. There wasn’t really a right move, was there? All Iwaizumi could do was hope that everything would blow over. 

You loved him after all; he was sure of it.

---

you knew, didn’t you?

knew what?

You grit your teeth at the quickly returned text message, then set your phone down at your desk letting out a hushed but aggravated sigh, before picking it up again and typing furiously. 

you texted me, ‘how’s everything going?’ right before all that shit happened.

that could mean literally anything??? What???

You didn’t know how much longer your friend was going to feign innocence, but it looked like not very long because once your eyes flitted back to the unfinished project proposal you had been working on, your phone quickly buzzed again. 

By the time you had told her what happened this morning on your morning commute to work, she had grown a little too quiet, interjecting very little as you spoke and not asking any clarifying questions. You had assumed that she had just been being extra considerate, but now that it was early afternoon and there was a lull in your concentration, it occurred to you again just how clearly she must have anticipated the awkward situation.

YOU said you didn’t follow sports anymore + it’s been 3 years. HOW was I supposed to know you were going to overreact?

Overreact?

There was a small pause in which you saw her speech bubble pop up and then down, and then up again.

Not overreacting I guess, but I’m just confused… Don’t you and Iwa talk? How did it become a huge deal?

You decided you didn’t really have an answer to that. All you could do was return a noncommittal idk, letting the conversation die out and returning back to the task at hand.

---

“Mommy, why does he look like that?”

Ushijima glanced for a split second at the small child pointing openly at him, giving a small, understanding nod to the mortified mother trying to quiet her son’s whispers before continuing on his way back to his hotel.

His face didn’t exactly throb anymore, but the bruise he had been gifted with was very noticeable even if he had to be thankful he didn’t have a black eye. Iwa had hit him surprisingly hard, which was good. At the very least, he could count on him to protect you.

Getting hit in the face by your athletic trainer wasn’t ideal but he and Iwaizumi were both professionals. They could put it past them.

Even if they didn’t have a deep friendship, there was a sort of camaraderie since they’d met in California years ago. That relationship didn’t have to sour, he told himself. 

He just needed to give you two a wide berth. 

Even if he didn’t want to, he had to. It was the right, mature thing to do. 

Even if he didn’t miss on the court, he’d missed a crucial set in life. 

He had no right to demand a second chance.

---

You hadn’t traveled home alone in a while, you realized, as you set pace towards your apartment after a long shift. The subway was cramped as usual, but the closeness of the quarters felt more noticeable and uncomfortable now that Iwa’s hand wasn’t holding yours and keeping you close to him. He’d messaged you about an hour before you were about to leave work to give you a heads up that he would be returning late, and for a moment, you wondered if it were really true or if he was still mad at you.

But you knew Iwa well enough to be confident that he didn’t hold grudges, and if he were still uncomfortable he would tell you - he would never actively avoid you. 

Then again, you hadn’t had a conflict like this before.

I don’t love him, I only love you, you’d said to him almost screaming, defensive because Iwa’s voice had sounded hurt when you failed to come up with the words to explain why you were so shaken still.

You’d meant that with your whole heart. So why exactly did you react so poorly? 

Maybe it was the final death rattle of unresolved feelings, rearing their ugly head before being banished to whatever realm past hurts went once they were healed.

When you finally made it to your apartment, you stood for a moment at the entryway after flipping the light switch, taking a couple of seconds to blink away the fact that things didn’t look quite right. 

For a moment, you couldn’t remember exactly when you had replaced your TV - was that before or after Ushijima? Had that couch always been in that position? 

Fatigue even made you wonder where your houseplants had gone, until you remembered you had all but given them all away, telling yourself that those last vestiges of your relationship would have to vanish before you could truly count yourself moved on.

Now that the plants were gone, were you truly over it?

You let out a sigh and set your keys down before shooting a message to Iwa to let him know that you had made it home. That proposal wouldn’t write itself, and you could tackle it anew once you’d treated yourself with a warm bath and a modest glass of wine.

---

Seated in his soon-to-be minimally used office, Iwaizumi leafed through the short stack of papers before him, including prior athletic history and a formal written statement from the team physician. Satisfied, he gathered the documents and gently pushed them across the desk towards the silent, patiently waiting athlete sitting across from him.

“It looks like you’re cleared for practice tomorrow,” he said, offering a measured smile to Ushijima.

“Not that I expected any issues,” Iwa continued, compelled to keep speaking from the lack of response from the man before him. While he didn’t exactly sense hostile energy from Ushijima, it seemed like he was even more difficult to read than usual. 

Then again, Iwa was unsure if he was projecting; he acknowledged that prior to this very moment in time, he had been more standoffish than usual, having avoided unnecessary interaction with Ushijima during the day’s orientation activities.

He took a surreptitious glance at the wall clock above his head. There were only two more members to clear after Ushijima and then he’d be done for the day and could go back home to you, maybe picking up sushi on the way home as a peace offering.

Ushijima didn’t exactly look like he was getting ready to leave, but Iwa hadn’t explicitly dismissed him.

The two sat in an awkward silence and Iwa wondered if he should apologize again to settle the stagnant air between them, not knowing that the man before him was considering the exact same thing. 

What happens now? seemed to be the question du jour.

“How’s your father?” Iwa asked abruptly, shifting in his chair and leaning forward on elbows propped onto the desk, maybe a little too forward, in attempts to keep his mind off the fact that the volleyball player before him had also played with his love’s heart.

“He’s been well. Thank you for asking.”

Another pause ensued and Iwa was running out of ways to tell him politely to get out of his office for his next client, but for once Ushijima was the one to break the silence.

“I want us to have a good working relationship despite everything.”

The statement hung in the air for a second before settling and Iwa could feel irritation start to bubble in the pit of his stomach once again, but instead he forced a pleasant smile.

“Of course.”

---

With feet tucked beneath you, your laptop perched on the glass coffee table and a half-drunk glass of white wine (refilled once) atop the end table next to the couch, the sad truth was that you had only written about five lines in the past 45 minutes. 

Instead, against all the advice you’d ever been given in your life, you had sleuthed your way into your ex’s Instagram and Facebook accounts, gleaning as much information as you could about what had happened after you were two, after you’d blocked him cold turkey on every social media application and vowed never to look back.

As expected, the pictures and life updates he posted were few and far between, but there were still some to learn from, especially when you looked through those snapshots taken by others in his life. You were initially surprised to see old pictures of you together still up if you went back far enough, but clicked past them quickly because the fact that you looked so happy was more irritating than sad at this point of time. 

You took another sip of your wine, feeling a soft warmth in your cheeks and a light pleasant haze fill your head while you kept perusing. Some pictures you recognized from his prior team here, Schweiden Adlers, and then there were other promotional images from a new team, Orzel Warsawa... He had even traveled to Poland without your knowledge, you mused.

You took special note of women he looked all too close to for friendship as you browsed, noting a gorgeous, tall blonde in several pictures he appeared to have dated for a brief stint of a couple of months.

1 short relationship in three years. It was a shame, you thought. They could have had the prettiest kids.

And there, you finally realized your internal monologue was crazy. Why were you doing this again?

You threw back the final bit of wine and switched back to your Word document. Maybe writing while a little tipsy wasn’t the best of ideas but any words on the page were better than none.

…

It didn’t take long for you to doze off and your boyfriend to find you sprawled on your belly on the sofa, your glass empty and precariously placed at the edge of the sofa, and your laptop placed just inches above your head.

Iwa’s smile was immediate as he admired your silly position while setting down dinner, quickly walking over to gather you up for bed.

You murmured slightly as he scooped you into his arms, your face instinctively nuzzling his chest. He couldn’t help but think of how cute you were, kissing your forehead softly before tucking you under the covers. You had been so exhausted lately from work, so he’d let you get some early shuteye rather than disturb your peace.

Leaving the bedroom to eat dinner alone on the couch, he noted your laptop in suboptimal location, moving it to the table before sitting down to avoid a future accident.

It flashed on with the slight movement, revealing a lengthy document with heavy blocks of text, which he saved just in case because autosave failure would bring you to tears. He then clicked out, only to see the results of your cyberstalking session.

His heart may have skipped a beat or two but he closed your laptop instead, leaning back into his chair to finish eating dinner.

The uneasiness that filled his stomach instead had to be related to the raw fish he’d brought home. 

There was simply no other explanation, couldn’t be.

[aelaer]

A quick apology to those I haven’t replied to in the last month. I haven’t been very good with it on tumblr and I haven’t been doing a good job at reblogging things I should be reblogging, either. So I just wanted to give thanks for including me though I have not been very good at replying. I will do my best to get to it soon.

The post just devolves into anxiety from here. If you’ve ever wondered what the inside of a brain with social anxiety looks like, it ain’t pretty. Today’s therapy session was devoted around two occurrences, one that happened 2 years ago, another that happened in *2014*. I presume normal people don’t think of social interactions from 2014, but there you go. But the rest of the ramble goes into the interaction from 2 years ago, as that’s the one relevant as to why I’ve been cautious on getting too much on tumblr.

(But I’m getting better, bit by bit. I still have a way to go.)

(I am still not sure how to tackle my largest individual cause of anxiety here on tumblr, either, especially because the individual who triggers it likely doesn’t realize that they do. I see their posts reblogged often and since I’m more easily triggered into anxiety attacks the last few months, I’ve been cautious on how much I’ve been on tumblr.)

(How do I tell a person that because they follow me but ignore everything I produce in stark contrast to the rest of their tumblr activity (it’s that *contrast* that makes it so obvious, the Stephen Strange fandom is pretty farking small) has been giving me anxiety attacks once every 3-4 months since the summer of 2019? (Yes I know that’s not normal, thus the therapy. She’s been an absolute godsend, though.) How do I tell a person that I wanted to try and start afresh but I have no idea how to because I’m just not that good with people, and I know that I angered them two years ago and probably butchered the apology? Why do they follow me if our last interaction was an apology that was never replied to? That’s the part I don’t get! They probably don’t like me, right, if they never accepted the apology? There’s no interaction with my work here on tumblr or AO3, so they don’t like the work either-- so why follow if you like neither the work nor the person behind the work? You wouldn’t follow someone you didn’t like, right? That’s the logical assumption, isn’t it? But then why no interaction if you interact regularly in fandom? And even after going through this whole thing for half an hour with my therapist, I still don’t know how to approach this.)

(It came up because today was trigger day for some inexplicable reason. I’d prefer either not to be followed or some sort of normal tumblr like-whatever interaction as is this blogger’s usual M.O., not this weird middle lurking ground. (And the weird middle ground is where that abusive sockpuppet of an IronStrange writer from also 2019 came from, so I’m now doubly paranoid about uncharacteristic middle grounds.) I haven’t blocked the person because they haven’t done anything wrong-- I was the one that committed the rather bad faux pas 2 years ago-- and it’s not their fault that I have social anxiety up the wazoo. And that’s the tale of my current greatest tumblr anxiety.)

(Yes, social anxiety plus atypical neurological brains means frequently thinking back to an interaction that you had 2 years ago that didn’t end well. Yes, it’s about as fun as it sounds.)

(And I am making these mental health posts in order to try and normalize the fact that no, I’m not fully neurotypical, and that’s okay. I mean, anyone who had a problem with that or made fun of that has bigger issues to deal with anyway, so I figure-- it’s fine to post such things here. Half of tumblr has a neurotypical issue to deal with anyway, so it’s nearly the norm on this website.)

[lupinepublishers]

lupine publishers| Infected Lymphangioma Tongue Presenting as Macroglossia – A Case Report 

Lymphangioma   is   a   benign   hamartomatous   hyperplasia   of   lymphatic  vessels,  with  three-fourths  of  all  cases  occurring  in  the  head and neck region [1-4]. Lymphangioma was first described by Redenbacher in 1828 and Lymphangioma of the tongue was first described  by  Virchow  in  1854  [2].  The  onset  of  Lymphangioma  is  either  at  birth  (60  to  70%)  or  up  to  two  years  of  age  (90%).  It  is  rare  in  adults  [3-6].  Lymphangioma  represent  about  6%  of  the  total  number  of  benign  tumors  of  the  smooth  tissue  in  patients  aged less than 20 years [7]. The oral localization of Lymphangioma is   less   usual,   and   the   most   common   site   in   this   case   is   the   tongue,  especially  the  anterior  two  anterior  [8].  Lymphangioma  usually  affect  the  ventral  part  of  the  tongue  and  are  solitaire  or  circumscribed.  Occasionally,  they  are  associated  with  Cystic  Hygroma  [9].  Rarely  they  are  seen  on  the  palate,  gingiva,  buccal  mucosa,  and  lips.  In  children,  intraoral  lymphangioma,  especially  tongue  lymphangioma  leading  to  macroglossia,  may  cause  speech  disturbances,  poor  oral  hygiene,  mandibular  prognathism,  open  bite, yawning, chewing difficulties, and maxillofacial deformities [6].  Therefore,  appropriate  and  timely  treatment  is  essential  to  avoid  undesirable  consequences,  which  in  most  cases  are  caused  by  macroglossia  due  to  tongue  tumors.  Various  modalities  have  been  applied  for  treatment  of  lymphangioma  of  the  tongue.  Main  aims of the treatment are to give symptomatic relief of pain, edema, lymph  and  blood  leakage,  and  prevent  super  infections,  as  well  as  addressing  cosmetic  concerns.  The  ideal  treatment  is  surgical  excision; however, this cannot be applied in all cases and leaves a scar [10]. Other treatment modalities include cryotherapy, radiation therapy,   steroid   administration,   Sclerotherapy,  

Ricciardelli  LJ  and  Richardson  MA  [13]  demonstrated  that Suprahyoid  lymphangiomas  had  a  significantly  higher  rate  of recurrence  than  Infrahyoid  lymphangiomas  [14].  The  commonest complication    of    the    lymphatic    malformations    is   infection,    associated  with  the  growth  of  the  lesion. Lymphocytopenia  has  been documented in all these patients, although a clear correlation with the infection risk must be established [14]. The rapid growth of Lymphangioma can be associated with hemorrhage or can lead to obstruction of the upper respiratory tract, 50% from the children with these lesions requiring tracheotomy [15]. For inexperienced clinicians or in lesions with atypical clinical features a definitive diagnosis  should  be  made  through  biopsy  and histopathological  examination.  Dental  preventive  programs  must  be  performed especially for children with macroglossia until surgery is possible. The inability to perform normal dental hygiene activities increases the risk of caries and gingivitis. Adequate surgery helps patients to keep the tongue inside as a good cosmetic result and they also have less orthognathic deformities [8].ConclusionOral   Lymphangiomas   are   uncommon   lesions   occurring   at   the  dorsal region  of  the  tongue.  Conventional  treatment  with  surgical excision with sufficient depth and width is recommended but  because recurrence  is  common  and  also  not  possible  in  all  the  cases hence  other  treatment  modalities  are  also  used  like cryotherapy, laser therapy  etc are also used; the later also can be used with superficial lesions. Knowledge for correct diagnosis is of fundamental  importance  and  for  proper  therapeutic  implications. Their  early  recognition  allows  proper  initiation  of  treatment and  prevents the occurrence of the complications. Lymphangiomas   are   uncommon   congenital   hamartomas   of   the   lymphatic   system,   usually   diagnosed   in   infancy   and   early   childhood as lobular masses or cystic lesions. They may be present anywhere  on  the  skin  and  mucosa.  The  most  usual  locations  are the head and neck, followed by the proximal extremities, buttocks and trunk. Sometimes they can be located at intestinal, pancreatic and mesenteric  level.  Lymphangioma  rarely  affect  the  oral  cavity. Affected  sites  in  the  oral  cavity  may  include  the  tongue, palate,  gingival  and  oral  mucosa,  lips,  and  alveolar  ridge  of the  mandible  [8]. Two major theories have been proposed to explain the origin of lymphangiomas [11]. The first theory is that the lymphatic system develops from five primitive sacs arising from the venous system. Concerning the head and the neck, endothelial outpouchings from the  jugular  sac  spread  centrifugally  to  form  the  lymphatic system.  Another theory proposes that the lymphatic system develops from mesenchymal clefts in the venous plexus reticulum and spread centripetally   towards   the   jugular   sac.   Finally,   lymphangioma   develop   from   congenital   obstruction   or   sequestration   of   the   primitive lymphatic enlargement. Histopathological classification of lymphangioma is as follows: a) Lymphangioma simplex, small thin-walled lymphatic vessels.b) Cavernous   lymphangioma,   dilated   lymphatic   vessels   with   surrounding adventitia.c) Cystic lymphangioma,  large  lymphatic  spaces  surrounded  by  fibrovascular tissue; and d) Benign      lymphangioendothelioma,      lymphatic     channels      separated by collagen bundles [2]. These categories are somewhat artificial, and many lesions are   combinations   of   categories.   The   differential   diagnosis   for   lymphangioma   includes   Hemangioma,   Amyloidosis,   Congenital   hypothyroidism, Neurofibromatosis,  Mongolism,  Primary muscular hypertrophy. Lymphangioma are known to be associated with  Turner’s  syndrome, Noonan’s  syndrome,  trisomies,  cardiac  anomalies,  fetal  hydrops, fetal  alcohol  syndrome,  and  Familial  pterygium colli [6]. A classification of the lymphangioma of head and neck on the base of the spread the anatomical involvement had been proposed by De Serres LM [12]: a. Stage/class I – Infrahyoid unilateral lesions.b. Stage/class II – Suprahyoid Bilateral Lesions.c. Stage/class III – Suprahyoid or Infrahyoid Unilateral Lesions.d. Stage/class IV – Suprahyoid Bilateral Lesions.e. Stage/class V – Suprahyoid or Infrahyoid Bilate electrocautery,   embolization,  ligation,  laser  surgery,  and  radiofrequency  tissue  ablation.    Successful    treatment    necessitates    inclusion    of    a    surrounding  border  of  normal  healthy  tissue  without  damage  of  vital  structures.  The  following  case  report  is  of  a  patient  with  Lymphangioma of the tongue and its management.Case Report A  young  female  of  20  years  presented  to  the  department  of  ENT  at  Mayo  Institute  of  Medical  Sciences,  Barabanki  with  chief  complaints  of  progressively  increasing  size  of  the  tongue  for  the  past few years with difficulty in swallowing and dribbling of saliva from the mouth. Recently she started developing difficulty in eating food  and  closing  the  mouth  due  to  fullness.  Her  speech  was  also  affected  but  her  sensation  of  taste  was  intact.  The  patient  also  complained  of  bleeding  from  the  lesion  site  on  incurring  trauma  like  mild  injury  tooth  during  mouth  closure.  She  also  complained  of   tongue   bite   during   mastication.   On   inspection   tongue   was   there  was  a  reddish  blue  colored  marked  soft  tissue  swelling  involving  entire  tongue  with  numerous  papillary  and  vesicle-  like  projections  which  made  it  appear  irregular  and  granular  (Figure  1). On palpation, the swelling was soft, non-tender and pebbly. The surface  was  irregular.  The  mouth  opening  was  normal  and  there  was  no  restriction  of  functions  of  the  tongue  however  slurring  of  speech  was  noted.  On  the  basis  of  history  and  clinical  features  a  provisional diagnosis of vascular anomaly of the tongue was made and  the  patient  was  subjected  to  Fine  needle  aspiration  cytology  of  the  tongue  which  was  inconclusive  hence  later  a  small  biopsy  was  done  under  local  anesthesia  which  turned  out  to  be  Infected  Lymphangioma Tongue (Figure 2). Her systemic examination did not reveal any other congenital anomaly. Since the lesion involved whole of the tongue (both anterior and posterior) hence we decided not to operate and go with Sclerotherapy of the lesion. Patient was admitted and properly investigated and taken up for the procedure after explaining the risks and expected response. 1 ml SETROL (Sodium Tetradecyl Sulphate) with dilution was used for each side of the tongue, the patient experienced swelling of the tongue in the evening  which  resolved  by  the  morning  and  otherwise  tolerated  well. A total of 2 such injections were given at an interval of 1 month which resoled the lesion, her macroglossia got reduced and papilla on  the  dorsum  of  tongue  reappeared  and  all  other  symptoms 

For more information###

click here###

[biomedgrid]

Biomed Grid | Primary Neuroendocrine Carcinoma of the Cervix: A Case Report and Review of the Literature

Introduction

Neuroendocrine tumors (NETs) are neuroendocrine cellderived malignancies that can occur in various locations. They are divided into four categories: small cell, large cell, atypical cell, and classical carcinoid tumors [1] . Neuroendocrine carcinoma of the cervix is a rare malignancy and accounts less than 2% of all cervical cancers [2] . In literature, there are very few reported studies and they involved only small series and case reports of neuroendocrine small cell cervical carcinoma. Furthermore, the patients are at advanced stages in most of the reported cases. It is difficult to manage these tumors. They are often diagnosed at an advanced stage and the prognosis is generally poor[2, 3]. The most common treatment for patients with advanced disease is chemotherapy based on etoposide and cisplatin. Through this case, we report our experience in the management of this particular tumor and discuss it in comparison with literature.

Case report

We report the case of a 62-years-old woman with a medical history of diabetes under oral antidiabetic drugs. She reported in July 2018 o occurrence of spontaneous low abundance metrorrhagia. The clinical examination revealed a large cervical hemorrhagic mass at the level of the cervix measuring 6cm. Cervical biopsy revealed an infiltrating malignant process and the immunohistochemical study showed a positive staining for the P16, synaptophysin (Figure 1), chromogranin A (+), and CD5/6. Thus, the cyto-architectural and immunohistochemical aspect was compatible with small cell carcinoma of the cervix () thoraco pelvic abdominal CT scan revealed a locally advanced cervical tumor with metastatic lymph nodes in addition to pulmonary and bone metastases (Figure 4).

The patient received first line chemotherapy based on cisplatin 80 mg / m2 and etoposide 100mg / m2 (j1, j2, j3) with bone modulating agents based on denosumab because of the presence of bone metastases. The patient received 3 cycles with partial response then continued until a total of 6 cycles. The evaluation have shown disease stability. Therefore, a follow-up of patient was decided. After 18 months of follow-up the patient is still with good clinical and radiological control (Figure 1)(Figure 2)(Figure 3)(Figure 4).

Discussion

Neuroendocrine tumors originate from Kulchitsky cells which can be found in all parts of the body, cervical localization is rare and represents only 3% of cervical tumors which are predominantly squamous cell carcinomas[4]. During the last two decades, and unlike squamous cell carcinoma of the cervix, an increase in the incidence of small cell neuroendocrine carcinomas has been observed. These tumors occur at a median age of 40 years (20-87) [5], which appears younger than for squamous cell carcinoma of the cervix. The clinical symptomatology is nonspecific it is most often metrorrhagia, recurrent leucorrhea or pelvic mass. The diagnosis is based on the histological study, neuroendocrine differentiation can be shown by many methods. The most important of all these methods is immunohistochemical study with chromogranin A, neuron specific enolase (NSE) which was implemented in this study. Chromogranin A is a more specific stain on this issue.

In the literature, there are studies that have been conducted to show the presence and significance of neuroendocrine differentiation in a specific tumor, especially on gastrointestinal tract and lungs, and these studies have concluded that this differentiation is related with poor prognosis and survival [6].Race, age and stage of the tumor seem to be the prognostic factors also smoking and advanced stage are reported to be poor prognostic factors for survival in patients with NE small cell carcinoma of the cervix . Of all these, the most important prognostic factor is lymph node metastasis. While the lymph node invasion in neuroendocrine tumors is more than 30% [7]. Given the strong trend towards regional and remote dissemination, the assessment should include abdomino-pelvic imaging, preferably magnetic resonance imaging. In order to improve ganglion staging FDG-PET is significantly more accurate than computed tomography (CT) and is recommended for loco-regional lymph node and extra pelvic staging. The metabolic dimension of the technique provides additional prognostic information, allowing a good follow-up of the target lesions, it becomes the tool of choice when one wishes to appreciate at best the effectiveness of a treatment [7].

The treatment of cervical neuroendocrine carcinomas is modeled after squamous cell carcinoma, taking into account the characteristics of neuroendocrine tumors of the lung. In the case of metastatic disease, palliative chemotherapy with cisplatin and etoposide or VAC- type chemotherapy (vincristine, adriamycin and cyclophosphamide) are indicated [8, 9] However, in the presence of small series and a few case reports it is difficult to analyze the effects of a treatment. Our patient was diagnosed at an advanced stage and having benefited from the systematic chemotherapy. After 18 months of follow-up the patient is still with good clinical and radiological control.

Conclusion

The cervix is a rare location of this subtype making the diagnosis very challenging and the confirmation is obtained by histology and immunohistochemistry. Conventional chemotherapy based on platinum and etoposide is still the mainstay of treatment in metastatic setting. More advanced research is required to better understand these tumors and allow development of effective drugs for this rare disease and improve the outcome of patients.

Read More About this Article: https://biomedgrid.com/fulltext/volume6/primary-neuroendocrine-carcinoma-of-the-cervix-a-case-report-and-review-of-the-literature.001069.php

For more about: Journals on Biomedical Science :Biomed Grid | Current Issue

[fictionfromgames]

Insurrection (SWSE)

.“This is Seven-Aurek-Six to city patrols, we need backup at the Ekrine Zoo immediately!” Ayoma shouted into the comm link. Despite not having actually authority, they still gave the rangers a through-line to real law enforcement, along with an official call-sign. The convolutions of their employment were ultimately public sector.

“Seven-Aurek-Six, you are on official channels,” dispatch droned in reply.

“Affirmative, GUF sighted, armed and headed my way now, request backup!” she panicked.

She’d already called the zoo personnel, some of whom had armed themselves with the weapons intended for reek break outs. But not her human co-workers. The realization had made her nauseas. Two of them were rangers too.

“Ayoma, they’re calling back at my desk, civilian lines,” Tharun Ex, the Besalisk zoo director yelled over to her, “Did you already use the LE comm?” “Yes!” she replied in exasperation, “Please tell them it’s for real and I’m not just some idiot playing a joke in a crisis!”

“I have been!”

Ayoma didn’t know the words for the sizes of army detachments, but there were at least a hundred humans outside, half armored and some with gauche pre-packaged propagandist holobanners. Some had been firing wildly into the air already.

“Get everyone inside, active shooter drill-style, but like, this time, do fight back as they come in!” she called down to Tharun, “This is gonna be bad either way but we’re gonna lose harder if we meet them on this!”

She ran towards the employee entrance landing in case the imperialists had been looking for a convenient place to get in, hoping for law enforcement in a what-if-i-won-the-lottery kind of way, when she saw something impossible-- that tall woman from earlier in the day (Ayoma was working doubles because of all this nonsense), back watching the Toorgas, almost exactly where she met her.

“Ma’am?! Uh, *whatwasyourname,* Ilah?!” she called out to her, jogging up.

The Kaminoan woman turned and gave her that same smile, like starlight, the kind that made her stomach feel funny in ways that weren’t related to imminent insurrection, and she just waved.

“Ilah this is the absolute worst time to visit the zoo, we closed, the GUF is outside, uhhh,” Ayoma ran a hand through her own hair, working out the best place to just hide, “I think maybe if we got you to the sublevels, you’d be safe, I’m so sorry.”

“I am not worried, Ayoma,” she said just as warm and calm, sending a wash of relief over the Mirialan that Ayoma knew was out of place given the situation.

“But you need to be, that’s the problem,” Ayoma was so tempted to take Ilah’s three-fingered hands and pull her away from the loping toorgas, “There’s armed and marching GUF outside and they’re staring right at the z--”

An airspeeder crashed into the toorga exhibit, but given the space the animals needed, they managed not to hit anyone, toorgas included. Ayoma drew her blaster and set her stance to aim-- it was not as close as she was used to firing, but she was hesitant to get closer.

Three humans clambered out of the now-wrecked airspeeder, each with blasters of their own, and checked themselves while Ayoma fired.

It was not protocol. Blasters were for the dangerous animals, not people. And she hadn’t given them warning, but they had rifles and GUF armor. They weren’t here to see the baby reek.

Only one was even looking around, the other two were still checking the ship when she fired, but she got them square in the chest plate. He wasn’t down, but he looked hurt, and decidedly shocked. Thank you, she prayed silently. By the time the other two began returning fire, a peculiar thing happened.

Ilah pulled out a blue lightsaber and began parrying away their fire, even when it was aimed at Ayoma specifically.

“We should move in,” she said over the din, manipulating the laser sword with preternatural grace. Ayoma was beginning to swoon, literally.

“We should retreat!” Ayoma managed to answer, her head swimming. How was a Jedi here, in her zoo, saving her life? “There’s more at the entrance level who will get in!”

“All the more reason to take care of the situation here.”

The blaster fire swept around her as Ilah took off-- Ayoma thought the Jedi was flying, but didn’t think too long as she went for cover finally. She peeked up in order to get the shot, but one GUF goon was now without a rifle, and the others were trying to back away from a whole Jedi swinging at them. But there was something conspicuous in the way Ilah wasn’t murdering them. Now that they were distracted, Ayoma snuck around to get into a decent pistol range.

Over the hum of that legendary weapon, the ranger heard Ilah... talking them down? That can’t be right! Ayoma sat confused.

“Your enterprise is doomed to fail,” blaster fire, parry, repeat, ”Rather than be here, taking over the very obviously crucial target of a city zoo, you could be at home with your families,” rifle clatter, “There is a worthier cause in peace than profit,” now, just the sound of the saber.

“You’re right,” one of the humans said through a cheap helmet, “I don’t know why we’re here.”

“Miss Ayoma, is there an emergency exit nearby by which they might egress?” Ilah inquired in those same exact beach-shore tones, soft waves of sense and sensibility in every word.

“Yeah, I gotta unlock it,” Ayoma stood, “It uh... Was secured earlier, for, ya know...”

Ayoma waved her pistol around helplessly at the would-be soldiers. Ilah chuckled, causing Ayoma’s purple skin to deepen. She went over to the emergency lift for their level, manually unlocked it, and let the imperialists... just go. But the clicks of it relocking and a deep breath made her feel better.

“Ilah, why are you here?” she turned back to the seemingly ever peaceful woman.

“I had to.” she shrugged, then folded her arms.

“What does that mean?”

“I sensed something about you.”

“What does that mean?!”

“Come, I fear the next part will be far less pleasant,” Ilah began walking into the zoo while Ayoma stood agape. The ranger had almost forgotten her comm-link.

“Seven-Aurek-Six to zoo broadcast,” she said through a fog of shock, “Reinforcements are here.”

****************

Ilah Pei

A true once-in-an-era occurrence, this Kaminoan Jedi has taken up the path of a Consular, feeling as though the Jedi had many warriors and far fewer diplomats as in ages past. Removed from the center of galactic politics has relegated her to small, informal goodwill missions rather than proper politics. She has shown great aptitude as a peacemaker in more than one instance where even last measure violence would have created intractable situations for generations to come, such as the Arkanian Situation in 119 ABY. Ilah is one of the few extant Jedi who essentially grew up as one. As atypical as it is, she was foreseen by the Jedi who would become her own master, and was subsequently adopted when the question of what to do with a Force-sensitive Kaminoan came up.

She was given as much education on her own people as was feasibly obtained and could be taught by an offworlder. She is thus a bit more personable than your typical Kaminoan, rather less servile and instead driven to the cause of peace.

That did not stop her from mastering Ataru, but that’s another story.

Ilah Pei Kaminoan Jedi 7/ Jedi Knight 7

Str 10 Dex 15 Con 12 Int 14 Wis 16 Cha 18

Feats 1 Weapon Finesse 2b Rapid Strike 3 Force Training 4b Skill Focus UTF 6 Force Training 6b Assured attack 9 Follow Through 12 Force Training

Force Powers 12 Rebuke Hawkbat Swoop Saber Swarm Disarming Slash Sarlacc Sweep Surge Move Object Mind Trick x3 Farseeing Force Thrust

Force Techniques Force Point Recovery Improved Mind Trick Improved Move Light Object

Talents Block Deflect Adept Negotiator Force Persuasion Shii-Cho Ataru Vigilance Sheltering Stance

Skills Trained Use the Force +21 Jump +12 Knowledge: Life Sciences +14 Knowledge: Galactic Lore +14

Pontite Crystal in standard lightsaber

[suddencolds]

Atypical Occurrence [2/?]

hello!! 10 drafts and (exactly) 3 months later, I am finally back with part 2 of Atypical Occurrence 😭 You can read part 1 here!

This chapter is a little personal to me. I don't tend to linger on writing scenes like this (in part because they are a little difficult for me), so it took awhile to hammer out the dynamic I wanted. That said, here it is at long last!!

This is an OC fic ft. Vincent and Yves. Here is a list of everything I’ve written for these two! :)

—

Summary: Vincent shows up late to a meeting. It just goes downhill from there. (ft. fake dating, the flu, a house visit, and certain revelations)

—

There’s a grocery store that’s a ten minute drive from Vincent’s apartment. Yves picks out ingredients for chicken soup, two different kinds of cold and flu medicine, a new pack of cough drops, a few boxes of tissues, a small thermometer. All in all, it’s less than a thirty minute excursion—something he’s done many times before in uni, where everyone seemed to catch something in the middle of exam season, and a house visit was just a short walk away.

Chicken noodle soup isn’t difficult. He’s made it a hundred times—he’s experimented with a dozen different variations of it. He puts the groceries in the fridge, washes the vegetables, and gets to work.

While the soup cooks, he half watches it, half busies himself with cleaning the apartment—loading up the dishwasher and hand washing everything that doesn’t fit, stocking the fridge and the medicine cabinet with the groceries he’s gotten, vacuuming the floors with a vacuum cleaner he finds tucked behind the fridge.

Then he shreds the chicken, chops a round of fresh vegetables to add to the broth, and waits.

 It’s comfortably quiet. Outside, rain drums steadily on the windowpane. It shows no signs of stopping soon. It’s dark enough outside—the sun fully set, the clouds heavy overhead—that the lit interior of the apartment kitchen feels like a warm reprieve.

Yves likes cooking. He doesn’t actively enjoy doing chores, but there’s something comforting to how mindless they are. It’s an appreciated distraction. 

The rain outside is loud enough that he doesn’t hear the footsteps, approaching, until Vincent clears his throat from behind him.

Yves jumps.

“You’re up,” he says, spinning on his heels to face him. Vincent looks a little worse for the wear—his hair a little messy, his shirt slightly rumpled from sleep, his glasses perched haphazardly in place.

Yves watches him take everything in—the pot on the stove, the chopping board set out on the counter, the empty paper bags from the grocery run flattened and stacked into neat rectangles.

“And you’re still here,” Vincent says.

“I made soup,” Yves says, by way of explanation. “It’s chicken noodle. I wasn’t sure if you’d be up for trying something new.” He reaches over to lift the lid off of the pot of soup. Steam wafts up from it, carrying with it the faint scent of the aromatics he’d added—thyme, bay leaf, garlic, peppercorns. “Actually, you picked a good time to wake up. I just added in the noodles, so it’s almost done.”

Vincent eyes the pot, his expression unreadable. “Did you leave to get groceries?”

“Earlier, yeah. You weren’t kidding about your fridge being empty.”

Vincent frowns. “I can pay you back. Did you keep the receipt?”

In truth, the price of the groceries is the last thing on Yves’s mind right now. He waves a hand. “Don’t worry about it.”

“It must have taken a long time.”

“Soup is pretty forgiving. You just toss everything into a pot of boiling water and wait. It’s barely any work at all.”

Vincent stares at him for a moment longer. Then he says: “That’s an oversimplification.”

“Not really. Besides, I enjoy cooking,” Yves says. “Thanks for letting me use your kitchen—though, technically, I guess I’m asking forgiveness instead of permission. I’ll clean everything up, by the way.” He’s done dishes along the way, so there isn’t really much to do besides rinse off whatever’s left, load up the dishwasher, and store whatever’s left of the soup in the fridge.

“You don’t have to,” Vincent says, before turning into his elbow with a few harsh, grating coughs. “I can clean up. It’s my apartment.”

“If you think I’m letting you do household chores while you have a fever—”

“It’s not that high,” Vincent interrupts, perhaps a little stubbornly. Yves lets out a disbelieving laugh. He leans over the counter, shifts his weight forwards on his feet to press the back of his hand to Vincent’s forehead.

It’s concerningly hot, still, which isn’t a surprise. Though perhaps the way Vincent blinks, a little tiredly, and leans forward into Yves’s hand is a giveaway on its own.

“It’s definitely over a hundred,” Yves says, withdrawing his hand. “If you don’t believe me, I’ll have you know that I bought a thermometer.”

For a moment, Vincent looks surprised. Then he sighs. “That was an unnecessary purchase.”

“Are you admitting that I’m right?”

Vincent just frowns at him, which—Yves notes—isn’t exactly a denial. “Fever or not, there’s not much I can do except sleep it off.”

“You can go back to sleep after you’ve had something to eat,” Yves says. “What was it that you said? That you haven’t had anything to eat since yesterday?”

“...You won’t leave unless I eat, then,” Vincent says. He says it evenly enough that it barely registers as a question.

Yves smiles at him. It’s not a wrong conclusion. “Exactly,” he says.

—

In between the hallway and Vincent’s kitchen is a small dining area, furnished with a high table and two high chairs. Yves waits until the noodles are cooked just enough. Then he turns off the stove, unrolls a placemat to lay out on the dining table, and carries the pot over.

He gets everything he needs: two bowls, two spoons, some of the fresh parsley he’d chopped earlier, for garnish—and lays it all out.

“I can help,” Vincent says, for maybe the third time. 

He’s seated on one of the chairs, which Yves had pointedly pulled out for him, looking like he’s perhaps a few seconds away from getting out of his seat and doing everything himself. It’s just like Vincent, Yves thinks, to offer to help—even at work, aside from all the work he takes on, it feels like he’s always finding some way or other to be useful. 

Yves says, “When you’re not running a fever, you can ask me again.”

When everything is laid out, he pulls up a chair for himself, so he can sit across from Vincent—who is still perched on his seat, though he looks a little less like he wants to get out of it. “You didn’t have to wait for me,” Yves says.

Vincent blinks at him. “It would have been rude to get started on my own.”

“Nonsense,” Yves says. “I made it for you.”

He takes a bite. The soup tastes fine. That is, it tastes the same as every other time he’s made it—light and comforting. It’s just one of those recipes Yves thinks he can make in his sleep. Nothing about it is particularly inventive. Still, he hasn’t cooked for Vincent before—not formally, at least, other than the dish he’d bought to Joel’s potluck—so it’s a little nerve-wracking to watch Vincent take a bite. 

It’s worse, still, to watch his eyes widen by a fraction. For a moment, Yves wonders if he’s done something wrong—if perhaps, it isn’t to Vincent’s taste, after all. He sets his spoon down. “Is it okay?”

“It’s really good,” Vincent says. “I can see why Mikhail said what he said.” 

“What?”

“That your cooking was half the reason why he roomed with you.”

Yves laughs. “So does that mean you’ll forgive me for trespassing?” 

Vincent smiles back at him. “I’ll consider it.” Now, with his glasses off, Yves can see his eyes a little more clearly—they’re slightly red-rimmed, his eyelashes long and dark, his cheeks flushed brighter with fever. There’s a little crease at the edge of his eyes which shows up when he smiles.

Yves is caught off guard, for a moment. The tightness in his chest is nothing, he tells himself. Certainly not a crush that he shouldn’t be allowed to have. 

A crush. That’s new, too. It’s ironic, considering the terms of their fake relationship. He thinks it’s probably supposed to make him better at this—what better way to feign romantic interest than to not have his feelings be so fake, after all?—but instead, he finds himself at an uncharacteristic loss for words, finds himself stumbling over the most basic of pleasantries. 

Of course, he has no intention of acting on his feelings. Vincent is attractive, yes—but he’s also considerate, and attentive, and hardworking enough to go early and stay late, to take on work he doesn’t get credit for. He’s thoughtful enough to entertain Yves’s friends, to have lunch with Yves’s siblings, to fly all the way to France to meet Yves’s family.

But all of that is inconsequential. None of it is going to amount to anything, because Yves knows how to keep his distance. Because Yves needs this—the perks of their fake relationship—more than he needs to indulge in any inconvenient crush. Because he knows enough to know how things would turn out if he were to say something.

That’s the thing. Vincent isn’t cruel. It’s for that reason, precisely, that Yves knows that he’d drop this arrangement immediately if he knew. Vincent would never string him along knowingly, and that’s what makes this so much worse—Yves has gone and gotten himself stupidly attached. 

Now that they’re sitting across from each other, in Vincent’s apartment, having dinner, Yves thinks—a little selfishly, perhaps—that this is the best that he can ask for. It is all that he can ask for. Far better to keep up the pretense entirely, far better to pretend that this is all just for show. When they put an end to this arrangement—someday, inevitably—Yves will thank Vincent for everything, and then they’ll go their separate ways. He already knows how it will go. There is no need to complicate things.

It’s quiet, for some time. Yves finishes his bowl first, heads over to the sink to rinse it off, and positions it neatly in the lowest compartment of the dishwasher. When he gets back, Vincent is spooning more soup into his bowl. Yves allows himself to feel a little relieved to see that he has an appetite.

“It’s been awhile,” Vincent says, after some time. “Since anyone’s done this for me.”

“Made you chicken soup?” Yves says, a little puzzled. “If you want the recipe, I can give it to you. I make it all the time.”

“No,” Vincent says. His expression is unparseable. “Just— since anyone’s looked after me, in general.”

“Oh.” Yves finds his mind is spinning. “How long have you been living alone?”

“Since university. I had suitemates, in my second year. Then I got an apartment of my own.”

“Because you like the privacy?”

“It was just simplest.”

Yves thinks back to his years, rooming with Mikhail—the conversations they’d have to have to figure out groceries, to alternate cooking dinner and doing dishes, to manage transportation. He has a studio apartment now, too, but he’s over at his neighbors’ house frequently enough, or otherwise at home with Leon and Victoire for dinner, so it doesn’t really get lonely.

“You have a pretty spacious kitchen,” he says. “I hope you don’t mind that I used your pots and pans. I’ll wash them, I swear.”

Vincent takes in a small, sharp breath. Yves looks up just in time to see him twist away from the table, tenting his hands over his nose and mouth.

“hhIHh’IIKTS-HHuhh-!”

“Bless you!” Yves exclaims. Judging by the way Vincent keeps his hands raised over his face, he assumes that there are going to be more. He rises from his seat, heads back into the kitchen in search for—ah. Six boxes of tissue boxes, stacked neatly into a block. He tears off the thin plastic film around them, removes a box from the pile, and pulls off the tab.

When he gets back to the dining table, Vincent is ducking into steepled hands with another—

“hhih’GKKT-SHHh-uuUh! hh’DDZSChh-HHuh! snf-Snf-! hhh… Hh… hh-HH-hh’yIIDDzsSHH-hHUH-!!”

The sneezes seem to scrape painfully against his throat, for the way he winces in their aftermath. He twists away from Yves to cough lightly, after, into his shoulder, his eyes watering. “Bless you!” Yves pushes the tissue box towards him. “Here.”

Vincent takes a tissue from the box, blows his nose quietly. When he emerges, lowering the tissue from his face, his eyes are a little watery. He eyes the tissue box. “Did you buy these earlier, too?”

“I did,” Yves says. “I picked up some medicine, too. I didn’t know what flavor you wanted, so I got a couple different kinds. And some other stuff—your fridge was getting pretty empty, by the way—in case you needed it.”

Vincent lifts his head to study him, as if there’s something he’s trying to understand. Finally, he says, “Do you do this for all of your friends?”

“What?”

Vincent frowns, as if the subject matter should be obvious. “Cook for them. Get groceries. Clean their apartment.”

“Sometimes,” Yves says. He’s certainly no stranger to stopping by to help—sometimes with homemade soup, or tea packed tightly in a thermos, or something else. Then again, that was easier to do back in uni, when everyone lived within a twenty minute radius. “It depends on what they need.”

“So this is just a Yves thing.”

“What? Showing consideration for my friends?” 

“Showing consideration is one thing,” Vincent answers. “You could have left after dropping off the files. You would still have been showing your consideration.”

“I guess that’s true. But at that point, I was already here,” Yves says, with a shrug. “It seemed logical to check up on you.”

“Well, now you’ve checked up on me,” Vincent says. “So you can go.”

Yves supposes this is true. 

“Do you want me to go?” he asks.

Vincent says, “It’s late. I assume you have things to get home to.”

“That’s not what I asked,” Yves says.

Vincent says nothing to that.

But Yves gets the message, even without him saying it. If Vincent is the type of person who prefers to be alone when sick, Yves won’t take it personally. He doesn’t want to overstay his welcome—arguably, he’s already stayed for much longer than Vincent had invited him to.

There’s leftover soup in the fridge—enough to last Vincent a couple days, hopefully through the worst of this—and Vincent’s apartment is reasonably well-stocked now. He has something to take if his fever gets any higher; he has all the basic supplies Yves could think of off the top of his head.

And Vincent is a lot of things, but he isn’t irresponsible. He’s shown himself to be self-sufficient more times than Yves can count. There’s no reason why Yves should have to stay and look after him for any longer—no reason, perhaps, aside from the fact that seeing Vincent ill has left him more worried than he’d like to admit.

“Okay,” he says. “I’ll go. But at least let me clean up first.”

He does dishes, leaves the cutting boards and the pot out to dry on the drying rack, transfers the soup to smaller glass containers to store it in the fridge. He returns the vacuum cleaner to the storage closet he found it in. Then, as promised, he gathers his things—not much, just his phone and his car keys—and heads toward the front door.

Vincent follows him to the door, presumably to lock it after he leaves. 

Yves steps outside, lingers for just a moment on the doorstep. The car is parked close enough that he hadn’t bothered to grab his umbrella, but now it’s dark out, and it’s raining just as hard. 

“I left new cough drops on the kitchen countertop,” Yves says, biding his time under the overhang until he inevitably has to get rained on. “The medicine’s in your bathroom, behind the mirror, with the thermometer. Everything else is either on the counter or in the fridge. Don’t come back to work until your fever’s completely—”

It happens in a moment: Vincent stumbles. Yves is looking at him, which means he sees the exact moment when it happens. Yves doesn’t think, just reacts—he reaches out to grab his arm to keep him from falling entirely. 

“Woah,” he says, steadying him. “Are you—”

Vincent’s hand is concerningly warm, even through the fabric of his sleeve. For a moment, he leans into Yves’s touch, though this seems less intentional as it is inevitable. He’s breathing heavily, his eyes tightly shut, his shoulders rising and falling not as soundlessly as usual.

Yves swallows past the alarm he feels percolating in his chest. Had he been about to pass out? Just how high is his fever right now? “Vincent—”

“Sorry,” Vincent manages, through gritted teeth. He makes an effort to regain his balance, to move away. He sways on his feet, and Yves feels the panic in his chest rise anew. 

He reaches up and slings an arm around his waist. “Hey,” he says, trying for reassuring. “I’ve got you.”

Vincent doesn’t say anything, to that. He just stands there, perfectly still, his eyebrows drawn together, his shoulders a little stiff under Yves’s touch. 

Without letting go of him, Yves shuts the front door gingerly behind him, toes his shoes off at the door again. “I think it would be best if you laid down,” he says. “Do you think you can walk?”

Vincent nods, slowly. Yves tracks the bob of his throat as he swallows. 

“Sorry,” Vincent says, again. “I… didn’t expect it to be an issue.”

He’s frowning, hard, as if he’s upset with himself, though Yves can’t quite piece apart why he’d have reason to be. “Hey, no apologizing,” Yves says. “Save your energy for walking.”

Vincent seems to understand that their current arrangement will not change until he’s in bed, so he lets Yves steer him towards the bedroom. It’s a short walk—down the hallway and then off to the left—but Yves spends half of it distracted by how warm Vincent is. Like this, he practically radiates heat.

It’s not until Vincent is settled on his bed, the blankets pulled loosely over him, that Yves allows himself to let go.

Truthfully, the last thing he wants to do right now is leave. But it isn’t about what he wants, and perhaps Vincent would sleep better if he did.

“Are you warm enough?” Yves asks. The words feel heavy on his tongue.

A nod. 

“Do you need me to get you anything else?”

Vincent shakes his head.

“Okay,” Yves says. “I guess I shouldn’t overstay my welcome, then.”

Vincent will be fine, he tells himself. At the end of the day, they are only coworkers, and Vincent is one of the most independent people he knows. If Vincent doesn’t want him here, the best Yves can do is comply with his wishes. He straightens. “Text me if you need anything, I mean it.”

He lets go of the blanket, rises to his feet. Only, then—

There’s a hand on his sleeve, tugging.

Yves goes very still.

When Vincent notices what he’s done, alarm flashes through his expression, and he pulls his hand away as if he’s burned. 

“Sorry,” he murmurs, again. And just like that, he’s back to how he always is—his expression perfectly, carefully neutral, in a way that can only be constructed. “I’m sorry.” But Yves doesn’t forget what he’s seen. “You can go.”

Yves’s heart aches. He settles back at the edge of the bed, reaches out a hand, settles it gently at the edge of Vincent’s forehead. At the physical contact, Vincent’s breath catches.

And for a second, Yves wonders if he’s made a mistake—if maybe Vincent doesn’t want to be touched, right now. If he’s misread the situation; if Vincent wants him to go, after all. He opens his mouth to apologize.

But then Vincent shuts his eyes. The tenseness to his expression eases, almost imperceptibly, his eyebrows unfurrowing. Oh, Yves realizes. His head must hurt—Yves suspected as much—but if he’s not mistaken, the expression on Vincent’s face right now is…

Relief. Cautiously, Yves traces his fingertips lightly over the edge of Vincent’s temple, combs them slowly through his hair. Vincent’s eyes stay shut, but the furrow to his eyebrows loosens, and his jaw unclenches, just a bit. The change is minute, almost imperceptible. If Yves weren’t paying close attention, he might’ve missed it.

As if he could pay attention to anything else, right now.

Tentatively, Yves cards his fingers through Vincent’s hair, traces slow circles into his scalp, slowly, carefully.  He does it until the heartbeat he feels thrumming under his fingertips—quick and erratic—slows. Until Vincent’s breathing evens out, until the hurt in his expression dulls. Until the tension in his shoulders eases.

By the time he finally withdraws his hand, Vincent is fast asleep. Yves fetches a new glass of water for his nightstand, changes out the plastic bag lining the trash can, and lines the cough drops and medicine up at the edge of Vincent’s desk. He flips through folder 2-A, assessing.

Then he heads back out to his car to get his laptop, and gets to work.

—

He doesn’t remember falling asleep.

But when he wakes at Vincent’s desk, it’s to an unpleasant ache in his neck that spreads laterally into his shoulders—probably from sleeping with his head pillowed awkwardly against his arms. He lifts his head. 

Behind him, there’s a weak, uncertain breath, and then the sort of cough that makes Yves’s chest hurt in sympathy. It sounds wrong, somehow—too quiet, for its proximity. Muffled.

It’s dark inside, aside from the faint glow of Vincent’s digital alarm clock, the pale green digits cutting into the black. He hears the rustling of blankets, followed by another short, painful intake of breath.

The sneeze that follows is stifled into something. Even stifled, it sounds uncharacteristically harsh—all force, pinched off into a short, muffled outburst which sounds barely relieving, at best.

“hH’ih’iNNGKkk-t!”

Yves blinks. Then he leans over the desk to flick on the lamp. Dull golden light suffuses the desk, bright enough to cast Vincent in form and graying color. 

“Are you okay?”

At the light, Vincent’s eyes widen. He looks—stricken, somehow. Then his expression shutters, and he frowns. “Did I—” he stops to cough again into his fist. It sounds as though each breath he’s taking in is an effort of its own, shallow and unsatisfying. When he speaks again, his voice sounds noticeably hoarser. “—Did I wake you?”

Yves opens his mouth to respond. Before he can think up a convincing excuse, Vincent shakes his head dejectedly, as if he already knows the answer.

“Sorry,” he says. “I was - cough, cough - tryidg to be quiet.”

Quiet. As to not wake Yves, presumably. The revelation causes an ache to settle somewhere deep inside of him, heavy and inexorable. Yves is more than certain that this flu is already miserable enough on its own, even without the added challenge of having to be quiet about it. He wants to say, do you really think that’s what matters to me? He wants to ask, how long have you been up dealing with this on your own?

“You don’t have to be quiet,” is all he manages, instead.  It’s a miracle that his voice manages to come out as evenly as it does.

Vincent looks like he’s about to say something. But before he has a chance to, he twists away to cough harshly into his shoulder. Now that he doesn’t make an attempt to muffle the coughing fit, Yves can hear just how harsh it sounds. 

It’s the kind of coughing fit that just sounds exhausting—forceful enough to leave tears brimming at the edges of his eyelashes, his breaths coming in shallowly. 

“Can I get you anything?” Yves asks, when Vincent is done coughing.

Vincent just looks back at him, unmoving. In the dim light of the desk lamp, he looks perhaps more exhausted than Yves has ever seen him—really, he looks as though he hasn’t slept at all. He’s seated with his back against the headboard with a blanket pulled around his shoulders. One of his hands is clenched loosely around it, pinning the corners in place. 

“Tea?” Yves offers, because it’s better than saying nothing. “Water, cough drops. A cold compress?” Vincent doesn’t say anything, but Yves thinks, a little helplessly, that there must be something he can do. “Extra blankets? Tissues? Ibuprofen?”

“Water… would be nice,” Vincent says, as if it takes a lot out of him to admit it. Yves blinks, surprised—he had half expected no answer at all. At Yves’s split second of hesitation, Vincent’s frown deepens, his grip around the blankets tightening slightly. “...If it’s not too much trouble.”

Yves has never gotten out of his seat faster. “Of course,” he says. “I’ll be right back.” he swipes the empty glass from the nightstand and heads out into the hallway.

It’s dark. There aren’t many windows in the hallway to let in light from outside, but once he gets to the dining room, it gets easier to see. Judging by how dark it is outside, there are probably a few hours left until sunrise. It’s still early, then. Early enough that it’s quiet, around them—no traffic out on the streets, save for the occasional car, headed to who-knows-where; no neighbors going about their early morning routines; just the steady trickle of rain on the windowsill. Yves rinses the cup out in the sink, shakes it dry, and fills it again.

When he makes it back to the bedroom, it’s unusually quiet. Vincent is still sitting at the edge of his bed, looking like he hasn’t moved at all since Yves left the room.

Yves crosses the room to hand him the glass. Vincent blinks up at him, a little blearily.

“I got you water,” Yves says, unnecessarily.

Vincent takes the glass from him with both hands, as if he doesn’t quite trust himself to hold it with just one. Yves looks away as he drinks.  

When Vincent lowers the glass at last, Yves takes it from him and sets it back into place onto the bedside table. He straightens, turns to face Vincent again. “Any better now?”

Vincent nods. It’s quiet, for a moment. Outside, the rain has nearly stopped—the room is soundless, aside from the thin whirring of the air conditioning. “I didn’t think you’d still be here.” 

Yves hums. “To be honest, I didn’t either.” He stifles a yawn into one hand—he’s still a little tired. “I didn’t mean to fall asleep.”

“You must be tired,” Vincent frowns, looking him over. “You came right from a full day of work to check on me. Does your neck hurt?” 

“What?”

Vincent inclines his head towards his desk. “I’ve fallen asleep there before. It’s not very comfortable.”

Yves thinks he shouldn’t be surprised, at this point, that Vincent has picked up on something so subtle. “It’s not that bad,” he says, reaching up with a hand to massage his neck. “My neck would probably be sorer if I’d slept through the whole night. I should thank you for waking me.”

“You could’ve taken the couch instead,” Vincent says, a little disapprovingly. “It would probably have been wiser.”

“I wanted to be here so I could keep an eye on you,” Yves says, because it’s true. “Besides, you sat in a chair while I slept in France. That can’t have been comfortable either.”

“It’s not just about that. You—” Vincent raises a hand up to his face, ducks into his wrist for a sudden: “hh-! hhiH’GKT-sSHuh! snf-!” He sniffles, then presses the wrist closer to his face, his expression shuttering. “Hh…  hh’IIDDZshH’Uhh-!” 

“Bless you!” Yves says, startled.

Vincent blinks, a little teary-eyed, turning over his shoulder to muffle a few harsh coughs into his wrist. “You shouldn’t have slept so close to me. I really don’t want you to catch this.”

He’s frowning, as if it really is a big deal. As if even now, even shivering and feverish, it’s somehow Yves that he’s more worried about right now.

Yves isn’t particularly concerned about that—he has no shortage of  sick time to take off of work, in any case. If he does manage to catch this from Vincent, he’ll just stock up on essentials before the worst of it hits. It would be nothing he hasn’t done before. Still, Vincent looks so—well, so tornby the mere possibility of it that Yves wants to say something to comfort him.

“How about this?” he says. “If you’re so worried about it, you can buy me cough drops next time I come down with something, deal? Then we’ll be even.”

Vincent’s eyebrows furrow. “That’s a terrible deal for you.”

“I’ll get sick at some point in my life, anyways,” Yves says, with a shrug. “If this means I get free cough drops out of it, I’d say it’s a win.”

He moves the desk chair over so he can sit down at the edge of Vincent’s bed. Vincent watches him, uncertain. He looks like he’s resisting the urge to say something—to tell Yves to move further away, probably.

“Relax,” Yves says, reflexively. “It’ll be fine, seriously. I know what I signed up for.” 

He leans forward, presses the back of his hand against Vincent’s forehead. Vincent closes his eyes. A slight tremor passes through his shoulders at the contact, but aside from that, he stays perfectly still.

“Your fever’s worse than before,” Yves says, withdrawing his hand.

“It’s not.” Vincent’s eyes are still shut. “The temperature is just higher because it’s night time.”

The suggestion is so far from comforting that Yves almost laughs. “You know,” he says, “that’s not very reassuring.” The blanket around Vincent’s shoulders starts to slip, so Yves reaches over and snags an edge of it, fluffs the whole thing outwards to lay it neatly around Vincent’s shoulders, like a cloak. Secures it with a loose knot. “Are you feeling any better than before?”

Vincent does open his eyes, now. He looks as though he’s trying hard to figure out how acceptably he can lie. “I…”

“You can be honest.”

Vincent’s jaw clenches. He reaches up with one hand, his fingers curling around the blanket Yves set down around him.

“My head feels heavy,” he says. He screws his eyes shut, his eyebrows furrowing. “And my chest hurts.” He lets out a short, frustrated breath, as if every sentence is a new and difficult admission. “I’m… not used to getting sick like this.”

Yves’s hands still. “Like what?”

“In any way that would necessitate taking time off from work,” Vincent says, looking away. The discomfort sits, plainly and indisputably, in the way he holds himself—his shoulders stiff, his jaw clenched—everything a little too tense, despite his exhaustion.

Yves stares at him for a moment, considering. In the end, it’s the small, impulsive thought that wins out.

He takes a seat at the edge of the bed, next to Vincent. The mattress dips under his weight. 

Vincent has always been taller than him, but sitting down like this, they nearly see eye to eye. It’s a risk, of course, to offer this. He and Vincent haven’t been physically intimate outside of the times where they’ve had to prove their relationship to an audience. But when he thinks back to how Vincent reacted to Yves feeling his forehead, or Yves carding his hands through his hair—if he hasn’t misread, it almost feels like—

Yves opens his arms out in offering, tries on a smile. “I’ve been told I give good hugs. Good enough to cure all ailments, obviously.”

For a moment, Vincent stays perfectly still. Yves has five seconds to overthink all of his actions over the past twenty four hours. 

Then Vincent inches closer, ever so slightly, to lean his head on Yves’s shoulder.

Yves curls his arms around him. There’s the slightest hitch in Vincent’s breath, at the contact. Then the stiffness seeps out of his shoulders, and he presses a little closer—as if he’s allowed himself permission, at last, to let go.

His whole body is concerningly warm. “You’re burning up,” Yves says, softly. He reaches up with one hand to run his fingers through Vincent’s hair.

“...I figured,” Vincent says. The next breath he takes comes in a little shakily. “Whoever gave you the review was right. You are a good hugger.”

Yves laughs, a little surprised. “Careful. You’re going to inflate my ego if you keep talking.”

“I can’t help it if it’s true.”

Yves has hugged a fair share of people in his life. He doesn’t think he’d be able to list them all if he were asked to. It’s different, though, being so close to Vincent—so close that Yves can reach out and let his hair fall through his fingertips. He can lift up his palm and feel the rigid line of his spine, the slope of his shoulders; he could reach out and trace the dip of his wrist, the form of his hand. Vincent’s chin digs slightly into his left shoulder. His nose is turned slightly into Yves’s neck—like this, he is almost perfectly still. Yves can feel the warm brush of air against his neck whenever Vincent exhales. He is so close that Yves is afraid, for a moment, that he might hear how badly his heart is racing.

Would dating Vincent be like this? Would this kind of exchange be given and received as easily as anything? Yves wills himself not to think about it. This is nothing, he tells himself, but a simple offering of comfort between friends. To think otherwise would be disingenuous.

They stay like that for some time. Time slows, or perhaps it expands or collapses—really, Yves would be none the wiser. The whir of the ceiling fan and the light rain on the rooftop a constant. When Vincent pulls away at last, it’s to turn sharply off to the side to muffle a sneeze into his sleeve.

“Hh-! hhIH’IIDZsSHM-FF! snf-!” 

“Bless you,” Yves says, blinking. The sudden absence of warmth is a little jarring. But Vincent isn’t done.

His eyebrows draw together, and he ducks tighter into his elbow, his shoulders jerking forward. “hHIH’iiGKKTsSHH—! Sorry, I— Ihh-! hHHh’DZZSSCHh—uH-!”

“Bless you again,” Yves says, reaching past him to hand over the box of tissues on the nightstand. He holds out the box for Vincent to take.

Vincent turns away to blow his nose. When he returns, he’s a little teary eyed. The flush on the bridge of his nose hasn’t gone away.

“When I asked you to come over,” he says, “I wasn’t expecting you to stay.”

Yves blinks. “Is it so strange for me to be here?”

To that, Vincent is quiet, for a moment. Yves looks out the window, where he can see the skyline, off in the distance, the dark form of the apartment building across the streets, the street in between lit dimly with golden streetlights.

“A little,” he says. “When I was young, if I got sick, it wasn’t really a big deal.”

At Yves’s expression, he amends: “That’s not to say that my family didn’t care, because they did. No one spent too long in my room—better to not risk catching it, if they could help it—but back then, if I didn’t have much stomach room, my mom always cut fruits for me to leave on my desk. Sometimes she made ginseng tea, too.” he shuts his eyes. There’s a strange expression on his face—something a little more complicated than wistfulness.

“We had a habit of keeping the heat off, in the winters, and closing the windows. But if I was running a fever, my brother always made sure to keep the heat on.” His lip twitches, almost imperceptibly. Then: the smallest of smiles. “Sometimes he’d stay outside my door to talk about his day. He was the class lead, back when he was in high school. It was always something inconsequential, like which of his classmates he liked and which ones he held a grudge against, and why. Almost always for the smallest reasons, like someone borrowing a pencil and forgetting to give it back, or someone tossing the ball to him in gym class.”

“Were you and your brother close?” Yves asks.

“Close is relative,” Vincent says. “I never really knew how to—inhabit his world, I guess. When I moved to the states, and when I decided to stay here, part of it was out of some sort of defiance. I didn’t want to have to follow in his footsteps, because then I could only ever be focused on doing things differently.”

He shuts his eyes. “But I felt close to him, then. When he stood outside my room and told me those stories. Even if they were things I wouldn’t have cared about had they happened to me, I guess. It’s strange how that works.”

“I think I know what you mean,” Yves says. He’s always had a good relationship with Leon and Victoire, though that doesn’t mean they’ve always seen eye to eye on things. “Sometimes it’s less about what they say, and more about the fact that they’re saying it.”

Vincent nods. “They all cared about me in their own way,” he says, at last. “I don’t think I appreciated the extent of it at the time. When you’re a kid, you tend to take everything at face value.”

“Do you regret it?” Yves asks. “What?”

“Not appreciating them more, back then.”

Vincent smiles. “I was just a kid. I suppose it’s natural that I didn’t know better.” Yves has a feeling that that statement is perhaps further reaching than Vincent is making it out to be. “I didn’t think much about it at the time.”

“Do you ever miss being part of a large household?”

“It’s peaceful on my own,” Vincent says, at last. “I usually don’t mind it. I usually have other things to worry about.”

He hasn’t asked if the information is useful to Yves, Yves realizes, a little belatedly. Back then, at Joel and Cherie’s potluck, Vincent had seemed to believe that the only way Yves could possibly be interested in him was if the information could serve their fake relationship, somehow.

The realization settles him. Perhaps Vincent has shared this because he knows Yves cares.

“Your apartment is nice,” Yves says, trying to ignore the insistent beat of his heart in his chest, which all of a sudden seems to want to make itself known. “I can see why you would like living here.”

Vincent tilts his head up towards the ceiling. “It’s not the same, of course. As home. Though that’s a given.” Yves notes the usage of the word: home. Here, instead of home, the clarifier salient, even though Vincent’s done nothing to emphasize it. Could it be that after all these years, Vincent still considers Korea to be home, for him? “When I’ve had people over, it was just for dinner. Not for…”

He looks over to Yves, now. Yves knows what he means, knows how to fill in the rest of the sentence: not for the reason you’re here, now.

“I know I’ve intruded a little,” Yves says, with a laugh.

Vincent frowns at him, his eyebrows furrowing. “I wouldn’t consider it an intrusion,” he says. “You’ve helped me a lot. I just—I’m a little embarrassed that your first time over had to be under these circumstances.”

Your first time over. Yves ignores—well, tries to ignore—the implication that this could be the first out of many. That he might have another opportunity, in the future, to swing by. Vincent hasn’t confirmed anything, and it’s not likely that their fake dating arrangement would warrant another house visit, out of the public’s eye. Yves tells himself that the warmth he feels in his chest is misplaced.

“You don’t have to worry about that. I like seeing you,” Yves says.

Vincent raises an eyebrow at him. “Even bedridden with a fever?”

Isn’t it obvious? “Of course.”

“I’ve been terrible company,” Vincent says. “And even worse of a host. I recall I fell asleep yesterday, only for you to spend two hours cleaning my apartment?”

“Vacuuming is therapeutic.”

“You said that about cooking, too,” Vincent says, narrowing his eyes. “Am I supposed to believe that you enjoy doing all household chores?”

“It’s not like you made me do them. I just wanted to be useful, and your vacuum was easy to find.”

“I’ll be sure to hide it thoroughly next time,” Vincent says, deadpan.

Yves laughs. “It’s like I said,” he says. “I like spending time with you. Even—” To steal Vincent’s words from earlier. “—bedridden with a fever.”

Vincent huffs a sigh, a little incredulously. 

“Though, I promise I won’t intrude for much longer,” Yves tells him. “I’ll probably head out in the morning.” He’s almost done with the work Vincent has on his desk—he’d fallen asleep checking over one of the income statements for discrepancies. A few hours should be enough time to make sure that everything is in order. He still has work at eight—he’ll probably be a little tired for it, considering how late he’d slept, but that’s nothing new.

“I’m sorry,” Vincent says, averting his glance. He frowns down at himself, as if he really is apologetic. “You must’ve had other evening plans.”

None as important as taking care of you, Yves catches himself thinking. He can’t say things like that if he wants to keep this—well, this unfortunate recent development, i.e., his feelings for Vincent—to himself.

“It wasn’t just for you,” he says, instead.

“What?”

“I didn’t just do it for you.”

Vincent blinks at him, a little confused. “Are you going to say you get personal gratification out of seeing my apartment clean?”

“It’s like you said,” he says. “I’ve never seen you this unwell. You said this doesn’t happen often, right? When you didn’t show up at work, I…” The next admission feels a little too honest—but there’s a small, unwise part of him that wants to get it across, regardless. “I was really worried. Even though you said you had everything covered, I wanted to make sure you were fine.”

Vincent nods. “I get it. It would be an inconvenience if I were unfit to be your fake—”

“It has nothing to do with that,” Yves interrupts him. His heart hurts a little, with it. “I wanted to see that you were fine because I care about you. To be honest, I think I would’ve spent the entire night worrying if I hadn’t come.” He laughs, a little self-deprecatingly. “It’s a little selfish, I know.”

Vincent’s eyes are very wide.

“Anyways,” Yves says, with the sinking feeling that he’s said too much, “you should try to get some more sleep.” He rearranges the blankets around Vincent, a little unnecessarily, fluffs the extra pillow that’s leaned up against the headboard, and turns away. “It’s still really early. If you’re planning to be back in office next week, it would be best to keep your sleep schedule intact.”

“Yves,” Vincent says, from behind him.

“Hmm?”

“...Thank you.” 

When Yves works up the courage to look over, Vincent is smiling, unreservedly, as if something Yves has said has made him very happy.

Yves’s heart stutters in his chest. Fuck.

(On second thought, it might not be so easy to live with these feelings, after all.)

—

At daybreak, Yves drives home to get changed, takes a quick shower while he’s at it, and heads off for work. He yawns through half his morning meetings, adds an extra espresso shot to the coffee he snags from the break room.

The text arrives halfway through the day, just before he’s intending to head downstairs for lunch.

V: When I asked you to bring folder 2-A, I didn’t mean for you to complete my work along with it.

Yves smiles. He’d emailed Vincent the completed work from yesterday’s late-night work session before he’d left. Vincent must’ve seen it.

Y: some genie i met told me your wish was to have your work done before the deadline

V: What are you talking about?

Y: he also told me you were very stubborn about not redistributing your assignments to anyone else  Y: so you can’t blame me for taking matters into my own hands

V: Yves.

Y: feel free to check it over for errors :)

[suddencolds]

Atypical Occurrence [1/?]

Happy birthday to my dear friend, @caughtintherain!! I wanted to give you some Vincent suffering to chew on for the occasion, so please take this fic (or, first part of a fic) as a gift <3

this is an OC fic - here is a list of everything I’ve written for these two! chronologically, this fic takes place a month or so after the last installment leaves off :)

Summary: Vincent shows up late to a meeting. It just goes downhill from there. (ft. fake dating, the flu, a house visit)

—

Vincent is late.

Yves tries not to stare at the empty seat across from him. The meeting—their first meeting of the day—started five minutes ago. If there’s anything Yves knows, it’s that Vincent always comes in early. 

In stumbles Cara, handling a morning coffee with probably more espresso shots than anyone should have at 8am. Then Laurent, briefcase in one hand, paging through a folder of files in his other. Then Angelie, Isaac, Garrett, Ray, Sienna. Then they get started, and Yves turns his attention towards the graphs projected onscreen at the front of the room, and tries very hard not to think about Vincent.

It’s five minutes later that the door swings open, near-silent.

Sienna—who’s presenting—stops, for a moment, to look back at Vincent from where he’s standing in the doorway, which means that of course, everyone looks.

Cara turns around in her seat, raising an eyebrow. Angelie frowns at him. 

“Sorry I’m late,” Vincent says, quietly. “It won’t happen again.”

Isaac shrugs. Angelie looks a little concerned, but she turns back to her work, anyways. Sienna resumes her presentation. All in all, it’s nothing—or it should be nothing. Probably traffic, on the way here; a particularly unlucky commute. An unlikely occurrence, but—to anyone else—not anything worth dwelling over.

It might be a sufficient explanation, if Yves didn’t know better.

Vincent takes care to close the door quietly behind him, then heads over to the only open seat, across from Yves. He unzips his briefcase, quietly, unobtrusively, and takes out his laptop. Yves tries to focus on what Sienna is saying—she’s giving a review of a client’s current investment strategies; he’d reviewed her work on this just a couple days ago.

Vincent asks good questions throughout—he always has a good sense of what areas still lack clarity, Yves has found. Today is no exception. He takes part in the meeting with such calculated precision that Yves almost misses it.

Almost misses: the slight stiffness to his shoulders, as if it’s taking more than the usual amount of effort to keep himself upright. The way in which he clears his throat before speaking, like it might actually hurt. The way he rests his head on one hand, halfway into the meeting—as if even now, barely forty minutes into the workday, he’s already exhausted.

It’s subtle enough to go unnoticed, subtle enough that Yves wonders if he’s just reading too much into it—if, perhaps, Vincent is fine, after all.

—

He doesn’t see Vincent again until lunch.

Or, more accurately, he doesn’t see Vincent again until he’s headed down for lunch with Cara and Laurent. Vincent is already on his way out of the cafeteria, a takeout container in hand.

“You’re not going to eat here?” Yves asks.

Vincent doesn’t look at him. “I have some work to get done at my desk,” he says. He clears his throat again, like it’s irritating him.

“Okay,” Yves says. Vincent turns to leave, and Yves thinks of a hundred ways in which he could possibly prolong this conversation, and then decides against it. Vincent is already so busy.

“You look tired,” he settles on, instead.

He expects Vincent to dismiss this, to reassure him that it isn’t true. But Vincent looks up at him at last, blinking, as if he’s surprised that Yves noticed at all. His eyes are a little dark-rimmed underneath his glasses.

He doesn’t deny it, which is as much of a confirmation as Yves needs.

“The sooner I can get this work done, the sooner I can go home,” he says. Yves supposes he can’t argue with that.

“I guess I’ll see you around, then,” Yves says, even though he wants to say more, even though he feels like there’s more that he should be saying. “Don’t work too hard.”

Vincent nods, at this, and resumes walking.

—

Yves is probably overthinking it. There isn’t anything concrete, really, to justify his concern.

Vincent’s lateness to the meeting could just as easily be the consequence of an alarm he’d forgotten to set, his exhaustion just as easily a side effect—of recent late nights in the office, of arbitrary changes to the projects he’s on, of last-minute demands from clients.

The next time he sees Vincent is at the end of the work day. Yves always takes the elevators on the north end of the building—they’re ones that lead directly out into the parking garage. When he gets out to the hallway, Vincent is already standing there, waiting for the elevator.

Yves watches Vincent stiffen, slightly. Watches him raise one hand up to his face to shudder into it with a harsh, “HHihH’iKKTSh-hUH!”

A thin tremor runs through the line of his shoulders, as if he’s too cold, even though the office air conditioning is no colder than usual. His hand, cupped to his face, remains there for a moment more before he lowers it.

He sniffles, then, rummaging through his pocket for—something. When he doesn’t find it, he just frowns a little, sniffling again. 

“Bless you,” Yves says.

“Yves,” Vincent says, his shoulders stiffening a little. He clears his throat, turning around so that he can address Yves properly.

It’s only a few seconds later that he’s turning sharply away, tenting both hands over his nose and mouth for—

“Hh-! hHiH—HIHh’DZSSschh-uhh! snf-!”

“Bless you again.” 

Vincent sighs. “Don’t bother.” He really looks exhausted, Yves realizes. During their brief interaction at lunch, he’d already sensed as much, but the harsh white glare of the bright corporate lighting only makes it more evident.

Vincent looks a little paler than usual, if only slightly, and there’s a slight flush that spreads itself over his cheekbones. He looks—well, nearly as put together as always, distilled only by the slight crookedness of his tie, as if it’s been on too tight; the near-invisible sheen of sweat over his forehead. The slight redness to the bridge of his nose, the slight shiver to his hand as he reaches up to adjust his collar.

Yves frowns, taking this all in. “You look kind of…”

“Terrible?” Vincent finishes for him.

Yves winces. “...Well, terrible is a strong word. I was going to say, you look like you could use some sleep.”

“I’m… feeling a little off,” Vincent says, staring straight ahead, as if it’s not an admission at all. But Yves suspects, from the way he avoids eye contact, that perhaps it was something he was intending on keeping private. “You should keep your distance.”

The elevator dings. The sliding doors part, and he steps inside. 

“First floor?” Yves asks, hesitating next to the panel of buttons.

“Yes,” Vincent says. Then, quietly: “Thanks.”

“You know, now that busy season is over, the world is not going to end if you take a sick day,” Yves tells him. “Even if you do like, twice the amount of work as everyone else on the team, if you needed to call out, I’m sure something could be arranged.”

Vincent smiles at him, a little wryly. “I must look pretty bad if you’re saying this to me.”

“Yes, I was lying,” Yves says. “Clearly, you look terrible.”

It isn’t true at all—even here, even like this, Vincent doesn’t look terrible, not even in the least. But Vincent still smiles, at this—a tired smile.

The elevator doors slide open.

“Text me if you need anything,” Yves says, impulsively. “Seriously. Tissues, soup, medicine—whatever. It’s not far of a drive.”

“That’s very considerate of you,” Vincent says. “I will see you tomorrow.” And then he steps out of the elevator, and Yves is left with an inexplicable sinking feeling in his stomach. As far as he knows, it has no place there. Obviously, Vincent can take care of himself. Obviously, Vincent can handle a cold. Yves has nothing to be concerned about.

—

The next day is rainy—a constant, torrential downpour, which makes his commute to work take almost twice as long as it usually does. It wouldn’t be spring here, Yves supposes, without dreary weather like this.

Back in uni, when he rowed crew, they’d practice out for hours out in the rain. Now that he spends the majority of his day inside, he supposes he can’t complain. The shelter of the office building is a reprieve.

Vincent doesn’t show up.

“I think he’s out sick,” Cara says, when Yves asks. “You know, it’s funny. I don’t think I’ve actually seen him take a sick day before.”

“For how hard he works, he definitely deserves one,” Garrett says.

“He seemed fine yesterday, when I saw him,” Cara says, with a shrug. “Probably came on quickly.” Yves nods.

But that isn’t quite right, is it? Vincent hadn’t seemed fine, had he? Yves thinks back to the things he’d noticed—Vincent, uncharacteristically exhausted during the meeting, though it was clear he’d been just as engaged as usual. Vincent, shivering in the elevator, telling Yves to keep his distance. How poorly had he been feeling already, yesterday? How poorly does he have to be feeling today to have called off of work for it?

He finds some time just before lunch to text.

Y: how are you holding up? Y: yesterday’s offer stands if you need me to bring you anything!

He doesn’t get a response from Vincent, which is a little concerning. He checks his phone halfway through lunch, and then twice more, in between his afternoon meetings, just in case he’s missed a notification.

“Are you expecting a text from someone?” Cara says, looking a little curious.

“Just a friend,” Yves says, which is and isn’t true.

To make a point—to Cara, and possibly to himself—he shuts his phone off. He very pointedly does not look at it again for the remainder of the hour.

It’s not until mid-afternoon that he finally gets a response.

V: Sorry to get back to you so late.

Yves sits upright, fumbling with his phone to get it unlocked. The text bubble pops up again, somewhat intermittently, to show that Vincent is typing.

V: If it’s not too much trouble, there’s a blue folder on my desk labeled 2-A.

Yves blinks at this, a little disbelieving.

Y: you’re asking me to bring you work files? Y: arent you supposed to be resting 🤨 Y: paid sick leave, remember? as in, leave your work at work??

V: I meant to pack them yesterday.

Y: that’s like a genie grants you 3 wishes and you ask for an extra day of assignments Y: terrible waste of a wish if you ask me

V: As a genie, you’re quite judgmental

Y: ok ok Y: as your loyal lamp dweller i’ll be over around 8pm with folder 2-A  Y: you need anything else? 

V: Nothing else V: You can just leave them outside my door 

A beat. Then Vincent sends:

V: Sorry to trouble you

Yves thinks of twenty responses he wants to send to that text. Then, thinking better of himself, he shuts his phone off and gets back to work.

—

It’s a little past seven when he finally checks out of the office.

Outside, the rain hasn’t even begun to let up—it falls, straight and heavy, in large, globular droplets. The streets gleam with water. Yves leaves his umbrella in the trunk, tunes out everything but the static of the rainfall, and drives.

Yves has only ever been to Vincent’s apartment once—to pick him up for the New Years’ party Margot hosted—and even then, Vincent had met him at the door. But he recognizes the unit, nonetheless.

For a moment, he considers leaving the folder of files outside of Vincent’s door and taking his leave.

But it’s windy, and he’s afraid the papers might fly away, torn up by the biting wind, and get lost face down in a puddle somewhere, which would defeat the purpose of him coming here in the first place, and would probably also breach some employee confidentiality policy. So instead, he knocks.

It’s silent for a moment. Rain beats down on the slanted rooftops, a constant thrum. 

Yves is about to reach out to knock again, when the door swings open.

There stands Vincent, in a pale blue hoodie and loose-fitting pajama pants, with neat rectangular cuffs.

He looks tired. It’s the first thing Yves registers—the unusual fatigue to his expression, which he can’t quite seem to blink away; the flush high on his cheekbones. The way he holds himself, his shoulders stiff, carefully, defensively; as if despite his exhaustion, there’s a part of him which wishes to appear presentable still.

It’s only a moment later that he’s taking a halting step back, ducking into a hoodie sleeve. Yves catches the shiver of his expression, his eyebrows pulling together, before it crumples, and his head jerks forward with a harsh—

“hHihh’GKkTT—! Hh-!! iHH-’DZZSCHh-uuUh!”

The second sneeze sounds louder and harsher than usual, even muffled into the fabric of his sleeve. It betrays his congestion all at once. 

“Bless you,” Yves says.

Vincent emerges, sniffling a little. When he speaks, he sounds a little hoarser than he did yesterday. “I thought I said you - snf-! - could leave them on the front step.”

“You did,” Yves says, glancing down at the folder in his hands. “But it’s windy, and it’s raining. I figured you’d prefer to have your files intact. How are you feeling?”

Vincent blinks at him. He’s leaning heavily against the doorframe, Yves realizes, one hand gripped tightly around the frame, his knuckles white from the pressure, as if it would take him too much effort to stay upright otherwise. 

“Alright,” he answers. “Thanks for making the trip here. I… it must’ve taken longer, in the rain.” He squeezes his eyes shut, as if his head hurts, as if the light coming from outside is exacerbating his headache. “If you ever need me to pick something up for you, I owe you.”

“You don’t owe me anything,” Yves says. Despite himself, he reaches up to press his hand against Vincent’s forehead.

The heat under his fingertips is alarming, to say the least. Yves blinks, lowering his hand, and tries to keep the worry out of his voice. “Have you taken your temperature?”

Vincent shakes his head. “I don’t think I have a thermometer.”

“Have you eaten, then?”

Vincent averts his glance, looking sheepish. “I… was planning to stop for groceries, yesterday,” he says. Planning to.

Yves thinks back to the elevator ride yesterday. Vincent had probably already been feeling very unwell, then. And yet, he’d talked with Yves as if nothing was out of the ordinary. I’m feeling a little off, he’d said, as if anything about his current affliction could possibly be characterized as “little.” I will see you tomorrow—as if he had really, genuinely been intending on showing up at work. 

“So I take it that there’s nothing in the fridge, either,” Yves says.

“If it’s any consolation, you’ll be pleased to know that I slept,” Vincent says, in lieu of answering.

Then he shivers—the sort of concerning, full-body shiver that is a little concerning, coming from someone who is usually unaffected by the cold—and Yves is immediately reminded that the door they’re speaking through is open.

“Can I come in?” he asks.

“You probably shouldn’t,” Vincent says, before his expression scrunches up, and he’s ducking away with a— “hh—! hHih-II—TSSCHHh-UH! snf-!”, smothered hurriedly into the palm of his hand. He sniffles, emerging with a slight wince. “This came on pretty quickly. It might be the flu.”

“It’s fine,” Yves says. “I got my flu shot in the winter. And anyways, I’ll be careful.”

Vincent is quiet, for a moment. Then, frowning, he says, “I’d feel terrible if you caught this.”

That’s the least of Yves’s worries—he doubts he’s going to catch this. Even if he does, it will just mean a few days off of work. Not the end of the world, by any means. Nothing to warrant the expression on Vincent’s face—Vincent looks upset, as if he’ll really can’t think of anything worse than Yves catching this. Like even the thought of it is worth being upset over.

Yves shakes his head. “Don’t worry about it, seriously.” He pushes past Vincent to step inside and shuts the door behind him. “Here, I’ll set these down on your desk. Where is it?”

“Down the hallway, to the left,” Vincent says.

Yves takes the folder, leaves his shoes at the door, and heads inside. 

Vincent’s bedroom is small and organized—it’s the kind of bedroom that’s tastefully minimal, in the sort of unified manner that implies that everything in it has been carefully arranged. There’s a small white desk in the corner, a stack of files arranged neatly next to Vincent’s laptop, its lid halfway to shut. There’s a bookshelf, leaned up against the wall far; the bottom shelf looks to be filled with textbooks; the top shelf lined with books, both in Korean and in English. The walls are painted slate gray, the carpets lining the floorboards picked out to match, and there are pale blue curtains hanging from the windows, pulled tightly shut.

There are signs here, too, of his illness, but they are subtle. A tissue box, nestled between his pillow and the headboard, half empty. A waste bin at the foot of the bed, conveniently in reach. A small bottle of aspirin on the bedside counter; an empty packet of cough drops sitting at the edge of his nightstand.

Yves sets the folder at the end of Vincent’s desk, next to the rest of his files, and turns to face him.

“You’re not going to work on these until you’re feeling better, right?” he asks.

“Only if I can’t sleep,” Vincent says, which Yves supposes is a satisfactory answer. Then he twists away, his eyebrows furrowing, lifting a loosely clenched fist to his face to cough, and cough. 

The cough is harsh and grating—his entire frame shudders with the force of it, his breaths shallow and raspy. He really sounds awful. This must have come on quickly, Yves thinks.

If it’s upsetting, seeing Vincent like this, it’s even worse to be standing here, in his room, doing nothing. So—if only to make himself useful, if only to convince himself that there’s something he can do—Yves ducks out into the kitchen.

The pantry is meticulously organized—glasses lined up in neat rows; stacks of bowls sorted by size. He fills a glass with water, shuts the cabinets, and takes it back to the bedroom. 

By the time he gets back, Vincent is sitting at the edge of his bed. His glasses are folded neatly, left at the very edge of the countertop.

“Here,” Yves says, crossing the room, holding out the glass for him to take. 

“Thanks,” Vincent says, taking it gingerly from him. He takes a small, tentative sip, and then another—his hands are a little shaky, Yves notices. “You - snf-! - should really go.”

“I’m not entirely convinced you’ll be fine on your own,” Yves says.

“Of course I will be,” Vincent says, with all of his usual certainty. He lays down, pulling the covers over his body. “I have been fine on my own for years.”

It’s meant to be reassuring, Yves supposes. But he doesn’t feel reassured in the least.

“Thank you again for bringing me the files,” Vincent says, at last, shutting his eyes.

“You could’ve asked me to get you groceries,” Yves says. “There’s a supermarket not far from here, right? And you’re out of cough drops.” He takes a few steps over, towards the desk in the corner of the room. “These—” He examines the bottle of ibuprofen on the table. “—are expired.”

“Just because you’ve extended this kindness to me,” Vincent tells him, “doesn’t mean I should take advantage of it.”

Yves blinks, a little taken aback. “It’s only groceries. I wouldn’t have minded, really.”

“See,” Vincent says, with a note of—something in his voice. It sounds a bit like resignation. “That’s just the kind of person you are.”

Yves doesn’t know what to say, to that. 

Before he can think up a fitting response, Vincent’s breathing evens out. Yves lets himself listen to the shallow, steady cadence of it. Lets himself acknowledge the heavy, painful feeling in his chest for just a moment. Then he shuts the lights off and heads back out into the hallway.

[ Part 2 ]

[wyrdsistersofthedas]

Death in the Fade: If a sylvan falls in a forest... (Part 2 of 3)

We’ve answered part one of this ask in Death in the Fade, but it was a very long answer.  Let’s see if breaking it into three pieces will make it more user friendly. 

Part 1: Death in the Fade

Part 2: If a Sylvan Falls In a Forest...

Part 3: A Baroness of Purpose - Justice Outside of the Fade

Theses (I don’t often get to use the plural!): Justice is trapped in the mortal world due to his own desire to fulfill his purpose, his (mostly) mistaken belief that he will fade away and die without a host body, and his growing fascination with the waking world.  The spirits and demons that possess sylvans and corpses return to the Fade as energy, like any other spirit, unless outside forces intervene to continue their purpose.

If a sylvan falls in a forest, does its energy return to the Fade?  (Part 2 of 3)

Sylvans aren’t actually insane; they’re rage demons or other ‘aggressive’ spirits.  Trees offer so little resistance to possession that they don’t cause the spirit/demon to go insane.  It is, however, very rare for another type of demon to possess a tree, probably because rage demons are thought to be “weaker” than most other denizens of the Fade.  Other demons have better options, but rage demons apparently have to make due with whatever they can find as far as possessing shit goes.  Add their permanently irate nature and they spend their years in the mortal world attacking any passersby.  The Grand Oak is a rare example of a tree possessed by a different type of spirit, thus his gentle nature.  

Spirits or demons that possess corpses, on the other hand, are driven insane by their own actions:

“[After crossing the Veil, demons] attempt to possess the first living creature they see.  They are unable, however, to distinguish that which was once living from that which still is... in fact, a corpse provides an even more tempting target to a weaker demon as it has no will with which to resist the possession. The demon cannot rationalize why this is so; it only sees a target and grasps at the opportunity.

A skeleton is exactly that: a corpse animated by a possessing demon. Upon finding itself trapped within a body that cannot sustain it, the demon is driven insane... it seeks to destroy any life that it encounters, attacking without thought to its own welfare.”  -Codex

Justice, again, must be exceptional because he wasn’t driven mad when he was torn through the Veil and forced into Kristoff’s body.

All the evidence so far implies that sylvans and corpses would typically return to the fade as energy like any other spirit or demon.  There are codex entries, however, that say that spirits and demons who are destroyed become wisps or wraiths in both the waking world and the Fade.  This sounds to us like the first step in the spirit reforming its consciousness, slowly gathering more energy and knowledge until it discovers wonders in the Fade and the mortal world.  Wisps seem to be able to cross the Veil with relative ease, probably because their limited consciousness is too slight to be damaged in the passage.  Mages summon wisps to aid with spellcasting, especially healing.  It is likely that wisps can also be corrupted like any other spirit, which results in the nasty wisps that lead travelers astray to their doom.  The codex entry also suggests that wisps or wraiths are the remnants of powerless spirits or demons, suggesting that they were almost destroyed but retain some of their purpose.

In order to fully reform, Solas says that the spirit or demon must be powerful by nature, or be attached to a purpose that is common in the world such as rage, or they need a potent memory to shape their energy.  People like the Avvar use their collective thoughts, dreams, and memories to speed this process along and eventually have a spirit that is or is like their fallen god.  So, unless the corpse or sylvan really makes an impression on the people it meets or is stronger than the average, it is unlikely to reform in a complex way.  But there are always a few exceptions.

The Grand Oak would probably have a better chance at respawning.  He is clearly a more complex spirit, although what type is up for debate, and certainly makes an impression of the mortals he encounters.  The only thing that might trip him up is that he lives in a pretty scary ass forest that few people, besides the Dalish, would want to live in.

Corpses possessing demons respawning would also be quite rare, but there is one very clear precedent for such an occurrence.  The “magister” (arcane horror) who cursed the Stone Brothers in Awakening does respawn, ironically, because the Statue of War cannot stop thinking about taking revenge on the magister who cursed him.  War’s memories draw other demons who then possess the body of the dead magister or cause the spirit that first possessed the magister’s corpse to reform, making it seem as if the magister cannot be killed.  An immortal stone statue hating on a dead magister is probably an atypical occurrence so this isn’t likely to happen too often.  (So...maybe I actually helped the Statue of War because I told him to forget about his anger and go to sleep, then killed the shit out of that magister.  Stay forgotten this time, you bastard!)

-MM

[juniperpublisherscasestudies]

Juniper Publishers-Open Access Journal of Case Studies

Akhilanand Chaurasia

CD4+ counts and Oral Lesions in HIV infected/ AIDS patients- an Indian Perspective

Authored by Akhilanand Chaurasia

Editorial

HIV infection constitutes a main health problem world¬wide. The oral and perioral manifestations are common in HIV infected patients and often influence the debilating general health status, a worse prognosis of the disease as well as a diagnostic factor in the monitoring of the immune status of the patient [1,2]. The vast majority of the HIV infected subjects have presented at least one manifestation in the head and neck area in any state of the disease representing these oral lesions as oral signs of the disease [3,4]. In addition the occurrence of these lesions indicate a great susceptibility for opportunistic infections and a great possibility of rapid progression to AIDS [5]. Acquired immunodeficiency syndrome (AIDS) is an infectious disease caused by the HIV and is characterized by profound immunosuppression that leads to opportunistic infections, secondary neoplasm and neurologic manifestations [6]. India is one of those countries where the HIV epidemic is growing rapidly. The National AIDS Control Organization (NACO) estimated that 1.8-2.9 million HIV-positive individuals were living with HIV/ AIDS in India.

Oral manifestations are common in HIV-positive patients and can be used to diagnose the immune status of patients. The fact that oral lesions can be readily detected by a trained clinician in a standardized, objective fashion without any complicated or expensive diagnostic technique has increased their utility [7-9]. Oral lesions might be considered as the initial manifestations of the disease. Oral manifestations of HIV infection are important in the AIDS epidemic and some of them could be used to assess the status of immune suppression and determine the prognosis of the disease. Some oral lesions may even alter patient’s quality of life. Early diagnosis and appropriate treatment of oral lesions have great influence on patient’s general health and can reduce the mortality rate of the disease [10]. HIV infection remains a significant health care problem. Since Barre Sonoussi and Gallo’s initial description of the human immunodeficiency virus type I (HIV1) in 1983 and Clavel et al. first described HIV2 in 1986, these two viruses have been recognized for almost 20 years as the primary cause of the acquired immunodeficiency syndrome (AIDS) [11].

Oral manifestations are among the earliest and most important indicators of HIV infection [12]. At present, three groups of oral manifestations of AIDS are defined based on their intensity and features. Group 1 is composed of seven cardinal lesions (oral candidosis, hairy leukoplakia, Kaposi sarcoma, linear gingival erythema, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis, and nonHodgkin lymphoma) that are strongly associated with HIV infection [13]. The second group includes atypical ulcers, salivary glands diseases, viral infection such as cytomegalovírus (CMV), herpes simplex virus (HSV), papillomavirus (HPV), and herpes zoster virus (HZV). On group 3 are lesion rarer than those on groups 1 and 2, such as diffuse osteomyelitis and squamous cell carcinoma [14]. The presence of oral lesions can have a significant impact on health related quality of life. Oral health is strongly associated with physical and mental health, and there are significant increases in oral health needs in people with HIV infection, especially in children, and in adults particularly in relation to periodontal diseases. Thus, physical and mental health measures of HIV patients should incorporate indicators of oral functioning and well-being.

Oral manifestations can suggest, decreased cluster differentiated 4(CD4+) T cell count and increased viral load [15] which might also aid in diagnosis, progression, and prognosis of the disease [16,17]. Risk of oral complication increases with immunologic deterioration [18]. Oral examination is therefore useful for early diagnosis which can prolong asymptomatic period, delay disease progression and prevent opportunistic infections with proper education and counseling of patient. The CD4 cell count and viral load have been used lately as the most important laboratory parameter to evaluate the evolution of the disease [19]. Several studies have been focused in the correlation between oral lesions prevalence and the laboratory parameters such as CD4 cell count and viral load in HIV/AIDS patient serum evidencing a strong correlation between the oral lesions, lower CD4 cell count and high viral load concluding that these are involved with monitoring and progression of the disease as well as the antiretroviral therapy [20,21].

The ratio of CD4 to CD8 T lymphocytes (CD4-CD8 ratio) is an important diagnostic marker of immune system functioning. The majority of healthy individuals display a CD4-CD8 ratio in the range of 1.5-2.5 to 1 [22] whereas an inverted ratio is characteristic of intense chronic immune responses such as in graft vs host disease and also in several viral illnesses most notably HIV infection [23]. CD4-CD8 ratio predicts the time taken for progression of HIV infection to acquired immune deficiency syndrome (AIDS) and the long-term survival of AIDS patients [24,25]. The oral and perioral manifestations are common in HIV infected patients and often influence the debilitating general health status and they can serve as a strong predictor for HIV infection. To date, CD4 cell count, viral load are recognized and widely used as a marker of HIV related disease progression [26]. The stage of infection can be determined by measuring the patient’s CD4+ T cell count and the level of HIV in the blood. Acute viremia is associated in virtually all patients with the activation of CD8+ T cells which kill HIV-infected cells and subsequently with antibody production or seroconversion. The CD8+ T cell response is thought to be important in controlling virus levels which peak and then decline.

A good CD8+ T cell response has been linked to slower disease progression and a better prognosis though it does not eliminate the virus. The CD4:CD8 ratio helps determine the risk of disease progression in HIV-infected patients on HAART [27]. Being aware of individual significance of CD4, CD8 cell count and oral lesions in assessing the disease status it was thought worthwhile to correlate whether the presence of specific oral manifestations and the number of different concurrent intraoral lesions among HIV-seropositive patients are associated with the levels of CD4+ cell count, CD8+ cell count and the CD4+/CD8+ ratio and to evaluate whether oral examinations would be an essential component for early recognition of disease. There was higher prevalence of levels of bacterial species in HIV-seronegative than that of HIV-seropositive patients [28]. However a recent animal experimental study shows the presentation of T-cells (including CD4) attenuates the progression of periodontitis [29] .Moreover a study done in HIV-infected subjects found more progression of periodontitis related to low CD4 [30] whereas another study found CD4 has no association with periodontitis progression but high viral load was associated with increased tooth loss [31].

The presence of oral lesion in HIV infected person as well as the presence of wide range of other opportunistic infections is generally accepted as the result of severe immune-suppression caused primarily by destruction of T helper cells after infection by HIV virus. Indeed it has been shown that the low circulating CD4 cell count is associated with the progression of HIV infection to AIDS and used as a marker for the commencement of the patient therapy. We found a close association between the patient’s immune state and the presence of oral candidiasis with an increase in frequency of oral candidiasis as CD4 count decreased. Most of the cases of oral candidiasis were found in low CD4 count (<200 cells/mm3) and pseudo membranous candidiasis was the most common variant. The periodontal disease occurred in less severe immune-suppression with its mean CD4 count being 491. The most common variant linear gingival erythema cases were observed in high CD4 count (>400 CD4 cell/ =mm3) [32].

The hairy leukoplakia was not associated with increasing level of immune-suppression because the presence of this oral lesion did not significantly increase as CD4 cell count decreased. These findings were consistent with the findings of other studies [33,34]. Recently others investigations have reported that a CD4 cell count less than 200 cells/mm3 and a viral load higher than 10,000 copies/ml associated to other factors including tobacco consumption, poor oral hygiene and xerostomia could facilitate the occurrence of oral lesions in these indi-viduals [35]. A low value for CD4+ cell characterizing the presence of immunesuppression is a predisposing factor for the development of opportunistic infections [36,37]. The fact that the average CD4 percentage was low for children with gingivitis and most of them had serious immunosuppression may also be explained by negligence on the part of those responsible for oral hygiene. More lesions are present in the oral cavity in more immunologically compromised patients. This can make it painful to brush their teeth.The relationship between low CD4 and the presence of conventional gingivitis has also been observed by Howell et al [38]. So it can be concluded that CD4+ cell count plays an important role in manifestations of oral diseases.

For more Open Access Journals in Juniper Publishers please click on: https://juniperpublishers.business.site/ For more articles in Open Access Journal of Case Studies please click on: https://juniperpublishers.com/jojcs/ To know more about Open Access Journals Publishers To read more…Fulltext please click on:  https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555573.php

[ourhaileydavies]

Unilateral Bleeding Polyp in a Child: Lobular Capillary Hemangioma-Juniper publishers

Abstract

Epistaxis, though being common, always attracts special attention from medical professionals due to the nature of bleeding involved in the process. Children presenting with unilateral epistaxis warn otolaryngologists as the cause can vary from nasal foreign bodies to life threatening hemangiomas and angiofibromas. We present a rare case of lobular capillary hemangioma originating from nasal septum in a child who presented with episodes of profuse bleed. Early diagnosis and management with total excision was awarding. The occurrence is rare, however it should be in the differential diagnoses of unilateral nasal bleed in outpatient and emergency settings and strong suspicion is warranted.

Keywords: Unilateral bleeding polyp in children; Nasal bleeding polyp; Unilateral nasal bleed; Lobular capillary hemangioma; Hemangioma of nose; Unilateral epistaxis

Introduction

Lobular capillary hemangioma (LCH) is an acquired benign vascular proliferation of unknown origin, which was first described as human botromycosis by Poncet and Dor in 1897 [1]. Skin of head and neck and mucos membrane of the oral cavity are common sites but LCH is rare in the nasal cavity of children. The nasal septum is the most common affected nasal site, vestibule and middle turbinate being the other involved sites [2,3]. We present a case of lobular capillary hemangioma in a nine year old child who had presented with unilateral nasal bleed.

Case Report

A nine year old child presented to the outpatient department of otolaryngology and head and neck surgery with 5 months history of recurrent nasal bleeding from left nasal cavity and left sided nasal obstruction. History of frequent nose picking present. On anterior rhinoscopy, single red fleshy lobulated mass of size 1.5x1.5cm was present in the left nasal cavity surrounded with blood clot. Contrast enhanced Computed tomography (CECT) of Paranasal sinus revealed a heterogeneously enhancing soft tissue lesion attached to the cartilaginous part of nasal septum (Figure 1). Rest of the head and neck and systemic examination was normal. Hence provisional diagnosis of a vascular nasal mass was made. Patient was planned for endoscopic excision under general anesthesia.

Under general anaesthesia, after decongestion of bilateral nasal cavity, evaluation of the nasal mass was done. Endoscopic evaluation revealed a pinkish nasal mass which was arising from the cartilaginous part of the nasal septum (Figure 2). Stalk of the nasal mass was cauterized with bipolar cautery and the tumour was removed into to with sacrifice of 0.5cm surrounding mucosa at the site of attachment of the lesion. Adequate haemostasis was achieved. Anterior nasal packing was done. Anterior nasal packs were removed after 24 hours and patient was discharged. The follow up of the patient was uneventful, Histopathological examination revealed the diagnosis of lobular capillary hemangioma. Microscopic examination showed biopsy tissue lined by focally ulcerated stratified squamous epithelium with underlying lobular arrangement of capillaries surrounding a large central vessel. The lumen of these capillaries varied from barely visible to large vascular spaces. The spindle shaped pericytic cells were seen in the periphery. No atypical mitotic figure or evidence of necrosis (Figure 3 & 4).

Discussion

Lobular capillary hemangioma (LCH) was thought as pyogenic granuloma in earlier times but later denoted as misnomer because of non-infectious and non granulomatous nature. Present terminology of LCH is based on the characteristic histopathological findings described by Miller [4].

Incidence of LCH is more in females as compared to males and is common in third decade of life [5].  Nasal cavity is an unusual site for LCH. Gingiva is a common site of lobular capillary hemangioma. Among the nasal sites, anterior septal mucosa and tip of turbinate's are the most frequent involved sites [1]. The presented case is that of a 9 year old male child who presented with a bleeding polypus of the anterior nasal cavity and which turned out to be LCH. The lesion in this case was found to be attached to the septal cartilage.

Natural history and progression of LCH involves many contributing factors. These include trauma, hormonal imbalances, viral oncogenes, arterioveno malformation and angiogenic growth factors etc [6]. This child had a history of frequent nasal pricking, which could have led to repeated microtrauma and proliferation of vessels to form LCH attached to the nasal septum anteriorly. LCH have also been described as pregnancy tumour [7] due to increased associations with high levels of estrogen and progesterone during pregnancy.

LCH usually presents with various symptoms such as unilateral epistaxis, nasal obstruction, nasal discharge, facial pain, headache etc depending on the site of lesion [6]. This patient had presented to our OPD with repeated episodes of left sided nasal bleed especially after nose pricking. Father of the child had noticed a small red mass in the left nasal cavity for which he brought the child into our outpatient department.

CECT of the nose and paranasal sinuses is the preferred investigation for diagnosis of vascular lesions. Magnetic Resonance Imaging (MRI) with T2 weighted images reveal vascular soft tissue lesions with multiple flow voids [8].

Criterion standard treatment in LCH has always been complete surgical excision of the lesion. Surgical technique and instrumentation used for such kind of lesions include cold instrumentation (with or without preoperative embolization), electrocoagulation, cryotherapy and LASER [9]. We did endoscopic excision of the hemangioma followed by cauterization of its base at the nasal septum which had the feeding vessels in it.

Recurrences of the lobular capillary hemangioma are a rare occurrence. However, evidence in literature report a recurrence rate of 0 to 42% depending on the location, extent of removal and time of follow up [10]. This case has been followed up for 4 months till date and there is no evidence of recurrence of the lesion.

Conclusion

Lobular capillary hemangioma of the nasal cavity is a rare entity especially in a male child in first decade of life. However, it should be considered as one of the differential diagnoses of unilateral epistaxis in children. High index of suspicion is the key for identifying such a lesion. Endoscopy guided complete surgical excision of the lesion is the management of choice for nasal lesions. Recurrence is rare with no malignant transformation reported till date.

To know more about Open Access Journal of Head Neck & Spine Surgery please click on:

https://juniperpublishers.com/jhnss/index.php

To know more about Open access Journals Publishers please click on : Juniper Publishers

[blue-opossum]

Our Mansion with Amazing Amalgamations

        Morning of August 10, 2019. Saturday.

        Dream #: 19,227-02. Reading time (optimized): 3 min.

        This online dream journal entry describes and explains chronological segments from instinctual dreaming, that is, dream exploration and control without so-called lucidity. Such dreams share the same processes, often in the same order towards the waking process. Their content mainly stems from modulatory factors of both (precursory) liminal space and enigmatic space with the usual dream state indicators, vestibular system adaptation, and wall mediation.

        My dream is atypical as it provides two porch settings, one for co-occurrence with liminal space, one for enigmatic space. (Usually, one porch serves as both in an amalgam. Because of that, I mostly only use the typification "porch as liminal space" as enigmatic space is tricky to confirm without reasonable evidence.)

        My ongoing dream vivifies with the process of exploring instinctual realization that I am asleep as has occurred every sleep cycle since I was a toddler. I find myself in the Cubitis house (irrelevant since 1978) without my conscious identity. Earl (half-brother on my mother's side; deceased) is sleeping on the floor in my old bedroom with his head oriented toward the door. It is just light enough to see some detail. I have no recall he had died or any recall of ever having lived in Wisconsin at this point (only this Florida setting). There are stacks of books on the floor. Earl's head is close to one small pile of about four books as he is on his left side (as I am in reality as sleep simulacra in dreams typically match my sleeping position). I tell him to be careful about one possibly falling on his head. (This is my subliminal directive to remain asleep, as books require wakefulness to read.) I see the moonlight through the south window and consider the beauty of my room.

        Dream processes progress toward liminal space emergence. There is a vague backstory of having human remains in a small sack (a play on being in bed). They represent the essence of my dream self being ephemeral illusory "remains" of my waking life identity. It is still nighttime. Regardless of just having been in the house in Cubitis, Florida, I am now on the front porch of the Barolin Street house in Australia. I recall I had placed the remains in the basement but in the open. I also consider I should check to see if there is enough food in the house. I wonder if Earl will need something to eat or drink soon. I soon see bright light shining up through the floorboards. I consider the basement light is on. Eventually, that area of the porch floor (south side) is missing, and I can look down to see one section of the basement. (Note that there was no basement in any house I have lived in, in Australia.) I realize I need to turn the light off, so the public does not see into our basement or start intruding upon that area.

        I go outside and walk around to the back of the Barolin Street house. Nevertheless, I soon reach the front of the Loomis Street house without a second thought. The porch door is erroneously at the south side instead of the front (east). At this point, enigmatic space emerges to a lesser degree. With ambiguity, I consider there may be people active on the street at the front of the house (even though it was the back of the house seconds ago). After I am on the porch, my perception of physicality intensifies. I vividly feel the hook as I fit it perfectly into the eye latch, oriented on the right. (This act is the most vivid part of my dream.)

        I wander around in the basement. I see various packages of food and consider how much effort was needed to place it in different areas. I see many boxes of cereal and packets of potato chips that are almost empty.

        My focus changes. I start thinking that there are two access points at the front of the house, my illusory thoughts again erroneously contemplating the front of the Barolin Street house. However, to the left would be the outside area of the Stadcor Street house. Instead of a basement wall directly in front of me, it is a garage door that opens into the front yard. I falsely recall this is how someone carried the groceries in.

        From here, I step into the lounge room of our present home (W Street). Zsuzsanna says something to me about needing a flashlight (consciousness).

[itshistoryyall]

Part 5: Wrapping Up Europe

(Holy Roman Empire) 

I am not gonna lie, that last section exhausted me. It took some time to get back into a researching worthy headspace. Regardless, this section will be much shorter and will put us up to speed so that we can end with the Salem Witch Trials, and perhaps some modern witch hunts and why that terminology is confusing for the U.S. President to use.

These next trials have casualties numbering in the thousands and occur during one of history’s most tumultuous time periods. Beginning with the Würzburg Trials in 1626, the executions lasted through 1631 with only 219 taking place within the city proper. By comparison, Bamberg, a city with the largest death count, numbered in the thousands. A bit of background before we dive in—the Holy Roman Empire (800-1806) encompassed much of central and western Europe, including all of what is now Germany. During the late 16th/17th centuries the world experienced a period of atypically cold temperatures that caused crop failures, deep freezes, poor survival of livestock, and a higher risk of disease. This is referred to as The Little Ice Age, and as you can imagine pushed tensions to a precipice and made people suspicious. Quickly, all of the calamity that had befallen the common man was blamed on the mystical, and it was believed that only a supernatural force could account for the loss a normal way of life. As we progress through a few decades, there were sporadic executions for witchcraft under each prince-bishop’s rule in Bamberg; however, the real trouble starts with Johann Georg Fuch von Dornheim in 1626. One night a severe frost decimated crops and livestock in a large area, and the slowly fizzled-out witch hunts resumed their prior intrigue—this time with a few major changes. Times were tough, and officials needed a better way to execute witches without wasting precious firewood, so a large crematorium was constructed in the epicenter of the executions. Additionally, Bamberg constructed a large prison to house the insurmountable number of accused. The prison called a Drudenhaus or Malefizhaus, were large structures built with single cells for individuals as well as larger cell sections that could house larger groups of prisoners. The structure in Bamberg, has been all but completely destroyed in our current time, and we have little information on what it actually looked like, but what we do know comes from prints that were illustrated within a pamphlet distributed during the time of the executions. In the prints we can see some of the layout of these prisons as well as some inscriptions on plaques above the entrance.

“And at this house, which is high, every one who passeth by it shall be astonished and shall hiss; and they shall say, ‘Why hath the Lord done thus unto this land and to this house?’

 9 And they shall answer, ‘Because they forsook the Lord their God who brought forth their fathers out of the land of Egypt, and have taken hold upon other gods, and have worshiped them and served them; therefore hath the Lord brought upon them all this evil.’”(1 Kings 9:8-9)

The other passages were in a medieval dialect of German that was difficult to translate, so I did not, but there were also passages from the Bible covering the walls within the hallways. Those accused of witchcraft were held here and tortured. I don’t know if any of this is starting to sound really familiar or not, but it seems to me as if it shares a few similarities to a large-scale genocide that occurred about three centuries after these events.[1]

(Picture Public Domain)

One of the most important sources of information that we have regarding the torture of prisoners is the letter that one of the victims, Johannes Junius, had written to his daughter explaining his confession of practicing witchcraft. He mentions in the letter that he had already been tortured, and that some kindly executioner told him that if he didn’t confess in some way that he would continue to be tortured until it killed him. Since Johannes had already faced severe torture, he decided to take the less painful route and confess to the crimes that he was falsely accused of. In the margins of the note he details that some of his accusers apologized to him because they were also forced to accuse him with the threat of torture.[2] The executions and torture went on for quite some time until the working class began to realize that no one was safe from the accusations which were synonymous with execution at this point, and began to refuse to contribute fire wood, or other important materials that were needed to perform the executions. The final nail in the coffin, after the chancellor of Bamberg himself, was the execution of a wealthy woman named Dorothea Flock. She was the second wife of the city’s councilor whose first wife was also executed for witchcraft. Dorothea’s family quickly tried to have her released and every effort was thwarted. Eventually, her husband entreated the highest council of Germany known as the Hofrat to send release documents to have her taken out of the prison and returned home. However, the witch hunters were tipped off about the arrival of the letters, and they executed Dorothy before they had a chance to be delivered. This did have a positive outcome, though, and the trials were halted pending an investigation by the Hofrat in 1630, leading the Catholic Church to blame the bishop for the issue. There remained a small trickle of executions for two more years until the Swedish Protestant troops arrived in Bamberg and released the remaining prisoners asking that they refrain from divulging information regarding the activities taking place inside the prison walls.

The last European trial I wanna talk about is not so much a trial as it is a giant historical scandal which are by far the most fun topics to research when sifting through a ton of material. It is called the Affair of Poisons, and it took place in France during King Louis XIV’s rule between 1677-1682. This is not a prominent number of casualties; however, it is one of the closest occurrences to the trials that occurred in the American Colonies. I find this particular event especially interesting because this is the only case where some essence of a realistic explanation is the root cause of the accusations and consequential executions. It all began with a tale as old as time—an arbitrary case of a woman conspiring to poison her father and two brothers so that she and her lover could inherit the estates and money. The accused, Marie Madeleine d’Aubray, marquise de Brinvilliers, was a part of a Parisian fad to dabble in the spiritual and exciting aspects of magic, and she visited her regular spiritual councilor to procure the poison that she used to murder her family. Often this popular fad would include seances, fortune-telling, and love potions that were very très chic at the lavish parties that the French aristocracy was widely known for, and its popularity spanned the gap between classes including bourgeoisie and poorer peoples of France.

The fun was short-lived, however, and Marie’s trial drew a lot of attention and spurred the anxieties of other nobles who were afraid something similar might happen to them. A special court was instituted to help quell these panic-driven accusations. Known as chambre ardente, or burning court, the court held 210 sessions over three years and issued 319 arrests.[3] Once fortune tellers were arrested for providing poisons to murderers, they gave up lists of their clients—these lists gave no distinction between those who might have had a spiritual reading versus those that had purchased a poison with the intent to murder someone. The most famously known execution is that of Madame Monvoisin, whose client list included marquises, family of clergy members, military heroes, and many more of France’s most elite members of society—including, Madame de Montespan, mistress to the king. Montespan was accused of having won the king’s love via potions and other nefarious and manipulative magical means, but it is important to note that she was interrogated while intoxicated and was never proven to have taken part in these dealings. The tribunal that was established to deal with these cases is notable because it is one of the only witch hunts to have been conducted so professionally, and with far less of the hysterics that were typical of other trials on this scale. There were only 36 people sentenced to death and many others were not even brought to trial.

So concludes our European adventures, and I think that we can without a doubt say that it doesn’t even begin to end there. There are still so many other cases that I didn’t look into because of the sheer amount of information that needed sorting through, but I hope that the important information about this topic was conveyed clearly and in a memorable way. I know that I certainly learned a lot from this part of the project, and I’m looking forward to finishing it with the conclusions we can draw, the historical implications of these events, and the parallels that we can draw from these events that reflect on recent and current events. See you guys in America circa 1692!

[1] That would be the Holocaust that I’m referring to here. You know, the one where they built prisons that they tortured people in on massive scales? Wait, wasn’t that about religious intolerance too? It’s almost like it’s always about religious intolerance….weird

[2] (History Muse, 1628)

[3] (Encyclopaedia Britannica, 2010)

[suddencolds]

Vincent + Yves | Fic Masterlist

here's a masterlist of everything I've written for these two, listed in chronological order! you can also find everything under the [yvverse tag] :)

—

I. Fool Me Twice

[Part 1]

[Part 2]

[Part 3] (edit: check out @mallangkonddeok's lovely comic!!)

[Part 4]

[Part 5]

[Part 6]

II. Foreign Home

III. Small Price to Pay (edit: now w this lovely comic I commissioned from @kotyonoksnz!)

IV. The Worst Timing

[Part 1]

[Part 2]

[Part 3]

[Part 4] (edit: check out @unstifled's gorgeous art for this!!)

[Part 5]

V. Atypical Occurrence

[Part 1]

[Part 2] (edit: added a very long author's note regarding the construction of this chapter)

[Epilogue - Of Painkillers and Lenience]

—

edited to add: filled out a picrew of them! (under the cut)

[adtwixt]

Adtwixt - News: Un accident survenu sur l’autoroute à Verdun aurait pu avoir des conséquences dramatiques, hier, mardi 4 juin

Une voiture a quitté la route avant de s’encastrer dans une barrière de sécurité. Le chauffeur du véhicule s’en est sorti indemne. Notons que cet accident a provoqué un ralentissement sur ce tronçon d’autoroute. Verdun : une voiture s’encastre dans une barrière de sécurité The post Verdun : une voiture s’encastre dans une barrière de sécurité appeared first on inside news :. #Home

You're reading Cracking the Herpes Encephalitis Code | Causes, Symptoms and Treatment, originally posted on Pick the Brain | Motivation and Self Improvement. If you're enjoying this, please visit our site for more inspirational articles. Herpes Encephalitis resembles a psychiatric syndrome onset due to the invasion of the Herpes Virus. The correlation between herpes and Encephalitis is rare, but the instance itself is a nightmare for Encephalitis patients. The Central nervous system of the brain gets populated with a host of Herpes DNAs and those DNAs start replicating inside their host swiftly to take over the immune system. Inflammation with excruciating pain in the brain, the experience is not so pleasing for herpes patients. Herpes Cure Care is a website dedicated to providing credible and science backed information on herpes. If you want in depths of Herpes Encephalitis, we have a dedicated and in-depth analysis post which can be accessed through "The Dangers of Being Careless on Herpes Encephalitis." Herpes Simplex Virus 1, 2, and Varicella Zoster Virus are the prominent executioners of infection in the brain. HSV 1 and HSV2 are common viruses across the globe with an exclusion of Varicella Zoster Virus, which primarily affects the anterior and posterior structure of the eyes. Varicella Zoster Virus may infect the nervical structure through trigeminal or olfactory nerves, and this eventually may result in Herpes Encephalitis. Herpes Encephalitis- Deep Understanding Herpes Encephalitis is an atypical infection of the brain with an occurrence rate of 1 in every 200,000 to 250,000 individuals. A majority of herpes encephalitis instances occur due to the disease caused by Herpes Simplex Virus 1. According to Jamanetwork, a journal dedicated to providing health information, "HSV 2 infection in the central nervous system is the most probable cause of acute meningitis but not subacute Encephalitis. They rarely involve brainstem." Though, some cases have been registered in the medical scrutiny where the occurrence of involvement of brainstem had put the scientist community in shock. Symptoms of Herpes Encephalitis Headache followed by fever, muscle pain, with the stiff neck are most common symptoms which may upgrade to its severity and may start radiating to more severe afflictions. At the initial stage of herpes encephalitis infection, the symptoms are often mild or unnoticeable but as the condition starts getting it's back straight, the more severe health complications a patient has to suffer. We are enlisting some of the severe Herpes Encephalitis Symptoms which should be taken as a warning sign. As soon as you start seeing any of the enumerated symptoms, you are advised to see your GP. ⦁ Hallucination ⦁ Problem in coordination ⦁ Seizures ⦁ Confusion ⦁ Loss of vision ⦁ Memory loss ⦁ Difficulty in communication with words. Exploring the diagnosis options [caption id="attachment_65684" align="alignnone" width="300"] Exploring the Diagnosis Options[/caption] Every health condition comes with a mild symptom, which often starts deteriorating if no preventive or healing measures exercised. In the event that any of the symptoms as mentioned above outbreaks, one should consult with the doctor. The role of diagnosis is pivotal to manage the herpes encephalitis and its symptoms successfully. Early diagnosis may emphasize the healing process to be instantly in case of encephalitis before it touches the dead end. There are many conventional ways to diagnose Encephalitis out of which we hand-picked some of the most definitive approaches. 1. Polymerase Chain Reaction Test (PCR) It is one of the most sought after examination methods requested by General Physicians. Cerebrospinal fluid is sampled out of the brain or spinal cord to examine any potential health risk or diagnosis. In the PCR test, the fluid may give the doctors an idea of the type of infection in the brain. Though, a very low numbers of test yield positive response. 2. Lumbar Puncture Test A lumbar puncture test can help in assessing any severe infection of the brain or any part of the central nervous system. A needle may be inserted into your spinal tab between the two bones of your spinal cord, and a kind of fluid is extracted to send the sample for further evaluation. It is not painful as the area numbed by the healthcare professionals. This test may help in identifying your herpes encephalitis without delay. 3. Blood Culture Test It is a test where the blood samples are sent to the laboratory for the evaluation of herpes virus in the bloodstream. It may help you understand whether the blood is transporting the pathogens or not. 4. CT Scan Computed Tomography or CT Scan test is performed to perceive if there are any bone or muscles disorders present in the affected part of not. CT scan may also identify if there is swelling in the brain. When it comes to diagnosing herpes encephalitis, CT scans are not that comprehensive compared to MTI detection. 5. MRI (Magnetic Resonance Imaging) It uses a powerful magnetic ray to form the images of the organs and other internal body structure. It is used to help detect any sort of disease in the brain or other organs of the body. When it comes to herpes encephalitis, MRI is one of the most comprehensive tricks to know the swelling of the brain-stem and its surrounded area. Treatment to Help Ease the Symptoms of Herpes Encephalitis Prompt treatment of herpes encephalitis is imperative, which opens up a broad spectrum of effective treatment options. If there is any delay in initial stage treatment, the propagation of the herpes virus may take the brain into its custody. Therefore, it becomes an essential factor to commence the medication as soon as the definite diagnosis of herpes encephalitis. Below we have compiled some of the effective treatment options that could be exercised as treatment mechanisms. 1. Use of Anti-viral drug The practice of taking antiviral drugs may significantly improve the symptoms within days. Medicines such as Zovirax, acyclovir, Valacyclovir are some of the best options which can be relied upon to treat herpes encephalitis. We know that herpes cure is far thinking as of now, but we certainly can limit the symptoms produced by the notorious virus. It also should be noticed that if one has developed an advanced stage of Herpes Encephalitis infection, the antiviral therapy may or may not work. Those who also have developed the drug resistance, the treatment may not do wonders for you. Seizures associated with herpes encephalitis can be healed through anticonvulsants. 2. Adequate intake of fluid Adequate intake of liquid may speed up your healing process. The fluid helps the metabolism function at its potential, and your metabolism is the part of your immune system, with that said, adequate supply of water into the body will speed up the healing process. 3. Keep Anxiety and depression at bay People often found to have developed psychological conditions if they are suffering from a chronic and incurable disease. Though we accept the herpes encephalitis is incurable, but we can limit the complications caused by the infection at any stage of the infection. Some studies have correlated the anxiety with frequent outbreaks of herpes infection. Therefore, you are advised not to let the psychology rule your mind. Conclusion Herpes encephalitis may rule your body but don't allow the infection to take over your brain. Herpes encephalitis is suppressible and so its symptoms if managed with great attention. Antiviral drugs such as Zovirax, acyclovir, Valacyclovir are some of the prominently used drugs in suppressing therapy of herpes infection. You are counseled to see your GP as soon as the very onset of any symptoms described above. You've read Cracking the Herpes Encephalitis Code | Causes, Symptoms and Treatment, originally posted on Pick the Brain | Motivation and Self Improvement. If you've enjoyed this, please visit our site for more inspirational articles. #Home AMAZING MACHINES THAT CAN DO COOL THINGS For copyright matters please contact us at: copymanager.mn@gmail.com Mind Warehouse ► https://goo.gl/aeW8Sk #Home We see a lot of natural beauty products around here. Like, a lot. As summer arrives, we finds ourselves returning to a short list of tried and true products we know will keep us tan, smooth, cool -- and all the other things we want to be June through September. Here are all thirteen... castor oil lash and brow wand | Castor oil is an incredible ingredient for promoting hair growth. Swipe a little onto brows and lashes every night and watch them get thick and gorgeous after a couple of weeks. Work this easy single-ingredient step into your daily routine for the ultimate no-makeup hack. CHECK OUT dphue scalp scrub | Shampoo only goes so far during the summer, when our locks are collecting sweat, sand, and dry shampoo. If you rely on dry shampoo more often than you should, you're going to want to order a scalp scrub ASAP. Easier to use than it sounds, scalp scrubs leave scalp and hair feeling clean on a level we can't get over.  CHECK OUT   ice roller | You don't know bliss until you pull one of these babies out of the freezer on a hot summer day. We love using ice rollers across the face to reduce redness and de-puff. It's also amazing if you've hiked a little too hard and need to give your muscles some relief.  CHECK OUT vita liberata tanning mousse | Getting that perfect summer glow doesn't have to compromise the health of your skin. This non-toxic tanning mousse is a great natural shade, gives strong color and lasts long without creating weird splotchy patches. CHECK OUT sw basics powdered aloe | Traveling anywhere with aloe vera gel is impossible. S.W. Basics little packets of this dry aloe powder make addressing the first signs of too much sun a snap. Mix a bit of powder with water to form an ultra-soothing paste. Need a little hydration boost? Blend some powder into your usual lotion or face serum and let the aloe work its magic, without dealing with a cold gloopy mess. CHECK OUT one love body scrub | There's no better beauty ritual to kick off summer than a body scrub. It will sloff off winter dryness and prep your skin for bronzer, tanner or a good summer moisturizer. This vitamin C infused body polish contains an ultra-concentrated combination of vitamins, shea butter and sugar crystals to exfoliate gently and nourish deeply. CHECK OUT gerolsteiner water | Does water count as a beauty product? In this case, yes. Gerolsteiner sparkling mineral water is packed with magnesium, meaning as you're hydrating you're mineralizing too. Gerolsteiner and Pellegrino made it into this video on our Editor In Chief's daily diet.Both waters contain a ton of beautifying minerals that are easy to sip on all summer long. CHECK OUT The sign Tribe nail remover cream | Between beach days and pool adventures, our manicures don't stand a chance during the summer.This game-changing polish remover comes in cream form. Simply dot a dollop onto your nail and swipe away you polish. It's the fastest, easiest, most gentle at-home mani hack we've ever tried. CHECK OUT C and the moon body scrub | This delicious body scrub was called out by Kim Kardashian as one of the best ones ever -- and we coun't agree more. The ingredient list looks a lot like a healthy cookie recipe (in a good way) featuring brown sugar, coconut oil, sweet almond oil and jojoba seed oil. It leaves skin amazingly hydrated and smells divine.  CHECK OUT kosas sport lip | This majorly hydrating new lip product with SPF is designed for our sweatiest moments, whether that's an intense workout or a long day at the beach. Infused with hyaluronic acid and nourishing natural oils, it effectively plumps, soothes and smoothes lips. CHECK OUT vivesana sunscreen | No list of essential summer beauty products would be complete without a luxe natural SPF. Vive Sana's light-feeling, organic formulas are some of our favorite for their natural ingredient list, quick absorption and non-greasy feel. CHECK OUT The post Castor Oil + Scalp Scrubs: 13 Picks On Our Summer Beauty Short List appeared first on The Chalkboard. #Home Adtwixt - News source http://feedproxy.google.com/~r/Adtwixt-News/~3/B0NCU4XCB50/un-accident-survenu-sur-l-autoroute-a-verdun-aurait-pu-avoir-des-consequences-dramatiques-hier-mardi-4-juin

[healthchoicerhodeisland]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3364648/?report=printable

What is regressive autism and why does it occur? Is it the consequence of multi-systemic dysfunction affecting the elimination of heavy metals and the ability to regulate neural temperature?

Graham E. Ewing

Montague Healthcare, Mulberry House, 6 Vine Farm Close, Cotgrave, Nottingham NG12 3TU, United Kingdom

Correspondence to: Graham W. Ewing, Director, Montague Healthcare, Mulberry House, 6 Vine Farm Close, Cotgrave, Nottingham NG12 3TU, United Kingdom.

Copyright : © North American Journal of Medical Sciences

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

There is a compelling argument that the occurrence of regressive autism is attributable to genetic and chromosomal abnormalities, arising from the overuse of vaccines, which subsequently affects the stability and function of the autonomic nervous system and physiological systems. That sense perception is linked to the autonomic nervous system and the function of the physiological systems enables us to examine the significance of autistic symptoms from a systemic perspective. Failure of the excretory system influences elimination of heavy metals and facilitates their accumulation and subsequent manifestation as neurotoxins: the long-term consequences of which would lead to neurodegeneration, cognitive and developmental problems. It may also influence regulation of neural hyperthermia. This article explores the issues and concludes that sensory dysfunction and systemic failure, manifested as autism, is the inevitable consequence arising from subtle DNA alteration and consequently from the overuse of vaccines.

Keywords: autism, physiological systems, autonomic nervous system

Introduction

That the occurrence of autism has risen steadily in the last decades is not in dispute. Prior to the 1930's and the introduction of vaccinations autism was unknown. By 1968 in the UK, when Polio and DPT vaccines were given at 6 and 7 months autism was very rare. In 1988, when Polio and DPT was given at 3 months, DPT at 5 months and MMR at c13 months autism rates were still low. In 1996, when Polio and DPT/HIB injections were given at 2, 3 and 4 months, followed by MMR at c13 months autism rates began rising rapidly. By 2006 the occurrence of autism had reached pandemic proportions. In the period shortly before the 1980's the occurrence of autism was estimated to be circa 3-5 per 10,000; the majority having autism from birth[1]. Since the introduction of multiple vaccines the prevalence of autism has increased to an estimated 1 in 166 i.e. 60 per 10,000. Furthermore the trend is that of a continued increase. Some British teachers are claiming to see ASD in one in every 86 children[2]. This is supported by research which suggests that one in 100 British children may have some form of autism[3] and that ASDs are more prevalent than hitherto imagined[4] i.e. only severe cases of autism are recorded in the statistics. Such claims have been dismissed as mere speculation on the basis that there is not yet definitive proof of such claims however the perceived lack of evidence does not indicate that proof does not exist[5,6]. It may indicate that the understanding of the condition remains ‘beyond the prevailing level of knowledge’ (Table 1) [7].

By 1985 the incidence of regressive autism had equalled that from birth. By 1997 both types had increased although the regressive form was now >75% of the total occurrence. This suggests that an acquired condition was overtaking birth defects or purely genetic conditions. Autism affects four boys to every girl[10]. By contrast Autism appears not to occur in communities which do not use vaccines[11]. It occurs in immigrants from tropical climates who appear to have greater familial predisposition to autism[12] e.g. among Somali students in Minneapolis there was a rate of 1 in 28 (which compares with the local average of 1 in 56). This is more than five times the national rate of 1 in 150. Since the 1960's the number of vaccines given to a child before entering school has risen to c33. In children born to military families the occurrence of autism may now be as low as 1 in 67. In the vast majority of cases, the emergence of autistic indications appears to happen in children who had developed normally[10,13,14], and before three years[15,16]. The development of normal immune function appears to cease in the second year and is linked to the schedule of vaccines[17] and/or the MMR vaccine[18,19]. The consequences to society are estimated at c£2.4M in an autistic child's lifetime[20] which, if it continues to increase as many predict, will impose an unsustainable financial burden upon healthcare, education and social welfare systems.

The Systemic Nature of Physiology and Function

The body is a bio-dynamic, wholistic and systemic organism. It responds to sensory input which enables the autonomic nervous system thereby influencing behavior, the regulation of physiological systems, and function of the visceral organs (Fig. 1). The established association between visual perception, the autonomic nervous system, physiological systems, and biochemistry[21] raises issues which may be relevant to autism research.

Different diseases are associated with differing colour perception[22] e.g. a yellow-blue deficit in diabetes[23], etc

Different drugs are associated with altered color perception[24].

Enzymes/Proteins are active in the visual spectrum[25,26].

Suppressed immune function affects cognition[27]. In particular, t-cell deficiency (a common indicator of stress) is linked to cognitive dysfunction.

Any form of biochemical variation must therefore influence sense perception, sensory coordination and cognitive function. The existence of the physiological systems is not in doubt although there is not universal agreement on their structure. There is wide recognition that they regulate the function of organs (in each system), and that there are higher and lower levels for each system (homeostatic limits), however such systems remain an elusive and under-researched area of medicine. The Russian researcher I.G.Grakov[28,29] has mathematically modelled the consequences of cognition upon the autonomic nervous system and physiological systems. This included identifying and mapping the nature and structure of the physiological systems (Table 2).

Physiological Systems

Sleeping, Breathing, Digestion, Excretion, Osmotic Pressure, Blood Pressure, Blood Cell Content, Blood Volume, Blood Glucose , Sexual Function, pH, Temperature, Posture and Locomotion. See Table 2.

Such an explanation is highly inclusive and complete by comparison to the currently accepted but exclusive and limited explanation. The essential functions of temperature, sleeping and pH are now included; excretion is not limited to urination; whilst blood cell content (and other related systems) comprise what has hitherto been regarded as the immune system. Absorption of nutrients is influenced by system function including (but not limited to) blood pressure, blood volume, blood cell content, pH, temperature, etc. Elimination of toxins is similarly influenced by the complexities of system function.

The brain manages the autonomic nervous system and the function of the physiological systems. In addition, the brain waves are in a dynamic relationship with molecular biochemistry illustrating how drugs can be used to influence the body's biochemistry in order to act upon the symptoms of disease and how brain wave technologies such as neurofeedback can be used to alter the brain waves, physiological systems, organs, cells and molecular bio-chemistry.

Such systems regulate the function of the body's biochemistry e.g. (1) Most enzymatic reactions in the body are temperature dependent and catalysed by Magnesium. (2) The body requires maintenance of pH within a narrow operating range, and also the supply of minerals and vitamins/cofactors, to catalyse protein-substrate reactions in the body. (3) Appropriate blood volume, blood pressure, blood cell content and pH are required to ensure optimal absorption of minerals, vitamins, fatty acids from the intestines.

It is increasingly accepted that the synchronised activity of groups of neurons[30] in functionally coherent structures (the physiological systems), which exist in the brain and the body, synchronise their electrical impulses[31]. This may be evident when noting the evoked visual potentials, indicative of neural synchronisation, which are atypical in autism[32] and which may be part of the processes influencing sense perception (figure 1), sense coordination, memory[33], learning, etc. If so, this indicates that sensory input through the neurovisual pathways is integrated into actions, behaviour and movement and that learning requires synchronised activity between the brain, sensory organs[34–36], and visceral organs. This is severely disrupted in the autistic[37]. Autism affects the function of all of the brain[38–40]. It is a neurobiologic, multi-systemic disorder i.e. affecting the function of every organ but not necessarily its structures[41]. It affects all aspects of the autonomic nervous system and hence influences all aspects of brain's function including that of neural networks involved in learning, memory, the function of the senses and the visceral organs.

The cerebellum, considered to be implicated in autistic spectrum disorders[42] comprises an estimated 50% of the brain's total processing capacity yet its role is not clear or understood[43]. It is involved in the accumulation of sensory data from the internal environment, including the organs in the body and those in the brain (including the sensory organs), thus distinguishing between sensory input from the external environment (a significant function of the cerebrum) and that of the biochemistry affecting the function of every organ (a significant function of the cerebellum), including the cerebellum. Such a role includes the processing, regulation and distribution of this data, through structures such as the Purkinje cells in the cerebellum which are attached by nervous structures to every part of the body. This includes the receipt of biosignals involved in the processes of movement, coordination and balance. Impaired flow of data to the brain via the cerebellum (and brainstem) may lead to functional problems affecting the body's fine control of e.g. balance, coordination, etc. Movement and balance involve the coordinated function of all body systems and organs and are coordinated by (1) sensory feedback from the external and internal environments and (2) the allocation of energy resources to and from each organ. They are dependent upon the precise nature, and timing, of data about each organ being provided to and by the cerebrum andcerebellum. This illustrates how the brain determines behaviour and actions appropriate to developing situations. It illustrates how changes at the organ, cell or molecular level influence brain function and vice-versa.

There are indications of cerebellar dysfunction in autism[44]. Inhibited flow of data to the cerebellum may be followed by developmental decay, cerebellar dysfunction[45,46], and reduced size of brain-stem. This is equivalent to the ‘use it or lose it’ phenomena affecting muscle tone and function.

Without cognitive input the brain cannot and does not function. Disease and drugs create cognitive dysfunction, altered sense perception, in particular affects visual perception. Accordingly, vaccines must also influence sense perception and coordination. Vaccines have a long-term influence and hence may have a more pervasive influence upon sense perception.

Our cognitive function depends upon the extent and coordination of sense perception i.e. between the eyes, ears, nose, mouth and skin. Genetic and/or environmental influences affect sense perception, the degree of sensory coordination and ultimately our connectedness with the surrounding world. Visual function is linked to the primary mechanism (rods, cones and pigments) but is also influenced at the biochemical level – noted by how pathology and drugs alter color perception[22,47] and affect the magnocellular and parvocellular neurovisual pathways which alter color perception and visual contrast. This influences the stability and function of the autonomic nervous system[48] and alters the processes of memory fixation, concentration, and behavior[49].

Anyone contracting disease e.g. measles, mumps, rubella, tetanus, etc; experiences altered visual perception therefore a weakened strain of the disease e.g. in vaccines, must also influence visual perception/cognition. Chronic disease is also accompanied by significant cognitive dysfunction and influences the coordination and processing of sense signals by the brain. The greater the number of illnesses, drugs or vaccines[50] the greater the alteration to the body's biochemistry therefore the greater its influence upon sense function and the degree of sensory distortion. It influences the autonomic nervous system and physiological systems and hence the coordination and function of every organ – visceral and sensory. This is a significant feature of autism[51,52].

Almost all diseases are linked to cognitive and behavioral disorders. Conversely, behavioral traits are influenced by biochemistry e.g. testosterone, oestrogen, cortisol, oxytocin, adrenaline, etc. Oxytocin influences the formation of social bonds influencing social engagement and attachment - which are dysfunctional in the autistic child[53–57].

Autonomic nervous system dysfunction?

In general problems with the stability of the autonomic nervous system[21,58] can be expected to be manifest as follows:

Loss of Sense perception and Sensory Coordination

System dysfunction (e.g. influencing breathing, blood pressure, heart rate, etc)

Behavioural dysfunction (including learning problems, information feedback)

Problems with Diet and Elimination (of toxins and wastes)

Impaired and/or Delayed Neural Development

Atypical brain waves

These are prevalent in autism.

Evidence of Systemic Dysfunction in Autism

Multi-systemic dysfunction is associated with a wide range of physiological disorders e.g. diabetes and obesity[59], cancer, cardiovascular disorders, pre-eclampsia, dyslexia[60], depression, etc. It affects the central[39] and autonomic nervous system in autistic children[61]. Systemic dysfunction in Autism includes that of temperature, blood cell content and immune function[62], blood pressure[63,64], digestion, excretion, posture and locomotion, sleep[65–67], pH, breathing; respiration rates, lower skin temperature. Each influences metabolic rate[68]. Autonomic dysfunction has also been linked to problems with appetite, swallowing food, nausea, recurrent vomiting, and abdominal bloating; constipation or diarrhoea; dry eyes, dilated pupils; dry skin, flushed skin following a meal, abnormal sweating, and unexplained high fevers; sleep apnoea, insomnia; bed-wetting, difficulty urinating, difficulty potty-training; altered perception of pain, sensory defensiveness, poor socialisation skills, anxiety, phobias, tics, emotional instability; and light intolerance. That autistic seizures are often linked to neural blood flow[69–71] is supported by fact that medications used to raise or lower blood pressure can alter the occurrence of seizures and improve sleep in the autistic child.

Autism affects sensory processing and sensory coordination[72] which is manifest in various ways e.g. tactile perception[73], vision[74], hearing[75], and smell. Autistic children may also display synaesthesia in which sensations become confused with one another[76]. Sounds may be experienced as touch or as visual stimulation e.g. autistic children may cover their eyes when they hear a loud sound. That autistic children have such sensory synaesthesia and sensitivity may indicate that their brains have extreme problems with sensory processing, regulation and coordination[77,78,60].

Vaccines and Vaccine Side-effects

Background

The introduction of modified live viruses as vaccines enable the virus to attach its genetic material into the cell which replicates i.e. the host cell continues to function whilst producing the viral protein. This stimulates the production of antibodies. Under normal circumstances exposure to a viral disease would be countered (in vivo) at various levels enabling the body to steadily increase its immune response. By contrast, the injection of vaccines directly into the blood system overpowers the normal immune response leading to its rapid depletion. It is now suspected that long-term persistence of viruses and other proteins may produce chronic disease i.e. instead of producing a genuine immunity the vaccines are altering the body's systemic and biochemical stability, suppressing the production of differing types of white blood cells and hence immune function. Furthermore the introduction of many vaccines (up to 30 in a typical vaccination schedule) introduces a large number of foreign proteins which may be sufficient to ensure that immune function never returns to baseline and/or that immune biochemistry is fundamentally altered[62]. Consequently there now exists a growing concern which links immunizations to the huge increase in recent decades of auto-immune diseases[79] e.g., rheumatoid arthritis[80,81], multiple sclerosis, lupus erythematosus, lymphoma, leukemia, autoimmune demyelinative optic neuritis, diabetes mellitus, etc.

Vaccinations influence the balance of viral scavengers[82,83]. They suppress the production of b-cells, t-cells, etc. The synergistic action of these cells impairs antibody formation and becomes less effective in phagocytosis. This influences recognition of viral pathogens, leads to the progressive failure of immune function and hence to the increased incidence of auto-immune disease which we note as allergies[84–86] and immunodeficiency[87].

Some vaccinations have a greater effect than others e.g. Hib vaccine, pertussis vaccine[88–90], measles vaccine[91], etc. Indeed some articles indicate that the use of such vaccines can reliably induce asthma[92] by moderating adrenergic function[93].

Modified live viruses alter the structure and function of DNA. Each virus is a large molecule therefore its spatial arrangement must be influenced by its biochemistry which influences cross-helical structures and linkages within the DNA helix. Accordingly it is inevitable that the steady accumulation of such foreign proteins arising from an intensive vaccine programme will reach the stage where it significantly weakens DNA, gene, and chromosome structure and function. The prevailing reaction conditions - the consequence of protein expression which has been influenced by previous vaccines - will also affect the introduction of each modified live virus. Each will depress immune function. The greater the number of viruses and foreign proteins (1) the greater the influence upon immune function and the time required for recovery from each vaccination; (2) the greater their influence upon DNA, gene and chromosome structure and function, the greater will be the risk of protein inhibition, system dysfunction, reproduction, etc.

The greater the amount of vaccines, introduction of foreign proteins and hence of alterations to the body's biochemistry the greater the risk that the body's immune function no longer recognizes or responds to existing vaccines or diseases[94] and/or that its immune response has been altered[95] and/or that sugar chains attached to an antibody alters its ability to bind to its receptors[96]. This may lead to mutated forms of disease[97–104] e.g. the reemergence of whooping cough[105], and a differentiated disease profile e.g. up to 30 per cent of individuals with a persistent cough are infected with B. pertussis[106]. Furthermore enhanced susceptibility to virus infection by vaccines is documented[107]. This could enable tougher strains to flourish[108].

Vaccines are not entirely safe. The currently used vaccines are merely less unsafe than previous vaccines[109,110] e.g.

The Urabe strain of mumps vaccine in the MMR vaccine was replaced by the Jeryl Lynn mumps strain in response to reports from Japan linking the Urabe strain used, in the MMR vaccine, with high levels of meningoencephalitis.

The Pluserix-MMR and Immramax-MMR vaccines were withdrawn because of reports of mild transient meningitis. The withdrawal of the smallpox vaccination led to a reduction in the incidence of TB.

The Rubini vaccine continues to be used in some European territories although discredited[111].

Leningrad-Zagreb strain is commonly used in developing countries, and may have superior efficacy when used during epidemics[112,113].

Different strains of disease have different safety profiles[114]

Different strengths of vaccine[115] carry risks which affect age groups or sexes differently.

There are concerns over the use of whole-cell vaccines[116,117] although some argue that acellular vaccines are less effective[118].

Sudden Infant Death Syndrome has been largely eradicated following withdrawal of the pertussis vaccine in Sweden and Japan.

Side-effects arising from vaccination are associated with the onset of autoimmune disease[79,119], arthritis, diabetes mellitus, autoimmune demyelinative optic neuritis, etc.

Sensory defects are a common side-effect of vaccines[120–122] e.g. sensori-neural hearing loss induced by the MMR vaccine.

Drugs inhibit the effectiveness of vaccines (see 3.3.2). Systemic glucocorticoids (steroids) suppress the immune system and create risk of disseminated infection from live virus vaccines[123]. Vaccines may also be influenced by levels of immune function, dietary factors, and stress[124]. Many parents of autistic children and a number of medical experts believe the MMR vaccine is the culprit behind autism. In c15-20% of children it causes fever 7-12 days following immunization.

What are the risks from the diseases against which a vaccine is meant to protect?

Diphtheria, Polio, Tetanus, Meningitis, Pertussis

Diptheria[125], Polio and Pertussis have largely been reduced in the developed world although there may now be mutated forms of disease, a differentiated disease profile and/or an altered immune profile, which may be responsible for further outbreaks in vaccinated children and adults. Diphtheria is an upper respiratory tract infection characterized by sore throat and minor fever. It affects the central and peripheral nervous systems leading to deterioration of myelin sheaths, loss of motor control and sensation. Fatality rates are 5-10% although the rate of mortality may be higher for those under 5 years and over 40 years. It can be treated by antibiotics which prevent its transmission e.g. using erythromycin, procaine penicillin G, rifampin or clindamycin. Other minor complications including neck swelling, nausea, vomiting, listlessness, pallor, and a racing heart beat; lead to long term effects e.g low blood pressure, cardiac myopathy and peripheral neuropathy. Poliomyelitis is an infectious viral disease. Although c90% of polio infections are symptom-free, if the virus enters blood circulation this may lead to further complications. In c1% of cases, where the virus enters the central nervous system, it infects and/or destroys motor neurons thereby leading to muscle weakness and paralysis, usually involving the legs. Tetanus infection occurs through open wounds. It occurs commonly in hot, damp climates with soil rich in organic matter. It creates muscle spasms in the jaw, difficulty in swallowing, muscle stiffness and spasms throughout the body. The neonatal form of the disease is a significant public health problem in the developing and/or agricultural economies. There are about one million cases of tetanus reported each year, mainly in the developing world, causing an estimated 300,000 to 500,000 deaths. In the United States, there are about five deaths from tetanus each year. Tetanus is the only disease that is infectious but not contagious. Pertussis is a highly contagious disease. There are 10–90 million pertussis cases and about 600,000 deaths per year. Sixty percent of all cases occur in the developing world. In children it is characterized initially by mild respiratory infection symptoms before developing into the characteristic ‘whooping’ cough. Other complications may include encephalitis, pneumonia, and secondary bacterial infections. Naturally-acquired disease caused by Hib (H. influenza) appears only to occur in humans with low natural immunity[126]. In infants and young children, H. influenza type b may cause pneumonia, and acute bacterial meningitis. Both H. influenza and S. pneumonia can be found in the upper respiratory system of humans i.e. both reside naturally in the body. Alterations in the immune response; attributed to poor nutrition, stress or transmission; enable their proliferation with potentially serious outcomes.

Measles, Mumps and Rubella

Measles is largely a consequence of compromised immunity arising from poor diet and is linked to high levels of mortality[127] in the developing world. In developed countries, most children are immunized against measles by the age of 18 months, generally as part of the triple vaccine treating measles, mumps and rubella (children younger than 18 months usually retain measles antibodies (Immunoglobulins (Ig)) transmitted from the mother during pregnancy) If the mother naturally had measles. The rate of mortality from measles is typically 0.3% however in the developing world this may be as high as 28%. The classical symptoms of measles are typically fever (up to 40C), cough, coryza and conjunctivitis. Complications include mild diarrhoea, pneumonia, encephalitis, SSPC, and corneal ulceration or scarring. They are usually more severe amongst adults. Permanent hearing loss or damage to vision is recognized complications of measles. Measles has been known to occur in children with congenital rubella syndrome, and has been implicated in the etiology of inflammatory bowel diseases (IBDs). The more common symptoms of mumps are parotitis, fever (typically 38.3C), headache and orchitis[128] Other symptoms of mumps include sore face and/or ears, and loss of voice. Known complications of mumps include infection of other organ systems, sterility in older men, mild forms of meningitis, encephalitis, sensorineural hearing loss, pancreatitis, inflammation of the ovaries, and risk of spontaneous abortion during pregnancy. Rubella is a mild disease which often passes unnoticed[129]. The primary reason for the introduction of a vaccine is to prevent infection during pregnancy. The common symptoms of rubella are the appearance of a rash on the face, trunk and limbs (after an incubation period of 14-21 days) which usually fades after several days. Other symptoms include fever (typically 38C), swollen glands (post cervical lymphadenopathy), joint pains, headache and conjunctivitis. Rubella is generally a mild disease, rare in infants or those over the age of 40. The older the person the more severe the symptoms e.g. some women experience arthritis type symptoms. Children exposed to rubella in the womb may show developmental delay, inhibited growth, hearing disabilities, diabetes, glaucoma, schizophrenia, etc. If infected during the first 12 week period of pregnancy this may lead to congenital rubella syndrome (CRS), which is manifest as a series of complications including spontaneous abortion and, in the neonate: cardiac, cerebral, ophthalmic and auditory side-effects. Known complications include prematurity, low birth weight, and neonatal thrombocytopenia, anemia and hepatitis. CRS is the main reason a vaccine for rubella was developed. It increases the risk of miscarriage or still birth in mothers who contract rubella shortly before or early in pregnancy. If the baby survives, it may have heart disorders, blindness, deafness, etc. CRS is manifest as sensorineural deafness, eye problems, heart disease. Other complications include low birth weight, mental retardation, problems with the spleen, liver and bone marrow, etc. Hepatitis B is difficult to catch and comes from blood or sexual contact with an infected carrier. Further, vaccine-derived immunity is thought to be short-lived. Hpv , an infection transmitted during sexual intercourse, clears naturally after several months/years. Mumps and Rubella may occur without the patient being aware that they have the disease.

Some diseases may confer natural immunity e.g. the mumps virus may confer a degree of immunity against ovarian cancer[130–133].

In summary, disease side-effects reflect the effect of the disease upon the body's functional systems i.e. upon temperature, digestion, excretion, etc. Typical viral fevers are circa 1-2C above the body's normal body temperature. Measles is particularly noteworthy because fever may reach 40C (or higher), some 3-4C above normal body temperature and just 1C below the point where proteins denature and at which brain death commences.

What are the risks from the Vaccine? Typical vaccine side-effects

There is evidence that BCG and measles vaccinations administered singly reduce child mortality[134] but that this is unrelated to the incidence of measles or measles deaths[135,136]. By contrast the pertussis vaccine is associated with a negative effect[137].

Dtap: Recorded common side-effects with the DtaP vaccine include fever, tiredness, poor appetite, vomiting and inflammation. Less common and more severe side-effects include distress (crying), seizures, lowered consciousness or coma, brain damage.

MMR: Recorded common side-effects with the MMR vaccine include fever, swelling of the lymph glands, tiredness, poor appetite, and abhorrence of bright lights. More severe problems include low platelet count, pain and stiffness in the joints/inflammation. Less common and more severe side-effects include distress (crying), seizures, deafness, lowered consciousness or coma, brain damage.

Tdap: Recorded common side-effects with the Tdap vaccine include pain, chills, fever, headache, tiredness, poor appetite, stomach ache, vomiting, diarrhoea and inflammation

The above listed vaccine side-effects are indicative of systemic instability affecting most physiological systems – temperature (chills and fever), excretion (inflammation of the lymph glands), blood cell content (low platelet count), excretion (diarrhoea), digestion (poor appetite, vomiting), sleep (coma), and metabolic rate (tiredness, lowered levels of consciousness). In addition there is evidence of altered sense perception, indicative of problems with the autonomic nervous system, which affects hearing, visual perception (abhorrence of bright lights), smell and touch.

Significant vaccine side-effects have been linked to swine flu vaccine (Guillain-Barre paralysis); in RSV vaccine[138]; in the measles, mumps and MMR vaccines[139]; hepatitis A and B vaccine[140]; tetanus vaccine; smallpox vaccine; polio vaccine; pertussis vaccine[141], etc. The incidence of vaccine side-effects may now be sufficiently great to question the claims that the risks from the disease exceed that of vaccines[109].

The MMR vaccine has been linked to autism, Crohn's disease, inflammatory bowel disease[142,143] and other serious chronic stomach problems[144], epilepsy, brain damage including meningitis[145,146], cerebral palsy, pancreatitis[147] and diabetes mellitus[148–150], encephalopathy, encephalitis[151,152], hearing and vision problems, arthritis, behavioural and learning problems, chronic fatigue syndrome, diabetes, Guillain-Barre syndrome, idiopathic thrombocytopaenic purpura, subacute sclerosing panencephalitis (SSPE), leukaemia, multiple sclerosis, and death.

There is evidence that in cases of immune deficiency that viruses continue to persist in the body[143,153–155]. The measles virus is known to persist in patients with subacute sclerosing panencephalitis (SSPE), measles inclusion body encephalitis (MIBE)[156] and multiple sclerosis[157]. Since the introduction of measles vaccines, vaccine-associated SSPE has increased in the USA. Furthermore patients with B or T-cell immunodeficiencies have cognitive side-effects[27] and are advised against vaccination due to the risk of severe and/or fatal infection (Merck). That viruses persist in the body and are linked to autoimmune disorders is a feature of rubella virus[158–160], anthrax vaccination[161], hepatitis B[162], etc. There is a reported increased risk of death with combined vaccination DPT and polio[134].

In summary, vaccine's side-effects reflect the vaccine's influence upon the body's functional systems i.e. upon temperature, digestion, excretion, blood cell content, etc.

The Cumulative Effect of Vaccines

There is concern that the cumulative effect of vaccines upon the body's function has not been properly assessed[137]. Unvaccinated children appear to have less exposure to disease[84,85], delaying vaccination reduces exposure to disease[163], contracting the disease naturally leads to less disease in future[164], and that excessive vaccination is considered ineffective and dangerous[165].

Vaccine-vaccine and Vaccine-drug interactions

In general, vaccines may be influenced by antibiotics[166], immunoglobulins, immunosuppressants, monoclonal antibodies, anticoagulants and corticosteroids. The interaction between a vaccine and a drug has been reported only with influenza vaccine and four drugs (aminopyrine, phenytoin sodium, theophylline, and warfarin sodium), and with BCG vaccine and theophylline. The clinical significance of vaccine-drug interactions is not fully determined[167]. There is further evidence of interactions involving most vaccines e.g. HPV Vaccine: (http://hpv.emedtv.com/hpv-vaccine/drug-interactions-with-the-hpv-vaccine.html); Shingles Vaccine: An Introduction: (http://senior-health.emedtv.com/shingles-vaccine/drug-interactions-with-the-shingles-vaccine.html); yellow fever vaccine; polio vaccine (neomycin, streptomycin, phenoxy ethanol, formaldehyde), rotavirus vaccine, etc.

Vaccines are not subject to double blind clinical trials despite the evidence of vaccine-drug interactions and perhaps also of vaccine-vaccine interactions.

Effectiveness of Vaccines/Vaccines are not 100% effective

Whooping cough is becoming increasingly prevalent[168–170]. Although claimed to be 88 per cent effective among children of 7-18 months, during a nationwide epidemic of whooping cough in 1993, a group of researchers discovered that 82 per cent had completed their full complement of DPT vaccines[171]. Others have commented that the whooping cough vaccine is only to be 36% effective[109].

Many studies show that the measles vaccine isn’t completely effective[172–175] and that a significant proportion of those infected in measles outbreaks (>60%) had been vaccinated. There is also a lack of consensus concerning the effectiveness of whole or acellular vaccines, each having their own side-effects and effectiveness[176] e.g. vaccine efficacy was estimated at 75.4% for an acellular 5 component vaccine, 42.4% for an acellular two component vaccine and 28% for a whole cell DTP vaccine[177]. The whole-cell vaccine was associated with different levels of side-effects including significantly higher rates of crying, cyanosis, fever, and local reactions than the other three vaccines.

There is evidence of declining vaccine immunity[178] illustrated by transmission of mumps[179], measles[180,181], rubella[182], polio[183], Hib[184,185], Hepatitis B[186,187], smallpox, diphtheria, varicella[188], whooping cough[189], etc.

Effect upon Learning

One in 14 children i.e. up to half of all children starting school, have problems with speech, language and communication[190]. Is this significant bearing in mind[4] that the occurrence of autism may be more widely spread than has hitherto been considered possible i.e. that only the most severe and chronic cases of autism are recorded? Learning problems are a significant problem in autism[191]. It affects the body's processing of data from the external and internal environments. This affects, in the autistic, the ability of the autonomic nervous system to regulate organ function and hence influences their ability to make sense of the external world. The problem may be part of a spectrum of biochemical disorders[60] influencing all aspects of the learning process e.g. including memory, concentration, sense perception and sense coordination.

Biochemical Evidence

Biochemical Instability

Indications of almost complete physiological instability are manifest in the autistic as a proliferation of biochemical deficiencies e.g. (1) Fatty acid deficiency[192]; (2) a distinctly different immune response[62] including reduced natural killer cell activity[193], decreased immunoglobulins and T cells and altered lymphocyte functions[194,195–197], (3) Vitamin D deficiency[198]. Vitamin D regulates the levels of glutathione which may explain the link between heavy metals and autism. Depleted levels of glutathione increase oxidative stress, suppress the detoxifying effect of liver enzymes e.g. P450, reduce the elimination of heavy metals, and increase the neurodegenerative effects of heavy metals. Mercury inhibits the enzyme methionine synthase which converts homocysteine into methionine. Accordingly, levels of cysteine, glutathione and metallothionine are low. This illustrates that the methionine pathway may be faulty in many with autism and supports earlier suggestions that redox imbalances[199–200] and detoxification are impaired. (4) Vitamin A deficiency[201–202] is a commonly observed symptom of measles. The severity of complications have been linked to the degree of Vitamin A deficiency; (5) Carnitine deficiency[203]; (6) increased norepinephrine levels and decreased dopamine-hydroxylase activity[204]; (7) demonstration of inter- and intra- species differences in serotonin binding sites by antibodies from an autistic child[205]; (8) the levels of gut flora[206]; (9) Enterocolitis in Children with Developmental Disorders[207]; (10) Adenosine Deaminase Activity Decreased in Autism[208,209]; (11) Small intestinal enteropathy with epithelial, IgG and complement deposition in children with regressive autism[210]; (12) Mitochondrial disorder[211]. Findings suggest that mitochondrial dysfunction, including abnormal enzyme function, mitochondrial structure, and mitochondrial DNA integrity, may be present in children with autism[212].

Other biochemical deficiencies/chromosomal abnormalities include:

Phosphoribosylpyrophosphate (PRPP) synthetase superactivity, Adenylosuccinate lyase deficiency, Histidinemia, Lesch-Nyhan disease, Fragile X syndrome, Rett Syndrome, Dihydropyrimidine dehydrogenase (DPD) deficiency, Tuberous sclerosis, Superactivity of pyrimidine 5’-nucleotidase (P5N), etc.

The use of Drugs

Biochemical instability is a feature of autism. Accordingly, drugs are used to mitigate autistic symptoms e.g. (1) Lofexidine[213] has been shown to improve prefrontal cortical function in nonhuman primates. This is consistent with the view that the prefrontal cortex regulates executive/system function. (2) An open trial[214] suggested that methylphenidate use in autistic hyperactive children may ameliorate hyperactivity, and impulsivity in autistic children. (3) Neuroleptics e.g. haloperidol, are mildly effective in reducing hyperactivity, impulsivity, and inattention in children with autistic disorder[215]; clonidine is used in the treatment of tic disorders and ADHD[216]. Other drugs used include Tianeptine[217]; Galanthamine[218]; Immunoglobulins[219]; melatonin[220]; and beta-blockers[221].

The Cause of Autism

The occurrence of autism is due to a significant genetic insult[222] but it is not considered to be an inheritable condition. How and when this occurs can be debated however, for a young child with a developing immune system, there are few factors which could be held responsible other than vaccines and/or the related and damaging effect of exposure to high levels of mercury. No other factor or explanation has been offered as a viable alternative explanation for the occurrence of regressive autism. The evidence indicates there is alteration to chromosome structure and/or function. It indicates the influence of external stressor(s) influencing mitochondrial structure and DNA, chromosomal instability and translocation, which ultimately influences protein expression. The combined effect influences system stability, organ function, the prevailing levels of biochemistry, sense perception, behavior, etc. It influences protein expression and the rate and completeness of subsequent protein-substrate reactions leading to lowered immune function, reduced absorption of nutrients, slowed metabolism, impaired development[262], etc; i.e. the body's biochemical processes do not proceed as they should.

Is this an indication of chromosomal damage?

Viruses are able to infiltrate cells, inserting their genetic material into them. As outlined earlier (see 4.1) there are biochemical markers of vaccine damage. That it affects four boys to every girl[10] illustrates that the condition is largely due to a defect with the X-chromosome and leads to consideration of the factors which could influence at the genetic/chromosomal level. In general, chromosomal damage is linked to radiation e.g. due to adverse nuclear events which leads ultimately to birth defects. The prevailing evidence appears to suggest the influence of e.g. proteolytic enzymes or temperature[223,224] which may alter chromosome structure. Little evidence has been offered for the 1 in 5 occurrence experienced by girls although this appears likely to be the consequence of a chromosomal stressor.

It is widely recognised that genetic predisposition and protein expression can be influenced by environment influences[7], and that genetic damage can be the result of exposure to radiation, however the evidence being offered appears to suggest a subtle form of genetic alteration - associated with the wider use of vaccines[17] - which may not necessarily be inherited but is responsible for altered system stability and function and consequently of altered biochemistry and function. There is evidence that system function is intact but dysfunctional i.e. that homeostasis is severely compromised. Such findings are supported by research into Gulf-War Syndrome (GWS) in which[225] untypical RNA was found in the blood of sick GW veterans. This illustrates that the viral encephalopathies originated from RNA-viruses and hence from vaccines. That immunosuppression, shown to be a factor in GWS[226] and autism, is associated with the concentrated use of vaccines[227] is further supported by the fact that French soldiers who were not vaccinated yet who served in the gulf war did not get GWS however American and British soldiers[228], irrespective of whether they served in Iraq or not, reported a significantly greater incidence of autistic-spectrum disorders and GWS.

The Effect of Heavy Metals

Heavy Metals and Mercury in particular, affects the function of the CNS and are extensively documented and associated with autism[229]. Amongst a variety of side-effects mercury decreases lymphocyte viability, and in the brain: dysfunction in the amygdala, hippocampus, basal ganglia, and cerebral cortex; destruction of neurons in the cerebellum; and brainstem abnormalities. Demyelination is evident in such conditions. The brain's electrical patterns are similarly abnormal.

The most significant contributors to the increased mercury burden are: Mercury in vaccines (e.g. DTP (at typically 25 micrograms of mercury per dose), Tetanus, Hepatitis B & (most) influenza vaccines), contamination of fish[230], wild/bush fires; and emissions from power stations[231] and industrial chimneys including incinerators, waste-burning cement works, crematoria, etc. The characteristics of autism and mercury poisoning are extremely similar which suggests that autism arises from mercury poisoning[232,233]. Children with autism have greater amounts of mercury and other heavy metals in their system[234]. For these children the exposure route is considered to be predominately via childhood vaccines, most of which contain thimerosal. Vaccinated children of circa 10-20 kgs are exposed to an adult overdose of mercury, over 62.5 micrograms of mercury within the first three months, which significantly increases a child's risk of developing some form of neuro-developmental disorder such as impaired development, speech and language, autism, stuttering and attention deficit disorder.

Children living downstream of coal-fired power stations have a greater incidence of autistic spectrum disorders[231]. This indicates that the innate physiological processes, which the body uses to eliminate heavy metals, are being overcome by overexposure.

Mercury poisoning is an insidious process. In general the symptoms do not appear immediately upon exposure, although they may in especially sensitive individuals or in cases of excessive exposure. The initial preclinical stage is followed by the development of symptoms of mercury poisoning over a period which may last from weeks, months, and years[235–237]. Consequently, mercury given in vaccines to very young children would not be expected to lead to a recognizable disorder, except for subtle signs, before age 6-12 months, and might not emerge for several years[233].

In autistic children, the initial signs occur shortly after the first injections, and consist of abnormalities in motor behavior and in the sensory systems, particularly touch sensitivity, vision, and numbness in the mouth[15,238]. These signs are followed by parental reports of speech and hearing abnormalities appearing before the child's second birthday[10]. Finally, there is the development of autistic-like traits and a continuing regression or lack of development in subsequent years. These symptoms change[239] depending upon the circumstances surrounding each child.

Most autistic children have impaired liver detoxification. Many have low levels of metallothionine, conceivably the consequence of a deficiency of Zinc, which is indicative of a lowered capacity to chelate mercury and other heavy metals. Mercury is a powerful oxidant which depletes cellular antioxidants, especially glutathione. The P450 detoxifying enzymes of the liver rely heavily on adequate availability of glutathione. EthylMercury the active component in thimerosal causes apoptosis of the t-cells[240–242].

Although the withdrawal of mercury from vaccines has not resulted in an overall decline in the occurrence of autism this does not mean that the problem does not lie with thimerosal[243,263]. It may indicate that the problem is associated with the elimination of mercury[244] i.e. affecting function of the lymphatic system and excretion[245]. This is supported by noting evidence of urea cycle dysfunction. Problems with the urea cycle, conceivably the consequence of mercury poisoning, have been linked to autism. A child with ornithine transcarbamylase (OTC) deficiency is likely to be lacking in energy, have appetite problems, poorly-controlled breathing rate and/or body temperature, and slow development. Significantly, OTC deficiency is an X-linked recessive disorder (http://www.merck.com/mmpe/sec13/ch164/ch164a.html) one of a number of primary immunodeficiencies associated with vaccine use.

As in autism, onset of Hg toxicity symptoms is gradual in some cases, sudden in others[232,233]. In the case of poisoning, the first signs to emerge are abnormal sensation and motor disturbances. As exposure increases, these signs are followed by speech problems, and hearing deficits[246]. Upon removal of the mercury the symptoms tend to recede except in instances of severe poisoning, which may lead to death[232]. As in autism, epilepsy arising from Hg exposure is also associated with a poor prognosis[247]. Mercury acts upon the catecholamines and influences the function of the autonomic nervous system[245]. This affects cognitive performance[248], spatial vision[249], etc.

Other metals have been implicated in adverse neurodevelopmental outcomes in children e.g. lead and mercury[250,251], with exposure to cadmium, arsenic, antimony and chromium also a concern. Studies have found adverse effects of prenatal lead exposure on growth and development, but little research has examined an association with autism. Whilst Mercury is of concern, because of evidence for neurotoxic effects and the fact that it has become so prevalent in the wider environment[250], Aluminum also shares common mechanisms with mercury e.g. it interferes with cellular and metabolic processes in the nervous system. Children given the recommended vaccinations are injected with nearly 5 mg of aluminum by the time they are just 1.5 years old, almost 6 times the safe level. Furthermore the nature of the Aluminium affects the prevailing blood levels and is also increasingly implicated, through their use as vaccine adjuvants, in autism[252].

Current Therapeutic Approaches used to Treat Autism

There is evidence that autism is a treatable disease and that some therapies can mitigate the effects of autism[253,254]. Although there is no recognised method of treatment, or of significant and/or proven outcomes, autistic children appear to respond to therapies which enhance the function of the breathing , to enhance oxygen levels[255], and excretory system e.g. by osteopathy[256]. Moreover a commonly observed side-effect with autistic children is that when a child has an elevated temperature, perhaps resulting from a fever, the autistic symptoms appear to recede and the child behaves normally[41]. Autistic children suffer from adverse sleep patterns. In the US autistic children are often treated by chelation therapy and biofeedback[257–259].

Dysfunction of the Excretory or lymphatic system leads to long-term exposure to mercury which under normal circumstances would have been rapidly eliminated from the body. This may also lead to higher neural temperatures which will inevitably influence brain function.

Further evidence of biochemical deficits[260] and of the benefit of biochemical based supplements e.g. vitamin B6 and magnesium; melatonin; methylcobalamin; vitamin A, C & D supplements; dimethylglycine (DMG) and trimethylglycine (TMG). DMG provides building blocks that are required for purine nucleotide synthesis. DMG comes from TMG when TMG methylates homocysteine. Significantly, absorption of Vitamin A Palmitate requires an intact gut mucosa at the appropriate pH and in the presence of bile for metabolism. Many autistic children have damaged mucosal surfaces therefore they have impaired capacity to absorb vitamin A[261].

That some children can become normal when their temperature increases above normal levels e.g. due to a viral infection,[41] may illustrate that the levels of the homeostatic mechanism affecting the physiological systems have been reset at what can be considered to be abnormal levels[47]. This may indicate that autism is treatable - perhaps to a greater degree than has hitherto been considered possible.

Discussion

The mass of scientific evidence compiled by researchers clearly indicates that the incidence of autism occurs following vaccination and is most closely associated with the schedule of vaccines culminating in the MMR vaccine. That vaccines suppress natural immune function is not in dispute e.g. those with naturally low levels of immune function (immigrants from tropical climates) show greater predisposition to autistic spectrum disorders.

The immediate effect arising from vaccination influences gene function and protein expression. This leads to lower levels of white blood cells including e.g. lymphocytes, immunoglobulins, t-cells, b-cells and/or neutrophils, and disturbs their synergistic action and hence their ability to memorize and respond to immune responses when challenged. This impairs the ability to kill pathogens thereby predisposing to further infections. The short and long-term outcome is to the neural mechanisms regulating system function affecting e.g. pH, the excretory system, temperature, and the elimination of toxins and heavy metals. This explains why the discontinuation of thimerosal in vaccines was followed by a steady increase in the incidence of autism and hence that researchers did not find a correlation between the incidence of autism and the use of thimerosal-containing vaccines[263]. This may also explain the effect of multiple vaccines, in particular the MMR vaccine, and the greater predisposition to autistic spectrum disorders in military families.

In most autistic children brain structures are initially unaffected but become steadily underdeveloped as a consequence of exposure to mercury and other heavy metals. This evolves into a neurodevelopmental problem leading to chromosomal abnormalities, affecting myelination, the subsequent degeneration of the cerebellum, etc.

The MMR triple vaccine may inhibit normal immune function which, directly or indirectly, ultimately leads to chromosomal and/or genetic damage and/or dysfunction. The occurrence of GWS in adults, a condition with many features which are common with autism, indicates the problem may be due to the number and/or intense schedule of vaccinations however this does not excuse the measles or MMR vaccine from suspicion. The combined vaccine raises body temperature whilst lowering immune and system function. This may make a mild measles vaccine more virulent which may increase fever to an abnormally high level. It suggests (1) single vaccines may pose less risk than triple vaccines; (2) some vaccines pose a greater risk than others e.g. pertussis and measles; and (3) the way in which vaccines are administered will be accompanied by different side-effects e.g. if pertussis is followed by measles or vice-versa, if BCG gives a beneficial effect to be followed by pertussis, if vaccines are given in combination, etc. Increased disease loading is the inevitable consequence of multiple vaccine or lots of single vaccines or triple vaccines e.g. of asthma, autoimmune disease, etc. It suggests that adherence to the vaccine schedule is the problem – too many vaccines, too quickly.

Vaccines cause an inflammatory response in some e.g. for those with an inadequately developed or artificially lowered immune system, for those genetically predisposed, or perhaps due to viral or bacterial infection. This creates genetic damage and/or dysfunction and hence influences the brain's ability to regulate the physiological systems, and especially to the lymphatic system and its ability to excrete mercury and heavy metals, would lead to long-term damage and problems processing sensory/cognitive input. This would inevitably affect the brain's ability to maintain a regulated temperature below that which affects brain damage (41° C). This inevitably influences the autonomic nervous system and the stability of all related physiological systems including temperature, blood pressure, blood cell content, blood glucose, digestion, excretion, sleeping, etc.

Further evidence of multi-level dysfunction is evident from unusual brain-wave stability, aberrant sleep patterns, loss of sense perception and coordination, mirror neuron dysfunction, lower pain thresholds, mental and physical deterioration, short periods of concentration, etc. That it is a problem of systemic dysfunction is further supported by noting how it can be treated using sensory therapies which may facilitate the re-establishment of some degree of physiological stability.

Where is the proof that vaccines are safe? The argument has never been that they are completely safe but that the consequences are less than having the disease. Now it is illustrated that the consequences of intensive vaccination schedules pose a greater risk than could ever have been imagined. This leads to the evolution of new viral strains, an unsurprising development when the environment to which it is exposed is being altered by new proteins, structural variants and altered DNA.