#also every test ive looked at is a nasal one

[everyfandomever]

i was afraid i had lost my smell but one spray of bath and body works frosted cranberry room mist cleared that up real quick

[chachkayes]

Are You With Me? - Mer x Hayes

Hey all! I wrote this fic based on the scene where Hayes finds Meredith passed out in the parking lot and continued the scene based on partially how I think it’ll go, and also how I hope it’ll go as a die hard Merhayes stan. I based the title of the fic on the song “Are You With Me” by nilu, which is featured in the season 14 episode “Personal Jesus”. I’d highly recommend listening to it if you haven’t already. It’s so good.

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“No. No!” Cormac Hayes’ worst nightmare was coming true. Just as he was heading out for the night, he was faced with Meredith Grey, laying unresponsive on the Grey-Sloan parking lot pavement. Cormac dropped his bag and ran to her side. “Grey! Grey!” He called out to her, praying that she would wake up and look at him. He knelt down beside her, placing a hand on her shoulder gently. “Grey, can you hear me?” Everything he’d ever feared since meeting Meredith was happening. He called for help, and several hospital staff came to their aide. As he handed out orders to quickly get Meredith to safety, he held her neck and checked for a pulse. He looked over her and tried to find any signs of life. “Can you hear me, Grey?” He asked again. He wanted nothing more than for her to open her eyes. God, this couldn’t happen again. He knew he wouldn’t survive if he lost her as well. “Grey, come on. Stay with me, Grey.” He was pleading to her, to God, and to Abigail. He felt all the emotions he’d had when Abigail was in her final days start to creep into his system. “I’m here, don’t worry. You’ll be okay. You’ll be okay.” He kept repeating it until he couldn’t anymore. Mostly in hopes that Meredith somehow could hear him but couldn’t respond, and also to keep himself calm.

Part of him felt partially responsible for whatever happened. She was tired and yet he paged her to go into surgery. He’d heard her talking to Jackson about how she was jealous that he had been in an OR and not her. He knew he had a patient that needed a general surgeon, he figured it’d make her happy – and it did, and part of him selfishly wanted to spend time alone with her. Had the surgery set her over the edge? Was it too much? ‘No, Cormac. No time to think like that.’ He thought to himself. ‘Not right now, not when you’re trying to save her life. She needs you to be strong for her.’ Where was the damn gurney? With still no sign of any staff returning, Cormac was petrified that Meredith was running out of time. So, he gently picked her up and rushed her towards the ER. He couldn’t waste any more time waiting outside.

As he reached the doors to the ER, he saw Bailey, Koracick, and Altman gearing up. Cormac had mixed feelings about this – he was glad that the nurse who’d ran inside had alerted others to help him, but he was upset that he couldn’t get the gurney quick enough.

“Hayes, what the hell happened?” Bailey said as he laid Meredith down. Altman and Koracick immediately surrounded her and started hooking her up to monitors. “I… I don’t know. I was going to leave, and I just saw her laying there on the ground. I don’t know what happened.” He turned away from Meredith for a moment to put on a trauma gown and gloves, then immediately returned to her side. He was so relieved when he turned around and the monitors confirmed her heart was still beating. He looked to the nurse who was with him in the parking lot and asked her to go get his bag from the pavement. It had his scrappy old N95, which he’d need if he wanted to help them with Meredith at all.

He couldn’t help but be pissed at himself for not telling Meredith about his feelings for her earlier. He was scared of them and what they meant. That fear seemed so insignificant now. So stupid. He could lose her, the only other person that understood him.

“She’s dehydrated, and it looks like she probably passed out from exhaustion. I guess it’s a good thing she passed out in the parking lot and not in her car. And it’s even better that you found her.” Koracick said after shining his flashlight in her eyes to make sure her pupils hadn’t blown. The nerves were eating Cormac up inside.

“I’m concerned about how low her oxygen levels are. I want to get her hooked up to IV fluids and continuous O2 until those levels improve” Teddy said as she grabbed the oxygen mask and placed it carefully over Meredith’s face. Bailey could see how distressed Cormac was about what had happened, he sat by Meredith’s side and held her hand, almost as if he were to let go, so would she. She placed a hand on his shoulder, and he looked up at her with tears welling in his eyes. “Dr. Bailey, is there anything I can do? Anything at all?” Cormac felt like he was a sitting duck – he wanted to do something to help out. He couldn’t just watch helplessly. Bailey sighed and racked her brain. “I’m worried she caught COVID. Get into full COVID equipment and then do not leave her side. Monitor her - you page me or Altman if anything looks off. She’s also going to need a familiar face to wake up to.” Hayes nodded and stood up, looking down at Meredith’s hand in his. Reluctantly, he let go to quickly get into his gear. Bailey grabbed her hand right afterwards. Cormac sprinted to get into his scrubs and full PPE, as well as text his son that there was an emergency and he wouldn’t be home that night.

When he returned, they were admitting Meredith and getting ready to transport her to her room. He walked beside her gurney, looking back to see her vitals every few seconds. When they finally settled in the room, Hayes took a seat right beside Meredith. Not too long after, Bailey, Koracick, and Altman left, leaving Hayes alone to take care of Meredith, and think about every worst possible case scenario.

Hours passed – Meredith’s vitals were still stable, but she still hadn’t woken up. Still holding her hand, he leaned back into his chair and closed his eyes. He talked to Abigail and prayed that Meredith would wake up, then tried to get some rest. 3 hours later, Hayes was abruptly woken up by a small squeeze on his hand. He woke up immediately and saw that Meredith’s eyes were still closed. “Grey? Grey, can you hear me? I’m right here.” She squeezed his hand again. “Okay, Grey – you need to open your eyes.” Very slowly, Meredith opened her eyes and looked beside her. Cormac breathed a giant sigh of relief. He smiled at her, and she returned the smile. He had never been so relieved to see it. Weakly, she spoke. “What happened?” Cormac could tell that she was still tired and very confused. “I found you laying on the ground in the parking lot. You were dehydrated and exhausted. Your oxygen levels were concerning, so we tested you for COVID. It’s why you’ve got your mask on and the nasal cannula.” He locked eyes with her. He didn’t ever want to break it. “And?” She asked. “We haven’t gotten the results of your test back yet; we’re taking precautions just in case. I have to hand it to you, Grey. You gave me one hell of a scare out there.” He told her, which prompted a slight laugh from her. “I seem to be pretty good at doing that to everyone.” Cormac looked down and let out a dry chuckle. He looked back up at her and took in every feature of hers.

“Can you take a deep breath for me?” He asked her. She nodded and took in a deep breath. “Did that hurt?” He followed up. “Only a little.” Meredith could see the light in Cormac’s eyes flicker out a little when she said that. “Hayes, let’s not worry until we have to.” Meredith sighed and let her eyes drift around the room. “You know, while I was out, I actually thought I was dead.” She commented after a few fleeting moments of silence. “How come?” Cormac tilted his head, confused. “I saw Derek. We were on a beach together, and he called out to me. I thought I had died and was meeting Derek in the afterlife.” Cormac smiled at Meredith; he was glad she didn’t die but she was so happy to have seen Derek. “That must have been amazing.” She smiled at him; he was the only one who could understand why she was so happy. “It was. It truly was.” He gazed deeply at her. “No matter what happens with your test, I don’t regret staying with you. I’m just glad you woke up. I don’t know what I would’ve done if I’d lost you.” She grabbed his hand again and gave him a small smile while gazing softly into his eyes. They sat in silence for a while, then they lightly chatted while enjoying each other’s company until Bailey came by about an hour later.

[xxxmisslxxx]

This Is Me.....

......so I'm new to this .... I'm hoping I can just vent here and also get those feelings out in the universe... because apparently its “bad to supress things.” 

I will keep some details anonymous because .... well the internet you know?

I'm a 35 year old Female from a small town that has eventually over the years turned into a huge over populated town, been here pretty much all my life and seen all the changes ..

I've been with my partner for almost 19 years now and some days it can be a challenge haha  you know how you love them to death but also want to kill them at the same time? now that's love hehe.

We have one child that's 2  and this is my main reason for starting this blog...

see i have infertility.... there i said it out loud .... its not something some women can say out loud or even want to discuss... i feel like it is because the fairy-tale is you get the guy, you get married and you have kids... seems simple right? its the way most little girls thinks it happens... but its isn't reality for some women... and I'm that person. 

We had tried for years .. many years of unprotected sex and nothing, and the fear and numerous thoughts go through your mind of what's wrong with me? or is it him? what if its both of us? so we decided to go get checked... and this is where the long journey started......

we did countless hours of internet searches trying to find “the right dr for us” , we found a fertility clinic and made our first appointment.. i was so scared of the outcome and what the dr will say, she was super nice but between you and me she had no personality haha kind of flat talking which i found a tad funny literally no facial expressions hahahaha but again super nice and understanding.

She sent us both for tests, from blood, scans to sperm to me having a HSG to check to see if my tubes were not blocked (PS OUCH!!!!!) all came back normal ... i knew i had polycystic ovaries but she definitely confirmed it as it never was actually confirmed by my other drs, see my periods were NEVER regular i could get my period from 28 days to 54 days so i could never pick ovulation in my cycles, she also confirmed i have an underactive thyroid and thyroid antibodies so she prescribed me thyroxine to take for the rest of my life.

so after all that we decided to go for IVF and she was happy to help us out and take us on ..

so first day of period came and i started medications seems easy ... not for me!!! i cant swallow tablets at all to save my life haha so definitely something to get use too (ps still to this day im not use to it) once that finished i started a nasal spray day and night, then a couple of weeks later the injections ... i actually found the injections easier then tablets lol i literally gag every time. first scan was due to check the follicles and they were doing great and was on track. i actually had no idea what to expect at this scan, a week went by and another scan was due to see how they were processing .... they were textbook apparently so they scheduled me an egg collection to go ahead with, i was so super nervous as i didn't know what to expect.

the night came where i had my final injection ... the “trigger injection” which helps the potential eggs to mature for collection ... and then the egg collection was to follow.

EGG COLLECTION DAY- omg was i nervous and no idea what to expect as i seen videos on YouTube of the procedure and oh my god it looked like it hurt i was FREAKING out!!! luckily it was nothing like that. i was laying in the hospital bed waiting for them to come get me. they came and wheeled me into the procedure room they were all so nice to me and comforted me to make me feel comfortable... then the dr inserted a cannula in my arm and said ok were administering the drugs now and i should start to feel it... all i remember it the room spinning then nothing haha it was such a weird experience since ive never had any stiches or operations in the past .... it was like i lost time is the only way i could explain it .... hubby was with me in recovery and said do you remember this and that etc. i was like nope haha. the nurse came in and told us we got 11 eggs which was a really good number we were pretty happy with that number she said they will call us tomorrow with the number of how many fertilised. i felt i fair bit sore so i got some pain medications and went home to sleep it off.

to be continued for another day ................. 

[morelikesin]

Warmth and Bruises

A self-indulgent take on the Forbidden Hospital Scene, where Phoenix's fall from the burning bridge is much more realistic, plus my take on what went down during Miles' visit to Phoenix afterwards. All art shown during the work is also mine 💕💕

Readers' Discretion; this starts off with gore due to Phoenix's POV right after he fell.

With that, the rest is under cut!!

The flash of darkness consumed Phoenix for an unknown duration of time - horror holding him in its maw during the entirety of his fall, and then some. It was so painful, how he landed - he felt as if he'd gotten punched in the stomach repeatedly. The back of his head pulsated, every pulse sending a wave of deep ache throughout his body; he knew he must have landed on the rocks rather than in the water, for the rapid, cold rush only grazed his fingertips even with his arms outstretched.

Breathing heavily through his nose, which smelled of iron, he brought his arms closer to try and lift himself up with his elbows - failing miserably as he writhed with every passing, agonizing moment of  movement. Every move he so desperately tried to make was quickly extinguished of its hope of working. He felt dizzy. So, so dizzy.

The last thing he remembered seeing prior to this was Larry reaching out to him, trying to save him from his fall; the man's face contorted into sheer fear, sheer despair as he realized he wouldn't be able to save him. As Phoenix's eyes met with the burning bridge high above him, he hoped Larry knew it wasn't his fault he was down here. He hoped he'd get to tell him that.

And suddenly, he choked. Gasping in shock, it sent more of whatever he was suffocating on down his throat the wrong way. He coughed, he wheezed, he gargled until he felt his breath return like normal and the warmth of the cause spilling from his lips and down the side of his face. Heterochromatic eyes widened as he tasted what he'd smelled earlier. A rustic iron.

Ever so slowly bringing one of his hands to his face, nerves in his limbs nearly shot, he touched his cheek to collect the substance he nearly died on and examined his fingertips. The light of the fire above him was enough to prove it was blood. That couldn't be. He wasn't wounded internally, so he couldn't have been bringing up blood, right?

The smell in his nose said otherwise. The painful ringing in his ears said otherwise. The fear of testing to see if any fluid drained from said ears was enough to make him not check at all. The back of his head he knew to have been injured, feeling the rock's blunt surface pressing into it. And yet even with being alive at all, something was still wrong.

His abdomen was sore; Phoenix trying not to focus on it so he could have some sort of mercy. He assumed his back must have taken its own heavy blow as well. He would have left it at that as he tried to get up once more, had it not been for the dull pangs that emitted from the area as he leaned up in the slightest. He planned to look down to try and recuperate, only for a moment. It took that moment for his eyes to meet the rod that jutted from the midst of his waist - sticking out about a ruler long, coated in flecks of innards and dark red blood. His clothes around the area were soaked much the same, dreadfully taken notice of due to a visible bulb of his intestine that was pushed out alongside the rebar.

His lips trembled. He swore he couldn't see for a second or two - vision coming and going as his head swam with nausea, with numbness, with such a profound terror of unknowing what to do, what will *happen* to him. His heart pounded in his ears like the loudest drums he'd ever heard, and his skin went cold.

And so he gripped the metal bar with both of his hands, loathing how warm it felt against his hold, and tried to hoist himself up from his lying position once more.

Mercy was deaf. The initial throbbing ache was traded for pure torment as he bent his torso - his vision going white for a solid few moments in its wake. Grunting and whimpering in distress, knuckles white, a sweat forming on his face, he couldn't find it in him to sob as he so irretrievably wanted to. Whatever tears spilled from his eyes were involuntary; they wouldn't have been noticed at all if it weren't for how they made everything look blurred. He gagged, he quivered, before suddenly everything went black again.

February 8, 10:35 AM

General Hospital

The halls were much too bright for his liking. Raising a svelte hand, he brushed back his long gray bangs as they threatened to look less than meticulate.

"I'm here to see Phoenix Wright."

The receptionist seemed to look through a few files on her computer before looking back up with a nod. "Room Two-Eighty-Seven, MICU."

Miles gave a polite nod as he turned away from the desk and prepared to travel through the halls; eyes narrowed and fighting watery-vision due to how blinding the tile was. Or maybe it was because he felt the need to cry. He couldn't really tell - both were true.

This wasn't true, right? Maybe Larry was seeing things. Maybe someone else was called Phoenix Wright. Right?

Yet as he made his way to the ICU Wing, and walked into the room, his eyes gave him his answer; sat up in a hospital bed, head tilted down and arms at his sides with numerous tubes inserted into his hands and wrists, was the man he felt so deeply for. Phoenix looked, as hurt as he was to admit, horrible from a distance. Hair disheveled, mannerisms taught and stiff...

Miles found himself walking up to the bed before he registered that he was doing so - a little hesitant with his greeting, "..Hello, Wright."

The recovering man seemed zoned out before noticing his visitor, his head raising up to meet Miles' silver gaze. Those heterochromatic eyes of his still held that special glimmer the prosecutor came to adore - the sight giving him a taste of peace despite the nasal canula that made Phoenix obviously uncomfortable, nose scrunching up occasionally. "Miles..? You...came to see me?"

"Of course I came to see you," Miles spoke gently, a coarse contrast to Phoenix's pained voice. "You had me terrified."

"I'm sorry."

Miles paused to think over that. He's sorry? There was nothing to be sorry for. Phoenix, "..Why?"

The tinge of hurt in Miles' tone wrenched Phoenix's heart a bit. His gaze fell as they rest upon the IV in his hand - going to sit up more before he winced at the pain in his abdomen and opted to lie still. The wince caused the prosecutor's expression to fall in worry before Phoenix finally came to reply; his voice being subtly rough. "..For scaring you. I-I don't want to distract you from your work just because I was.. careless. I mean, I don't think you were as scared as I was, but.. but I still feel bad for it." The defense laughed at his attempt for humour - disappointed to be met with a frowning sigh from Edgeworth. Of course Wright would joke at a time like this.

"Well, please don't. You're my priority." He gave the man a glimpse of softness, met with said man looking touched. "How are you feeling?"

Phoenix smiled to try and ease Edgeworth's painfully obvious frantic worry. "It hurts to lean, but.. otherwise alright. Just.. sore."

Miles had heard some of the story of Phoenix's fall from Larry, who had visited the man earlier this morning, yet some details were only known to the defense himself. Scratching that inquisitive itch of his, he begged a few questions.

"What, ah.. all are you recovering from?"

Phoenix's eyes lowered, recalling what he remembered in those brief minutes before he passed out, and what the doctors had told him upon his regain of consciousness. Finding what he needed to say, his gaze came back up. "I...landed on rebar - stuck out straight through me. They said it didn't sever anything in my spine, but it's a miracle that it didn't. I'm told I'm.. lucky, considering what happened."

Miles bit his lip and felt that watery threshold threaten the corners of his eyes. He blinked them back before Wright could notice. "I..I'm so sorry, Phoenix. I heard it was bad, but.."

"It's alright. You don't have to be sorry for me - just.. thank you for being here."

The two exchanged a tender smile before Miles' fell to keep questioning; torn to do so, but he wanted to know all he could. "I heard you also received head trauma?"

Phoenix grimaced as he slouched a bit. "Some, but I'm not surprised about that. When I landed, the back of my head hurt like crazy. I have some bruising and scrapes, but-"

"I'm sorry, what was that?"

"What was what?"

"What you just said."

Phoenix shrugged and cocked a brow slightly, "I have bruising? I would have to expect that, though."

Miles blinked in confusion, tripping over his words. "N..No, I.. Before that, about your head?" He swore he didn't hear that right.

"Oh-! When I landed, I had a god awful headache. It feels better than it did," Phoenix tried to humour Miles again, unsurprisingly to no avail. "-but it still hurts here and there."

"You were awake for that..?"

"I..I mean, not for long."

"Not for long-?!" Miles' voice came less calm than he wanted - the obvious distress soaked in his words, "I-"

"It's fine, Miles."

"It's not damn fine-!"

"Miles." Phoenix leaned up to take his companion's hand into his to help comfort him, disregarding the pain that came with bending his torso for the time being, even if it caused his voice to become a little strained. "I'm fine. It's- It's fine, I'm here now. I'm alive, it's fine-"

Phoenix cut himself off with a hitched breath and a wheeze before Miles quickly came a bit closer so the man could sit back again. The few moments it took for him to regain a steady breath left the quiet in the room to become tense.

Phoenix's voice came nearly inaudible. "..I'm.. sorry."

"Please.. stop saying that."

Phoenix shook his head, still clutching the prosecutor's hand as he tilted his head back up to share a desperate stare. "You have.. so many other things to.. to be doing right now. And, I'm sorry I dragged you out here-"

"You didn't drag-"

"Then why did you come?"

Miles wasn't sure he was ready to admit the truth yet. He couldn't. He didn't want to lose the person he had finally reconciled with after so long - he didn't want to lose him because of stupid, unnecessary feelings. "...I wanted to."

"Why? Larry might've told you, but- gh-" Another breather, "...But.. you.. didn't have to come. I-I'm glad you did, but-"

Miles pushed Phoenix's hand out of his own, turning his head away stiffly. Phoenix hushed his own breath. The silence that purged the room was sickening. With how long it lasted, Phoenix was convinced he had drove Miles away, to his own heartbreak - seemingly driving him away when he'd never wanted more in the past than now to just hold him and-

"...I've felt a closeness to you for years." Miles suddenly began, "Even in the time we held a void between us in our younger selves, and especially these past few years, I've felt.. content, with you. With the idea of you." He stopped himself to bite his lip - trying to successfully find the words for this, without saying too much. Lowering his body into the chair that was close to the side of the bed, his hands fidgeted in his lap - a usual nervous tick for him. "Even with all of my studies, you're more important. I'd never say anything else is more important to me than you and your safety. So, yes.. I came because I wanted to. I needed to."

When Miles came to look back up to Phoenix, he was disheartened to find him in tears. Before he could get any fumbled words past his lips, Phoenix shook his head and raised a weakened hand to try and clean his face, "..I-I thought I was a burden to you-"

Miles reached out to take Phoenix's hand as they so held just a bit ago. "You could never burden me, Phoenix Wright."

Miles sucked in a shaky breath before his thumb comfortingly rubbed against the back of his companion's hand, careful to not brush against the painted bruise on his knuckles. He was similarly praised as Phoenix took his other hand to place on top of Miles'; faces looking into one another’s with a sort of passion that was engulfing to both parties.

Miles slowly and reluctantly removed himself from their hand-embrace so he could shift the chair a bit closer and lean his waist on the side of the bed; his hands taking hold of Phoenix's cheeks as blushed thumbs wiped away his earlier tears. He was surprised to feel Phoenix's hands gently wrap around his wrists - and for a moment, the two of them held their breaths. For a moment, Phoenix studied silver, sharp eyes while Miles studied the contrasting russet brown and sapphire blue. For a moment, they noticed how perfectly the other's hair framed their perfect face. Phoenix found his hands taking hold of the red scarf around Miles' neck.

And, somehow, when they came forward into one another to kiss, it felt.. comfortable. The pining for one another slinked into the back of their minds as if it hadn't existed at all. For as long as it lasted, they drank in each other's taste, each other's warmth with feverish intent - the kiss starting as a heat of the moment mash of lips before it transpired into something deeper, more vehement, with the parting of their lips to messily meet at their tongues. It was uncertain, and unrefined, but fervid. It was perfect to them.

Miles had pulled away first, once tightened hands relaxing a bit as he caught his breath, face angled down and eyes kept shut. Phoenix moved his hands down to clutch the collar of Miles' coat - lip bitten and swallowing back a mixture of their salivas. It took a bit before they addressed what had just happened.

"...Is that why you came to visit me?"

Phoenix's comment earned him a sideways glare from Edgeworth, to which he laughed and raised one of his hands to caress the prosecutor's cheek again.

"..No. However, I.. have wanted to.. do that, for a... a while." Miles' unfamiliarity with this was showing, but frankly the feeling was mutual. The undefined way of what to do next unsettled the both of them equally.

"..You and me both."

Meeting at their eyes again, they held stern and furrowed expressions before relaxing and simply letting it be. They came close again as they held one another, foreheads pressed and eyes shut to bathe in each other's company. The quiet felt comfortable. The uncertainty merely a small obstacle.

With breathlessness hanging onto his words, Miles came to nervously ask "What does.. this mean, then?"

The defense broke into another smile. Swallowing back whatever anxiety ate at him currently, he sprouted his speech in hope. "I...guess...whatever we want it to mean. I-I..I want this to be more."

And with the statement spoken into the Universe, the two were guaranteed to have been thinking the same thing; 'Yes'. Even unsure of where this would take them, they wanted to try. They'd wanted this for so long - and by Gods, they wanted to try. Somehow the thought of the acclaimed Chief Prosecutor being bonded with the Miracle Defense Attorney also had an incredible ring to it.

"..Please recover, Phoenix."

"I will. Thank you for being here, Miles."

"I wouldn't want to be anywhere else."

[trishmishtree]

[Current as of March 13, 2020]

Dr. Shahed (screenshot above) is an emergency department physician in Ohio who shared this post on Facebook. It’s an account of COVID-19 from the perspective of an ICU doc working on the frontlines in Seattle. Some of my laypeople-friends were sharing it around (and I’ve seen it floating around on twitter and various internet forums], but I noticed that it’s really dense and contains a lot of medical abbreviations and jargon, like it was meant more for other physicians and isn’t really useful for the average reader. So I thought I’d provide a translation for my non-medblr followers who are looking to stay informed. (If you want further clarification, feel free to drop me an ask)

***

This is from a front-line ICU physician in a Seattle hospital

This is his personal account:

We have 21 patients and 11 deaths since 2/28.

We are seeing patients who are young (20s), fit, no comorbidities, critically ill. It does happen.

US has been past containment since January

Currently, all of ICU is for critically ill COVID patients, all of med-surg [medical-surgical] floors are for stable COVID patients and end-of-life care, half of PCU [progressive care unit], half of ER. New Pulmonary Clinic offshoot is open for patients with respiratory symptoms

CDC is no longer imposing home quarantine on providers who were wearing only droplet-isolation PPE when intubating, suctioning, bronching, and in one case doing bloody neurosurgery. Expect when it comes to your place you may initially have staff home-quarantined. Plan for this NOW. Consider wearing airborne-isolation PPE for aerosol-generating procedures in ANY patient in whom you suspect COVID, just to prevent the mass quarantines.

We ran out of N95s (thanks, Costco hoarders) and are bleaching and re-using PAPRs [powered air purifying respirators], which is not the manufacturer’s recommendation. Not surprised on N95s as we use mostly CAPRs [controlled air purifying respirators] anyway, but still.

Terminal cleans (including UV light) for ER COVID rooms are taking forever, Environmental Services is overwhelmed. This is bad, as patients are stuck coughing in the waiting room. Recommend planning now for Environmental Service upstaffing, or having a plan for sick patients to wait in their cars (that is not legal here, sadly).

CLINICAL INFO (based on our cases and info from CDC conference call today with other COVID providers in US):

The Chinese data on 80% mildly ill, 14% hospital-ill, 6-8% critically ill are generally on the mark. Data [in the US] very skewed by late and very limited testing, and the number of our elderly patients going to comfort care. 

Being young & healthy (zero medical problems) does not rule out becoming vented or dead 

Probably the time course to developing significant lower respiratory symptoms is about a week or longer (which also fits with timing of sick cases we started seeing here, after we all assumed it was endemic as of late Jan/early Feb). 

Based on our hospitalized cases (including the not-formally-diagnosed ones who are obviously COVID – it is quite clinically unique), about 1/3 of patients have mild lower respiratory symptoms and need 1-5L NC [1-5 liters of oxygen per minute, via nasal cannula]. 1/3 are sicker, need face mask or non-rebreather. 1/3 are intubated with ARDS [acute respiratory distress syndrome]. 

Thus far, everyone is seeing: 

normal WBC [white blood cell] count. Almost always lymphopenic, occasionally poly [neutrophil]-predominant but with normal total WBC count. Doesn’t change, even 10 days in. 

Bronchoalveolar lavage: lymphocytic despite blood being lymphopenic. (Try not to bronch these patients; this data is from pre-testing time when we had several idiopathic ARDS cases) 

Fevers, often high, may be intermittent; persistently febrile, often for >10 days. It isn’t the dexmed, it’s the SARS2. 

Low procalcitonin; may be useful to check initially for later trending if you are concerned later for VAP [ventilator-associated pneumonia], etc.

Elevated AST/ALT, sometimes alkaline phosphatase. Usually in 70-100 range. No fulminant hepatitis. Notably, in our small sample, higher transaminitis [elevated AST/ALT] (150-200) on admission correlates with clinical deterioration and progression to ARDS. LFTs [liver function tests] typically begin to bump in 2nd week of clinical course. 

Mild AKI [acute kidney injury] (creatinine <2). Uncertain if direct viral effect, but notably SARS2 RNA fragments have been identified in liver, kidneys, heart, and blood.</li>

Characteristic chest x-ray: always bilateral patchy or reticular infiltrates, sometimes peri-hilar despite normal ejection fraction and volume down at presentation. At time of presentation may be subtle, but always present, even in our patients on chronic high dose steroids. NO effusions.

CT is as expected, rarely mild mediastinal lymphadenopathy, occasional small effusions late in course, which might be related to volume status/cap leak.

Note - China is CT'ing everyone, even outpatients, as a primarily diagnostic modality. However, in US/Europe, CT is rare, since findings are nonspecific, would not change management, and the ENTIRE scanner and room have to be terminal-cleaned, which is just impossible in a busy hospital. Also, transport in PAPRs, etc. 

2 of our patients had CTs for idiopathic ARDS in the pre-test era; they looked like the CTs in the journal articles. Not more helpful than chest x-ray. 

When respiratory failure occurs, it is RAPID (likely 7-10 days out from symptom onset, but rapid progression from hospital admission). Common scenario for our patients is: admit on 1L/min oxygen via nasal cannula. Next 12 hrs escalate to NPPV [non-invasive positive pressure ventilation]. Next 12-24 hrs → vent/proned/Flolan. 

Interestingly, despite some needing Flolan, the hypoxia is not as refractory as with H1N1. Quite different, and quite unique. Odd enough that you’d notice and say hmmm. 

Thus far many are dying of cardiac arrest rather than inability to ventilate/oxygenate. 

Given the inevitable rapid progression to ETT [endotracheal tube, aka intubation] once respiratory decompensation begins, we and other hospitals, including Wuhan, are doing early intubation. Face mask is fine, but if patients are needing HFNC [high-flow nasal cannula] or NPPV [non-invasive positive pressure ventilation], just tube them. They definitely will need a tube anyway, and no point risking the aerosols.

No MOSF [multi-organ system failure]. There’s the mild AST/ALT elevation, maybe a small creatinine bump, but no florid failure. Exception is cardiomyopathy.

Multiple patients here have had normal EF [ejection fraction] on formal Echo or POCUS [point-of-care ultrasound] at time of admission (or in a couple of cases, EF 40ish, chronically). Also normal troponins from emergency department. Then they get the horrible respiratory failure, sans sepsis or shock. Then they turn the corner, come off Flolan, supined, vent weaning, looking good, never any pressor requirement. Then over 12 hrs, newly cold, clamped, multiple-pressor shock that looks cardiogenic, EF 10% or less. Then either VT [ventricular tachycardia, aka V-tach] → VF [ventricular fibrillation, aka V-fib] → dead, or PEA [pulseless electrical activity] → asystole in less than a day. Needless to say, this is awful for families who had started to have hope. 

We have actually had more asystole than VT. Other facilities report more VT/VF, but same time course, a few days or a week after admission, around the time they’re turning the corner. This occurs on med-surg patients too. One today, who is elderly and chronically ill but with baseline EF preserved, became newly hypotensive overnight, EF <10. Already no escalation, has since passed. So presumably there is a viral cardiomyopathy aspect, which presents later in the course of disease.

Of note, no wall motion abnormalities on Echo, right ventricular function preserved, troponins don’t bump. Could be unrelated, but I’ve never seen anything like it before, especially in a patient who had been hemodynamically stable without sepsis.

TREATMENT:

Remdesivir might work, some hospitals have seen improvement with it quite rapidly, marked improvement in 1-3 days. ARDS trajectory is impressive with it, patients improve much more rapidly than expected in usual ARDS.

Recommended course is 10 days, but due to scarcity, all hospitals have stopped it when the patient is clinically out of the woods. None have continued >5 days. It might cause LFT bump, but interestingly seem to bump (200s-ish) for a day or 2 after starting, then rapidly back to normal, suggests this is not a primary toxic hepatitis.

Unfortunately, the Gilead compassionate use and trial programs require AST/ALT <5x normal, which is pretty much almost no actual COVID patients. Also CrCl [creatinine clearance] >30, which is fine. CDC is working with Gilead to get LFT requirements changed now that we know this is a mild viral hepatitis.

Currently the Gilead trial is wrapping up, NIH trial still enrolling, some new trial soon to begin, can’t remember where.

Steroids are up in the air. In China, usual clinical practice for all ARDS is high dose methylprednisolone. Thus, ALL of their patients have had high dose methylprednisolone. Some question whether this practice increases mortality.

It is likely that it increases secondary VAP/HAP [ventilator-associated pneumonia/hospital-acquired pneumonia]. China has had a high rate of drug-resistant GNR [Gram-negative rod] HAP/VAP and fungal pneumonia in these patients, with resulting increases in mortality. We have seen none, even in the earlier patients who were vented for >10 days before being bronch’ed (prior to test availability. Again, it is not a great idea to bronch these patients now).

Unclear whether VAP-prevention strategies are also different [in China vs US], but wouldn’t think so?

Hong Kong is currently running an uncontrolled trial of HC 100IV Q8 [hydrocortisone 100 mg IV every 8 hours].

General consensus here (in US among doctors who have cared for COVID patients) is that steroids will do more harm than good, unless needed for other indications.

Many of our patients have COPD on ICS [inhaled corticosteroids]. Current consensus at Evergreen, after some observation & some clinical judgment, is to stop ICS if able, based on known data with other viral pneumonias and increased susceptibility to HAP. Thus far patients are tolerating that, no major issues with ventilating them that can’t be managed with vent changes. We also have quite a few on AE-COPD [acute exacerbation of COPD]/asthma doses of methylprednisolone, so will be interesting to see how they do.

[wafflesetc]

I’ve gotten a few asks and people inquiring about the journey of my health history.  I’ll be as open as I can be because parts of this are just raw and really close to home. There are just some of those things that I am only willing to disclose to close family and friends.

I also want to touch on the fact that I am extremely lucky and have a fantastic support group at home. My parents are with me when I need them, and I am very fortunate to have a medical team that listens to my needs. It can be very rare to have that combo in the journey of invisible illness and I have been blessed beyond measure in my battle.

In all honesty, with the procedure on my lung, I have been in a big mental funk recently. I was having issues breathing and working out. (This dates back to my marathon in October of 2018). Work had been crazy and demanding. Life had been hectic. There was a lot going on and I had been relatively ‘healthy’ for so long that I wasn’t listening to my body. In early December I got a cold that took forever to go away. I listened to my body, listened to the fact that my breathing didn’t feel right, and sought out my medical team. I’m not going to go into much depth about this one because it’s super raw to me. I am still mentally and physically healing from it, while also having to make lifestyle changes in the future.

I have a few health problems. I have Lupus, I have Celiac disease, and I also have Polycystic Ovarian Syndrome.

Growing up I had lots of small issues: joint pains, days where I’d have a low grade fever, where I was feeling faint all the time. I had sore throats, headaches, and vascular issues. More often than not, symptomatically I would appear to have things that were normal: a cold, the flu, a reaction to medication, or other things. I was tested here and there for junior rheumatoid arthritis and a few other more common autoimmune disorders, but they always came back negative.

What truly started the spiral of poor health for a solid few years was about ten years ago. I was a high school and collegiate soccer player. I tore my right ACL twice, once in high school and then once again in college. I had the surgery and then rehabbed my knee both times. Yet after each surgery, I would have flare ups where I bruised three hundred and sixty degrees around my knee. When I say I looked bruised- it looks like someone took a bat and beat me. These bruising flare ups were accompanied with high fevers, nasal congestion, sore joints, and more.

It went on and off for years. (About 2007-2013). During those years I saw every specialist under the sun. I was poked and prodded with needles. I gave more tubes of blood than my body probably can humanly hold. By the grace of some higher entity, by seeing these specialists I was diagnosed with Celiac and was massively able to change my diet and see improvement. I was diagnosed with PCOS and was able to get some answers for some health problems I was worried about in the future.

And finally, in the thick of it, one doctor looked at me, ran some tests and just knew.

Lupus.

It pretty much changed my world upside down.

Right after I was diagnosed, I went on a year of harsh IV treatments. Since then, I have been on a weekly dose or oral chemo medications. I have a highly suppressed immune system and get sick very easily. I was my hands like 40549 times a day and am that person that wipes down things with Clorox wipes. It’s for my own protection: a common cold can literally hit me and turn to pneumonia.

Most days I am relatively functioning. I’m healthy... But my “good days” are still nowhere near the average person’s energy level. I’m depleted more often than not. It’s exhausting- in laymen’s terms, my body is constantly at war or fighting something.

So, when I’m not feeling well or I am tired- I’m usually pretty beyond my physical limits of what I am capable of doing.

I am *truly* happy and thankful for my body and what it is able to do. I hate having to pretend sometimes that things are “OK” and that “I’m fine.” I’ll admit, I struggle and have more bad days than you’ll ever hear from me.

There’s a stigma around invisible illnesses. They are chronic- they are not ever going to go away, there is no cure. I’m still learning to get comfortable talking about my story and my issues, and getting comfortable acknowledging that it’s alright to talk about my bad days. 

Find a support system, reach out to proper help, be your own advocate. 

Know, it’s OK to need help. Know, it’s OK to not be OK. 

I hope this answers some of your questions. It’s definitely longer and more inclusive, but I’m not going to bore you with all the details. If you have any specific questions, please feel free to reach me.

All my love, Waffles

[veneataur]

Whumpmas day 23

Fandom: original fiction

Prompt: hemophobia

Title: Not Blood

Warnings: needles, restraints, thoughts of suicide, panic attack, depression, aftermath of torture, PTSD

Evie isn’t a woman of regrets. It’s not that she believes that everything that’s happened is good, but that everything shapes the person you are today. Take out something and who knows what type of person you might be. Getting captured and tortured has certainly shaped her into a type of person she didn’t expect and she doesn’t like. Coming down with a cold hadn’t been pleasant before, but now it’s unbearable, in part because it happens so much more often, but also because nine times out of ten, she winds up in the ER where the needles are so prevalent. And it doesn’t matter how many times she sees Emma, her psychiatrist, that fear never seems to fade. It’s PTSD, she’s told. It doesn’t help really. Yippee, there’s a name to attach to her fucked up mind. All it means is that when she has a flashback, she can whip out the name and garner pity and fear from everyone around. She wants to go back to normal.

It’s nearly midnight, which still seems strange to her to think about. For so long time was just counting and whenever master deigned to return to punish or teach her. Marla bought her a brand new watch, several actually, and put clocks in every room on every wall. Time is a constant now even though counting still seems easier sometimes. She counts herself to sleep at night and then during some of the long days when Marla and Nate are gone. They can’t be around all of the time, after all. They do have lives.

Marla doesn’t have much a life right now, though, as it seems every week she’s taking Evie to urgent care or the ER with a cold she can’t shake. It starts off with a simple cough, then comes dehydration and fever, which bring on flashbacks and nightmares, worse than usual. Evie knows they don’t think she can hear them when they’re talking, when Nate and Marla are wondering if she needs more care than they can provide. They say it wouldn’t be permanent, just a day thing, maybe weekly for a few weeks until she can get control over things.

She’d rather go back to master. She knows she’s not supposed to think that. Emma’s told her that master was bad and treated her poorly, but he never did. His punishments meant to teach her, to make her better. He’d be there for her without question, but then she remembers that she failed him and he left her. She was unworthy.

They all say that’s not true, but it has to be. She’s worthless here, an unnecessary burden on everyone. They should’ve just let her die. If she were braver, she’d take care of it for them.

“We need to take some blood to send it to the lab for testing,” the nurse, Izzy, says. “Are you up to sitting there or do we need some help?” Izzy is familiar with them. All of the ER staff is. It’s not hard to do when you have a panic attack every time a needle comes your way. She’s torn out a dozen IVs until they realize that the site has to be heavily taped and sometimes splinted so she can’t get to it. Nearly every visit to the ER results in being restrained, either by nurses or soft restraints and more often than she cares for, she’s sedated. No one knows exactly why she panics.

She shrugs her shoulders, coughing. The congestion in her lungs makes breathing difficult and her head ache. There’s also the fever that hasn’t let up. She’s not up to making any decisions tonight, no matter how simple. Decisions hadn’t been hers to make before.

“Let’s just do the restraints tonight, Izzy,” Marla says with a heavy sigh. “It’s been a long week.”

It should hurt that Marla goes for the restraints so easily, but she sees the worn look on Marla’s face. She’s wearing everyone down. Worthless. Evie doesn’t wait for the nurse to guide her to lay down on the bed. She even puts her arms and legs in the right positions and waits. Maybe she can do something right.

Izzy doesn’t waste any time in securing her with the restraints. The room is awkwardly silent, but Evie likes that. Silence is better than talking. It’s comfortable.

That’s all gone when she smells the antiseptic. Her heartbeat quickens and her breathing becomes shallow as she erupts into a terrible coughing fit. Izzy raises the head of the bed and replaces the nasal cannula with an oxygen mask. Evie’s throat and chest burn as she coughs. She’d like to curl up, but she can’t.

“Just try to take deep breaths, Evie,” Marla says, voice tired as she weakly holds on to Evie’s hand. It’s not that easy, Evie thinks. Every deep breath burns and brings about more coughing.

“Alright, I’m going to give you some time to get the coughing under control before I even try again,” Izzy says. “I’ll check with the doctor, but it’ll probably be a straight IV to make it easier to take blood and she’ll likely want you on fluids.” Izzy undoes the restraints but doesn’t put them away. Evie knows they’ll be back later, but she doesn’t care. She takes advantage of being freed to curl up, pulling her hands around her chest as she coughs. She doesn’t see the hurt look that crosses Marla’s face at the move and in the fit of coughing, she doesn’t hear the wearied sigh as Marla sits, pulling the chair close to the bed.

“I’ll be back in twenty minutes, but don’t hesitate to call if you need something,” Izzy says on her way out. Evie’s glad they have a room, not a curtain. It gives a little more privacy, but then she knows that she only disturbs others so it’s not really for her benefit, but everyone else’s.

Evie continues coughing, feeling everything grow in aching and pain. And then there’s the count down, the timer until Izzy comes back to put an IV in her. It nearly always happens when she’s in the ER because she’s dehydrated. She’s also underweight. Marla gets frustrated with her because she doesn’t eat. She can’t.

“You sound like you’re getting a little better,” Marla says.

Evie doesn’t say anything. She’s not sure if Marla is right. It doesn’t feel any better. Marla doesn’t say anything more as Evie tries to steady her breathing. If she can do that, then, when Izzy comes back she can do the IV, and they can go on as normal.

“I don’t hear any coughing,” Izzy says when she returns a little more than twenty minutes later. “Can you roll onto your back so I can see how you’re doing?”

Evie does as she’s asked. Although the coughing fit has gone, her breathing still feels rough and her chest aches.

“Everything looks as good as it can for now. You ready for the IV?”

Evie shrugs her shoulders and puts her limbs back in place for the restraints. Izzy puts the restraints on again and gets the kit set up for the IV.

“Before I get started, I want you to know that unless something unexpected happens, I’m going to keep going until I get this secured, okay?”

Evie nods, coughing.

“Okay. The doctor’s ordered treatment for likely dehydration as well.” Izzy talks as she’s preparing everything. It distracts Evie until she smells the antiseptic and then she’s starting to panic. She hates the feeling that her heart will tear from her chest and that the air is thinner. She can’t control any of it, either. Emma’s worked with her, but none of them know what happened to her. Amber, the lead detective in her case, doesn’t even know everything. She refuses to say anything. She can’t. That might get master in trouble.

So she panics. She gasps for breath as she coughs and feels her body grow distant until Izzy steps back, hands up. She says something, but the buzzing drowns it out. Still, she knows the gesture. Izzy’s done. There’s a slight lessening in the tension, but it’ll take time for her body to settle out. In the meantime, Izzy sets up the nebulizer to help with her breathing from the congestion and asthma.

“If she’s not settled anymore in ten minutes, call for me and I’ll give her a sedative. The doctor wants to hold it in reserve given her condition,” Izzy tells Marla.

“Sure.” Marla nods tiredly. Izzy leaves again and the room is silent save for Evie’s breathing and the machines. As the medication takes hold and the panic attack subsides, Evie starts to grow restless.

“You ready for me to undo these?” Marla points to the restraints. The nurses generally leave it up to Marla to undo the restraints once they’ve done their job.

Evie nods, the mask still in place. Marla undoes the restraints and replaces the mask with the nasal cannula. They’ve spent enough time here that she knows when it’s safe.

The peacefulness lasts a few minutes before Evie goes for the IV. Marla, in her tiredness, is too slow and Evie manages to get the IV loose, tearing it out of her hand as blood spurts freely from the vein, staining the bedding and Evie’s clothing. Marla slaps a hand over the wound as Evie continues to fight her. With her free hand, Marla pushes the help button.

That sets off a chain reaction. A few nurses and the doctor enter the room, going into action as soon as they see the situation. The restraints go back on, a sedative is administered, and a new IV is put in, in the other arm while the old site is stitched and bandaged. Evie panics at first until the sedative calms her. She’s not out, but she doesn’t have the strength to fight them.

“The restraints have to stay on this time,” the doctor tells Marla. “I’m working on getting her a room. She’s going to have to stay overnight at least.”

“Okay.” Marla sighs. The doctor says she’ll be back later to check on Evie and leaves with the nurses. Marla sits back to take in the all-too-familiar situation. How many times have they wound up like this? Evie’s been home for a month, in therapy for two months and nothing’s getting better. No one even knows for sure what’s happened to her save for the physical marks and what inferences Emma makes based on her behavior.  

“Damn it, Evie. I don’t understand this. Why won’t you fucking tell us what’s happened? We’re the good guys. It’s the people who took you who are bad, not us. We’re just trying to help you.” Marla can’t help her voice raising as she speaks. If Evie hears, she doesn’t know, doesn’t care. She can’t keep it in anymore. “I don’t know what to do to help you anymore. You’re afraid of everything. You can’t keep time. You don’t eat and you can’t make a single fucking decision, not even to decide what color shirt you’re going to wear.” It’s a lack of breath that stops her tirade.

“You think I’m happy?” Evie’s voice is quiet, tired and comes after a long pause.

“No, of course not, but…” Marla huffs. “You don’t tell us anything. We have no idea what happened to you except that you’re afraid of things you never were, like blood and food and people and so many other fucking things.”

“Not blood.”

“What?”

“It’s not blood.”

“That you’re afraid of?”

“Not blood,” Evie repeats.

“Then what?”

“Not blood.”

“Okay, it’s not blood then.” Marla sighs. It’s something, she supposes. It’s more than they’ve gotten from Evie in two months willingly. Whatever it is that Evie’s afraid of, it’s not blood.

[takeeachdayonebookatatime]

Triple f  day  [flashpoint fanfiction friday]

 

(Sometimes you wonder if this attack was planned)

Staring the whole team.

Greg : pov  the new guy on team 4 is weird, the way he stares at jules, he always seems so angry around her to me. The other team leaders/Sargent's are talking about him since Donna is out for a few weeks for her honeymoon Carl has never been around another woman officer, only Jules. We think it might be a woman he does not like, we are not sure. Spike and Wordy are restocking the self while Sam and Jules exercise together. We decided to watch him closely from now on.

Wordy : pov me and spike are restocking the shelf and telling jokes. We talk about family and I told him the girls made get well soon cards for his dad, and I would drop them off tomorrow so he could give them to his dad.

Sam : pov I had to pee so bad but I did not want to leave jules alone that one officer Carl is weird around her. Since no one was in the gym, jules told me she would be fine. and to go pee 2 minutes after, on my way back to the gym I hear her scream really loud I manage to pull him of off her. Since he was choking her he ran off,  while I caught her before she fell onto the floor. I laid her down then checked her vitals. She was not breathing and unconscious. I managed to call winnie, and have her call medics and have wordy bring a medical kit. A few seconds later and wordy arrived with the medical kit I opened it. And grabbed the resuscitation mask i had wordy slowly pumping air into jules. I felt around her neck and put an ice pack on it, to try and keep the swelling  down. spike was by the door waiting for the medics.

Jules : pov I was working out with sam while he was in the bathroom. Carl came into the gym and started yelling about how women are worthless, useless and have no place on an sru team. He accused me of hoarding the work out equipment for myself. All of a sudden he started to attack me. He was choking me but I managed to scream before Sam came and everything started to turn black it was so hard to breathe.

Ed : pov we were not fast enough and that sob attack jules now we need to go find him, sam is taking care of jules we are looking in every room for him even in the closets. He was not on the main floor of the building. His car was still in the parking lot so he could not have gone very far.

Sam : pov I found an epi pen in the medical kit and decided to try it to see if it would help open up her airway. Once the medics arrived they took over, I told them her vitals and what happened.  A medic named Terry tilted her head back and inserted a number 5et tube since her airway was closing, he went with a smaller tube. Once it was properly in place he secured it and then inserted an iv in her arm. He also hooked her up to some monitors. I rode with her the whole way to the er. A dr and a specialist were waiting for us in triage room one. They gave jules some pain meds since she was starting to stir a little. Once she was back asleep a dr named Jerry did an ultrasound of her neck while dr Jen felt around she said everything feels okay, but she wants some scans to be sure. 40 minutes later and she came back to talk about the results. She said it is very severe bruising of the airway with some soft tissue that is injured/inflamed it will be at least 3 days before the breathing tube can come out. Maybe more he went to tell the team the update on jules while she was moved to the icu.

Spike : what happened to jules was so scary. I'm so glad Troy and Greg thought to look in the woman's bathroom because they found him hiding in there. Sam gave us an update on her injury; it does not sound good at all. The dr told Sam a few more seconds and she would have died. He really did save her life today. We visited her every day for 5 day.

Sam : pov it has been 5 days  since the attack the dr said we could try and wake her up just slowly. At noon jules woke up and was trying to pull her breathing tube out.  The specialist dr Jen came in and checked jules's vitals then started to take the tube out. Once it was out she switched her to an oxygen mask. She told her no talking, swallowing will be hard and hurt alot. A nurse wheeled in a cart with some  supplies on it, dr Jen said it is for her feeding tube jules was not happy with that at all once the dr placed the feeding tube down jules's nose she taped it in place and started administering the tube food.

Jules : pov ugh the feeding tube is ruff, swallowing hurts, breathing hurts. I'm just plain miserable, I fell asleep until 6 then the team came by. They talked with me About their day and how the new recruits are working out. I wrote my sentences down on a dry erase board so I could be included in the conversation. The team left at 7 except for Greg who stayed a little while extra so Sam could eat, it was awesome Greg stayed with me for a bit, we got to talk about stuff so he talked I wrote what I wanted to say afterwards me, and Sam went to bed. In the morning I got transferred to a regular room. Then Sam showered while my dr checked my vitals and stuff she said I could shower if I wanted to.

Sam : pov Dr Jen said jules could shower but the oxygen mask goes back on immediately after. A shower chair was put in the bathroom for jules 15 minutes later and jules was back in bed and asleep. I went down to the cafeteria for lunch. It was now 1pm and Jules was up and we watched a movie. Jules signed to me that she was thankful I saved her life. Yesterday shelly had stopped at jules house in the morning and got her some clothes which jules was wearing now. Tomorrow jules had physical therapy and a form of food therapy. The team came to visit for 1 hour, Wordy talked about his kids and so did ed they even had get well soon cards from their kids. After we went to bed. It was the 7th day jules had spent in the hospital, jules did not get her morning feeding.  A guy from Food therapy came to see jules, Dr Jen switched her to nasal oxygen, he checked her throat and cleared her to try liquids. Water was the first down it was ruff but it went down, her breakfast was a protein drink. After the physical therapist came to work with Jules she had her walking around and doing some light exercises. Lunch was some chicken broth. Dr Jen cleared jules to not need oxygen one step closer to getting released. Sam played a few board games with jules she showered, so did sam dinner was a smoothie for jules and a sandwich for him. The team came by and talked about their day and how jules was doing. They talked for an hour while jules signed/wrote down what she wanted to say after Dr Jen came in and gave jules her medicine for her throat. She pulled Sam aside to talk about jules and how she was making good progress, she said if everything looks good tomorrow they can start to talk about  a release plan for her.

Jules : pov

It was the next morning my breakfast was a protein shake, the lady from pt was ruff everything was so sore I guess a week of not moving does that to you. Lunch was more broth this time it was beef flavored. Sam had a roast beef sandwich then we both showered. I was taken down for some neck/throat scan which made me scared Dr Jen said everything was looking better. She said I could try and talk but to not use my voice too much it will hurt a lot. I tried to talk but nothing happened. I was then taken for more test and  scans afterwards a speech therapist came by to see me. She said it might take time and hard work but I would talk again. Later After dinner which was a smoothie for me and pasta for sam. The guy from food therapy came by and talked about solid foods I can have starting tomorrow. 

Sam : pov the team came over at six, I told them the good news jules could have solid starting tomorrow I also told them the not so good news that jules could not talk yet The dr cleared her for it but no sound came out when she tried she thinks it is temporary. In the morning jules got her feeding tube taken out it was not pretty. Breakfast was apple sauce which went down dr Jen said jules would need to eat soft foods for a week and then go from there at her follow up appointment. Jules was so excited she signed does this mean I'm getting released and dr Jen said after lunch if all looks good. I called Greg and told him the good news jules had oatmeal for lunch. I had some eggs, wordy called and asked me if jules needed anything food wise because shelly is at the grocery store and can pick it up so when you get home there will be soft foods available for jules. Sam thanked wordy and told him what jules could eat he said shelly could pick up some baby food. Since that is very soft and comes in a lot of flavors. Sam asked Jules, she said it was okay with her. 40 minutes later and jules was getting released dr Jen handed jules her speech therapy scheduled. The speech therapist had handed to her she was cleared for light workouts and exercising and to not over do it. At home shelly had left a note, jules napped until dinner which was banana baby food jules, signed it tasted good. We showered and went to bed. In the morning I got jules showered and my self her breakfast was a protein drink. We made it to her therapy appointment on time. Since they had run some tests at the hospital they knew all about her medical history the slp named Jessica did some manual  circumlaryngeal techniques on jules. She also showed us some stretches and self massage techniques. After we went home and jules ate mashed potatoes, she then fell asleep until dinner which was more baby food peas and carrots yum. Tomorrow she had more speech therapy. To be continued........

[grahkingston]

Pet Dental Care Kingston - Why It’s Important to Keep Your Dog’s Teeth Clean

For what reason is it critical to keep your canine's teeth clean? 80% of canines have dental disease by age 3. That is a beautiful stunning measurement. It's the most widely recognized clinical disease found in canines. Also, in addition to the fact that it is normal, canine dental disease can transform into genuine medical issues further down the road.

At Grah Kingston, we are providing quality Pet Dental Care Service in Kingston. We are known as one of the best in dog dental care and cat dental care vet clinics in Kingston open 7 days a week.

Where It All Starts

Dental disease starts when microscopic organisms transform into plaque that adheres to the outside of the teeth. Minerals in the salivation solidify the plaque into tartar which spreads under the gum line. Microbes under the gum line secrete toxins that add to tissue harm.

This bacterium is viewed as an unfamiliar trespasser by the safe framework and it causes an invulnerable reaction. The insusceptible framework responds to fiery synthetics move in and these synthetic compounds cause harm to the supporting tissues of the tooth. Rather than tackling the issue, your canine's invulnerable framework exacerbates the disease.

Dental disease has numerous causes. Diet is an immense segment, yet it's by all account not the only part hereditary qualities, irritation, diseases, drugs, a Jing inadequacy, and an absence of pet dental care service may likewise be adding to its turn of events.

At the point when we talk about hereditary qualities, a few varieties are inclined to dental issues. Here are a few examples:

·         Maltese – late improvement of teeth, held deciduous (infant) teeth

·         Yorkies – held deciduous teeth, polish hypoplasia (veneer disintegrates or doesn't exist, and plaque and tartar stick truly well – causes issues)

·         Brachycephalic breeds – Pugs, Chihuahuas, Cavaliers – swarming of teeth, sideways teeth, underbite

·         Greyhounds – polish hypoplasia

·         Shelties – oligodontia (missing teeth)

·         Chinese Crested – teeth develop in delicate, with shallow roots

·         Boxers, Bulldogs – underbite, swarming of teeth

What Is Your Dog Eating?

By a wide margin, the most well-known reason for canine dental disease is diet. Sadly, the hypothesis that dry food helps clean the teeth is a grounded and acknowledged legend. In all actuality, dry food causes dental rot. This is because sugars are a significant segment of most business kibbles. These carbs separate into sugars and those sugars adhere to the teeth.

Is It Jing Deficiency?

As per Traditional Veterinary Medicine, kidney Jing is the existing substance – you're brought into the world with it and it's answerable for the legitimate development of the mind, bones, and teeth. On the off chance that your canine has a Jing inadequacy, this implies he has less life embodiment.

This might be because of: hereditary qualities, helpless sustenance of the mother, safe framework challenges, inoculation during pregnancy, disease during pregnancy, meds that were given to a mother during pregnancy or to a little dog from the get-go throughout everyday life (antibiotic medication, doxycycline, oxytetracycline, minocycline), contaminations or irritation right off the bat throughout everyday life.

Manifestations of Dental Disease

What are the side effects of dental disease? On the off chance that your canine has at least one of these issues, he might be experiencing dental disease:

·         bad breath

·         dropping food from the mouth

·         the bad scent from the mouth

·         visible plaque and tartar

·         tilting head aside when biting

·         loose teeth

·         loss of teeth

·         unwillingness to eat

·         unwillingness to bite hard articles

·         crying out in torment

·         shying away from contact

The Importance of Canine Dental Care

Dental issues and dental disease don't simply influence the teeth. Dental issues can prompt other genuine medical problems:

·         Tooth root abscesses

·         Osteomyelitis (contamination of the bone): the foundations of the teeth are connected to the jawbone and any disease in the tooth can spread

·         Jaw breaks

·         Nasal release and sinusitis: if your canine has constant sinusitis it very well may be a tooth root issue

·         Damage to heart valves, prompting cardiovascular breakdown, liver and kidney harm: the mouth is an exceptionally vascular territory – there are bunches of bloodstream here – and the microscopic organisms in the mouth can get gotten and work their way into the circulatory framework and through the filtration frameworks of the liver and kidneys

·         Poor diabetic control

·         Septicemia (contamination in the blood): can prompt stun and demise.

·         For people, dental care is a significant piece of our everyday cleanliness schedule. So, for what reason would we say we aren't taking similar care with our canines' teeth?

·         Diet, crude bones, brushing, and common at-home dental care can go far.

At-Home Pet Dental Care

What would you be able to do at home? There are loads of items available that can be utilized to keep your canine's teeth clean:

·         Dental washes

·         Dental sprays

·         Dental drops

·         Water added substances

·         Dental bites

·         Dental eats fewer carbs

Be that as it may, not all are made equivalent and not all are protected.

Safe Teeth Cleaning

Even after you've made an honest effort to keep your canine's teeth clean normally, and have done all that you can to try not to go to the vet, here and there proficient examination and cleaning (under sedative) is unavoidable. We realize that the possibility of putting your canine under can be terrifying, yet for legitimate dental care now and again it's fundamental.

There are sans sedation options now, yet lamentably this cycle frequently doesn't get sufficiently profound. So, if your canine needs his teeth cleaned or a dental medical procedure, the key is to ensure the system is done appropriately and securely.

If your canine winds up requiring an expert cleaning, first, you need to ensure your canine is adequately sound to go under sedation. Your vet should run the fundamental tests before you consent to the strategy. Contingent upon your canine's condition, pre-sedation testing may include:

·         Bloodwork

·         EKG

·         Chest x-ray

·         Heart exam

Along these lines, in light of those tests, your vet can tailor the sedation dependent on what your canine has going on. Sedation ought to never be done on a one-size-fits-all premise.

The more information you have going into the technique, the better, so don't be hesitant to pose these inquiries:

1.       Who's doing the technique? What's their experience and preparation? Is it a tech with long periods of experience and appropriate preparation or a custodian who simply hops in when their administrations are required?

o   The individual playing out the method ought to have numerous long periods of preparing, ideally as a guaranteed veterinary expert, with uncommon preparing in dentistry. Veterinarians at vet clinic Kingston once in a while play out the dental methodology themselves, except if they have a unique interest and preparing in dentistry (much the same as going to the dental specialist where the hygienist plays out the cleaning).

2.       Who will direct the sedation? Once more, what preparation and experience does this individual have?

o   The veterinarian and prepared specialist ought to supervise the sedative system. They ought to individualize the convention for every creature (see the pre-sedation testing above).

3.       What sort of observing would they say they are doing? Is pulse being observed, is there an IV catheter set up, is oxygen immersion being checked, is internal heat level being observed? How are they doing to protect your canine?

o   Observing ought to incorporate EKG, pulse, oxygen immersion, and internal heat level, at the very least. CO2 levels are once in a while observed. An IV catheter ought to consistently be set, just as liquid help.

Discover a vet who will band together with you, one who perceives your feelings of dread and will do everything to make it simple (and safe) for both you and your canine.

Why Not Non–Anesthetic?

For some, anxious pet proprietors, going the non-sedative course in some cases appears to be a more secure decision. In any case, proficient vets at vet clinic Kingston don't suggest non-anesthetic cleanings. They simply don't get sufficiently profound. Without sedation, you're taking a gander at a failure to clean under the gums, within surfaces of teeth, and behind the back teeth.

Free or harmed teeth won't be taken out. Torment is normal and your canine could be harmed on the off chance that he moves during the technique. Non-sedative cleanings will likewise result in inferior cleaning (or none by any stretch of the imagination) which makes it simple for plaque and tartar to develop.

Because your canine's mouth and teeth look great on a superficial level or with a truly brisk look, doesn't mean things are extraordinary when you look nearer.

In some cases, crude substantial bones are sufficient to keep your canine's teeth perfect, sound, and solid, however, it's not generally that basic. Canine dental care is so significant, not only for the wellbeing of your canine's teeth and mouth, however his general wellbeing.

Gardiners Road Animal Hospital can help you take care of your dog’s teeth and keep her happy and healthy. Animal Hospital in Kingston strongly inspires pet parents to get their pet’s teeth cleaned and polished on a routine basis.

Regular veterinary appointments at vet clinics in Kingston are important for maintaining your dog’s health and spotting any problems before they become too severe. Learn about our veterinary office by calling us today at +1 613-634-(KVET)5838.

[covid19updater]

COVID19 UPDATES: 03/26/2020

Brazil: Brazil’s coronavirus-driven political meltdown seems to be moving very fast and not in a good direction. Governors of all Brazil’s 27 states to convene later tonight to discuss president Bolsonaro’s behaviour

France: French Public Health Official Reports 2,827 People In Need Of Life Support Due To Coronavirus (prev 2,516) - Latest French Death Toll From Virus Stands At 1,331 Deaths (prev 1,100)

NYC: Despite #coronavirus restrictions, NYC subway cars are still PACKED. This video, taken YESTERDAY, shows passengers in an overcrowded train with little evidence of social distancing LINK

Michigan:  2 members of Detroit PD die from COVID 19

US: At least 11 states have reported over 100 new cases of coronavirus on Wednesday, according to updates from each state's Department of Health or state officials. Here is the breakdown from each of these states: New York added over 5,000 cases New Jersey added over 700 cases Louisiana went up 400 cases Pennsylvania reported 276 new cases Texas increased by 259 cases Florida jumped over 215 cases Georgia went up 150 cases Ohio added 140 cases Indiana gained 112 cases North Carolina climbed 106 cases Virginia added 101 cases

US/DOD: EXCLUSIVE-U.S. DEFENSE SECRETARY ESPER ISSUES A STOP MOVEMENT ORDER HALTING ALL TRAVEL AND MOVEMENT ABROAD FOR UP TO 60 DAYS

US: BREAKING: 5 more U.S. Navy sailors aboard aircraft carrier Theodore Roosevelt test positive for Covid-19 in Western Pacific, bringing total to 8 in past two days: U.S. officials The warship has a crew of 5,000.

NYC: CoV patient died in NYC hospital lobby waiting for bed

World: Wednesday's major coronavirus updates: - USA: +11,204 cases, +146 deaths - Spain: +7,457 cases, +656 deaths - Italy: +5,210 cases, +683 deaths - Germany: +3,907 cases, +47 deaths - France: +2,931 cases, +231 deaths - Iran: +2,206 cases, +143 deaths - UK: +1,452 cases, +43 deaths

RUMINT (Massachusetts): So some very solid info that I just got from my LEO friend down in Massachusetts... people here had posted a few days ago that they noticed a ton of power company trucks all over the place, both convoys and just sitting around in parking lots. Apparently the deal with that is authorities are extremely worried that a normal power outage due to a tree going down or a car hitting a pole would cause mass panic, making people think shit just totally hit the fan because of CoV. Because of this they are having the linemen pre-staged all over the place to respond immediately to any power outage and get it back on as soon as possible so people don't run downtown and start looting stores thinking society just collapsed.

Florida: Miami Commissioner Joe Carollo says he has heard of two additional cruise ships coming to Port Miami with passengers who have tested positive for COVID-19. He says he is concerned because the port is controlled by the county, not the city.

US: Hospitals across U.S. consider universal do-not-resuscitate orders for coronavirus patients LINK

NYC:  An emergency room doctor in Elmhurst, Queens, gives a rare look inside a hospital at the center of the coronavirus pandemic. “We don’t have the tools that we need.” LINK

NYC:  manager at Mount Sinai West hospital in NYC - where staff were forced to wear TRASH BAGS as protective equipment - dies of coronavirus at age 48 LINK

California:  17-year-old teenager died of coronavirus after being released from a Los Angeles hospital LINK

UK:  London hospitals are facing a "tsunami" of coronavirus cases and are beginning to run out of intensive care beds, a senior hospital figure has said. LINK

Italy: Italy's death toll from Covid-19 could be severely underestimated. The town of Nembro, near Bergamo, had 158 deaths so far this year vs 35 on average in the recent past. Only 31 deaths were attributed to Covid-19.

Portugal: 60 deaths and 3544 cases now in Portugal! +17 deaths, +549 new cases and 18,3% rise on cases.  61 critical.

Texas: Warning: 2 men wearing scrubs, masks trying to perform in-home coronavirus tests LINK

Singapore: Health officials in Singapore reported 73 new confirmed cases of the novel coronavirus on Wednesday, making it the country’s largest single-day increase in cases.

Italy: ITALY'S LOMBARDY REGIONAL GOVERNOR SAYS CORONAVIRUS DATA ON WEDNESDAY "NOT VERY GOOD", NUMBER OF CASES UP BY SOME 2,500

Switzerland: A strange pattern has emerged in COVID-19 CFRs in Switzerland. COVID-19 has been twice as likely to kill patients in French-speaking cantons of Switzerland than in German-speaking, and more than twice as likely to kill patients in Italian speaking cantons than in French ones.

UK: BREAKING - United Kingdom is changing how #COVID19 deaths are recorded and made public, a Downing Street spokesman confirmed. Seems the UK is starting to hide deaths now.

Germany: BREAKING - "We already have many infected with #COVID19. And we have many dead already." Germany's Health Minister adds: "This is still the calm before the storm."

Russia: BREAKING - The Russian Ministry of Defense has allocated 8.8 billion rubles for the construction of 16 makeshift field hospitals for #COVID19 patients across the country.

Germany: BREAKING - Germany's Minister of Agriculture complains about staff shortages in the food supply amid #COVID19. Foreign seasonal workers are lacking in slaughterhouses and dairies. Sowing of grain also at risk.

RUMINT (New Orleans): "I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know. Clinical course is predictable. 2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue. Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma. Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours. 81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical. Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town. China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails. Diagnostic CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox. Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95% CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated. Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner. Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that. A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation. An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes. Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal. Disposition I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation. Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020. Treatment Supportive worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle. Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post. We are also using Azithromycin, but are intermittently running out of IV. Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry. Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps. Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed. Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours. The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room. Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis. We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads. One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many. I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all."

China: BREAKING - China is drastically reducing the number of international flights from Sunday, as they fear a second wave of #COVID19 from foreign countries. But they cried when others banned flights from China.

US/DOD: US Army Goes To Highest State of Health Protection: SUBJECT: FRAGO 13 TO HQDA EXORD 144-20 ARMY WIDE PREPAREDNESS AND RESPONSE TO CORONAVIRUS (COVID-19) OUTBREAK// (U) REFERENCES. REF//A/ THROUGH REF//WW/ NO CHANGE. REF//XX/ [ADD] FRAGO 12 TO HQDA EXORD 144-20 ARMY WIDE PREPAREDNESS AND RESPONSE TO CORONAVIRUS (COVID-19) OUTBREAK, DTG: 230210Z MAR 20// 1. (U) SITUATION. [ADD] MITIGATION MEASURES TAKEN BY THE ARMY TO BLUNT THE SPREAD OF COVID-19 HAVE PROVEN INSUFFICIENT. COVID-19 CONTINUES TO SPREAD GEOGRAPHICALLY AS THE NUMBER OF INFECTED PERSONS CONTINUES TO RISE. CIVILIAN CAPABILITY AND CAPACITY ARE BECOMING MORE STRESSED AS DENSE POPULATION CENTERS CONTINUE TO REPORT HIGHER RATES OF INFECTION THAT ARE IMPACTING MAJOR TRANSPORTATION HUBS AND SUPPLY CHAINS. ADDITIONAL MEASURES AND ACTIONS ARE REQUIRED TO PROTECT THE FORCE FROM FURTHER SPREAD OF COVID-19. FOR EXAMPLE, TO MAINTAIN STRATEGIC READINESS AND PRESERVE OUR RAPID-RESPONSE CAPABILITIES, WE ARE PLACING RAPID-RESPONSE FORCES UNDER HPCON DELTA.

France: The newspaper "Die Welt" reports on Italian conditions in France: A team of German doctors discovered during a visit to Strasbourg that triage had long reigned in Alsace. Means: Patients are sorted according to chances of survival. Brigitte Klinkert, President of the French department Haut-Rhin, to "Die Welt": "We have been doing triage for two weeks. Patients over 80, over 75, and sometimes over 70 can no longer be intubated because we simply lack the ventilators. It cannot be said often enough, because not only the German neighbors, but also the French outside of Alsace are not yet aware of the situation here. "

NYC: BREAKING - Last night EMS in New York took 6,406 medical 911 calls. The highest volume ever, surpassing the level of calls on 9/11 when the terrorist planes hit the WTC.

US: BREAKING - U.S. Navy to test all sailors on aircraft carrier in Pacific as #COVID19 cases grow, and grow, and grow. 24 sailors aboard USS Theodore Roosevelt have now tested positive for the virus. TR pulling into Guam soon, Navy says

World: GLOBAL CORONAVIRUS CASES REACHES HALF MILLION MARK WITH CHINA, ITALY AND US ON TOP 3 LIST #breakingnews

New York: 34% OF NEW YORK CORONAVIRUS TESTS ARE COMING BACK POSITIVE

Italy: BREAKING - Italy reports 6,153 new #COVID19 cases and 662 new deaths. Total now 80,539 coronavirus infections in the country and 8,165 dead.  MOST NEW CASES IN FIVE DAYS

Louisiana: Another update on hospitalization of covid patients in Louisiana: Today, 676 patients (29%) are hospitalized. 239 of them are on ventilators, which are in short supply, especially in New Orleans.

US: FAUCI SAYS THINKS CORONAVIRUS WILL CONTINUE ON THROUGH SUMMER, DOES NOT THINK IT WILL "DISAPPEAR"

New Jersey: NEW JERSEY CORONAVIRUS CASES INCREASE BY 2,492 FROM DAY EARLIER TO 6,876, DEATHS UP BY 19 TO 81 -GOVERNOR PHIL MURPHY

New York: The number has now climbed to 351 members of the NYPD that have tested positive for coronavirus

UK: BREAKING: UK reports 2,129 new cases of coronavirus and 113 new deaths, raising total to 11,658 cases and 578 dead

France: LATEST DEATH TOLL IN FRANCE FROM CORONAVIRUS STANDS AT 1,696 DEATHS (VS 1,331 yesterday) - PUBLIC HEALTH OFFICIAL

NYC: NBC News: 131 FDNY members have tested positive for COVID19. More than 2,000 members of the agency are on medical leave, most of them with flu-like and coronavirus-like symptoms, per senior FDNY official. 

RUMINT: Report from a friend who is an ER PA in a mid size city. No, I will give no other identifying info about him. Testing 250-300 per day. Some positives with low grade (101 and below) fever, but those also have diarrhea. Their first cases were idiots who went to Mardi Gras. No, he in not in NOLA. These assholes transported the virus to their hometown. They expect it to really ratchet up next week, and go full on crazy the week after.

RUMINT (NYC): So many police officers in NY infected, many in quarantine, and more to follow. When the “urban youths” figure out the cats are unable to come out, it will be full on mayhem time. The guard will be necessary to tamp that shit down. If the rubber bullets don't at first work, I suspect there will be shoot to kill orders. Otherwise, the non rape/pillage/loot people will be butchered.

Anonymous Doctor’s Evaluation of COVID19: Ebola is a knock out expert. HIV plays the long game but only ends 1 way, COVID is the illegitimate brother to them both.

US: BREAKING: U.S. overtakes China as the country with the highest number of confirmed coronavirus cases

[brianjaeger]

2020 Academy Award Best Picture Nominees Guide For Those Who Haven’t Actually Watched Them

The 92nd Oscars are here and it’s time yet again for all of us to lord over one year’s worth of millions of people’s passions with the certainty of a judge at the Westminster Kennel Club Dog Show (which ironically takes places one day later) and say aloud, “This art is and forever shall be known as better than that other art!” 

Throw the notion that expression through the medium of film can exist simply to reflect a myriad of emotions and varied experiences right into the wind. We gotta know what that BEST art is, son!

So with mere hours left before Sunday’s spectacle, you’re probably asking yourself one question. “Brian, why do you keep doing this?” No, not that one. “Brian, Tumblr? Really? Does that still exist? Why don’t you spend the slightest amount of time to find a better medium for this?” No, not that one either. “But Brian, I haven’t actually watched any of these films. What am I going to do?!” Ah, now that’s the one. But fear not. I’ve got you covered. For the 6th time, I’m here to give you a rundown of what I think all of these movies are about without actually seeing them, along with some pithy little talking points to take into your Oscar parties to sound like a goddamn genius.

Ford V Ferrari

In this epic clash of man vs. nature set in the den of Harrison Ford’s summer home in Plano, Texas, the extremely hungry aging star has just had a large pie from Ferrari’s Pizzeria, located at 3949 Legacy Drive, delivered…and now it is time for battle. On the About Us section of their website, Ferrari’s Pizzeria makes a “promise to our customers to provide the best Italian food using recipes handed down from our Italian grandmothers.” Hold on to your Italian grandmothers, kids - that promise is about to be put to the test. (Yeah, it’s real.)

3 Things To Casually Inject Into Conversation To Prove You Saw The Movie And Sound Like An Expert:

That cameo by Mater from Cars is really what pushed this film into Oscar contention.

Christian Bale's car in Ford V Ferrari is also an unwavering method actor and remained in character as a car for the entirety of production.

Who won? I'll give you a hint, in the long run, it was not the quality of life for the American working class!

The Irishman

In this gritty thriller, Lucky the Leprechaun’s father, Frank Leprechaun, an immigrant who worked as a farrier making horseshoes in Ireland before coming to America, wishes on a shooting star for a way to make a better life for his family. He finds that chance by doing hits for the mob and we see his first job take place under a pale moon, when he shoots a diamond store clerk in the heart, blood red ballooning out onto the green grass, like crimson and clover. Later, an aging Frank Leprechaun kills union leader Jimmy Hoffa and as he dies, he divulges the secret that Hoffa’s body is buried on a plantation in Lexington to Lucky. The young boy looks back and makes a firm promise to his dying father. “They’ll never get Kentucky farm.”

3 Things To Casually Inject Into Conversation To Prove You Saw The Movie And Sound Like An Expert:

The de-aging technology used in The Irishman was so advanced that, while you can’t see it, De Niro's testicles are actually two inches higher in the first half of the movie.

The run time of the movie is 3 hours and 30 minutes which is also the average amount of time Netflix users scroll through options before deciding to just watch the same episode of The Office again.

In Ireland, this movie is known as The Man.

JoJo Rabbit

From M. Night Shyamalan comes the story of a scared young boy who claims to see Jewish people. While adults around him are trying very hard to see them too, it’s Adolf Hitler who helps the boy to overcome his fear and actually communicate with the Jews to understand them and realize that the reason that he can see them is because he can help them. And then at the end we realize that Hitler was actually a Jew himself THE WHOLE TIME!  

3 Things To Casually Inject Into Conversation To Prove You Saw The Movie And Sound Like An Expert:

I thought it was just a bit on the nose that Taika Waititi chose to have JoJo sing her hit “Leave (Get Out)” at all the Nazis during the Allied occupation of Germany.

While juggling roles in Marriage Story and JoJo Rabbit, Scarlett Johansson would often get confused resulting in one day on set when she tried to cut Sam Rockwell’s hair in a bathtub.

Of all the nominated films, when it comes to winning Best Picture, this is…Nazi one! (Cough. Look around. Place your drink on the table. Slowly collect your coat, walk to the door, pause as if to turn, sigh, leave.)

Joker

It’s 1964 and Cesar Romero has established himself as a force in Hollywood. A multi-talented performer and veteran of WWII, Romero has amassed an impressive body of work playing roles as a versatile character actor, when he gets a call from his agent.

Agent: Cesar, I’ve got something that I think you’d be perfect for.

Cesar Romero: Is it a complex villain in a new Western? A dark turn as a gangster in a noir? A comedic foil in a Sinatra vehicle?

Agent: No. Better.

Cesar Romero: What is it?

Agent: Get this. An evil clown Batman nemesis…on TV!

(Silence.)

Cesar Romero: Um.

Agent: You’ll be kind of like a sidekick to Burgess Meredith! And guess what he is?

Cesar Romero: (Deep breath.) What is he?

Agent: Like a half-man, half-penguin sort of thing…I think. But he’s also evil! Oh, and you’ll also get to star alongside Julie Newmar!

Cesar Romero: Oh, well that may have legs. So, do we have a “will they, won’t they” dynamic?

Agent: Not at all! But she is evil too. And also part cat!

Cesar Romero: I do not understand any of what you are saying.

Agent: And it’s got Frank Gorshin!

Cesar Romero: And what is he? Let me guess. Like an evil frog person?

Agent: No, no! He’s The Riddler. It’s sort of the same exact deal as your character, only he doesn’t wear any makeup. Isn’t this wonderful?!

Cesar Romero: (Pause.) You have to be joking.

Agent: No, Cesar. YOU have…to be joking.

3 Things To Casually Inject Into Conversation To Prove You Saw The Movie And Sound Like An Expert:

We still have a little bit of time for Joaquin Phoenix to die and win a posthumous Oscar for this role and keep with tradition. Then in 11 more years, a woman will win Best Supporting Actress for playing the Joker role and then in another 11 years the actual Joker will direct Joe Kerr in a reboot co-starring the Impractical Jokers…and win an Oscar.

I found the end scene touching when Arthur’s wife delivers his child and asks, “Arthur, what do you want to name your son?” And he replies, “Béla.”

Todd Phillips only made this big flashy blockbuster for the studio so that they’d let him do his deeply personal, intimate art house project, The Hangover IV.

Little Women

In a fresh take on a movie that I think is about some nuns living in a cottage during, fuck, I dunno like 1845? 1912? Aught 5? but there’s like a mean one, and a smart-and-sort-of-pretty-but-not-too-pretty one, and they probably have a dog, oh and a horse, and they have fights about vying for the love of the same boy they grew up with who is now some hot stud with poofy hair and poofy shirts and a nasally British accent, oh and there’s 2-3 other sisters that really just serve to further the main sister’s plot, and there is like fucking grass everywhere and how is all that grass not staining the shit out of those long flowy dresses that they always wear on their farm – or is it a glen? can you live ON a glen? – but later the guy marries the right one and he’s a strong man but is totally cool with her writing about some bullshit about being like a female doctor pioneer or something – oh and she’s wearing a straw hat with like a ribbon that’s always flapping the fuck around behind her – I forgot also that they only have one parent, the other is definitely dead and that comes up a little too often, and my mom and two sisters have to have tissues near the goddamn couch while they watch this seemingly 14 hour fucking miniseries or movie or Hallmark marathon because even though each of them could goddamn recite the dialogue from memory they still cry every…single…time…and OH MY GOD, CAN THIS ANNE OF GREEN GABLES, SOUND OF MUSIC, LITTLE HOUSE ON THE PRAIRIE, PRIDE AND PREJUDICE OR WHATEVER THIS GIRL STUFF IS PLEASE BE OVER SO I CAN HAVE THE LIVING ROOM TV BACK TO WATCH BOY STUFF!

3 Things To Casually Inject Into Conversation To Prove You Saw The Movie And Sound Like An Expert:

Not many people know this fact but on her death bed, Louisa May Alcott’s final request was that if a woman ever directed a film adaptation of Little Women they would absolutely under no circumstances be nominated for a Best Director Oscar. So, really, that’s on her.

To ants, these are very big women.

Alan Dershowitz and Prince Andrew's favorite film.

Marriage Story

Dr. Ellie Sattler has established her second career as a divorce attorney after years as a paleobotanist and now fights so that “woman inherits the earth”...or at least gets primary custody and more than half of the assets.

3 Things To Casually Inject Into Conversation To Prove You Saw The Movie And Sound Like An Expert:

The roommates of Noah Baumbach and Greta Gerwig have become increasingly annoyed listening to several minutes of the two repeating, “No I hope YOU are recognized by the Academy of Motion Picture Arts and Sciences with the Academy Award for Best Picture…and hang up first,” before ending their long phone calls every night.

While juggling roles in Marriage Story and JoJo Rabbit, Scarlett Johansson would often get confused resulting in one day on set when she tried to hide Robert Smigel in the attic.

Variety reports that a remake of Marriage Story is now slated for fall of 2026 with Colin Jost in the role originated by Adam Driver in a version of the story that will be produced by real life.

1917

The seventh and final installment of the 1910's saga follows the previous successful box office hits 1911: The First One, 1912: Now There's Two, 1913: Why Not Three, 1914: Get It? Years Are Sequential. That’s Really All This Joke Is, 1915: This Is The Fifth One (But Fourth Sequel), and 1916: 19 Fast 16 Furious.

3 Things To Casually Inject Into Conversation To Prove You Saw The Movie And Sound Like An Expert:

Originally, the movie was supposed to have a ton of cuts between scenes but after saying, “Action,” a producer whispered to Sam Mendes that they only had budget left for one single take after hiring every single recognizable British actor still alive – so Mendes started screaming, “Run! You there, start shooting at them. Keep rolling! Keep running! Jump down that waterfall! Let’s go, people, keep up! Hide in those trees now! Oh look, more bad guys! Pew pew! Duck! Run over that way! Do not…stop…shooting!”

If this movie was called 2017, Colin Firth would have just pulled out his Samsung Galaxy Note 8 and texted, “Call off attack,” with a GIF of Admiral Ackbar saying, “It’s A Trap!” Then, mere seconds later he would have received, “lol k thx”.

1917 earned Benedict Cumberbatch a nomination for “Most Distressingly Off-putting Mustache”.

Once Upon A Time In Hollywood

Once Upon A Time In Hollywood harkens back to a time long, long, long ago in Hollywood's history when the majority of top actors were white, the majority of directors were old men and individual parts of women's bodies were oddly objectified and sexualized. We’ve come so far since then!

3 Things To Casually Inject Into Conversation To Prove You Saw The Movie And Sound Like An Expert:

Please don’t ruin the fun and let Brad Pitt know that a movie was actually being filmed around him from June to November 2018.

I didn’t think the film was particularly that great but every single person I know who lives in L.A. and is either in or adjacent to the entertainment industry corrected me that it actually is.

Oh, I’m sorry – I think you’re in the wrong place. This is the once upon a time where a man is burned alive with a blowtorch. If you’re looking for the once upon a time where a man’s eyes are drilled out of his face, well then, pal, you’re gonna want to go to Mexico.

Parasite

Oh. I’m sorry. I accidentally put a Best For'n Language Film here at the end of this list of the best ‘Murican films.

3 Things To Casually Inject Into Conversation To Prove You Saw The Movie And Sound Like An Expert:

Parasite was, by far, the best movie I read this year!

나는 기생충을 진심으로 감사 할 수 있도록 한국어를 배웠습니다.

Bong Joon-ho's Parasite might leave you asking who are the real bottom feeders in the black comedy about social structures. There's plenty of food for thought as this picture is deeper than than what it may seem like on the surface…is the word-for-word review from Rotten Tomatoes Super Reviewer Aldo G that I just read to you out loud after pulling it up on my phone here.

[kgillsofrp]

So let me tell you a thing about losing a lot of weight really quickly (and why you shouldn’t do it)

So I wasn’t doing this on purpose, honestly. My body is actually fucked up not just from the extreme weight loss but also from what caused it. It’s been five months of not being able to eat and it took them three weeks to get me back to a normal range of nutrition. During those three weeks, for two and a half of them I was being fed through an IV tube directly into my heart 24/7. They had to slowly up the dose every day to avoid “Refeeding Syndrome” which is essentially when your body rejects the nutrients after being without for too long. For the last week and a bit I’ve only been having it at night. And yesterday they started to cut back the dose. This is the best thing, honestly I can’t describe how I feel right now, knowing that I am getting healthier and my body will be able to survive post-op.

Before all of this I was almost 90 kilos. That’s 198 pounds. I’m 5′1″ or 155cm tall. I was technically overweight. I now weigh 51.8 kilos (114 pounds). When I was admitted three weeks ago I weighed 45 kilos (99 pounds). The week before I was admitted I dropped 5 kilos (11 pounds) in three days. This is not healthy, but I shouldn’t need to tell you that.

Over five months the changes to my body were a lot. I became paler then I normally am. My skin actually had a greyish-blue tinge to it. My face became drawn, I looked tired all of the time. I had dark bags under my eyes that I couldn’t get rid of. I had no energy to do anything. I couldn’t concentrate, I couldn’t remember simple things. I couldn’t walk for a minute without getting tired and needing to sit down. I was cold all of the time. If I was outside for more than a minute, my fingertips would start to turn blue because my heart was more focused on getting blood to my brain and other organs. My blood pressure dropped to 70/50 (which is dangerously low). My heart rate sped up from the smallest of activities. I was constantly at the risk of having a heart attack at 22. 

I developed little hairs all over my body, which was my body’s way of trying to keep me warm (it doesn’t work). My hands shook all of the time. My legs were weak. Whenever they tried to take blood from me for blood tests and they had to use a tourniquet, my fingers and hands would start to cramp right away and I wouldn’t be able to uncramp them, or move them, for at least a minute after they took the tourniquet off. I was grumpy all of the time. I snapped at people easier. Anything would set me off. This caused me to withdraw from my friends and family because I didn’t want to hurt them.

At my job, I’ve always been the best. My stats have always been perfect and I have never failed a call before. I failed two in a week over things that I knew and I knew how to do them. And I was always on the right pages of scripting but I just couldn’t focus on things and I was making mistakes that, in my line of work, were detrimental. I’m lucky that through all of this and my time in the hospital, my work has been extremely supportive and are holding my job for me until I get better. But not everyone has that.

Mentally I grew depressed. I couldn’t see how I was going to live passed all of this. When my psychologist asked me where I saw myself in a year, and what my goals were. I could also answer with “I don’t even see myself tomorrow”. The hopelessness was hardest on my family and the guy I’ve been seeing. They wanted to help me, I knew they did, but I couldn’t live anymore. I took each day minute by minute and tried to survive but I was on autopilot for five months. That’s the hardest part looking back on all of this.

I’m still not recovered. I’m having surgery that will literally save my life in a week. And then I have to recover from that which they think will take me at least another month in hospital. For my surgery they need three different surgeons because of the areas of my digestive tract that are affect. It’s going to take 5-6 hours for the surgery they kind of have planned (the only real thing they know for sure is that they’re removing one third of my large bowel). There is a possibility that I’ll be in for longer and I might come out with an ileostomy (which is a temporary bag connected to your intestine that collects waste). But they’re not sure of that yet. They won’t know what they’re actually doing until they’ve opened me up. And let me tell you, as someone with bad anxiety, this has caused quite a number of panic attacks and withdrawals.

But I’m getting better now. My weight is maintaining at between 50 and 55 kilos. I feel like I have more energy now that I’m a lot more nourished than I was three weeks ago. I’m happier. I’m less depressed. My skin has colour in it again. My mum complimented me and said “Teagan, you’re looking so much less anorexic than you were. Less dead”. Because losing a lot of weight and not eating, your body starts to die. It starts eating itself. You don’t heal from things as quickly as you normally would

Now, for me this was all unintentional. But there are people out there who strive for this. You do this to themselves. But please, if you want to lose weight, do it through healthier methods. You won’t be lucky and get fed through an IV, no you’ll get a nasal-gastric tube which is exactly what it sounds like. And they’re the worst (trust me, I had one for two days). I got a scratch on my nose from it and I’m still healing that scratch (it’s been two weeks). You might not even be one of the lucky ones who survive what this does to your body. And that’s terrifying. Think of what it does to you and those who love you. And please, if you ever feel like that, come and talk to me. Because before all of this I was doing it too. I was restricting and controlling because it felt nice to control something while my life felt out of control. I was throwing up when I ate too much, or when I felt like I didn’t “deserve” the food.

Don’t do this to your body, your body loves you unconditionally. It will try its hardest to keep you alive and keep you going and eventually that won’t be enough.

So please, please, talk to me, or your best friend, or your cat. Talk to anyone. You will get through this. You will survive and be strong. I believe in you. Your body believes in you. You’ve got this.

[mypetshopworld]

Help! What Cold Medicine is the best for Cat Flu.

What is Cat Flu?

A Cat flu is like a human cold it has the same symptoms as for us humans. Your cat will have a runny nose and runny eyes, sore throat and probably no appetite. Sometimes your feline friend can have aches and pains in the muscles and joints.  Mouth ulcers, loss of voice and fever as well as dribbling and sneezing can be a side effect of the flu just like in humans. Cat flu symptoms in cats In a typical case, a cat flu is not so severe in adult cats, but they suffer depending on how strong the symptoms appear and the cat flu takes out a lot of energy from your cat, you know from your own experience you can be quite ill with influenza. I recommend that all cats with the flu or cold should see a vet. Depending on how fast your cat is diagnosed and treated with a cat cold or cat flu, the cat flu recovery time is typically from around 12 days to four weeks.

Human cold medicine over the counter is a no-go for your cat.

Unfortunately, when your cat is suffering from a runny nose or sneezing a lot, you can not give her the cold medicine you buy over the counter for your self. Always keep in mind that human medicine is made for humans and not for cats or pets. I know sometimes we feel sorry for our feline friend and we can see how much they suffer, but think in the best interest of your cat that human medicine might harm your cat or in the worst case poison your cat. The best thing you can do for your cat is, bring your cat to the vet and get it diagnosed and treated. The vet will give you the appropriate medication for your cat and for you the proper instructions on how to administer the medication to your cat.

Help your cat to get over the flu with ease.

There are little things you can help your cat get over the flu with ease. It is depending on your cat on how much your cat is tolerating what you do with her. Topics of the Cat Flu Provide your Cat with a recovery area Turn up the heat and keep your cat warm Food and water during the flu is important for your cat Critical facts during the time your cat has the flu. Testing the dehydration of your cat Vaccination Environmental Stress Factors Vitamins and Supplements for Cats Medical Membership for Pets to Reduce Costs

Give your cat the space it needs to become well again. Provide a recovery area.

As you know cats when they are sick or feeling not well, they look for a place to hide. Make sure you have access to your cat, and you can help and provide your cat with a recovery area. Cats don't like noise especially when they are sick. Keep them out of the way from the household traffic and your other pets. The area should be kept warm and comfortable with a bed, a litter box, water and food in close reach. Your cats' favourite toys ( please wash them after the cat recovers) in case they are not washable, please trash them and get new ones to avoid spreading the infection.

Cat Flu and well being. Turn Up the Heat keep your cat warm. 

Create for your cat a warm place where she can hide, but you still have access to it. If you are a smart cat owner you understand your cat's needs.  Cats do not like water but getting the cat into the hot steamy bathroom when you are taking a shower will do wonders in opening their airways, nasal passages while fighting the infection. That is a great "cat blocked nose remedy." If you have floor heating in your bathroom, your cat will properly already made herself a home there. Cats are finicky so don't stress them out with too much home remedies. But one thing that helps me with my cats in winter they love to stay in our bathroom under the sink as we have floor heating. If you do not have floor heating get a heating pad but use it with care and don't make it too hot as you can quickly burn the paws of your cat. If you live in a cold country you have to switch on the heating and that in general makes the air dry. We can feel it ourselves. Switch on a humidifier for around 30 min each day in the recovery area of your cat for two or three days; it will relieve the congestion for your cat. It works the same as for Babies. You can do it for longer if your cat needs longer time to recover.

Food and water during the flu is important for your cat

The same as we humans, your cat will lose the appetite and smell during the time we have a cold. The same goes for your cat, because of that your cat might refuse to eat and to drink. Especially when your cat has a sore throat. From my experience when a cat has a cold or flu, they will not eat the canned food with jelly, because when a cat has a sore throat, it is hard for them to swallow. You can use can food with gravy and warm it a bit, so the smell and the flavour come out more. That might help to awaken the appetite in your cat. Cats love to smell. If you wonder what to feed a cat with a sore throat, I mix up some vegetable fish or meat and put it with a bit of broth in the blender and feed it to my cat. I change the fish or meat each day, so my cat does not get bored of it. Believe me; you become very creative when you have a cat who refuses to eat because it is sick and you will worry a lot. Cat lovers know how fuzzy a cat can be about food. Monitor your cat during the time it has the cat flu. Cat flu weight loss is unavoidable, but you have to decide when it is time make a trip to the Vet.

We all know that trips to the Vet are expensive and if you have more than one pet the bill gets bigger. Save with PetPlus Membership. 

Critical facts during the time your cat has the flu.

One thing is critical during the time your cat has the flu. Your cat needs to be kept hydrated, and water is essential. If your cat is getting dehydrated, you might have to bring her to the vet for a saline drip iv infusion to keep her hydrated. Keep the water bowl ( better put a few around the house), and one near the place where she is residing so your cat does not need to walk too far to get the water. Clean and change the drinking water and water bowl 2x a day. You can also use electrolyte replacement fluids for pets. ( ask your pet shop or your veterinarian for it. That will help to fight the dehydration. If your cat utterly refused to drink, try chicken broth a couple of times. Testing the dehydration of your cat It is vital that you monitor your cat's hydration levels. To get an estimate of how hydrated your cat is by gently pinching the at the spot area of your cat. It is the area where a mother would pick up her kittens. Pinch that area and hold it up for five seconds if the hydration of your cat is healthy it will snap back in less than a second. If your cat is dehydrated, it will take longer to snap back. You can calculate for each extra second it takes to snap back to its original position takes 3% to 5% of dehydration. Most vets estimate 3% to 5% of dehydration for each extra second until it returns to its original position. Dehydration levels of 5% and above need a trip to the vet. Another way to test the hydration levels of your cat with the flu. Take caution with that method as your cat might bite your finger. You can check your cat’s gums. Usually, the cat has a soft pink colour gum, and it is wet and slippery. ( like a human gum) In case the gum of your cat is red or pale, and the feeling on your finger is tacky and sticky then your cat is dehydrated. Be aware that your cat might bite your finger when trying to test this method. An experienced cat person should only use this method. When you believe your cat is dehydrated than you should see a veterinarian immediately to prevent further issues such as bacterial pneumonia. It is also essential that your cat is urinating and defecating when you discover that your cat has diarrhoea that will lead to further dehydration.

Cat Flu and Fever

If your cat develops a fever then you have to take a trip to the Vet. A cat with a fever has hot ears, hot and dry nose, and hot feet and paws. The eyes look a bit glossy and the cat is in general tired. Check for Infection and shock you can recognize it with cold feet and pale gums, (press gently on the gum to see if blood re-enters, good gums look pink and healthy, just like you and me)

Help your cat grooming. Groom your cat regularly each day

Help your cat grooming, brush the fur of your cat every day even if your cat is not sick. You help your cat with grooming her coat, and there is less hair in your house, at the same time you spend some quality time with your cat ( my cat loves the grooming), and your cat is swallowing less hair because you take out quite a bit. I had once a problem with my tuxedo cat she was grooming and grooming chewing of her hair at the back, I thought in the beginning, she, but the vet checked and said just nervousness. So I started brushing Minka 3 times a day instead of one time, ( I still brush Minka 3 times a day) and in two weeks all the hairs she chewed off started to grow back. I guess it is the same with us, when we go to the hairdresser we feel after the haircut itchy and change the shirt or blouse. So for me, this is the same for cats they get itchy because of the underfur getting lose and they start to itch. FREE 24/7 VET ACCESS Access a vet specialist 24/7 via email, chat or phone. Our members can easily save between $300 and $800/year on unnecessary vet visits Normally a $170/year value. Free with PetPlus.

Discharge coming from the Eyes

Mucus or discharge is common in cats with the flu. You have to clean the eyes of your cat frequently with soaked cotton balls best use lukewarm salt water. Do not use the cotton balls twice, discharge them after each cleaning to prevent the spreading of the infection especially if you have more then one cat. When the discharge is excessive, and your cat's eyes hurt when you clean them, then it is to visit your vet as the infection may have caused a corneal ulcer, and that can only be treated with professional help your veterinarian.

When the nasal passage is congested

Use a soft damp cloth or a soft wet cotton ball and wipe your cat's nose on a regular base. Use salt water a pinch of salt for 200ml water. You can also use chamomile water solution. You can mix in one drop of non-perfumed coconut oil ( do not use more than one drop) to prevent the discomfort when wiping the nose of your cat. We all know how sensitive and red the nose becomes when we humans have the flu or cold. The same goes for our cat. Removing the discharge makes the breathing for your cat more comfortable. Be gentle to your cat's nose. Be sure to discard any used cloth or cotton balls after one time use to prevent the spread of infection, and do not use them a couple of times you will make the matter worse.

The reason for cat flu

The feline herpesvirus can affect our cats in both ways in a viral and in a bacterial sickness. The feline herpesvirus causes eye ulcers, and the feline calicivirus causes an oral ulcer. Both the feline herpesvirus and the feline calicivirus are most of the time 95% responsible for the cat cold. That said a cat cold could also be caused by a combination of viruses and bacteria that comes in contact with your cat or other cats, especially with outdoor cats.

Environmental Influences for Cat Flu

Cats are sensitive, and they need the routine in changing the routine of your cat, you might cause her stress and that will weaken her immune system and can trigger a cold or the flu. For example, you go on a holiday, and you put your cat into a boarding residence — the recuperating from being spayed or neutered. Moving to a new home, loss of a person in the household, the loss of a pet, a new baby arrives, there are many factors and influences where a cat can get easily stressed. Not every cat is the same some adapt easier, and some have a hard time to adjust to changes.

Cats and Vitamin supplements to prevent Cat Flu

Can a cat take vitamins to help her strengthen the immune system? It is not clear on giving a cat vitamin supplements will help for the cat flu or cat cold. The recommendation is that you should consult your veterinarian for advice and the right supplements. Again it is not recommended to use the human vitamins for a pet. Most Veterinarian will recommend Lysine.

What is Lysine and how can it help?

It is like in humans once a cat has contracted the herpes virus ( most of the cats have the herpes virus in their body, and most of the time it is dormant) it will remain in the cat's system. Same goes for cats who had the cat flu. The herpes virus will be with them forever. Your vet might suggest lysine, an essential amino acid that serves as a building block of protein, helping to inhibit the replication of the virus. Recommended doses are around 500 mg and given a few times per day. The Lysine is available in a gel formula and pills. Depending on your cat but the tablets might be a challenge for you to give your cat. In most of the treats, there is lysine, but it is only a fraction of the daily dose required to become effective. You might use Lysine 5 to 7 days before any stressful events. It may be helpful in boosting the immune system of your cat and at the same time lessening the risk of upper respiratory infections following these events. Other home remedies It is commonly discussed on the Internet to use Vitamin C and Apple Cider Vinegar, and I am amazed when people can feed or administer this to their cat. As cats have a sensitive smell and usually do not like apple vinegar or vitamin C. I do not recommend this solution with apple cider vinegar or Vitamin C. You might harm your cat instead of helping her.  Home remedies can help but can also harm your cat. Whenever you see signs of that your cat might develop the cat flu or the cold than please take a trip to your veterinarian. Essential oils for cats and dogs 

Can the vaccine help?

The cat flu has a lot of different strains of viruses, and it is the same as the human flu the vaccine is not effective against them all. If you decide to vaccinate your cat against the cat flu, there are two doses of vaccine needed initially followed by boosters. Your Vet will be pleased to help you out and explain to you in details. In case that you go on a holiday and put your cat up into a boarding home than you need to be up to date with your vaccinations for your cat. The cat flu vaccine cost is different from Veterinarian to Veterinarian. I hope I give you some valuable information about the cat flu and the cat cold. Please tell us and give us your helpful advice on how you handled your cat or cats when the flu has visited your cat.

Conclusion.

My cats are outdoor cats and do not stay inside all the time. But I have taken the initiative to vaccinate all our cats. I know there are pro and cons about vaccination, but so far we are lucky and had no significant issues with the cat flu. Our cats come together with our neighbour's cats, and we had 2 of our cats with the cat flu. Luckily it passed after 12 days. If you have more than one cat and one of them has the cat flu or cat cold, the best advice I can give is keep them separate. Wash your toys, bedding, cat litter etc. after your cat is well again and do not use the same items with your other cats. The cat flu is a nonpredictive disease that can cause harm to your cat if left untreated for too long. With a proper and healthy diet, your cat will have a long life. I know I talk a lot going to the vet and I also know a vet is expensive. When you have more than one pet or only one pet I highly recommend the pet plus membership it will help you to reduce your vet bills and it keeps your four-legged friends save. You can save hundreds of dollars in vet bills and medication. 

15 deadly plants for your cat Do you speak cat  Thank you for taking the time to read my blog All Yours Melanie Read the full article

[agentexeider]

Zootopia: Kaiden’s Story...Chapter 12: Crossroads

The black was empty for a while, a void, endless and silent. Kaiden felt light, floating on an abyss. In a way, this was better. It was finally quiet, the pain gone, the worry and care of existence faded away. Facing potential eternity with only what he brought with him. Alone on an endless sea, bound no longer by time or space, at last it was over.

The void filled up with thoughts, images, feelings, memories both pleasant and horrible. Kaiden began walking through the events of his life, wondering if this was what mammals had always meant by ‘lives flashing before their eyes.’ Yet he had always known that to come before death, not after. As the disjointed images and sounds passed him by he started to feel very heavy, his body aching and feeling very tired. The images had a surreal quality to them, becoming distorted and faded like aged sepia-toned film on its last legs before burning and breaking.

Feeling very hot, Kaiden felt the void filling up with flames all around him, coming from seemingly nowhere. The familiar terror gripped his heart. Lily’s screams seemed to resonate in the void around him, calling for him, begging for him. The claws of demons pawing at him, scratching him with their claws. They appeared as black shadows swirling around him, screaming as if they were right in his ear. Screams that blended into a sheer tone, solid and boring straight into the inner recesses of his head. The flames licked at his fur, the pain of the heat, the crisping of his skin. He cried out, but his mouth made no sound. Closing his eyes, he emphatically prayed for it to end.

Suddenly, Kaiden’s eyes opened. The silence resumed save for a faint repetitive beeping. His blurry vision told him he was in a room, and that he was lying in a bed. Slowly it resolved, more things coming into focus. It was a hospital room, and a number of machines were dotted around the head of the bed. Feeling a presence to his right, he turned his head to see it. White, with two blue eyes, blue as river stones. For a moment, Kaiden thought it was her, his dear Lily. He tried to speak, but all he could manage was a groan due to the tube that was lodged deep in his throat. The image resolved, it wasn’t even a rabbit but a white tigress nurse checking on him.

“I know you still feel woozy, but we have to take the tube out of your throat.”

Kaiden reacted to the word ‘we’ with unease. She turned away and an otter doctor climbed up on a stool that was close to the bed.

“Mr. Ellison, my name is Doctor Boyd. You’re at Bunnyburrow County Hospital. You were severely injured during a fire.”

Kaiden grunted.

“Mr. Ellison, please don’t try to speak until we get the tube out of your throat,” Dr. Boyd urged.

The otter nodded to the nurse, who released the saline that kept the tube in place.

“On the count of three, I want you to blow out as hard as you can.”

She counted, and on three Kaiden blew as the nurse extracted the tube, coughing and sputtering. He took a deep breath of the cool dry air of the hospital, his throat stinging with agitation. The top of the bed was inclined so he could sit up slightly.

His deep and slow breathing had an airy, almost haunting quality to it, but he was able to breath on his own. Kaiden noticed that he couldn’t see the left side of the room. Holding his paw up to his left eye, all he could see what blackness. He turned back to the doctor confused.

“Mr. Ellison, you need to understand that when you were brought in, you were barely alive. And honestly, I don’t quite understand how you are either. You have a very powerful will to live sir.”

“But, you also need to understand what you suffered was the definition of catastrophic injury, so while we did keep you from perishing you are still very much critically injured,” Boyd said, trying to inform with as best a bedside manner as possible.

“How long?” Kaiden whispered.

“You’ve been in a coma for a month,” the doctor answered.

“My injuries?”

“Massive blood loss due to internal injuries. Your limbs were shredded, and I don’t know if reconstructive surgery is even an option given the level of damage and your weakened state. The gunshot actually went between the hemispheres of your brain. Miraculous really. Also, a hematoma and brain swelling is why you are blind in your left eye,” Boyd calmly explained.

Kaiden looked down to see that his arms were bandaged up from his paws to his shoulders. Faint and dry spots of leaking fluid had stained the gauze, and given that it was still doing this after a month of being comatose was not a good sign. His body was trying to fight and heal before the scar tissue would die and decay. Kaiden tilted the sheet up and looked down at his legs. Heavily bandaged as well, with fluid stains on the gauze. He knew what this meant: infection, sepsis, and a very painful death.

“How long doc?” Kaiden asked.

The otter doctor took a deep breath, not wanting to deliver the bad news.

“Doc?” Kaiden asked again.

“Days…a week, maybe two as most,” Dr. Boyd answered as if delivering a death sentence.

Kaiden breathed heavy on hearing the news.

“I’m sorry Mr. Ellison. I’ve contacted Zootopia General, and perhaps they may have specialists that can help you,” Dr. Boyd consoled.

Kaiden sat back on the bed looking up at the ceiling.

“If you need anything…If the pain…”

“I know the drill doc. I’ll holler if I need something,” Kaiden interrupted.

The nurse fitted Kaiden with a nasal cannula and adjusted a few of the machines that he was hooked up to. Both saddened, the doctor and nurse left, realizing that sometimes the best thing to do is leave the patient to come to grips with things on their own.

Kaiden sat in silence for a long time. He didn’t know how long he sat there, the IV drip making him fall asleep several times only to jerk awake as discomforting dreams would find him. He inclined the bed enough to look across the room to the nearby mirror mounted on the wall. For the first time he saw the reality of his situation. Like his arms and legs, his head was wrapped up with thick bandages. A small tube filled with red fluid, presumably blood, was coming out of his head and into a nearby bag to drain the hematoma and keep his brain from swelling.

“So this is how it ends,” he quietly muttered.

Kaiden took a moment to really consider those words, the finality of them.

“Really? I’ve never known you to be one for giving up,” said a voice.

Kaiden craned his head towards the voice. It was a raccoon dressed in a sharp suit looking at Kaiden concerned.

“Who the fuck are you?”

“My name is Christopher Talmadge, and little do you know, I have been following you practically your entire life.”

“What?!”

“I know… I mean, I knew… your parents,” the raccoon answered.

Talmadge stepped out of the doorway and entered, closing the door behind him on his way in. He walked over to the bed and climbed up on the stool that the doctor used. He gave Kaiden a once over.

“I’m so sorry,” he apologized.

“What for?”

“For not coming for you sooner.”

“Who are you?” Kaiden asked again.

“I told you, my name is–”

“No, I mean who are you?” Kaiden asked, indicating he was meaning something else.

Talmadge looked down almost in shame, taking a sharp inhale as if in grief.

“You remember ‘The Pit’ don’t you?” Talmadge asked as he cast his gaze back at Kaiden.

Kaiden huffed in amazement.

“Remember? I’ve been doing everything in my power to forget that place,” he replied.

“Remember the final test, and the administrators that were behind the mirror?” Talmadge asked.

Kaiden didn’t answer, just waiting for the raccoon’s answer.

“I was one of the administrators of that program.”

“So you’re MIA. Come to finish the job?” Kaiden concluded.

Talmadge gave an almost defeated laugh.

“I guess I deserve that. I was MIA. In fact I was a lot of things, and it took a very wise mammal to show me how wrong I was.”

“So what are you here for?” Kaiden asked, almost annoyed.

“To start a long journey towards making things right,” Talmadge answered.

“You think your apology means anything to me. You think anything means anything to me?” Kaiden asked insultingly.

“I know about your current condition Kaiden. I know you’re dying, and I’m here to make you an offer.”

“Not interested,” Kaiden said coldly, sitting back.

Talmadge looked behind him to see if anyone was there. After doing so, he leaned towards the fox’s ear, grabbing him by the shoulder.

“Listen god damn it, this is bigger than you know. You think what happened to you was because Jarod was taking out revenge? This is so much larger than you. A group is doing this, a group that’s been around a long time. Been part of every government, every law enforcement and intelligence organization. And they seem to have been around since the dawn of Zootopia. That has got to mean something to you.”

Kaiden glared at Talmadge, gritting his teeth.

“Not my problem anymore. None of this is my problem, and I never wanted any of this. They took everything from me already.”

Kaiden’s anger gave way to tears. “Please, just let me die in peace.”

Talmadge paused for a few moments. There was so much that needed saying, and the fox was seemingly in no mood to hear any of it.

“They took from you more than you know,” Talmadge said cryptically.

“You don’t want me to frame this in terms of the world and everyone else, fine. Then let me tell you the personal cost of what it was they took from you.”

Kaiden looked at Talmadge with his good eye.

“Your parents. They weren’t who they appeared to be. Robert and Kathleen were MIA agents.”

“That’s a fucking lie,” Kaiden vehemently denied the accusation.

“It’s the truth. Your parents were ex-MIA agents. They were my best friends, and when they wanted out, I did everything I could to get them out.”

“Why? Why’d they quit then?”

“You of course. When Kathleen found out she was pregnant with you, she wanted out then and there, but Robert and I convinced her that if she and her husband were to leave so suddenly, it would look too suspicious. It took me ten fucking years to get them out of deep cover work and into lesser classified work,” Talmadge explained.

“Import/Export?” Kaiden asked.

“Yes, by putting them there it gave enough time for the MIA to not consider them critical assets anymore, and it gave me the opportunity to have them quit without the MIA concerned about what they knew. And of course, as soon they got out, they packed up everything and got the hell out of Zootopia.”

“To the burrows,” Kaiden whispered.

“Yes, as far away from the big city and the MIA as possible. To get out of the way of history and out of ‘that’ world,” Talmadge answered.

Kaiden huffed in disbelief. He had become accustomed to lies so much that while this new revelation surprised him, it made sense in a strange sort of way. There were many times he would ask his parents about what life was like before him and in the big city, but they generally steered the conversation away from the topic, phrasing that life there was frantic and stressful and that life in the burrows was ‘better’ and ‘safer’. They had been trying to protect him from that world since he was born, trying to give their son a better life than what they endured.

Even knowing that they lied to him about their past, they did so because they loved their son, which make Kaiden love them that much more. Despite their efforts however, destiny had its own plans, and he felt sad that his parents’ sacrifice seemed to be in vain.

“Thank you for telling me about my parents. It answers a lot of questions. Now please, just leave me alone,” Kaiden replied, turning away from Talmadge and lying on his side.

Talmadge didn’t try to continue. After a brief moment of tense silence, he stood up and pulled out a card, leaving it on the nearby rolling table that patients use to eat off of. The business card was white card stock with a phone number printed on it, as well as a black lion’s head logo that simply had the number 13 written below it.

“If you change your mind, call this number.”

“I assure you, I won’t,” Kaiden muttered.

“Just in case,” Talmadge replied before stepping down from the stool to leave.

Kaiden waited for the raccoon to exit the room, hearing the click of the door latch. Now knowing the truth about his parents, he could finally grieve. The silence of the room filled with the soft whimpering and sobbing of the damaged fox.

Several Days Later…

Dr. Boyd appeared intermittently to supervise the nurses replacing Kaiden’s bandages with fresh ones. Even though the surgery when they brought him in had removed the thousands of pieces of shrapnel and foreign objects, the sheer physical damage was enough for anything to occur, from opportunistic infection to scar tissue. The prognosis was clearly not good by the worried faces on the staff. It was simply management at this point, and there was really nothing that could be done to save the dying fox.

After dealing with the interesting humility of being given a sponge bath, the room was quiet again. Kaiden started to notice a routine of periodic activity; it would be quiet, then busy, then quiet again. Much like his life, he wondered if perhaps that’s what life was in general: a series of moments, some quiet, others frenetic. He had his time to ponder on these kinds of thoughts at least until the final hours when all there would be was pain. But that time was seemingly distant, and for now, the peace and quiet of a solitary hospital room became his existence, and listening to the sound of his own breathing became the rhythm of life for him.

There was a tap at the door, interrupting the quiet of the room.

“Mr. Ellison?” The voice was Dr. Boyd, muffled from the other side of the door.

“Come in doc,” Kaiden beckoned.

The otter opened the door and climbed up on the stool, sitting down on it.

“More bad news doc?” Kaiden asked.

“No, no. This I confess is more of a personal visit,” he admitted.

Kaiden’s eyebrow perked up.

“I knew your wife, Mr. Ellison.”

“She did say she knew people at the hospital, colleagues,” Kaiden remarked.

“Yes, we were colleagues. We worked on several research projects together. We were also friends, and we talked about each other’s lives and the mammals in it,” Dr. Boyd said.

“Thank you for being her friend, doc, I know she needed friends all the time I was away,” Kaiden thanked.

“Call me Joseph,” the otter replied with a smile.

“Well, Joseph, what can I do for you?” Kaiden asked, cutting to the point.

“I was not sure how I would tell you this, or if I even should. I reasoned you had enough grief to deal with, and the fact that in the end it doesn’t matter anymore. But I figure if I was in your position, I would want to know.”

“What are you getting at?”

“Did Lily manage to tell you why she saw me that morning? Why she was ‘sick’?” Dr. Boyd inquired.

“No, she didn’t even tell me that she saw you.”

“Lily came to me with symptoms of nausea and what seemed to be a stomach virus, or so I thought, and I told her it would clear up in a couple days and that there was no problem. But the symptoms persisted, so I ran some blood work, and it was the morning of the fire that I found out what was making her ‘sick’.”

“Aw crap, don’t tell me she had cancer or something,” Kaiden shook his head.

Dr. Boyd snickered.

“No actually, something much more wonderful. Well at least, it was.”

The otter wrested his paws and smacked his lips trying to work up the nerve to say it. Finally, after a moment of silence, he took a deep breath and looked the fox square in the eye.

“Lily was pregnant,” he said softly.

Kaiden flashed back to that moment on the couch, to what Lily was wanting to tell him. ‘That must have been it,’ he thought.

“How is that possible?” Kaiden whispered.

“I don’t know,” Dr. Boyd replied.

“It shouldn’t be, but her blood showed levels of mCG and other pregnancy hormones, so there was no mistake,” Dr. Boyd continued. “She was pregnant, and I know that Lily loved you very much. She had always said that if she could she would find a way.”

“I don’t know what she did, or how, but she was brilliant, and if anyone could have figured it out, it was her. She loved you that much.”

Kaiden took the news like a kick to the chest, feeling the wind knocked out of him. He teared up, wincing with physical and emotional pain. He started to sob softly, staring up at the ceiling and willing the suffering to go away. Even Dr. Boyd was caught up in the heat of the moment and teared up a bit.

“What happened to you and her was unfair. I don’t pretend to know what business it is that you do. But what happened was an injustice, and I wish more than anything I could do something, anything to help you. Because I can’t stand the thought of the mammals who attacked you getting away with it. I’m deeply sorry. I know I’m supposed to remain professionally detached, but she was my dear friend,” the otter said, choking up on a few words. He cupped a paw over his mouth and started to shed a few tears.

Kaiden looked out the nearby window with misty eyes. He saw the moon staring down at him through the glass. He would often think back to those nights he sat in his cot during training, wondering if Lily was looking up at the moon as the same moment. It seemed Kaiden was faced with a choice, yet again brought before the crossroads to consider the options and possibilities. Death, or a fate worse than death. Lily was gone, the last light in his heart taken from him. The mammals who did this might as well have pierced his heart and forced the love to flow from the wound. All there was now was sadness, and sheer pain. They couldn’t be allowed to get away with this. They couldn’t be allowed to drive this pain onto others, and to create whatever horrors they have planned. This wasn’t about altruism, about doing the right thing. No, this was about Lily, and not seeing this repeat itself the world over. To watch from the eternal rest as others lament over their lost loves and lost families, knowing that he could have done something, that he should have done something, anything to prevent it, filled him with a renewed sense of determination.

In his heart of hearts, if Lily could speak to him now, he knew what she would say. “Do what you need to, to survive.”

“I love you Lily…I love you so much,” he thought to the moon, that in some time, some place, she would hear it.

Kaiden turned back to Dr. Boyd.

“Hey doc, you can do something for me.”

“What is it, what can I do?” the otter asked.

Kaiden motioned towards the nearby table, with the small business card on it.

“Call the number…Tell them, I changed my mind.”

Sometime later…

The offer that Talmadge had made was something of a mystery, and for good reason too. Had he said anything more during the time of his visit Kaiden likely would have scoffed or rejected it outright as abominable. But after listening to his heart and the reality of his situation, his mindset changed. It didn’t matter what it was, nor what was being asked of him. As long as he could bring Lily’s killers to justice, they could carve out a piece of his soul if necessary. And perhaps in many ways, that’s exactly what they did.

Cybernetic Augmentation, the wave of the future and the first step to self-controlled biological evolution, or so the futurists say. Going by how they would phrase it, one would think it almost a blessing, and maybe on some level it would be. The ability to surpass normal biological limitation, to correct a defect granted by genetics, or even bypass death all together. However, one would be foolish to not take into account the societal changes such technology would bring. But philosophy class was not what was on Kaiden’s mind. Even saving his own life was not important to him anymore. As far as he was concerned, his life was lost the moment Lily died, but there was some part of her calling out to him, something from the hereafter. He understood and accepted the level of augmentation that would be required. Even for this organization that Talmadge worked for, other agents had an arm or a leg replaced. Even two appendages was within the realm of possibility. But Kaiden’s case was one that, if successful, would be one for the record books.

Kaiden didn’t remember much after they transported him to the underground bunker, a place called ‘Bureau 13’. He couldn’t help but think that it was a fittingly cryptic name for a cryptic group. It was created many years ago by a small corps of agents from various groups, mainly the MIA. The signing of a federal executive order, officially called ‘Executive Order 60659’, also known as the ‘Bureau 13 Creation Order’ or the ‘Double Blind Contingency’, was what officially started the clandestine organization. The idea in short was that an agency operated separately from the government that employs it. The agency’s existence is even kept secret, and only known by a select few. This obfuscation would prevent such a group from being infiltrated, and moreover, make it capable of acting against any kind of infiltration into the government and other organizations in Zootopia. While given a high degree of latitude, their responsibilities are explicit: to find threats to Zootopia and its interests, and prevent such threats from carrying out their plans. However, Bureau 13’s ability to depend on other segments of Zootopian government is limited, hence the use of more stealthy solutions where possible.

Kaiden underwent several surgeries to stop his body from killing itself. The first and rather obvious one was the removal of his now dying limbs, which at this point were decaying and thus toxifying the remaining living tissue. A quadruple amputation, the removal of both arms at the shoulders and both legs at the hips, leaving the remaining torso and head. In any other circumstance, one would wonder what quality of life a mammal would have, but these were extraordinary circumstances. The joints were capped off, and metal attachment points were anchored to the joint bone, additional reinforcement added both above and below the tissue. The limbs themselves were made of made of metal, polymers and carbon fiber laminate over the metal structure. The augmentations were not limited to the external either. His internal organs were heavily modified as well. His lungs were revamped with an implanted rebreather to filter out toxins and even be exposed to zero oxygen environments for a short time. Angiogenic protein stimulation for accelerated healing, electrochemical conversion to allow food energy to be able to power the mechanisms, retinal prosthesis for enhanced and augmented vision modes, and much more. There wasn’t a part of his body that hadn’t been augmented in some way. Even his brain was augmented with a brain-machine interface chip that joined the organic to the synthetic, bonding electrodes to his central nervous system to allow the augments to not be simple prosthetics, but an extension of his very being.

It was quite literally brain surgery, which unearthed his memories and dreams. While the surgeons worked to fix his body, his mind drifted to her, the way she felt, the way she laughed, her scent, her taste, all the memories of days and nights gone by. The passion, the fire, sadness that dwelled within him that she alone could cure. The rage and frustration burning, he could feel his teeth grit and his fists clench. Desiring to kill Jarod for what he had done, for whom he had taken.

Kaiden opened his eyes, the grogginess of the whole ordeal still making his eyes feel heavy. He was in a lone hospital bed, the room dim with no light save for the fluorescent lamp softly buzzing above the bed, casting its diffuse light and barely illuminating the entirety of the room. There was an eerie quiet about the place. The twenty-four hour clock showed that it was past midnight. It would make sense to have such clocks due to the absence of windows, at least none that Kaiden could see. There would have to be some way to tell day from night. The feeling he got from the place was that it was underground. He wasn’t quite sure how, but he could almost feel the mountain of dirt above and around him just outside the concrete walls.

He looked around. He was hooked up to an IV and heart monitor, but gone were the plethora of machines from his old room. There was a slight pain everywhere, and his whole body ached. Feeling stiff and stretched like taffy in a pulling machine, even breathing caused a slight twinge.

“I assure you it will get better,” said a familiar voice from the nearby doorway.

Kaiden craned his head and looked at the figure, recognizing him immediately from his silhouette.

“You of all people would be the last I would expect here,” Kaiden replied.

“I suffered from my own hubris, and what happened to me was not to be expected,” said the voice.

The figure stepped out of the doorway and came over to Kaiden’s bed. It was a large grizzly bear. He had been injured some time ago, bearing his own set of scars and disfigurements, the most obvious of which was the fact that his arms had been replaced with cybernetic augments. Scarring was visible on his face, neck and chest, at least going by what little that peeked from above the collar of the shirt he was wearing.

“So…what are you doing here Kerberos?” Kaiden asked.

“I came to see you. When I heard that you had been injured and that you had decided to join up, I just had to see you,” Kerberos answered.

“I’m touched,” Kaiden replied sarcastically.

“I deserve that. Actually I deserve a lot more than that. After what I put your children through, I don’t deserve a second chance,” the bear said plainly.

Kaiden’s eyebrow perked up. He had known Humphrey Kerberos as many things. A hard ass, a cruel taskmaster, and even a downright aggressive son of a bitch, but never once had he seen the expression that was on the bear’s face right now: regret. Regret with a side helping of humility. Kaiden was a bit more receptive, that and the fact that he was in a hospital bed.

“I guess one of the reasons I wanted to see you was, I wanted to say… I’m sorry,” Kerberos apologized.

Kaiden was shocked. He apologized, he actually apologized for something. Admitting wrongdoing was also not something Kaiden had known the bear to ever do, not in all the years during his time in ‘the Pit’.

“Why?” Kaiden asked.

“Because of what I did,” Kerberos replied matter of factly.

“No, not that, I mean why do you even feel bad about it now?” Kaiden clarified.

“Because sometimes blind faith can make you rationalize things that you shouldn’t, and I was a patriot Kaiden, zealous even. I did what I did because I believed in what they were selling, that what I was doing was in the service of Zootopia. That even as sins go, it would make all the difference later. I believed, even when they asked me to do even worse things for them later.”

“Worse than child abuse? Worse than turning children into weapons, weapons that would then be pointed at innocent people to make room for what, some kind of new world order?” Kaiden scoffed.

“In short, yes. Because while what I did to you in many ways made you stronger, at least it produced something for that effort. Every single one of you became stronger as a result. I’m not saying that excuses me, but it created something, and that at least is something productive. All the years after were spent destroying something,” Kerberos explained.

“And that is?”

“The world, the structure of it. The small little places of peace and tranquility, because we were told that our way was the best and the only way. I believed in the lie just like you. I knew on some level it was wrong, but I ignored it same as you.”

“So what changed?”

“Same as you. I awoke. Opened my eyes one day and realized the truth of what I was doing. I lost the zeal, the commitment, and eventually the focus, which caught up with me rather quickly,” Kerberos replied, holding up his cybernetic paws as proof.

“So what made you join this outfit?”

“We all have the same motivations here. We joined up to do many things, but ultimately, because we wanted to serve and protect, to make the world a better place. And we realize now that we broke it. WE broke it, not any one of us, but a group effort of many people, across multiple disciplines, all running blindly towards it. Why are we here you ask? Because we all realize our part in this, even you. And just like you, we want to work at helping to fix it,” Kerberos said.

Kaiden weakly reached up with his paw to grab the side rail to his bed and was stunned, seeing the prosthesis for the first time. Flexing the fingers and rotating his wrist, it felt like his paw. It moved like it, but it was made of metal and polymer. His pawpads had a rough feel to them to replicate his old ones. Touching the metal rail felt cold, it actually felt cold. The fact that he could feel anything at all was a shock, but whatever process that was allowing him to feel was able to do so pretty accurately compared to before.

Kerberos saw the expression on the fox’s face.

“That was the other reason I wanted to be here.”

“What, to see me marvel?”

“No, to help you through this.”

“Through what?”

“Using them, training with them. Simply walking is going to be harder than you think,” The bear informed.

“You offering to train me again? Is that it?” Kaiden asked.

“Kaiden, despite what you think about me, training the next generation is what I do. Imparting my knowledge and experience to allow others to achieve. I can’t make up for the past, and I can apologize a thousand times, and it won’t change what I did or what happened. But if you let me, we can change how it goes from here.”

“It’s not like I have a choice anyway,” Kaiden muttered.

“No, I guess you don’t. But I would rather you be a willing participant this time, especially since willpower will be a major factor here.”

Kaiden heaved a sigh, noticing the clear irony and seemingly cyclical nature of the universe. How the crossroads of our lives seem to come right back at us again and again, each time a new chance at the road. Does one go right or left, forward or back, and how attitudes and beliefs can make all the difference in the world. At the very least he would work with the old bear to learn his new capabilities. It’s not like they left him with an owner’s manual.

Three months later…

Training with Humphrey Kerberos wasn’t exactly what Kaiden expected, not just because part of it felt more like physical therapy than military training. Learning to walk again, to grasp things gently without crushing them, etc. The power of the augmentations was nothing that could be denied, but finer control, things like picking up a fork and using it to eat, or drinking from a glass without shattering it in a paw, that was something else.

But despite all of that, there was something different about Kaiden’s training regimen than the content: patience. Kerberos was patient with Kaiden, and in fact all of the recruited agents that were in various states of augmentation were patient with him. Where in the past Kerberos was cold and hard, even cruel, none of that existed here. He was kind, patient, even compassionate. Kaiden wondered exactly what caused such a complete inversion of his personality. He concluded something bad must have happened, something that shook the bear to his core.

During their training, Kaiden had slowly but surely tried to get him to talk about it, but the bear would always change the subject and even sometimes tell Kaiden to drop it. Kerberos knew what the fox was digging for, and Kaiden considered the bear would give him an answer eventually.

The pair had been paged to Director Talmadge’s office. Walking through the halls past the command center, they arrived at the raccoon’s office, standing ‘at ease’ in front of the mahogany desk. The raccoon had flipped through the last few pages of a file.

“These are your copies,” the raccoon gestured toward the more appropriately sized copies of the file on his desk.

The pair picked them up and began to review them. A picture of a red-furred squirrel caught their attention.

“Do you know a mammal named Milton Hamilton?” Talmadge asked Kaiden.

“Isn’t he some big time tech mogul?” the fox replied.

“Was,” Talmadge replied.

“Was?”

“Lucas Technologies purchased Hamilton Industries, a hostile takeover. Milton Hamilton Sr. had died a year earlier and left the company to his son. Milton Hamilton Jr. had been working an incredibly brilliant bit of programming. Basically, it’s a publicly available encryption scheme that, and here’s the kicker, doesn’t have any kind of government back door into it. Apparently Junior doesn’t trust the system any more than we do.”

“Ok, so what does that have to do with us? Didn’t that happen like, I don’t know, two, three years ago?” Kaiden asked.

“Four,” Talmadge corrected.

“Ok, four. Point is the company was bought, and Junior here, didn’t he just go off into obscurity? Probably enjoying his fat bank account,” Kaiden said.

“Actually, the director and I believe that Milton Hamilton was abducted, and the story of his ‘riding off into the sunset’ planted for the sake of explaining his disappearance,” Kerberos clarified.

Kaiden nodded and looked back at the file.

“What the hell does Lucas Technologies want with a twenty-one year old kid?” Kaiden asked.

“Not Lucas Technologies, but rather the mammals behind the corporation,” Talmadge put rather delicately.

“Kaiden, perhaps there is something that needs a bit of explaining. We’ve discovered that there is a group of mammals, across many areas and disciplines of influence, who are working together for some kind of goal that as of yet we haven’t figured out,” Kerberos explained.

“Have you ever heard of a group called the ‘Council of Five’? Or perhaps by their more colloquial name, the Illuminati?” Talmadge asked.

Kaiden’s head snapped to match his gaze with the raccoon, displaying a stern expression.

“I take it from your reaction, you have,” Talmadge replied, answering his own question.

“You could say that. Just before Jarod, that bastard, shot me in the head, he said that’s who he worked for. In fact, he said that’s who we’ve always been working for, that they ran the MIA. Hell, by his reckoning they run all of Zootopia.”

There was a thick pause in the room. Kaiden waited for at least one of them to set him straight. He shot a glance back and forth between Kerberos and Talmadge, neither taking the opportunity.

“Well, he’s not far off,” Talmadge said, breaking the silence.

Kaiden’s brow perked in surprise.

“We have known for some time now that there is a group of powerful mammals who have been trying to manipulate society from behind the scenes. We aren’t sure when they established themselves. In fact, there is a very concerning notion they may have actually been in their position since Zootopia’s founding. In either case, they have been attempting to elicit more and more control over everyday forces that run not just the city, but the entire planet. And we have come to the conclusion that such a position is not in our best interests,” Talmadge explained.

“So, they’re literally the invisible paw, the power behind the throne, the um…masters of the world or something to that effect?” Kaiden asked flippantly.

“Correct.”

“Ok…Well let’s let that nightmare sink in for a second. What are we supposed to do about it?”

“They’re not invincible, Mr. Ellison. They are just mammals made of flesh and blood. Powerful yes, and with a wide range of resources, but that hasn’t stopped us before, nor has it even stopped you when you worked for the MIA. It requires the smart use of tactics and resources, but there is an answer to find. The question is can we be smart, strong and fast enough to find and use it?” Talmadge said confidently.

“And luck, luck helps too,” Kerberos added.

“Well I think we’ll need plenty of that,” the raccoon nodded.

“Well I knew the other paw was going to drop at some point, just didn’t realize how big of a drop it would be,” Kaiden remarked.

“This isn’t just about you Kaiden. It’s about Zootopia. It’s about all of us. We rise or fall together. You need to understand that nothing is more important than the security and safety of Zootopia and its citizens. Not you, not me, not any of us. I think deep down you believe that too,” Kerberos said.

Talmadge pulled a patch out of his desk and slid it across to Kaiden. The patch would become the symbol that would define his life from this moment on.

The patch had a stylized white-furred lion head on it with a mane of black, the number ‘13’ embroidered below it, and words written in a circular alignment along the edge.

“Cum Animus Et Ferocia Nos Tueri Zootopia”

“With Courage and Ferocity We Protect Zootopia”

Kaiden took the patch from the desk and studied it for a moment. Feeling the sensation of the patch in his newly minted mechanical arm, it seemed purpose found him again right when he needed it.

“OK…Let’s get started.”

[saintkimora]

anyways here is how my doctors appointments went

so first i went to my regular doctor. so i got there and it was sooooo busy and i was waiting forever then they finally took me. they took blood and they had me sitting in a chair instead of laying down which made me feel worse tbh but they didnt take as much as last time bc it was over much quicker. then the dr came in and i told him about my ear and he was like yeah that membrane looks funky so he sent me to an ear doctor. im gonna call tm to get my blood test results to know if i have mono or not

so i went to the ear doctor and since i havent been there in years i had to fill out the new patient forms which was really extra then the wait was SO long. then they finally called me in and the pa asked me the questions and stuff and said ok the dr will be w you shortly. i was sitting in that exam room for at least 25 minutes and i was PISSED bc i was really hungry at this point and my phone had really bad service at all of these doctors offices so i couldnt even do anything bc nothing would load

then my ear dr came in. first he looked at my throat then felt the bumps on my neck and he was like “yeah i can guarantee you have mono” then he looked at my ear and i apparently i have a big ear infection and a hole in some membrane in the ear. idk if its the eardrum or the tympanic membrane or what but my mom had one a few years ago and it was really troublesome so obv i was not happy

this is where the torture started. so first he put this tube in my ear and he started suctioning the fluid out of it. it didnt hurt but it was really loud obv since its a suctioning thing right in my ear and it was really upsetting like i was tearing up and squeezing the arms of the chair. he said he did it to drain the puss out of my ear so i was thankful for that i guess

now heres the really bad part. he had this long skinny tube w a light at the end and he was like “im just gonna stick this in your nose a little” so he did and he stuck it so DEEP i could feel the end of it in the back of my throat and he kept making me do various things like take deep breaths, make an eeeeeeeeeee sound and swallow. swallowing was the absolute worst bc it hurt to feel the tube in the back of my throat bc it felt like i was choking and like if this was quick it wouldnt have been THAT bad but he was looking around in there for so long i was definitely tearing up at this point too. it had nothing to do w my nose so im assuming he was looking for s/t related to mono

then he had me do a hearing test (with another long waiting period but not as long as the other ones) and i did poorly on it obv since the hearing in my right ear is like muffled

then he took me into his office to discuss my issues. so he said he called my regular dr and they agreed that i prob have mono in addition to my ear problems. he couldnt prescribe anything until the test results come back though so i have to wait til tm for that but when i do get it its gonna be like 4 pills a day rip

for my ear he prescribed eardrops to use and he said i could get those now but he lied bc my mom went to the pharmacy and the office didnt send over the prescription so i couldnt get them! and the office was closed by then and i didnt know what kind of eardrops they were so i couldnt get like a covering dr to prescribe them for me instead 

also after the discussion he made the pa teach me how to use this nasal rinsing thing which seems really annoying to have to use every day 

so then i went home w my dad and i was so pissed off at this point bc i thought it was gonna be quick! i thought my regular dr was gonna be like “yeah thats an ear infection ill prescribe you s/t rn and call tm for your test results” and that would be it but instead i had to go to an ear doctor which took so much time! in total i was there for like 3 hours and most of it was just waiting around

so yeah i was really upset bc it was dinner time now so i missed the opportunity to eat my sandwich for lunch so i was really in a mood as soon as i got home it was time to fight in my house and my mom was pissed too so we had a lot of drama

like one thing is she was like “this is why you have to TELL US when somethings wrong see you waited too long w your ear and now you have a rupture” and like i DID tell them! i told my parents the second i started having the pressure related ear problems and i didnt have the fluid problems until like 2am the night before my appointment so idk how much sooner i could have told them! so yeah i was pissed but then i had pizza for dinner then my parents and brother went to his science expo thing so i had some alone time to relax and i ate the sandwich i had prepared too so i was content by then 

so yeah thats p much it. i mostly likely have mono which is whatever but at this point i just want these ear problems to go away bc those are whats really inconveniencing me rn. i have absolutely no idea where i could have gotten mono like idk if its from kissing (if it is it could be from yousaf, alex, OR tristan) or whether a worker w mono spit in my food when i had takeout (which i really hope is not the case) or like...idk! i dont really have much contact w people from the outside world bc i just stay in my house all day so its definitely a mystery

on the bright side the part w the nausea and vomiting seems to be over and ive like completely regained my appetite so thats good

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10 tips for men’s sexual health

Contents

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