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The Devil puts things into motion... accidentaly and far away.
2023.06.04 19:55 Anonymous_D-boi The Devil puts things into motion... accidentaly and far away.
Hi everyone! This is a continuation piece of my previous work
probably will turn this into a series/proper universe down the line), however reading it isn't necessary for understanding this story.
Any and all criticism is welcome. Hope you'll like it! -
For captain Gryio, it was a pretty uneventful afternoon shift aboard his mining ship, prospecting beyond the Imperial border. He was looking outside into the void from his cabin, watching automated drones bring asteroids full of rare metals into his ship's belly, when his comms officer, Lila, walked in on him with a datapad. She explained to him that they captured a transmission on the short range public interstellar channel. Curiously, the transmission came not from within the Imperial border, but from without. It seemed navy in origin and simply read: "To anyone who hears this message, forward it whole to the nearest Imperial ship or station as fast as possible. The reward for the first person to do so will be 100 thousand Imperial crowns." What followed was about a minute of what seemed to be static. Gryio, a former navy officer, recognized in it a classified message that was encrypted, so no one without the proper software would be able to read what it says. Navy messages coming from beyond the border usually meant pirates, however pirate warnings were always without any encryption. Thinking he would rather get the money than rummage through classified navy business, he ordered his comms officer to retransmit it to the nearest Imperial border outpost. What he didn't know was that the transmission would end up being sent to two locations. As it turns out, the comms officer made a deal some time ago. A mysterious individual aproached Lila with an offer. He would pay for her father's surgery if she gave him a valuable piece of information about the Imperium's actions on the frontier. A desperate sounding encrypted Imperial navy broadcast was sure to be worth more than fixing up an old man's heart, she thought. -
Some time later, at the Imperial navy HQ, located at the Imperial capital, the message caused quite a lot of upheaval. It said that the 16th Imperial exploration fleet made violent first contact with a newly discovered intelligent race.
The fleet's commander, a young prince of the Heyduk kingdom, decided that the smartest thing to do was to conduct a raid on the species' planet, the Earth, hoping to prove himself as a warrior, this attempt ending when an explosion took of his leg and forearm. The species', the Humans they call themselves, military then managed to push back the Imperial marines to their original landing site and forced them to evacuate to their voidships. They left with heavy casualties, with several of their landing craft being shot down as they attempted to fly to orbit. The prince, before being put into an artificialy induced coma to help him heal, then called for reinforcements directly to his father, the king, using a genetically matched long range transmitter that only he could use. His second-in-command then ordered a retreat behind the moon of the Earth. A lone SIGINT vessel, the Poltergeist
, was then ordered to return back to Earth's orbit to monitor any attempt by the Humans to shoot back at the Imperial ships. After not hearing from the vessel for half a day, they decided to peak from the dark side of the moon to establish visual contact. When they saw the Poltergeist's wreck entering the Earths' atmosphere, the crew presumed dead and entombed within the ship, they decided to call for help properly. With his most powerful antenna destroyed and the second one being unusable by anyone except a half dead aristocrat, the second-in-command used the public channel, desperately hoping that anyone would listen and retransmit.
One of the officers present then cared to check the Imperial navy Central Information System, and sure enough, a small military transport fleet of the Heyduk navy just left port, with their stated destination being a system on the edge of Imperial space close to the newly discovered Earth. The fleet was ordered back home. The young prince broke both Imperial and Common Galactic law by initiating first contact violently without provocation and considering the already shaky relationship between the Imperium and the the Galactic Alliance and the prince being, ultimately, an Imperial officer, the prospects for a quiet resolution weren't good. Someone finally ushered the words: "The Emperor should know about this." -
On a port orbiting a world far away from the Imperial capital, Hako Undu was at a bar, drinking, when his datapad got a notification. It was a message from the local company handling interstellar comms that he got a message. He payed for his drink and left for the nearest message kiosk. He downloaded the message without looking at it and went to his apartment. Once there he opened it. "Hope it's enough. Lila," read the message. He recognised the name as a girl he managed to strike a deal with. It also had an attachment. The attachment was an audio file, with a voice ordering the listener to retransmit it to the nearest Imperial forces and a minute of static. Hako walked to one of the cabinets in his apartment and moved it away, revealing a safe. He entered the passcode and opened the safe. Hako pulled a small box out from it. He connected his datapad to the box and ran the program that was installed on it. This decryption computer wasn't as powerful as the one they had back at the Bureau, but it should give him an idea if the message was worth passing on.
Once the box finished it's work to the best of it's ability, Hako played the now deciphered message. Not everything was intelligible, he didn't expect it to be, however with every passing second he wanted to hear more. An Imperial aristocrat and officer, initating first contact violently without provocation, wounded and forced to retreat with heavy casualties? He even heard something about a Poltergeist burning up in atmo. Hako had to stop himself from audibly laughing. Considering the events of the last few years, he found himself with the key that the Bureau, and by extension the Alliance, can use to push back against the ever more audacious Imperials. He put the box back into the safe, locked the safe and put the cabinet back in it's place. Then he walked to the ugly part of the station, the part where you can find a guy that does illegal interstellar transmissions that can't be tracked back to their origin. Once he had done his business there, he went to his bank, where he made a transfer of several thousand Imperial crowns to a bank account whose details he had memorized a long ago. "The lass struck gold while literally prospecting for gold," he thought as he signed the transfer papers, smirking to himself. -
The Imperial palace was usually quiet this time of day. Today, howerer, a visitor is causing ruckus. His uniform would tell you that he is from the Imperial Intelligence Agency, First Contact Detachment. They are the guys making sure that any first contact goes down in accordance with the Imperial and Common Galactic law while gathering intelligence on the contacted species and, most importantly, that nobody messes anything up. And boy did they mess up this time.
When his superiors knocked on his door with the top secret preliminary report about the whole Earth situation, he was suprised that anyone would entrust him with intel that highly classified. Then they told him that he would be presenting the whole ordeal to the Emperor in 2 and a half hours. Before he had time to ask any questions, they shut the door behind them after wishing good luck. They probably wanted to safeguard themselves, shifting blame to a lower ranking agent if anything more went wrong. He then studied the report, memorizing the most important event, numbers, names and the general timeline. When he was done with his studies, the transport to the Imperial palace was already waiting. He double timed it through the palace, stopping before the Emperors study. A servant opened the door and our agent walked exactly three steps into the room before kneeling, as the protocol required. The Emperor then spoke to him: "Rise. I am expecting you agent. But before we begin, please tell me your name." "I am lieutenant Coje Wetr of the Imperial Intelligence Agency, First Contact Detachment, my lord" said our agent. "Good, lieutenant, good. Please, take a seat, and begin"
The whole presentation took about three quarters of an hour, with the Emperor asking supplementary questions for about half an hour more. Coje noticed that the Emperor was slowly turning more agitated, however he managed to hide it well, but not so well that a trained intelligence officer wouldn't notice.
"The Hayduk king, a fool that has even more foolish children. I should have never given his son the commision, but it's too late for regret. The question is, agent, what do we do about it? We pushed against the Alliance, and it looks like the universe pushed back for them. If they find out what happened, they might be emboldened to consider economic or even military action, and we have no chance of quick and decisive victory against the whole Alliance at once, the best we could hope for is a slow battle of attrition, either of the military or economic kind. Do they even know about these so called Humans?" spoke the Emperor with a severity that he reserved for only the most difficult circumstances
Coje replied: "The exploration vessel that originally found them was civilian, meaning they presumably spread the word at the first opportunity they had. Being the first to identify a new intelligent species is a rare thing these days and such a discovery would bring them a lot of fame. But, considering the location of this Earth, everyone probably thinks that initiating first contact themselves isn't worth travelling through the whole Imperium, so they presume that we will be the ones to do the honors. However, this is just conjecture based on the limited information we have available. As far as i know, an exploration fleet from one of the Alliance nations could be asking for permission to travel through our Imperium to this new world right now."
The Emperor thought for a while, then motioned for the agent to come to him. He whispered: "Then we have to be fast. I want you to make sure that the expedition to Earth never happened. Make sure that nobody ever mentions that an Imperial exploration fleet made it to that system. Bribe, imprison or kill anyone that doesn't cooperate willingly. Purge records and falsify new ones when needed. We must convince the galaxy that the fleet that attacked that planet were pirates, or renegades, or mercenaries, or deserters, just that it wasn't us
. Now, go home, relax and sleep well. Tomorrow morning, a courier will deliver an Emperor's charter to you permitting you to use any and all resources that you might need in fulfilling your mission. You are also immediately promoted to major, so that your colleagues take you more seriously. I expect regular updates on your progress. You may now go, Major Wetr. Good night, and good luck. The future of the Imperium sits on your shoulders." -
The headquarters of the Galactic Alliance Intelligence Bureau is naturally one of the most secretive places in the galaxy. That is even before you enter the eastern building's cellar. Within it is a security guard that usually hangs out near one specific briefing room present there. The odd thing about this room is that it seems to never gets used. If you say the right thing to him, he places his ID card on top of the speaker's table, revealing a secret elevator. Ride the elevator down, and welcome to the top secret Directorate "J" of the Bureau, a whole department dedicated to gathering intelligence on the Imperium, buried under enough concrete to withstand nuclear bombardment. Now it's time to pass through a dozen biometrics checks to make sure it's truly you
The Directorate is filled with the best and brightest intelligence officers the Alliance produces. But it wasn't always like this. Two decades ago, Directorate "J" was seen as the most useless of the bunch. The only meaningful intel they produced back then was finding about lower then expected productivity on an agri-world a few weeks before it became public knowledge and other similar matters. The "Jokers", they started to be called. But then, a new Emperor came to the throne, more ambitious then the previous one. Suddenly, ships and stations on the border between the Imperium and Galactic Alliance started going missing, their crews and passengers missing or dead. At first, these were attributed to pirates and renegades, however as time went on, more and more evidence came out pointing at fact that these attacks were to well coordinated to be random bands of pirates. Things started pointing at a more organised force. Once the probability of the Imperium being directly involved reached "maybe", all of Directorate "J"s activities were marked Top Secret/Need to know only and every current and former member was persuaded
to never talk about anything they did as agents of the Bureau. With the Imperium's recent hawkish policies againts a species not yet in the Alliance, the pressure to find something that the politicians could act upon. Considering that the Imperium exports a lot of it's raw resources to the Alliance, and also does a lot of it's manufacturing, no action could be taken unless concrete evidence of the Imperium's transgressions could be presented.
A message was received by the Bureau. The encrypted code at the beginning identified the agent from whom the message came, and the letter "J" signaled which Directorate it should go to. The agent receiving the message 250 meters underground listened to it. She then notified her supervisor, he then notified his superior. In about 20 minutes, every Directorate higher up present was listening to it in the Director's office. Someone shed a happy tear and declared: "We got them boys and girls, we got them!"
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2023.06.04 18:40 RazTheExplorer Part 11.5 - Closure
“Hey Raz, I got one!” Raz’s voice was cut by static as he called back, “Great! …at quarry …die.” Well, that wasn’t ominous at all, I thought to myself as I adjusted the rear-view mirror to check on the operator I had just blown past. They were doubled over coughing, their gas mask swayed side to side on the ground next to their feet. I don’t know what compelled me to not flatten what I had thought to be an AQ soldier, but I’m glad I didn’t.
I slammed my hummer in reverse, coming to a stop next to the helpless operator. “Hop in bud, we can get you to final exfill yet.” He slowly hauled himself into the bed of my hummer, landing with a dull thud and a groan as he fell onto his back. We cleared the gas, and I was immediately put on edge as my passenger started to gain consciousness. If he was planning anything nefarious, there wasn’t much I could do about it now. “You good back there? Normally I’d stop to send an invite but given the situation that might have just caused more problems.” He leaned through the non-existent rear window, “Nah, I understand man. When we get further from the gas we can stop and squad up. Don’t need to risk lighting each other up if things get hot at the exfill.” I couldn’t help but chuckle, “I don’t think that would be much of an issue regardless. Hey, we didn’t leave any of your friends back there, did we? I know we peeled out pretty quick.” I saw him shake his head and point to our left in the rear-view mirror. “We got split up, but they were running for a car, so I wasn’t too worried.” I followed his finger, a white hatchback cruised along parallel to us, swerving through buildings trying not to eat too many AQ bullets. “Hey boys, Dutch here is gonna roll with us to final. We’ll squad up when we get there.” I was barely able to make out one of his squad mates call out “Tight!” over his earpiece.
“Hey, listen, I’ve got friend I’m rolling with. His name’s Raz, he’s gonna meet us at final. If you see a red, white, and blue LTV, don’t shoot alright.” Raz chimed in, his radio finally clear of the static, “That’s very kind of you to tell them not to shoot me Dutch.” Before I could respond, a black turreted LTV slid out of Said City ahead of us. “Is that your boy Dutch?” I wanted to give my passenger the benefit of the doubt, it is windy in the box after all, he might not have heard me. “Nah man, wrong colour, and he didn’t have a turreted LTV last I saw.” The black LTV continued North along the main road as we cut away into the quarry proper. “Raz, company is headed your way. Looks like it’s just a solo in that truck but you can never be too careful.” “Thanks for the heads up Dutch.”
I rolled to a stop at the base of the helicopter ramp, gently flattening a couple of AQ who were getting a little to close to the bird for comfort, just shy of the battery running dry. The other two operators in the hatchback slid to a stop just down the hill from us. I got out of the hummer, a tad worried that my good fortune was about to come to an end at the hands of these fellas. As they ran up the hill, the notification finally popped. I accepted and ran down the hill to grab the hatchback, breathing a sigh of relief. “Wait, where you goin’ Dutch?” One of my clients called out. “Raz and I will run interference while we wait for the chopper to take off. Any AQ or unfriendly operators are gonna have to go through us.” “You keep talking about this Raz guy, but I’ve yet to see anyone other than that black LTV.” Almost on queue, a black LTV flew up the hill narrowly missing my hatchback. My clients went into a frenzy. “Operators pushing us! Take ‘em down!” The LTV spun in the sand in front of me, a glorious and perfectly oiled moustache glinting in the Al Mazrah sun. “Hold your fire! It’s Raz!” I called from below my clients. I sent an invite to him which he had hopped out and accepted faster than any of these guys could pull the trigger. “You see the operator that was in that earlier?” Raz shook his head, “No, I pulled up on it and they were gone. Must be out on foot somewhere.”
With 5 seconds left on the clock, there wasn’t enough time to go find them, our clients now panicking as they realized we weren’t on the bird. “What are you two doing?!” They shouted from the air as we waved goodbye. “Al Mazrah is our home gentlemen. That bird was never meant for us.” I gave Raz a pat on the shoulder as the gas rapidly approached, another successful day had come to a close.
The clack of a Kastov charging handle was almost unmistakable. We both turned to see the operator from the LTV standing there, rifle honed on us. “Well shit.” Their rifle dropped towards the dirt as they looked back over their shoulder at the nearly out of sight exfill chopper. They pushed through us, wandering towards the North side of the quarry. Raz and I locked eyes, shrugging in unison. That was one of those moments where we really wouldn’t have blamed them for their decision, whatever it might have been. “We better get back to HQ, Compton said I.T dropped off something for you.” Raz said as the gas engulfed us.
“I’m going back to the island boss.” My hands were shaking as I gripped the file folder that I.T had left for me. “Twitch.” “He’s back, it took him a bit, but he’s managed to re-take the castle and hunker down since we last saw him. And if he’s back then we might finally be able to get some proper intel on those blue tracers, direct from the source.” I handed the folder to Raz. He took it, turning to no doubt address the rest of the crew. I grabbed his shoulder, stopping him before he could speak. “Not everybody, not this time. They’ve doubled the defences; we’d be walking into a slaughterhouse.” “Well, you can’t go in there alone, we look out for our own Dutch, you know that.” Raz’s brow tightened, I could tell he was already trying to figure out what my plan was. “I’m bringing Maze and Alex. They’ll provide sniper cover while I infiltrate the castle. I still have my old uniform. As long as they haven’t drastically changed up their callsigns, I should be able to get in undetected.” I could tell Raz wasn’t convinced. “Dutch, like you said, you’d be walking into a slaughterhouse. How does you going in solo make that any better.” “After what happened in the complex…I’m not putting anyone else at risk, I can’t. The Bomb Maker…Twitch, I’ve gotta face him myself. Look him in the eyes so he knows I crawled out of Hell to drag him back down there.” “Alright, I couldn’t really stop you if I wanted to, could I?” Raz shrugged. “No, not unless you shot me, and honestly, I’d take those odds.” I punched his shoulder and started heading for the breakroom to grab Maze and Alex. “You keep that up I’ll be moving you back out to that sea can of yours.” Raz smirked.
The locks took a bit of fighting to get open. While this footlocker had only been on Ashika Island for a few months, the constant spray of salt water had worn away what little integrity it once had. The black uniform, emblazoned with the Rook and Spade of Shadow Company, was still in excellent condition, save for a bullet hole just under where the plate carrier would sit. I paused for a moment, holding it up in the air, memories of the past flooding in. “Not a lot of fond memories in that uniform I take it.” Maze called out from the catwalk in our home away from home. “I think part of the problem is that there are good memories. It’s a little concerning that such fond memories can hide out amongst so much evil.” “We’ve all done things we aren’t proud of. Some of us just did things other people also wouldn’t be proud of either.” Alex chuckled to himself as he cleaned his rifle on the cot next to me. I grimaced, mostly because he was right. I slipped into the old black fatigues and strapped on my old plate carrier. My weapons were all still intact too, I pulled my Taq-56 out of the footlocker, running my fingers over the engraving in the side, ROOK-XLIV. I cycled the charging handle a few times before loading in a fresh magazine and setting it on the cot next to me. I pulled out a pistol belt, two pearl handled revolvers, one with an ebony Rook on the grip, the other, an ebony Spade. Umbra Catavae engraved along each barrel. Maze had come down from the rafters now, a look of mixed intrigue and concern on her face, “I take it those don’t invoke fond memories.” I had done a poor job of hiding my look of disgust. “No, unfortunately they do.” I felt a wave of guilt wash over me. “Each of these was given to me for completing outstanding performance in the field. I did things I’m not proud of, and I was rewarded for it, handsomely. Holding these in my hands, I feel the same pride I had felt when they were first handed to me. It makes me sick.” I strapped the belt around my waist. The pearl handles shining against my all black silhouette. Alex piped up again, “Hey, at least you are trying to make amends for your sins, not many can say the same.” I let out a long sigh, “I suppose you’re right. You both remember the plan?” “Get to the radio towers and start lighting the place up when shit inevitably hits the fan.” Maze grinned. “Close enough.” I pulled my balaclava up and headed for the door.
The guard at the gate didn’t immediately shoot me which gave me some spark of hope that this might work. “In position!” Alex and Maze called out almost simultaneously. “Jinx, you owe me a beer!” Maze rejoiced. “What? Why would I give you a beer for that?” Alex sounded genuinely confused. “Hey, cut the chatter you two, don’t need to give them any reason to not let me in alright.” The guard held up his hand. “I don’t recognize you, let’s see your I.D.” I held up my old I.D card. “Well I’ll be damned, look who crawled out if his grave.” He pulled my mask down to confirm. “You look pretty good for a corpse, though your I.D card is out of regulation. You might want to stop by the I.T guy to get a new one made.” “Thanks, I’ll head right over.” The first thought that came to my mind was Bob. There’s no way he still worked for these assholes, is there.
“You used your old I.D?! You mad man!” Maze cackled over the radio. “Ok, I’ll admit, this wasn’t my greatest plan. I honestly thought they’d just capture me after seeing who I was.” Alex cut me off, “Go with the flow I suppose.” “Spade-499 up one-two.” The local radio channel began to drown out my squad’s comms. “Rook-3468 down one-one” “This is some odd radio traffic Dutch.” Alex quipped. I watched as a Shadow Company mercenary approached a stairwell, each step primed and ready to pop a leg off whichever unfortunate soul chose to ascend. “Spade-5454 up one-two.” “It’s how they know to deactivate the traps.” I whispered into our secure line. I approached the same stairwell. “Rook-44 up one-two.” I could hear the traps audibly click off. The guard at the to put his hand out as I reached the top step. “Sorry, no ghosts allowed on the second floor.” “Ghost? What…” He bent over laughing. “I’m just messing with you man. They said you died holding off the ULF while Bob and Twitch escaped, going out in a blaze of glory. Clearly, they didn’t have their facts straight. Glad to have you back.” I’m glad I had the balaclava on because I was struggling to hide my confusion. Last I checked I was the scape goat for the largest backstab in Shadow Company history, not a hero. I was never a hero when I worked for them. “I take it you are going to see the boss, call up two-zero, we don’t want people to be just guess on the fly, just in case someone tries to sneak in.” If only he knew.
“We don’t have eyes up there Dutch. Whatever happens, you’re on your own.” I could hear a tinge of worry in Alex’s voice. “Just make sure whoever is in here doesn’t get reinforcements.” “You got it!” Alex and Maze both called out in unison. “Jinx, you owe me another beer.” “There’s free beer at headquarters, why would I owe you a beer for that.” Alex called back clearly still confused. “Radio silence please. I’ve got a rat to kill.” I took a deep breath, pulling my Bryson from its sheath, the chrome exterior brushed over with a dull grey to blend in. “Rook-44 up two-zero.”
“Well, well, well. I was wondering when I’d see you again after our last encounter. Urzikstan and Al Mazrah clearly hadn’t kicked your ass enough so you decided to come crawling back to me for another round.” The traps clicked off. “Come on up, I’ve been looking forward to this.” I slowly ascended, keeping my Bryson trained at the top of the stairs, my eyes scanning each stair for an actual trap. As I crested the stairwell, my eyes were immediately drawn to him. His back turned to me, Trophy Systems whirring and clicking around him. “I missed you Dutch. Well, the old you. The one that would shoot through a hostage just to prove a point, the one that would dangle captives from buildings by their collar until they squawked like a bird, and then still dropped them anyways. I miss the Dutch that smoked Keller because his gas mask worked and yours didn’t when we those crazy Russian’s tried to hit us with mustard gas. I still get a little nauseous when I think about you peeling his face out of there.” “I’ve changed Twitch, I’ve moved past all that. I found a calling that doesn’t require me to be a conniving bastard.” Twitch laughed as he turned around, his hands empty. I kept my Bryson trained on him. “That’s what you think I am huh? I prefer shrewd businessman, but if that’s what helps you sleep at night.” He walked to one of the barred windows. “You really think what you and those taxi driving hooligans are doing matters?” “Clearly it does, or you and the Chemist wouldn’t be working so hard to sabotage us.” I took a few steps towards him. “Well, I suppose it matters to one of us. The Chemist and Raz go way back, but you know that. What I care about is the money, and I get a lot of money for helping that crazy bastard try to wipe out your little band of Merry Men.” “And Women. This guy just loves the sound of his own voice. Can I remove his head already? He’s looking right at me, practically begging me to pull the trigger.” I could hear the contempt in Maze’s voice. Twitch always did love a monologue. “You can still fix your mistakes Twitch. Gives us what info you have on those tracers of yours and I might consider not killing you.” I snarled. “When you went soft Dutch, you lost any respect I might have had for you. We are long past the point where you can intimidate me. Besides, any info I did have, is with the Chemist. He paid a handsome sum to get the formula, and really, it was becoming a logistical nightmare to ship enough of those little blue gems across the sea. Better for everyone to have it made close to the front lines.”
“Spade-101 up two-zero.” Bob’s voice cut through the tension. “Well I’ll be, it looks like we are gonna have a little family reunion.” Bob’s head poked up the stairs, “Hey boss, another server bank has shorted out from the sea air, I told you we should invest in better waterproofing the housings but if you still…” He trailed off as I dropped my Bryson, the sling catching it just before it hit the ground, and drawing my two revolvers. “Oh, hey Dutch. Nice to see you too.” Bob stammered. I cocked the hammer on each one, keeping one trained on each of my old squad mates. “Really Bob? Really! I understand you sticking around the day of the heist. But now? After everything that Shadow Company has done to these countries. To its own people.” Before he could respond, a siren blared over the intercom system. “Defensive positions! Hostile operators have breached the perimeter.” “Dutch you’ve got six operators approaching the castle, I think it’s time to bounce.” Maze was drowned out by her own gun fire, her Signal .50 raining death into the courtyard. “Looks like our time is up here Dutch. Since you clearly don’t have los cojones to pull the trigger, you might as well see yourself out, and let me and my men handle this.”
“Fuck it.” The hammer of the first revolver slammed down, dropping Bob instantly. I turned to face Twitch, his face a mix of surprise and pride. “Maybe I was wrong, the old Dutch still lives.” I charged forward, tackling him through the window and off the roof. Both of us lay on the ground, groaning as the chorus of gunfire roared around us. He dove for one of my pistols, but unfortunately for him, I had managed to hold on to the other, putting a round through his arm just before he could grab the gun. He rolled out of the way of the second round, bringing his one working hand up to the radio on his chest. The explosion from the castle threw both of us across the courtyard, debris raining down around us. I felt like I was reliving one of the worst days of my life all over again. I hauled myself to my feet, Shadow Company mercenaries and operators wandered aimlessly through the ashes. Everyone seemed too disoriented to fight. “I think it’s time to leave Dutch.” “I second that.” Maze and Alex were barely audible over the ringing in my ears. “Regroup at the boat. If I’m not there in 5, go without me.” I never heard a response, even if they tried, they wouldn’t have convinced me to leave, not with him still breathing.
I combed through the smoke and fire, carefully checking every nook and cranny I came across but the slippery rat was nowhere to be seen. “Looks like you 3 aren’t thick as thieves after all, eh Dutch. Poor Alex here was left all alone on the beach, no boat to be seen.” Twitch was sucking in air between words, no doubt kept standing by adrenaline. “You lay a finger on him, and I’ll make you wish you had died in that explosion.” I spat into my mic. “Don’t make me wait too long.”
I limped over a hill towards the beach where we were supposed to regroup. “Alex! Where’s Maze?” I called out as I stumbled down the sand bank. Alex didn’t respond, his head held in a tight headlock by Twitch, my second pistol against his temple. “She abandoned you both, and now I get the pleasure of killing you both after yet another betrayal. When will you learn Dutch. This world is a cruel place. Only the strong survive, clearly Maze knew that.” Twitch cut me off before I could retort. “Save the fight me with honour B.S that I know you are gonna spew.” I’m gonna kill you and your buddy and salvage what little I can of this operation. Then maybe retire to Cuba. I do love a good cigar.” “Adios, pendejo!” Alex brought his arm down, the knife concealed in his hand connecting with Twitch’s thigh. Twitch let out a high-pitched yelp, letting loose a round from the revolver which narrowly grazed Alex’s hair. Alex dove into the sand right as Twitch’s shoulder exploded in a pink mist followed shortly by the unmistakable crack of Maze’s Signal .50. I squinted trying to see where the shot came from, all I caught was the glint from her scope in the sun, the boat hardly visible in the rolling surf.
I limped forward, Bryson in hand, chrome starting to show through the worn grey paint. I kicked the revolver away from Twitch, placing a boot on his chest and the barrel of my Bryson against his forehead. He began to mumble and cry, hardly able to string together an understandable sentence. “Save it, you’re gonna need your energy for what comes next.” Our boat slammed into the shore, Maze hopping off, rifle raised and ready. “Oh shit I actually hit that!” “I’m not gonna lie, I thought you’d actually just bailed.” I laughed as she helped Alex to his feet. “You still go those claymores?” I asked Maze as Twitch continued to writhe in panic under my boot. “You wanted the old Dutch, eh Twitch. Ask and you shall receive.” Maze handed me the claymores, while Alex kept sidearm pointed at Twitch. I planted 4 around him, just far enough away that they wouldn’t go off unless he moved. I drew one of my revolvers, popping the cylinder out and emptying all but one round. I gave the cylinder a spin before flicking it closed. I tossed the revolver at Twitch. “Don’t waste that on me. You’ll only regret it in about an hour.” I took my other revolver, and hurled it towards the sea, the pearl grip glinting in the sun as it spun through the air, disappearing into the crashing waves. “Good riddance.” I sighed, that chapter of my life finally ended. Twitch was silent, his whimpering now just deep, laboured breathing. I turned back before I stepped onto the boat, watching as his hand slowly moved to the pistol in the sand next to him. “Well played Dutch, well played.”
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2023.06.04 18:03 Spirited_Note3615 My Protector
Alright I'm not gonna exaggerate and make my fiancee sound like she's legit trying to be a manly man-girl. She does work out, she has some muscles, but not Arnold Schwarzenegger muscles, she likes to wear hoodies when cold, Calvin Klein sports bra/tanktop when hot, and she is taller than me, almost towers my dad. But she has long dark hair, looks beautiful in whatever dress she wears. She is still a lady. And always will be. With that being said, whenever she gets angry Belle becomes Beast. I don't want you guys to think I'm constantly being harrassed or bullied like some soap opera but on occasions there times you come across someone who just feels tearing you down for mo other reason except, they fucking felt like it. I think I may have told this story in comments but here's a recap. Fiancee and I went to the gym, and because I don't exercise that often I just stick treadmill, planks, and spot my girl when she's lifting weights. Anyway, I'm on the treadmill listening to a video when a girl who looked like she just came from a Concentration Camp (no disrespect intended I'm just emphasizing how skinny this girl was if you still have a problem with it let me know and I'll edit it I mean no disrespect) some anorexic chick comes up to the treadmill, leans against it and attempts to make small talk with me. I say hi, trying to be polite as I could even though I couldn't really hear because I had my headphones on. Then I see my girl confronting her, this serious look on her face, the skinny girl backing away like she had a gun infront of her then ran out the building. Apparently the girl was trying to flirt with me and not only is it against the rules at the gym to flirt(applies to guys and girls) but I'm my girl's man. No one should be flirting with me unless they are immune to being bashed in the head lol. So here's another story, this was last year so she was still just my girlfriend before we got engaged so just know I'm mentioning the same significant other. My girlfriend and I are getting ready to get on a plane to Florida, we were going to visit Weeki Waaci (a mermaid water park) then DisneyWorld because it was a rough week, we, or I needed a vacation. We're walking through the airport, once again we're dealing with who should carry the luggage. Most of it is our clothes. The other suitcase has personal stuff like her business laptop, books. And my Cheshire Cat themed bag she got me for my birthday with a couple of notebooks and my phone, charger cord, headphones. This isn't a legit full blown argument but it usually consists of her being, "No, honeybunny, only I should carry the stuff, you just bring your beautiful face"(She would say the loving yet cheesiest shit ever lol) and me going, "Babe it's not for you to carry everything, let me carry something otherwise I feel like an asshole." "Nope. I will not put my little prince through such labor" "Can I at least carry my Cheshire Cat bag. Its light." "Actually hon can you carry the Chesire Cat bag?" "If you insist babygirl." Y'all probably thinking "You're exaggerating because this is the rolereversal subreddit" but I'm not lol. This legit what I experience 24/7 with this goofball. God I love her. Anyway so we arrive at our gate. We have at least one hour before we board so we have time to sit and chill. I am very uneasy on flights so I take an advil and tylenol pill(half of a tylenol because I don't wanna be drowsy) so it'll calm my nerves. My girlfriend grabs me tea from a nearby McDonald's, sit me on her lap, I swallow them down and so we kill an hour snuggling on the seat. "Flight blah blah bloo to Orlando Florida now boarding". We get our stuff ready, girlfriend hands me my ticket, window seat😁, and we get in line. So we're just standing around waiting for our turn, when this dude (I gave him the name, Mr. Obnoxious Cougher)stands next to us and he starts coughing. I understand that we have the vaccine now so the idea of maybe getting stick shouldn't be as risky as it would've been back in 2020. But guys, please understand, we are taught in kindergarten to cover your mouth when your body releases bodily fluids like salvia or snot. Its fucking common curtsey. This 40 something year old is coughing like he's auditioning for "Cough The Musical". He is just doing the complete most. I start distancing myself from him but, and I shit you not, he came closer. "What the hell?" It went from a dude having a genuine respiratory issue to doing it on purpose to be obnoxious. He looks forty but hes standing there with his mouth open, coughing like a two year old. So my girlfriend and I just chatting trying to ignore him. I noticed a dude ahead of us with these sweet look shoes. They were Nikes, black bottom, and metallic top. They looked sick. "Hey do you think you could get me those?" "Yeah babe just remind me later" "Yeah yeah. Damn they look beautiful." Suddenly as if I feel like something had sprayed windex in my direction this guy starts coughing in my face. I was freaking livid. "Yo what the fuck?" "Oh sorry." He was standing little inches away from me and coughing right into my face. I actually began to angry cry(you know when you get so mad tears start falling but you're not necessarily sobbing) a millisecond later my girlfriend rushes at Mr. Cougher and actually pins him to the wall, her arm squeezing his throat. She's shouting loud enough for everyone to hear. "WHAT THE FUCK ARE YOU DOING YOU DISGUSTING PIECE OF COW FODDER?!" "S-s-sorry I'm ha-ha-having trouble breath-" "I DON'T GIVE A FUCK IF YOU'RE CHOKING ON YOUR BLOOD! COVER YOUR MOUTH! YOU DON'T COUGH ON NOBODY LIKE SOMR DAMN 2 YEAR OLD!!" I'm just standing there, wiping my face, almost no reaction while everyone else is like😮😲😬😳 "IF YOU EVER DO THAT CRAP AGAIN, YOU BETTER PRAY TO CHRIST YOU'RE NOT ON THE SAME FLIGHT OR I WILL BREAK YOUR NECK!!" She let's him go as his face starting to turn blue then returned to her place in line beside me. But not before giving the dude a nice knee to the crotch sending him down to the floor. Yeah, she does have a real short temper and was once attending anger management classes before she and I met. But she never gets angry at me because I'm the prince in the relationship. That and I'm fairly easy going so we don't have so different of opinions that we'd get into an argument (Yes I'm aware that its healty to have arguments we are our own person, different perspectives and ideas, I'm just saying I'm not the type of person who is eager to convince everyone that their way deserves more of a look into)unless you count the luggage lol. The only time I remember her being actually irritated with me is one time we went shopping and I would constantly let go of her hand just to rile her up. But thats a story for another time. For those who go to airports you know how the separate lines, right, "Now boarding line 1-5, now boarding line 1-5." We're in line 5-9 they now announce our line and we board our plane. My girl has a very successful career so I've only flown first class since having this girl in my life, hell yeah. So we get to our seat, I managed to snatch her carry on bags, and with speed lifted them into the cabinets above our seats before she was able to react. I had a look of triumph on my face as I took my seat near the window, meanwhile she had a slightly annoyed look on her face. Guess I have a lot to learn about being a little prince lol. So we get comfortable, we fasten our seatbelts and await for the plane to fill up. The armtray between our seats is moveable, so my girlfriend lifted it and put her arm around me as she usually does incase there are times I get anxious and need a snuggle. I nuzzled into chest, her arms wrapped around me and whispered, "My hero." since earlier and rewarded my maiden in shining armor with a kiss. The plane fills up and we're basically ready to get this bird across the runway. Until we see a stewardess and a familiar face beside her, its Mr. Obnoxious Cougher. "Attention passengers, our flight is full and we're look for volunteers who would willingly give up their seats and be bumped for a later flight for 200 dollars" Ironic enough we were flying American Airlines. If this was Spirits I'd wind up like that doctor. No one moved. In general my girlfriend and I wouldn't be the first people to give up seats because why ruin our trip because of someone else's problems. But because of what happened earlier with this person, there was no pity in my eyes. I was just chilling, enjoying snuggling with my girlfriend, but something told me that she was looking at the dude with fire in her eyes. It was unanimous that no one was moving so the stewardess had to escort Cougher out. Everyone could literally hear him throwing an absolute tantrum as he walked back down to terminal. He was swearing and screaming just running his mouth. It was quite amusing. The pilot went over the safety instructions, I turned on a inflight movie, and we relaxed as our flight got ready to take off. It wouldn't be the last time my girl had to bust some heads in order to make sure I was good and safe and God bless her for it. She's like my big sister, my best friend, girlfriend and now fiancee and I can't wait to spend time rest of my life with her.
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2023.06.04 18:00 SunsetBLVD23 Books for film (or any) music composers
Hey all! We've just put together a list of books that could be useful, especially for film music composers (but honestly, they're great for composers of any genre too.) These books are fairly well-known, so they might be more suitable for those who are just starting out as media music composers. Either way, we hope you find them helpful!
*Please note that the selection of books provided solely focuses on the theoretical aspects of music composition. Books specifically addressing the technical aspects of film scoring, such as spotting, synchronization, and other related topics, have not been included in this list.
- On the Track
Author: Fred Karlin, Rayburn Wright
Publisher: Routledge; 2nd edition (January 8, 2004)
Paperback: 560 Pages
Publication Year: 1995
If you’re interested in a career in film scoring, then we have no doubt that you’ve probably heard of this book (or maybe it’s already on your bookshelf). This comprehensive guide covers everything you need to know about the craft of film scoring, from the basics of music theory and composition to the more technical aspects of working with film crews and recording studios.The book is divided into two parts. The first part covers the basics of film scoring, including the history of film music, the different types of film music, and the role of the film composer. The second part of the book is more technical and covers topics such as spotting, synchronization, and orchestration.The only downside to On the Track is that it was published in 1990. As a result, some of the information in the book is now outdated. However, the vast majority of the information in the book is still relevant, and it is still a valuable resource for anyone interested in film scoring. Also, the book does not come with any audio tracks, but you can find many of the examples discussed in the book on other sources such as YouTube.
(Sidenote: Inside the Score
by Rayburn Wright (Kendor Music Publishing) is an extraordinary resource and a great guide for those interested in study of big band jazz.)
- The Art of Film Music
Author: George D. Burt
Publisher: Northeastern University Press
Paperback: 288 Pages
Publication Year: 1995 “The pages are enriched with detailed discussions of iconic scores from memorable scenes in films like The Best Years of Our Lives, Laura, and East of Eden.”
This book delves into the significant role and profound impact of music in film by analyzing various scenes from classic movies spanning the 1930s to the 1980s. The author thoroughly examines both the practical and aesthetic aspects of film scoring, drawing on the insights of esteemed composers such as Hugo Friedhofer, Alex North, David Raksin, and Leonard Rosenman. The pages are enriched with detailed discussions of iconic scores from memorable scenes in films like The Best Years of Our Lives, Laura, and East of Eden. Additionally, the book serves as a technical guide for composing film music, covering topics such as the spotting process, timing, synchronization, and general compositional approaches. It’s worth noting that the book does not include any audio tracks, most likely due to copyright considerations.
- Principles of Orchestration
Author: Nikolai Rimsky-Korsakov
Published: June 1, 1964 by Dover Publications.
Language : English
Paperback : 512 pages
*First Published July 15, 1822 “This book provides valuable insights into topics such as tonal resonance, voice combination, effective utilization of tutti effects, and more.”
“The Principles of Orchestration,” authored by Rimsky-Korsakov, a renowned master of Late Romantic orchestration, serves as a comprehensive guide to arranging parts for either a string or full orchestra. This book provides valuable insights into topics such as tonal resonance, voice combination, effective utilization of tutti effects, and more. Many of the musical examples featured in the book are drawn from the author’s own compositions, including notable works like Scheherazade and Capriccio espagnol.
However, it is important to consider that while we highly recommend this book and acknowledge its immense value, it may not be the most suitable initial resource for novice orchestrators. “The Principles of Orchestration” assumes that readers possess a solid understanding of music notation, orchestral instruments, and notation conventions. It is also worth noting that the book does not include any audio materials.
Author: Max Reger
Publisher : Dover Publications; Illustrated edition (June 5, 2007)
Language : English
Paperback : 80 pages “Consider it an essential companion for your writing desk, providing quick and accessible references whenever needed.”
Let’s diverge for a moment. While this book may not be exclusively focused on film scoring, it proves to be an exceptional resource for music theory in general. Have you ever encountered challenges when transitioning between different keys? Aptly named, this book is dedicated to the art of modulation and transposing from one key to another. With a focus on 100+ modulations using a 4-part voicing, this concise guide offers valuable insights into navigating key changes effortlessly.
- Music Notation
Author: Mark McGrain
Publisher : Berklee Press (July 1, 1990)
Language : English
Paperback : 216 pages
“This comprehensive book is a treasure trove of answers to the majority, if not all, of the notation questions you may encounter as a composer. “
Pausing your creative flow while composing due to confusion over technical aspects of notation methods can be quite frustrating. Fortunately, this book is specifically designed to alleviate such situations.
This comprehensive book is a treasure trove of answers to the majority, if not all, of the notation questions you may encounter as a composer. It covers a wide range of subjects, including Chord Notation, Dynamics (Location of Dynamic Information), Articulations (Placement of Accent, Staccato), and various other crucial aspects essential for maintaining a professional and polished appearance in your musical scores. Whether you’re seeking guidance on proper notation techniques or aiming to enhance the overall professionalism of your compositions, this book is an indispensable resource that every composer should have in their collection. With its extensive coverage and expert insights, it serves as a reliable and invaluable companion throughout your creative journey.
- The Study of Orchestration
Author: Samuel Adler
Publisher : W. W. Norton & Company; Fourth edition (June 1, 2016)
Language : English
Paperback : 1024 pages
“This book goes beyond being a mere reference and is often regarded as a bible for composers across various genres, not limited to film music. “
Samuel Adler’s “The Study of Orchestration” holds a prominent place on our list. Deliberately positioned as the final item, we assume that many readers of this article are already familiar with this renowned book. However, for those who are just starting their orchestration journey, it is an absolute must-have resource. Consider it a comprehensive guide that imparts essential knowledge, whether you are exploring the ranges and characteristics of different instruments, delving into specific notation methods, understanding timbre, or learning effective techniques for orchestrating your compositions, including considerations for doublings. This book goes beyond being a mere reference and is often regarded as a bible for composers across various genres, not limited to film music. Its invaluable insights make it an indispensable companion for anyone seeking to enhance their orchestration skills and craft remarkable musical works. And yes, this book comes with audio examples.
You can find additional learning resources on film composition right here.
… and the list goes on and on. While we couldn’t include all our recommendations here, we’ve compiled a concise list of additional books that we highly recommend. In our future posts, we will gladly share even more book suggestions. Thank you for your reading!
“Film Music: A Very Short Introduction
” by Kathryn Kalinak: This book provides an overview of the history and evolution of film music, exploring different styles and approaches used in film scoring.
“Audio-Vision: Sound on Screen
” by Michel Chion: While not specifically focused on composition, this book explores the intricate relationship between sound and image in film, which can help composers better understand the role of music in enhancing the cinematic experience.
“Music Composition for Film and Television
” by Lalo Schifrin: This book, written by the acclaimed composer Lalo Schifrin, provides insights into the creative process of composing music for visual media. Schifrin shares his experiences and techniques, covering topics like melody, harmony, rhythm, and orchestration. (Major drawback: No audio examples)
“Complete Guide to Film Scoring
” by Richard Davis: This comprehensive guide offers practical advice and techniques for composing music for film. It covers various aspects, including working with directors, understanding the business side of film scoring, and creating effective scores that enhance storytelling.
“Scoring the Screen: The Secret Language of Film Music
” by Andy Hill: In this book, Andy Hill explores the art and language of film music, providing a deeper understanding of how music can shape the emotional impact of a film. It covers topics such as orchestration, thematic development, and the collaboration process between composers and filmmakers.
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2023.06.04 16:50 hnqn1611 20 Amazing Uses of Toothpaste - DIY Toothpaste Hacks
| || |https://preview.redd.it/mas77l5vk04b1.jpg?width=1280&format=pjpg&auto=webp&s=80e755964f562a1c58d4b126faba6cde3454d465 20 Amazing Uses Of Toothpaste submitted by hnqn1611 to TopPersonality [link] [comments]
Toothpaste comes in many different flavors, whitening strengths, and brands, and it does a great job keeping your teeth clean and healthy. Assuming you actually use it of course… But, there are many amazing uses for toothpaste, aside from cleaning your teeth! In fact, there’s very little that tooth paste cannot do, so try a couple of these toothpaste hacks and see for yourself! It doesn’t cost much, so why not have a little fun with it? Let’s discover a few awesome ways to use toothpaste!
Number 1 - Eliminate Nasty Odors It’s easy to get left with smelly hands and fingers after cooking, especially with garlic, onions, fish, or any other pungent ingredient. These odors can actually make their way into your skin cells, which is why they hang around for so long. You can use toothpaste to remove these odors by simply rubbing a bit on your hands and rinsing them clean.
Number 2 – Relieve a Burn Burning yourself is no fun! It really hurts, and the pain seems to linger on forever. The next time you happen to burn your hand or fingers, try this simple remedy to ease the pain. First, run some cold water over the burn for a few minutes, as you normally would. Then cover the affected area with tooth paste for a soothing and cooling solution.
Number 3 - Repair Scratched CDs and DVDs While digital disks are slowly becoming a thing of the past, most of us do have a collection of CD's, and at least a rack full of DVD’s. And surely, you’re familiar with the joy of having a scratched disk… You know… listening to your favorite song, and it starts skipping or it just skips to the next song. Well, there’s a quick and easy fix! Toothpaste of course! It can be used to safely and effectively remove scratches from your CD’s and DVD’s. You just have to rub a little bit of toothpaste on the disk with a soft cloth and then wipe it clean.
Number 4 – Clean a Hair Straightener Girls, you’ve probably noticed that over time your flat iron starts to develop a grimy coating on the surface of the plates. This is caused by a build-up of everything from hair spray to mousse, shampoo, gel, or whatever else that you put in your hair. But, you can easily remove all this buildup. All you need to do is rub some toothpaste on the plates, and buff them clean with a microfiber cloth.
Number 5 - Clear Up Pimples Forget those expensive acne treatments. You can get great results with a cheap tube of plain white toothpaste! The ingredients in toothpaste dries up acne and leaves you with clear skin. Just dab a small amount on your pimples before going to bed. And when you wake up in the morning, you should see a huge improvement!
Number 6 - Polish Silver Jewelry Silver jewelry loses its shine over time. However, a little bit of toothpaste and an old toothbrush can bring back the sparkle. Just dampen the toothbrush and add a touch of toothpaste. Scrub your jewelry gently and then rinse clean with warm water. Simple as that!
Number 7 – Clean Your Nails A whitening toothpaste with peroxide will remove that unsightly orange or yellow tinge that nails tend to develop from dark nail polish or excessive smoking. All you have to do is apply a little toothpaste to a nail brush and scrub gently over your nails.
Number 8 - Freshen Up Your Car Toothpaste can easily eliminate odors in your car. If you want your car to smell minty fresh, just put a quarter sized amount of toothpaste onto a paper towel, and fold it in half. Leave it under your seat, and the toothpaste will make your entire car smell … well, like: toothpaste.
Number 9 - Treat Poison Ivy Stings If you happen to get a rash or a sting from poison ivy, use toothpaste to take away the worst of the irritation. Gently apply a bit to the affected area and leave it on for about 10 minutes. Then, wash it off with some cold water. You can repeat this until the stinging sensation subsides.
Number 10 – Style Your Hair Not a lot of people know that gel toothpaste contains some of the same ingredients as commercial hair gel products – which is certainly something to think about… However, the next time you’re heading for a night out, but realize you’ve run out of hair gel, just slick a little bit of toothpaste on your hair. This simple toothpaste hack will keep your stray hairs in place all night long!
Number 11 - Clean Baby Bottles & Containers It’s not uncommon for baby bottles to develop a slightly sour odor. But, you can get rid of this smell with toothpaste and a regular bottle scrubbing brush. Squeeze some toothpaste right into the bottle, and give it a good scrub. Be sure to rinse the bottles out thoroughly afterwards, because ingesting too much fluoride can make babies sick.
Number 12 - Reduce the Appearance of Bruises If you have a nasty bruise you want to get rid of it as soon as possible, you’re going to need two things. Some lotion, and you guessed it! A little bit of toothpaste! Now mix these two together, and apply the mixture to the bruise. Then cover the area with a large band aid. Leave it on overnight, and wash it off in the morning. Repeat these steps for another two or three nights, or until the bruise is gone.
Number 13 - Bring Old Shoes Back to Life Toothpaste can get those sorry looking leather shoes or trainers looking good again. Just apply some toothpaste directly to the dirtiest spots. Then, take an old rag or a brush, and scrub with a generous amount of pressure. Rinse off the toothpaste, and you got your shoes looking like new.
Number 14 - Deodorize Your Dog Dogs and skunks do not get along. In fact, dogs can find all sorts of smelly things to play with. The next time your pooch gets into something smelly, just wet his fur, and rub in some toothpaste. Massage his coat for about five minutes and then rinse him clean. The offensive odors will be gone!
Number 15 – Get Rid of Hair Dye Stains The next time you color your hair, make sure you have a bit of white toothpaste on hand for those color stains on your face, ears and neck. If your color runs and leaves a stain, just rub a bit of toothpaste on it and scrub the stain away.
Number 16 - Clean Your Refrigerator The seal around the door on refrigerators can get very dirty, and it can be quite difficult to clean. Simply add some toothpaste to a toothbrush and scrub away the grime. This will make your refrigerator sparkle like new.
Number 17 - Clean Walls If you have a child who aspires to be an artist and has chosen your walls as their canvas, you can easily remove those crayon marks with a damp cloth and a bit of toothpaste. Rub the stains vigorously in a circular motion, until they disappear. Then simply wipe off the residue with warm water.
Number 18 - Remove Gum from Hair I’m not sure how this even happens, but apparently it does. And it’s a sticky situation, that’s for sure! To get chewing gum out of hair fast and without having to reach for scissors, spread some toothpaste over the affected are and let it do it’s magic for a few minutes. The toothpaste will break down the sugars in the gum, and you’ll be able to lift it out much easier.
Number 19 - Buff Kitchen and Bathroom Faucets Instead of using a chemical based cleaning product, you can keep your kitchen and bathroom faucets looking bright – and all you need is some toothpaste! Grab a rag or a sponge, squeeze a little bit of toothpaste on it, and put yourself to work. Add a little bit of elbow grease and your faucets are going to look brand new in no time!
Number 20 - Repair Cell Phone Screens Cell phones have come a long way. But, they are still prone to scratches. Luckily you can remove minor scratches with this simple toothpaste hack! Lightly rub a dab of toothpaste over the scratched areas. Then, wipe it clean with a damp cloth and leave your phone to dry. Have you tried any of these toothpaste hacks? If you did, how did they work out for you? Let us know in the comments below!
2023.06.04 16:48 Advice_SexWork I have scars on my belly after surgery
My doctor told me it will take up to 8 months until they start to fade.
I had the surgery two months ago and took a break from work (I don’t sell on OF, I sell individually).
Sooo… what should I do? I‘m not very good at make up and it’s not easy to cover them. I also don’t want to put too much make up on them because they have to breath. I can’t hide them since they are a bit above my vagina (had a hysterectomy).
I also don’t really want show them since they don’t look very… sexy(?)
Does anyone have an idea? :/ My customers know about the surgery but not about the scars… I‘m not sure if I should ask them if it’s okay for them since I‘ll have to warn every new customer that there are scars on my body at that video and I don’t wanna give it too much attention..
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2023.06.04 16:07 dreadhead00 Chest revision question OHIP
Question about top surgery revision and OHIP. Does anyone know if the same surgeon has to do the revision or can another surgeon " correct" the original surgery and have it covered by OHIP? I had top surgery 2020 with Dr Mclean and bottom surgery at grs montreal 2023, would love to have montral do my revision if covered, thanks
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2023.06.04 15:39 dreadhead00 Chest revision question...
Question about top surgery revision and OHIP. Does anyone know if the same surgeon has to do the revision or can another surgeon " correct" the original surgery and have it covered by OHIP? I had top surgery 2020 with Dr Mclean and bottom surgery at grs montreal 2023, would love to have montral do my revision if covered, thanks
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2023.06.04 14:59 Danklyy The second Rayne administration: my headcanon for a second term in office (Chapter 1, part 2)
This is my headcanon for the events following Suzerain as the game played out in my (communist) playthrough:
Disclaimer 1: This obviously includes many spoilers from the game.
Disclaimer 2: This story is written with storytelling and lore at the forefront, not necessarily gameplay accuracy.
Disclaimer 3: This is only the first chapter (and backstory) of this headcanon story/fanfic/whatever you want to call it. I want to write more, but would like to see what people in the Suzerain community think about the writing so far and if they’d like to see more of it. :)
(Part 1 is on my page if you cannot find it elsewhere)
Chapter 1: Inauguration Day (Continuation) Serge had always been one for praise as long as Anton had known him, but it seemed to be out of sheer admiration and trust, unlike the usual political suck-up. It was definitely appreciated praise, but somewhat uncomfortable in a way, as Anton wasn’t used to such high praise from politicians, and was a little afraid all the compliments would bloat his ego. Though he rarely vocally disagreed with Serge’s remarks, as a president shouldn’t appear doubtful of their abilities. That was one of the many rules Anton had learned to follow as a president. He didn’t like it, yet it had still become almost second nature to him by now, something that also concerned him quite a bit.
“Thank you for your trust in me Serge. It truly means a lot.” Serge smiled through the rear-view mirror once more before replying “Thank you Mr. President for setting such a great example for the people of this nation.” Anton knew it would be impossible to beat Serge in a humility contest, so he conceded with his usual reply “You are too kind, Serge.” Before long they were off, and it didn’t take them as long as they’d thought to get back to the hill of pride, as the traffic had wound down along with the day. As the car headed up the long and winding road that led to the maroon palace through capitol park Anton noticed the palace gates were open and the driveway was filled with journalists, as opposed to the politicians and oligarchs usually present at the previous inauguration events. As Serge entered the car into the driveway, the journalists made way for the car to park next to the small row of black sedans and limos that had brought the rest of the night’s dinner guests to the palace.
Serge quickly stopped the engine and exited the car to open Anton’s door. As he did so, Anton was met with the now familiar camera flashes and the sounds of journalists speaking over each other to the point of near incomprehension. “Mr. President” started a young woman in a sharp azure pantsuit, holding a microphone up to the President’s lips. “There have been a lot of concerns voiced by the opposition after you used the phrase ‘Sordish Revolution’ at your rally. Is the opposition correct that this is an indication of political violence being endorsed by the presidency?” Anton noticed the ‘Lachaven Times’ label on the woman’s microphone before replying to her question. “No. Revolution does not mean violence. Revolution means that this country has problems, and we need radical and rapid change to address those issues.”
“Mr. President, one more question. This revolution outburst, as well as your administration’s close association with communism and United Contana, has brought fear to the hearts of many business owners in Sordland. Do you plan to completely nationalise our nation’s economy, and will business owners be compensated for the loss of the fruits of their labour? Anton briefly chuckled before opening his mouth to reply. Before he could do so however, he saw a hand cover the woman’s microphone. “The President will not be answering any more questions as of now.” Ranye looked left and saw his newly appointed Vice President, Lucian, looking as stern as ever. He took his other hand on Anton’s back, leading him away from the flock of journalists, into the maroon palace.
As they moved inside, there were still a large amount of journalists, although not as many as there were outside. These journalists however, knew better than to try and approach the President, as Lucian’s glare was warning enough. “It’s good to have you here Mr. President. We’ve already set up everything in the dining room upstairs, both for the dinner itself and the televising of the event. Your wife insisted on waiting on you in your office. It would be good for the press to be able to get pictures of you two together, so I would advise you to go get her so you can welcome the dinner guests together.” Anton now noticed his Vice President was wearing a tuxedo, as were many of the male journalists and camera crew. “Knowing you, there is already a tuxedo in my office as well.” Lucian nodded. “Thank you. I’ll go get ready.”
As the President and Vice President separated, it did not take long before Anton found himself in conversation again, while on his way to his office. This time with the director of the Sordish Radio and Television Supreme Council that Anton had founded during his first administration. In fact this was Anton’s first time meeting the director of the council, as Lucian was the one who appointed him. “Mr. President, it’s an honour to meet you. Damien Ves, at your service.” The stocky and wide man grabbed Anton’s hand and shook it. “It’s a pleasure to finally be able to meet with you Mr. Ves. Lucian told me you’d be in charge of today’s broadcast.” Anton began to increase his pace, which Damien attempted to duplicate. “Yes, it's all very exciting. It will be like you’re having dinner with the entire country! This new technology is amazing!”
“Yes, truly amazing. If you’ll excuse me I have to go get ready. It was nice meeting you.” Anton entered his office and closed the door with a sigh. Before being able to look around the room, he was ambushed by a hug from his daughter Deana. “Papa! You’re finally here!” Anton looked down at his daughter, who looked tired from the eventful day. “How did you like the rally sweetheart?” asked Anton as he got down on one knee to be eye-level with Deana. “There were so many people! Mama talked to so many of them. She talked a lot about exploitation. What is exploitation Papa?”
Before Anton could think of how he was going to explain that to his daughter, Monica came up behind her and picked her up. “Alright, let your papa at least get inside properly before you start asking him harder questions than the journalists outside.” Anton followed his wife into the room as she plopped down Deana on the couch. Only then was he able to see how beautiful his wife looked in her elegant scarlet dress. The only thing he could fathom doing was kissing her, and as he did, she pulled away. “Later. Now you have to get ready. It’s nearly seven.” Before going to the bathroom in his office to change, Anton took a last look at his wife as she started doing Deana’s hair. “You look absolutely gorgeous, honey.” Monica gave her husband a warm smile and a wink back as a reply.
Anton entered the office bathroom, where a tuxedo hung from the door on a hanger. It looked old, yet well-maintained. Its white bowtie and waistcoat, coupled with a long tailcoat reminded Anton of the similar suits worn by the wealthiest students during his time at university in the 1920s. As he put on the tuxedo and started adjusting it, he found a note in the left-hand pocket on the tailcoat.
It read “Anton, as you read this, getting ready for the start of your next term, know that the people of Sordland have reaffirmed their trust in you, and it is your duty to not let them down. This suit belonged to my father, and he used it for events just like the one you’re about to go to all the time when he was president. When he fell, Sordland became cursed with two despots, who ignored the cries of the weak. I believe that you have the power to break that curse, as evident by your first term. I believe that you are the only one who might be able to stop this curse now. But only if you keep true to yourself and your ideals, don’t let the world of politics suck you in too much. Don’t forget that you are where you are to serve the people. Not the powerful, but the weak. Good luck my old student and good friend. -Deivid Wisci.”
Anton had very fond memories of his mentor Deivid Wisci, both as his professor, and as his minister of foreign affairs. The day he retired was a sad day for Sordland. Although he definitely deserved a retirement, after all the good he had done, Anton thought to himself. He put the note back in his pocket and adjusted his bowtie for the final time. Before leaving the bathroom however, he remembered to take the pocket watch he was gifted by Serge from the breast-pocket of his usual attire. He placed it in the breast-pocket of his new tailcoat, slicked back his jet black hair, and headed out of the bathroom. “Ready?” Monica and Deana were sitting on the couch patiently waiting. “Yes, let’s go.” Anton reached out his hand to escort Monica out. As she put her hand into his, he kissed her hand before the pair proceeded out of the office along with Deana.
The Rayne family made their way into the maroon palace’s dining room, where the camera crew had already started filming. Anton and his family took their place in the lounge area that decorated the backdrop for the dining table, where the Rayne cabinet slowly started to assemble to be welcomed by Anton and Monica. First was Lucian who, to nobody’s surprise, came alone. He came up to Anton and shook his hand, followed by that of Monica’s, while Deana tried to hide slightly behind her mother. Lucian took his seat in the lounge, making sure to sit as close to Anton as he could.
He was soon followed by the equally lonesome minister of defence, Iosef Lancea. Unlike nearly every man present in the maroon palace however, Iosef came in his regular military attire, as opposed to a tuxedo, or even a regular suit. Although Anton was unsure, he might’ve added a few medals to his uniform for the occasion. He saluted the President and First Lady, to which Anton replied with an adequate, but not nearly as impressive salute. He took his seat next to Lucian, and they started the obligatory small-talk that was expected of them as dinner guests.
At last came the minister of agriculture, Gus Manger, who was accompanied by his wife and son. They walked up to the President’s family, where Gus proceeded to shake Monica’s hand, while his wife greeted Anton. They then switched places, and Anton welcomed Gus and his family to the palace, and to the dinner. Gus then took his seat beside Iosef, promptly followed by his wife and son. Anton didn’t know much about Gus’ family, however his son somewhat reminded him of Franc, albeit a few years younger. The boy didn’t seem that excited to be here, understandably enough. It seemed as though Monica had noticed the same thing, as she faintly pulled on her husband’s arm, gesturing to him to lead everyone to their seats at the table.
As he was about to do just that, the doors to the eastern wing of the room swung open one more time. It was Ciara. She was wearing an off-white dress, surprisingly similar in shade to the bathrobe she’d worn earlier today, though obviously much more classy. Monica gave Anton’s hand a slight squeeze as she noticed her friend. Anton looked towards a smiling Monica, and gave her a grin back. “You managed to get her to rejoin your cabinet?” Anton smiled even wider “It was a hard task, but I think you had a lot to do with it.” Ciara walked up to Monica and shook her hand, bowing slightly as she did it. She turned to Anton and shook his hand, though not with as much vigour as with Monica. “Mr. President.” “Ms. Walda. Welcome.”
When the rest of the guests noticed Ciara, Iosef flung up out of his seat, looking positively resentful. “What is she doing here? Didn’t you resign you-” Lucian quickly got out of his seat and put his hand on Iosef’s shoulder, or at least as far as he could get to the shoulder of the colossal man. Iosef turned his head sharply and scowled at Lucian, prompting him to remove his hand and gesture to Damien, who was behind the camera, making sure our conversation was out of range for the camera to pick up on. Iosef turned to Anton “Mr. President, with all due respect, did you really invite this woman back to your cabinet after her treacherous resignation?!” Anton had noticed the tension between Iosef and Ciara the few times they’d been in the same room together, and it was clear they were good at pressing each other’s buttons, intentionally or not. Iosef must’ve been glad when she resigned. For her to come back unannounced must’ve been seen as a big middle finger to not just Iosef, but Lucian as well, as Anton hadn’t discussed it with him either. But Lucian, unlike Iosef, knew how to act like a politician, and wouldn’t risk his career for a televised outburst.
“Iosef, with all due respect, I am your superior. We need people in our cabinet, and may I remind you that this event is currently being televised.” Anton stared at Iosef in a way he’d never done before. It was actually quite satisfying for Anton to be able to speak to Iosef like that, as he had real experience on how Iosef treated his subordinates from his time in the army. Iosef mumbled something before speaking up “Of course Mr. President. I am sorry.” Anton could actually see Iosef’s eye visibly twitch as he mouthed that last part. “Good, then we’ll be seated. Follow me everyone, right this way.” President Rayne led the dinner guests towards the table, where Deana and Gus’ son were seated first, followed by Ciara, Monica and Gus’ wife, the two latter of whom were seated by their husbands respectively. After which the rest of the cabinet, along with Anton took their seats.
The camera panned to look directly at Anton, who would deliver his post-inauguration speech to the nation. “Brothers and sisters, today has been a great day, not just for myself, not just for the USP, but for our nation. You have reaffirmed your support for me as your President, as a conduit for the will of the people. In doing so you have reaffirmed your trust in our nation, our collective passion to make the lives of others better. Because that is what a nation is. A nation is a band of people who share a home, and who are passionate enough to help each other and push each other forward to greater things. It is a sentiment to collectivism and what we can accomplish when we band together and fight for each other, with compassion and solidarity. That is what we are, we are brothers and sisters. No matter if you are a sord or blud, man or woman, eight or eighty. If you live in Sordland, your neighbours are your brothers and sisters, together you hold this nation on your backs through your trust and your belief that together we can make the world a better place. United we stand, divided we fall. A Morgna wes core, vectern sis da!”
The camera panned away from Anton’s face but continued filming the dining table. Everyone seated applauded Anton’s speech. He raised his wine glass, which had already been filled prior to everyone being seated. “I’d also like to raise a toast. To Bernard Circas. We sit here, on the four year anniversary of the tragic end of his great life. His words moved millions, and continue to move millions more after his death. He inspired love, compassion and hope. He dreamed of a better Sordland, one where we were free of exploitation and united in proletarian solidarity.” There were mixed reactions across the table, but mainly looks of disagreement. Anton continued nonetheless. “Bernard was killed for his beliefs. After a long investigation the main culprits are finally behind bars, but this does not solve the deeper issue. Fascism. The scourge that kept Bernard’s dream from being realised is what killed him, and he will have died in vain if we do not take that threat seriously, and do what we can to rid this country of the fascism that wants to tear it apart. It was only Bernard who would have the words to give us the hope we need, but while he is gone, his spirit remains, and it remains to give us the willpower we need to do what we can to make sure nothing like what happened four years ago ever happens again. To Bernard, our only strength is the will to survive.”
After Anton finished he took a sip of his bitter wine and sat the glass back down, followed by everyone else. Iosef mumbled something again, but as Anton briefly looked towards Damien, it looked like the speech, and following toast, had been a hit with him and the rest of the camera crew. “Well said Mr. President '' said Lucian, before taking another sip of his wine. A moment later, the chef, a tall and lanky young man, came out followed by servers bearing plates of food. “For the first course we have prepared…” The next few hours flew by as Anton was bored senseless by the conversations, or lack thereof, between the “strictly-work-talk” Vice President, traditionalist minister of defence, radical minister of education, and anrican capitalist minister of agriculture. After hours of dull conversation and several courses, all representing a different region of Sordland, the dinner was finally over and the broadcast finished off with a speech from the first lady. Anton felt bad, being too tired to properly listen to Monica’s speech, although it seemed to have a similar effect on the guests as Anton’s speech did. As the applause following her speech died down, the broadcast was shut off, and nearly everyone in the room let out a sigh of relief, including Anton and Monica.
Anton stood up, and was followed by the rest of the table. The presidential couple bid farewell to their guests as nearly everyone left. As Anton, Monica and Deana were getting ready to go change and head home, Anton was approached by Damien who wanted to have a few words before leaving.
“It was a wonderful broadcast Mr. President!” he said with a fake enthusiasm. Damien knew the basics of political intrigue, but had yet to grasp the subtle art of lying convincingly. Anton simply replied “Thank you, Mr. Ves, you did very well yourself managing the production.'' Unlike Damien, Anton bore no attempt to show his lack of interest in the conversation, as he slowly started making his way out of the dining room area of the palace. “Thank you Mr. President, you honour me!.” he nervously paused for few seconds before continuing “Mr. President, would you please consider having a meeting with me later this week.” “Whenever you have the time!” blurted out the nervous, and now slightly sweaty, man. “I’d be glad to have a meeting with you Damien. In fact I was planning on having one with you anyway, to discuss the goals and strategies of the commission going forward.” Anton again started walking a bit faster, trying to get out of the conversations with the hippo-like man. “How does tuesday 9:30 sound?” Damien struggled to keep up with the President, making him sweat even more profusely as he panted out a reply “Wonderful! Great! Thank you Mr.Presdi..Ray..” He stopped for a second to catch his breath “Thank you Mr. President!” he shouted down the hallway as the President hurried back into his office.
“Why do such social events seem to drain me more than dull meetings about infrastructure development?” joked Anton as he walked into his office to greet his wife. “It wasn’t that bad, I had quite the interesting conversation with Ciara and Erica.” Anton looked confused for a moment before Monica elaborated. “Gus’ wife. Erica Manger.” She sat down on the couch next to a half asleep Deana. “Ah! And what did she have to say?” inquired Anton, loosening his bowtie as he said it. “She was surprisingly supportive of our participation in politics, considering she’s from Anrica, like Gus.” Anton sat next to his wife, wrapping his arm around her before answering. “Well not everyone in Anrica is exactly Curtan Leste. You know he’s been losing a lot of support in the city ever since his stunt in Benfi, interrupting your speech like that.” Monica looked out the window to the view of capitol park. “Still, even with the waning influence of the old guard, both him and Gloria Tory have become increasingly popular with the conservatives now that Soll, Graff, Hawker and the like are all in prison. They are still a real threat, now with even more concentrated support.” Anton stood up and walked over to the window, now looking at dusk settling over the park as well. “I know.” he paused for a second. “We still have a lot of work ahead of us.”
The couple stood there for a few minutes in silence, enjoying a peaceful moment together while contemplating the future. After a while, however, they decided they best head home for the day. They went into the office bathroom to get changed again. After doing so, Anton took his sleeping daughter in his arms and the three of them exited the maroon palace. They had stayed there so long that all the journalists had gotten tired of waiting for them and gone home. The courtyard of the palace was all but empty, aside from a few guards, and of course, the Rayne family’s loyal driver. Serge opened the backseat door for the family to get in the car, where they were able to relax for the long drive home in the quiet of the night.
The new Valgslandian presidential car was slowly making its way towards the presidential residence built during the Alphonso presidency. It was a modern home, inspired by the works of some Arcasian architects. While Anton certainly disagreed with Alphonso about a lot, and despised Arcasia, he had to admit it was a pretty nice home. As he sat in the car he dreamt about getting home and being able to jump into bed after such a long day, and from the looks of it, Monica was thinking about the same thing.
They were driving past a newly built secondary school, Circas Secondary, that was built as part of Anton and Ciara’s education program during the first term. Anton’s mind drifted from the architecture of his own home to the architecture of this school, and was suddenly filled with pride, being able to see the material results of his work as president. He was admiring the building’s large gymnasium when suddenly the white walls of the pristine building turned a fiery orange hue, followed by a loud “BANG!”. Before they could comprehend what had happened the car had been flipped on its head and the glass from the windows shattered. Deana immediately woke up in panic and started crying. Anton was able to get to her quickly, and shield her and Monica. They sat there together in the wreck of the car for what felt like minutes, not being able to move out of pure shock, before they heard a series of coughs followed by the voice of their driver “Anton, Monica, Deana. Are you okay?!” Anton managed to muster a response despite his distress. “I think so Serge. How about you?”
As he felt a hand grab him by the collar of his coat, Serge replied “Don’t worry about me, we need to get out of here!” Before Anton could respond he felt his collar tighten around his neck as he was slowly dragged out of the car wreck along with his wife and daughter. When they were all out of the car Anton opened his eyes to find he was lying on the pavement, looking up at Serge who was examining the family for any serious injuries. He then heard the sound of sirens in the distance, and noticed the night looked very bright. He looked to his right and saw the cause of this brightness, the school was on fire. At least what was left of the school. There was rubble everywhere, it had been blown to pieces. He looked back up at Serge, with the starry night sky behind him. Hints of flashing red and blue lights began to appear as Anton’s eyes began to shut and the night became darker. The previously clear voice of his driver became muffled, as he heard cars approaching and the sound of doors being shut. Before passing out, he felt someone lift him up and put his body onto something soft, followed by the sound of doors being shut again.
To be continued.
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2023.06.04 14:34 Dirtclodkoolaid AMA RESOLUTION 235
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AMA RESOLUTION 235 November 2018 INAPPROPRIATE USE OF CDC Guidelines FOR PRESCRIBING OPIOIDS (Entire Document)
“Resolution 235 asks that our AMA applaud the CDC for its efforts to prevent the incidence of new cases of opioid misuse, addiction, and overdose deaths; and be it further, that no entity should use MME thresholds as anything more than guidance and that MME thresholds should not be used to completely prohibit the prescribing of, or the filling of prescriptions for, medications used in oncology care, palliative medicine care, and addiction medicine care: and be it further, that our AMA communicate with the nation’s largest pharmacy chains and pharmacy benefit managers to recommend that they cease and desist with writing threatening letters to physicians and cease and desist with presenting policies, procedures and directives to retail pharmacists that include a blanket proscription against filling prescriptions for opioids that exceed certain numerical thresholds without taking into account the diagnosis and previous response to treatment for a patient and any clinical nuances that would support such prescribing as falling within standards of good quality patient care; and be it further, that AMA Policy opposing the legislating of numerical limits on medication dosage, duration of therapy, numbers of pills/tablets, etc., be reaffirmed; and be it further, that physicians should not be subject to professional discipline or loss of board certification or loss of clinical privileges simply for prescribing opioids at a quantitative level that exceeds the MME thresholds found in the CDC Guidelines; and be it further, that our AMA encourage the Federation of State Medical Boards and its member boards, medical specialty societies, and other entities to develop improved guidance on management of pain and management of potential withdrawal syndromes and other aspects of patient care for “legacy patients” who may have been treated for extended periods of time with high-dose opioid therapy for chronic non-malignant pain.
RESOLVED, that our American Medical Association (AMA) applaud the Centers for Disease Control and Prevention (CDC) for its efforts to prevent the incidence of new cases of opioid misuse, addiction, and overdose deaths
RESOLVED, that our AMA actively continue to communicate and engage with the nation’s largest pharmacy chains, pharmacy benefit managers, National Association of Insurance Commissioners, Federation of State Medical Boards, and National Association of Boards of Pharmacy in opposition to communications being sent to physicians that include a blanket proscription against filing prescriptions for opioids that exceed numerical thresholds without taking into account the diagnosis and previous response to treatment for a patient and any clinical nuances that would support such prescribing as falling within standards of good quality patient care.
RESOLVED, that our AMA affirms that some patients with acute or chronic pain can benefit from taking opioid pain medications at doses greater than generally recommended in the CDC Guideline for Prescribing Opioids for Chronic Pain and that such care may be medically necessary and appropriate, and be it further
RESOLVED, that our AMA advocate against misapplication of the CDC Guideline for Prescribing Opioids by pharmacists, health insurers, pharmacy benefit managers, legislatures, and governmental and private regulatory bodies in ways that prevent or limit patients’ medical access to opioid analgesia, and be it further
RESOLVED, that our AMA advocate that no entity should use MME (morphine milligram equivalents) thresholds as anything more than guidance, and physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME thresholds found in the CDC Guideline for Prescribing Opioids.””
Pain Management Best Practices Inter-Agency Task Force - Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations Official Health and Human Services Department Released December 2018
“The Comprehensive Addiction and Recovery Act (CARA) of 2016 led to the creation of the Pain Management Best Practices Inter-Agency Task Force (Task Force), whose mission is to determine whether gaps in or inconsistencies between best practices for acute and chronic pain management exist and to propose updates and recommendations to those best practices. The Task Force consists of 29 experts who have significant experience across the disciplines of pain management, patient advocacy, substance use disorders, mental health, and minority health.”
In addition to identifying approximately 60 gaps in clinical best practices and the current treatment of pain in the United States, HHS PMTF provided recommendations for each of these major areas of concern. In alignment with their original charter, the PMTF will submit these recommendations to Congress to become our ‘National Pain Policy’. The 60+ gaps and inconsistencies with their recommendations will serve to fill gaps in pain treatment at both the state and federal level; and the overwhelming consensus was that the treatment of pain should be multimodal and completely individualized based on the individual patient. The heart of each recommendation in each section was a resounding call for individualization for each patient, in regards to both non-pharmacological and pharmacological modalities; including individualizations in both opioid and non-opioid pharmacological treatments.
While each of the gap+recommendation sections of what is poised to become our national pain policy is extremely important, one that stands out the most (in regards to opioid prescribing) is the Stigma section. Contained in this section is one of the core statements that shows our Health and Human Services agency - the one that should have always been looked to and followed - knew the true depth of the relationship (or lack of) between the overdose crisis and compassionate prescribing to patients with painful conditions:
“The national crisis of illicit drug use, with overdose deaths, is confused with appropriate therapy for patients who are being treated for pain. This confusion has created a stigma that contributes to raise barriers to proper access to care.”
The recommendation that follows - “Identify strategies to reduce stigma in opioid use so that it is never a barrier to patients receiving appropriate treatment, with all cautions and considerations for the management of their chronic pain conditions” - illustrates an acknowledgment by the top health agency of the federal government that the current national narrative conflating and confusing compassionate treatment of pain with illicit drug use, addiction, and overdose death is incorrect and only serving to harm patients.
Since March of 2016 when the CDC Guidelines were released, advocates, patients, clinicians, stakeholders, and others, have began pointing out limitations and unintended consequences as they emerged. In order to address the unintended consequences emerging from the CDC Guidelines, this task force was also charged with review of these guidelines; from expert selection, evidence selection, creation, and continuing to current misapplication in order to provide recommendations to begin to remedy these issues.
“A commentary by Busse et al. identified several limitations to the CDC guideline related to expert selection, evidence inclusion criteria, method of evidence quality grading, support of recommendations with low-quality evidence, and instances of vague recommendations. In addition, the CDC used the criterion of a lack of clinical trials with a duration of one year or longer as lack of evidence for the clinical effectiveness of opioids, whereas Tayeb et al. found that that was true for all common medication and behavioral therapy studies.
Interpretation of the guideline, in addition to some gaps in the guideline, have led to unintended consequences, some of which are the result of misapplication or misinterpretation of the CDC guideline.
However, at least 28 states have enacted legislation related to opioid prescription limits, and many states and organizations have implemented the guideline without recognizing that the intended audience was PCPs; have used legislation for what should be medical decision making by healthcare professionals; and have applied them to all physicians, dentists, NPs, and PAs, including pain specialists.441–444 Some stakeholders have interpreted the guideline as intended to broadly reduce the amount of opioids prescribed for treating pain; some experts have noted that the guideline emphasizes the risk of opioids while minimizing the benefit of this medication class when properly managed.”
“The CDC guideline was not intended to be model legislation for state legislators to enact”
“In essence, clinicians should be able to use their clinical judgment to determine opioid duration for their patients” https://www.hhs.gov/ash/advisory-committees/pain/reports/2018-12-draft-report-on-updates-gaps-inconsistencies-recommendations/index.html
HHS Review of 2016 CDC Guidelines for responsible opioid prescribing
The Pain Management Task Force addressed 8 areas that are in need of update or expansion with recommendations to begin remediation for each problem area:
Lack of high-quality data exists for duration of effectiveness of opioids for chronic pain; this has been interpreted as a lack of benefit Conduct studies Focus on patient variability and response for effectiveness of opioids; use real-world applicable trials
Absence of criteria for identifying patients for whom opioids make up significant part of their pain treatment Conduct clinical trials and/or reviews to identify sub-populations of patients where long-term opioid treatment is appropriate
Wide variation in factors that affect optimal dose of opioids Consider patient variables for opioid therapy: Respiratory compromise Patient metabolic variables Differences in opioid medications/plasma concentrations Preform comprehensive initial assessment it’s understanding of need for comprehensive reevaluations to adjust dose Give careful considerations to patients on opioid pain regimen with additional risk factors for OUD
Specific guidelines for opioid tapering and escalation need to be further clarified A thorough assessment of risk-benefit ratio should occur whenever tapering or escalation of dose This should include collaboration with patient whenever possible Develop taper or dose escalation guidelines for sub-populations that include consideration of their comorbidities When benefit outweighs the risk, consider maintaining therapy for stable patients on long term opioid therapy
Causes of worsening pain are not often recognized or considered. Non-tolerance related factors: surgery, flares, increased physical demands, or emotional distress Avoid increase in dose for stable patient (2+ month stable dose) until patient is re-evaluated for underlying cause of elevated pain or possible OUD risk Considerations to avoid dose escalation include: Opioid rotation Non-opioid medication Interventional strategies Cognitive behavior strategies Complementary and integrative health approaches Physical therapy
In patients with chronic pain AND anxiety or spasticity, benzodiazepine co-prescribed with opioids still have clinical value; although the risk of overdose is well established When clinically indicated, co-prescription should be managed by specialist who have knowledge, training, and experience with co-prescribing. When co-prescribed for anxiety or SUD collaboration with mental health should be considered Develop clinical practice guidelines focused on tapering for co-prescription of benzodiazepines and opioids
The risk-benefit balance varies for individual patients. Doses >90MME may be favorable for some where doses <90MME may be for other patients due to individual patient factors. Variability in effectiveness and safety between high and low doses of opioids are not clearly defined. Clinicians should use caution with higher doses in general Using carefully monitored trial with frequent monitoring with each dose adjustment and regular risk reassessment, physicians should individualize doses, using lowest effective opioid dose that balances benefit, risk, and adverse reactions Many factors influence benefits and risk, therefore, guidance of dose should not be applied as strict limits. Use established and measurable goals: Functionality ADL Quality of Life
Duration of pain following acute and severely painful event is widely variable Appropriate duration is best considered within guidelines, but is ultimately determined by treating clinician. CDC recommendation for duration should be emphasized as guidance only with individualized patient care as the goal Develop acute pain management guidelines for common surgical procedures and traumas To address variability and provide easy solution, consideration should be given to partial refill system
Human Rights Watch December 2018 (Excerpt from 109 page report)
“If harms to chronic pain patients are an unintended consequence of policies to reduce inappropriate prescribing, the government should seek to immediately minimize and measure the negative impacts of these policies. Any response should avoid further stigmatizing chronic pain patients, who are increasingly associated with — and sometimes blamed for — the overdose crisis and characterized as “drug seekers,” rather than people with serious health problems that require treatment.
Top government officials, including the President, have said the country should aim for drastic cutbacks in prescribing. State legislatures encourage restrictions on prescribing through new legislation or regulations. The Drug Enforcement Administration (DEA) has investigated medical practitioners accused of overprescribing or fraudulent practice. State health agencies and insurance companies routinely warn physicians who prescribe more opioids than their peers and encourage them to reduce prescribing. Private insurance companies have imposed additional requirements for covering opioids, some state Medicaid programs have mandated tapering to lower doses for patients, and pharmacy chains are actively trying to reduce the volumes of opioids they dispense.
The medical community at large recognized that certain key steps were necessary to tackle the overdose crisis: identifying and cracking down on “pill mills” and reducing the use of opioids for less severe pain, particularly for children and adolescents. However, the urgency to tackle the overdose crisis has put pressure on physicians in other potentially negative ways: our interviews with dozens of physicians found that the atmosphere around prescribing for chronic pain had become so fraught that physicians felt they must avoid opioid analgesics even in cases when it contradicted their view of what would provide the best care for their patients. In some cases, this desire to cut back on opioid prescribing translated to doctors tapering patients off their medications without patient consent, while in others it meant that physicians would no longer accept patients who had a history of needing high-dose opioids.
The consequences to patients, according to Human Rights Watch research, have been catastrophic.”
Opioid Prescribing Workgroup December 2018
This is material from the Board of Scientific Counselors in regards to their December 12, 2018 meeting that culminated the works of a project titled the “Opioid Prescribing Estimates Project.” This project is a descriptive study that is examining opioid prescribing patterns at a population level. Pain management is a very individualized process that belongs with the patient and provider. The Workgroup reviewed work done by CDC and provided additional recommendations.
SUMMARY There were several recurrent themes throughout the sessions.
Repeated concern was voiced from many Workgroup members that the CDC may not be able to prevent conclusions from this research (i.e. the benchmarks, developed from limited data) from being used by states or payors or clinical care systems to constrain clinical care or as pay-for- performance standards – i.e. interpreted as “guidelines”. This issue was raised by several members on each of the four calls, raising the possibility that providers or clinical systems could thus be incentivized against caring for patients requiring above average amounts of opioid medication.
Risk for misuse of the analysis. Several members expressed concerns that this analysis could be interpreted as guidance by regulators, health plans, or clinical care systems. Even though the CDC does not plan to issue this as a guideline, but instead as research, payors and clinical care systems searching for ways to reign in opioid prescribing may utilize CDC “benchmarks” to establish pay-for-performance or other means to limit opioid prescribing. Such uses of this work could have the unintended effect of incentivizing providers against caring for patients reliant upon opioids.
…It was also noted that, in order to obtain sufficient granularity to establish the need for, dosage, and duration of opioid therapy, it would be necessary to have much more extensive electronic medical record data. In addition, pain and functional outcomes are absent from the dataset, but were felt to be important when considering risk and benefit of opioids.
...Tapering: Concerns about benchmarks and the implications for tapering were voiced. If tapering occurs, guidance was felt to be needed regarding how, when, in whom tapering should occur. This issue was felt to be particularly challenging for patients on chronic opioids (i.e. “legacy” patients). In addition, the importance of measuring risk and benefit of tapering was noted. Not all high-dose patient populations benefit from tapering.
General comments. Workgroup members noted that most patients prescribed opioids do not experience adverse events, including use disorder. Many suggested that further discussion of opioids with patients prior to surgery was important, with an emphasis on expectations and duration of treatment. A member suggested that take-back programs would be more effective than prescribing restrictions.
Procedure-related care. Members noted that patient factors may drive opioid need more than characteristics of a procedure.
Patient-level factors. Members noted that opioid-experienced patients should be considered differently from opioid-inexperienced patients, due to tolerance.
It was noted that anything coming out of the CDC might be considered as guidelines and that this misinterpretation can be difficult to counter. There was extensive discussion of the 50 and 90 MME levels included in the CDC Guidelines. It was recommended that the CDC look into the adverse effects of opioid tapering and discontinuation, such as illicit opioid use, acute care utilization, dropping out of care, and suicide. It was also noted that there are major gaps in guidelines for legacy patients, patients with multiple diagnoses, pediatric and geriatric patients, and patients transitioning to lower doses.
There were concerns that insufficient clinical data will be available from the dataset to appropriately consider the individual-level factors that weigh into determination of opioid therapy. The data would also fail to account for the shared decision-making process involved in opioid prescribing for chronic pain conditions, which may be dependent on primary care providers as well as ancillary care providers (e.g. physical therapists, psychologists, etc).
Patient-level factors. Members repeatedly noted that opioid-experienced patients should be considered differently from opioid-experienced patients, due to tolerance.
Members noted that the current CDC guidelines have been used by states, insurance companies, and some clinical care systems in ways that were not intended by the CDC, resulting in cases of and the perception of patient abandonment. One option raised in this context was to exclude patients on high doses of opioids, as those individuals would be qualitatively different from others. A variant of this concern was about management of “legacy” patients who are inherited on high doses of opioids. Members voiced concerns that results of this work has caused harm to patients currently reliant upon opioids prescribed by their providers.
Acute Non-Surgical Pain
Patient-level factors. Members felt that opioid naïve versus experienced patients might again be considered separately, as opioid requirements among those experienced could vary widely.
...Guidelines were also noted to be often based on consensus, which may be incorrect.
Cancer-Related and Palliative Care Pain
It was noted that the CDC guidelines have been misinterpreted to create a limit to the dose of opioids that can be provided to people at all stages of cancer and its treatment. It was also noted that the cancer field is rapidly evolving, with immunotherapy, CAR-T, and other novel treatments that affect response rates and limit our ability to rely upon historical data in establishing opioid prescribing benchmarks.
Concern that data would not be able to identify all of the conditions responsible for pain in a patient with a history of cancer (e.g. people who survive cancer but with severe residual pain). Further, it was noted that certain complications of cancer and cancer treatment may require the least restrictive long-term therapy with opioids.
The definition of palliative care was also complicated and it was suggested that this include patients with life-limiting conditions.
Overall, it was felt that in patients who may not have long to live, and/or for whom returning to work is not a possibility, higher doses of opioids may be warranted. https://www.cdc.gov/injury/pdfs/bsc/NCIPC_BSC_OpioidPrescribingEstimatesWorkgroupReport_December-12_2018-508.pdf
CDC Scientists Anonymous ‘Spider Letter’ to CDC
Carmen S. Villar, MSW Chief of Staff Office of the Director MS D14 Centers for Disease Control and Prevention (CDC) 1600 Clifton Road Atlanta, Georgia 30329-4027
August 29, 2016
Dear Ms. Villar:
We are a group of scientists at CDC that are very concerned about the current state of ethics at our agency. It appears that our mission is being influenced and shaped by outside parties and rogue interests. It seems that our mission and Congressional intent for our agency is being circumvented by some of our leaders. What concerns us most, is that it is becoming the norm and not the rare exception. Some senior management officials at CDC are clearly aware and even condone these behaviors. Others see it and turn the other way. Some staff are intimidated and pressed to do things they know are not right. We have representatives from across the agency that witness this unacceptable behavior. It occurs at all levels and in all of our respective units. These questionable and unethical practices threaten to undermine our credibility and reputation as a trusted leader in public health. We would like to see high ethical standards and thoughtful, responsible management restored at CDC. We are asking that you do your part to help clean up this house!
It is puzzling to read about transgressions in national media outlets like USA Today, The Huffington Post and The Hill. It is equally puzzling that nothing has changed here at CDC as a result. It’s business as usual. The litany of issues detailed over the summer are of particular concern:
Recently, the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) has been implicated in a “cover up” of inaccurate screening data for the Wise Woman (WW) Program. There was a coordinated effort by that Center to “bury” the fact that screening numbers for the WW program were misrepresented in documents sent to Congress; screening numbers for 2014 and 2015 did not meet expectations despite a multimillion dollar investment; and definitions were changed and data “cooked” to make the results look better than they were. Data were clearly manipulated in irregular ways. An “internal review” that involved staff across CDC occurred and its findings were essentially suppressed so media and/or Congressional staff would not become aware of the problems. Now that both the media and Congresswoman DeLauro are aware of these issues, CDC staff have gone out of their way to delay FOIAs and obstruct any inquiry. Shouldn’t NCCDPHP come clean and stop playing games? Would the ethical thing be to answer the questions fully and honestly. The public should know the true results of what they paid for, shouldn’t they?
Another troubling issue at the NCCDPHP are the adventures of Drs. Barbara Bowman and Michael Pratt (also detailed in national media outlets). Both seemed to have irregular (if not questionable) relationships with CocaCola and ILSI representatives. Neither of these relationships were necessary (or appropriate) to uphold our mission. Neither organization added any value to the good work and science already underway at CDC. In fact, these ties have now called into question and undermined CDC’s work. A cloud has been cast over the ethical and excellent work of scientists due to this wanton behavior. Was cultivating these relationships worth dragging CDC through the mud? Did Drs. Bowman and Pratt have permission to pursue these relationships from their supervisor Dr. Ursula Bauer? Did they seek and receive approval of these outside activities? CDC has a process by which such things should be vetted and reported in an ethics review, tracking and approval system (EPATS). Furthermore, did they disclose these conflicts of interest on their yearly OGE 450 filing. Is there an approved HHS 520, HHS 521 or “Request for Official Duty Activities Involving an Outside Organization” approved by Dr. Bauer or her Deputy Director Ms. Dana Shelton? An August 28, 2016 item in The Hill details these issues and others related to Dr. Pratt.
It appears to us that something very strange is going on with Dr. Pratt. He is an active duty Commissioned Corps Officer in the USPHS, yet he was “assigned to” Emory University for a quite some time. How and under what authority was this done? Did Emory University pay his salary under the terms of an IPA? Did he seek and receive an outside activity approval through EPATS and work at Emory on Annual Leave? Formal supervisor endorsement and approval (from Dr. Bauer or Ms. Shelton) is required whether done as an official duty or outside activity.
If deemed official, did he file a “Request for Official Duty Activities Involving an Outside Organization” in EPATS? Apparently Dr. Pratt’s position at Emory University has ended and he has accepted another position at the University of California San Diego? Again, how is this possible while he is still an active duty USPHS Officer. Did he retire and leave government service? Is UCSD paying for his time via an IPA? Does he have an outside activity approval to do this? Will this be done during duty hours? It is rumored that Dr. Pratt will occupy this position while on Annual Leave? Really? Will Dr. Pratt be spending time in Atlanta when not on Annual Leave? Will he make an appearance at NCCDPHP (where he hasn’t been seen for months). Most staff do not enjoy such unique positions supported and approved by a Center Director (Dr. Bauer). Dr. Pratt has scored a sweet deal (not available to most other scientists at CDC). Concerns about these two positions and others were recently described in The Huffington Post and The Hill. His behavior and that of management surrounding this is very troubling.
Finally, most of the scientists at CDC operate with the utmost integrity and ethics. However, this “climate of disregard” puts many of us in difficult positions. We are often directed to do things we know are not right. For example, Congress has made it very clear that domestic funding for NCCDPHP (and other CIOs) should be used for domestic work and that the bulk of NCCDPHP funding should be allocated to program (not research). If this is the case, why then is NCCDPHP taking domestic staff resources away from domestic priorities to work on global health issues? Why in FY17 is NCCDPHP diverting money away from program priorities that directly benefit the public to support an expensive research FOA that may not yield anything that benefits the public? These actions do not serve the public well. Why is nothing being done to address these problems? Why has the CDC OD turned a blind eye to these things. The lack of respect for science and scientists that support CDC’s legacy is astonishing.
Please do the right thing. Please be an agent of change.
CDC Spider (CDC Scientists Preserving Integrity, Diligence and Ethics in Research) https://usrtk.org/wp-content/uploads/2016/10/CDC_SPIDER_Letter-1.pdf
January 13, 2016
Thomas Frieden, MD, MPH Director Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30329-4027
Re: Docket No. CDC-2015-0112; Proposed 2016 Guideline for Prescribing Opioids for Chronic Pain
Dear Dr. Frieden:
There is no question that there is an opioid misuse epidemic and that efforts need to be made to control it. The Centers for Disease Control and Prevention (CDC) is applauded for its steps to undertake this lofty effort. However, based on the American Academy of Family Physicians’ (AAFP’s) review of the guideline, it is apparent that the presented recommendations are not graded at a level consistent with currently available evidence. The AAFP certainly wants to promote safe and appropriate prescribing of opioids; however, we recommend that the CDC still adhere to the rigorous standards for reliable and trustworthy guidelines set forth by the Institute of Medicine (IOM). The AAFP believes that giving a strong recommendation derived from generalizations based on consensus expert opinion does not adhere to evidence-based standards for developing clinical guideline recommendations.
The AAFP’s specific concerns with the CDC’s methodology, evidence base, and recommendations are outlined below.
Methodology and Evidence Base
All of the recommendations are based on low or very low quality evidence, yet all but one are Category A (or strong) recommendations. The guideline states that in the GRADE methodology "a particular quality of evidence does not necessarily imply a particular strength of recommendation." While this is true, it applies when benefits significantly outweigh harms (or vice versa). When there is insufficient evidence to determine the benefits and harms of a recommendation, that determination should not be made.
When evaluating the benefits of opioids, the evidence review only included studies with outcomes of at least one year. However, studies with shorter intervals were allowed for analysis of the benefits of nonopioid treatments. The guideline states that no evidence shows long-term benefit of opioid use (because there are few studies), yet the guideline reports "extensive evidence" of potential harms, even though these studies were of low quality. The accompanying text also states "extensive evidence" of the benefits of non-opioid treatments, yet this evidence was from shorter term studies, was part of the contextual review rather than the clinical systematic review, and did not compare non- opioid treatments to opioids.
The patient voice and preferences were not explicitly included in the guideline. This raises concerns about the patient-centeredness of the guideline. https://www.aafp.org/dam/AAFP/documents/advocacy/prevention/risk/LT-CDC-OpioidGuideline011516.pdf
The Myth of Morphine Equivalent Daily Dosage Medscape Neuro Perspective
For far too many years, pain researchers and clinicians have relied on the concept of the morphine equivalent daily dosage (MEDD), or some variant of it, as a means of comparing the "relative corresponding quantity" of the numerous opioid molecules that are important tools in the treatment of chronic pain.
...And, most unfortunately, opioid prescribing guideline committees have relied on this concept as a means of placing (usually arbitrary) limits on the levels of opioids that a physician or other clinician should be allowed to prescribe. Although these guidelines typically bill themselves as "voluntary," their chilling effect on prescribers and adaptation into state laws makes calling them "voluntary" disingenuous.
Although some scientists and clinicians have been questioning the conceptual validity of MEDD for several years, a recent study has indicated that the concept is unequivocally flawed—thereby invalidating its use empirically and as a tool in prescribing guideline development.
The authors used survey data from pharmacists, physicians, nurse practitioners, and physician assistants to estimate daily morphine equivalents and found great inconsistency in their conversions of hydrocodone, fentanyl transdermal patches, methadone, oxycodone, and hydromorphone—illustrating the potential for dramatic underdosing or, in other cases, fatal overdosing.
Patients with chronic pain (particularly that of noncancer origin) who are reliant on opioid analgesia are already sufficiently stigmatized and marginalized to allow this type of practice to continue to be the norm.
Although the use of MEDD in research and, to a greater extent, in practice, is probably due to unawareness of its inaccuracy, we posit that the use of MEDD by recent opioid guideline committees (eg, the Washington State Opioid Guideline Committee and the Centers for Disease Control and Prevention Guideline Committee) in the drafting of their guidelines is based more heavily on disregarding available evidence rather than ignorance. Furthermore, their misconduct in doing so has been more pernicious than the use of MEDD by researchers and individual clinicians, because these guidelines widely affect society as a whole as well as individual patients with persistent pain syndromes. We opine that these committees are strongly dominated by the antiopioid community, whose agenda is to essentially restrict opioid access—irrespective of the lack of data indicating that opioids cannot be a useful tool in the comprehensive treatment of carefully selected and closely monitored patients with chronic pain.
Above 100% extracted from: Medscape Journal Brief https://www.medscape.com/viewarticle/863477_2
Actual Study https://www.dovepress.com/the-medd-myth-the-impact-of-pseudoscience-on-pain-research-and-prescri-peer-reviewed-article-JPR
Are Non-Opioid Medications Superior in Treatment of Pain than Opioid Pain Medicine? Ice Cream Flavor Analogy...
In the Oxford University Press, a November 2018 scientific white paper was released that examined the quality of one of the primary studies that have been used to justify the urgent call to drastically reduce opioid pain medication prescribing while claiming that patients are not being harmed in the process.
The study is commonly referred to as ‘the Krebs study’. “The authors concluded that treatment with opioids was not superior to treatment with non opioid medications for improving pain-related function over 12 months.”
Here is an excerpt from the first paragraph of the design section (usually behind a paywall) from the Krebs study that gives the first hint of the bias that led to them to ‘prove’ that opioids were not effective for chronic pain:
“The study was intended to assess long-term outcomes of opioids compared with non opioid medications for chronic pain. The patient selection, though, specifically excluded patients on long-term opioid therapy.”
Here is an analogy given in the Oxford Journal white paper to illustrate how the study design was compromised:
If I want to do a randomized control study about ice cream flavor preferences (choices being: vanilla, chocolate, or no preference), the results could be manipulated as follows based on these scenarios:
Scenario A: If a study was done that included only current ice-cream consumers, the outcome would certainly be vanilla or chocolate, because of course they have tried it and know which they like.
Scenario B: If a study was done that included all consumers of all food, then it can change the outcome. If the majority of study participants do not even eat ice-cream, than the result would certainly be ‘no preference’. If the majority do eat ice-cream it would likely be ‘chocolate’. Although this study is wider based, it still does not reflect real world findings.
Scenario C: In an even more extreme example, if this same study is conducted excluding anyone who has ever ate ice-cream at all, then the conclusion will again be ‘no preference’ and the entire study/original question becomes so ludicrous that there is no useful information to be extracted from this study and one would logically question why this type of study would even be conducted (although we know the answer to that)
Scenario C above is how the study that has been used to shift the attitudes towards the treatment of pain in our nation's medical community was designed. “One has to look deep into the study to find that they began with 9403 possible patients and excluded 3836 of them just because they had opioids in their EMR. In the JAMA article, they do not state these obvious biases and instead begin the explanation of participants stating they started with 4485 patients and excluded 224 who were opioid or benzo users.” That is the tip of the iceberg to how it is extremely misleading. The Oxford white paper goes into further detail of the studies “many flaws and biases (including the narrow focus on conditions that are historically known to respond poorly to opioid medication management of pain)”, but the study design and participant selection criteria is enough to discredit this entire body of work. Based on study design alone, regardless of what happened next, the result would be that opioids are no more effective than NSAIDs and other non-opioid alternatives.
The DEA Is Fostering a Bounty Hunter Culture in its Drug Diversion Investigators
A Good Man Speaks Truth to Power January 2019
Because I write and speak widely on public health issues and the so-called “opioid crisis”, people frequently send me references to others’ work. One of the more startling articles I’ve seen lately was published November 20, 2018 in Pharmacy Times. It is titled “Should We Believe Patients With Pain?”. The unlikely author is Commander John Burke, “a 40-year veteran of law enforcement, the past president of the National Association of Drug Diversion Investigators, and the president and cofounder of the International Health Facility Diversion Association.”
The last paragraph of Commander Burke’s article is worth repeating here.
“Let’s get back to dealing with each person claiming to be in legitimate pain and believe them until we have solid evidence that they are scamming the system. If they are, then let’s pursue them through vigorous prosecution, but let’s not punish the majority of people receiving opioids who are legitimate patients with pain.”
This seems a remarkable insight from anyone in law enforcement — especially from one who has expressed this view in both Pain News Network, and Dr Lynn Webster’s video “The Painful Truth”. Recognizing Commander Burke’s unique perspective, I followed up by phone to ask several related questions. He has granted permission to publish my paraphrases of his answers here.
“Are there any available source documents which establish widely accepted standards for what comprises “over-prescription?” as viewed by diversion investigators?” Burke’s answer was a resounding “NO”. Each State and Federal Agency that investigates doctors for potentially illegal or inappropriate opioid prescribing is pretty much making up their own standards as they go. Some make reference to the 2016 CDC Guidelines, but others do not.
- “Thousands of individual doctors have left pain management practice in recent years due to fears they may be investigated, sanctioned, and lose their licenses if they continue to treat patients with opioid pain relievers.. Are DEA and State authorities really pursuing the worst “bad actors”, or is something else going on?
Burke’s answer: “Regulatory policy varies greatly between jurisdictions. But a hidden factor may be contributing significantly to the aggressiveness of Federal investigators. Federal Agencies may grant financial bonuses to their in-house diversion investigators, based on the volume of fines collected from doctors, nurse practitioners, PAs and others whom they investigate.
"No law enforcement agency at any level should be rewarded with monetary gain and/or promotion due to their work efforts or successes. This practice has always worried me with Federal investigators and is unheard of at the local or state levels of enforcement.”
Commander Burke’s revelation hit me like a thunder-clap. It would explain many of the complaints I have heard from doctors who have been “investigated” or prosecuted. It’s a well known principle that when we subsidize a behavior, we get more of it. Financial rewards to investigators must inevitably foster a “bounty hunter” mentality in some. It seems at least plausible that such bonuses might lead DEA regulators to focus on “low hanging fruit” among doctors who may not be able to defend themselves without being ruined financially. The practice is at the very least unethical. Arguably it can be corrupting.
I also inquired concerning a third issue:
- I read complaints from doctors that they have been pursued on trumped-up grounds, coerced and denied appropriate legal defense by confiscation of their assets – which are then added to Agency funds for further actions against other doctors. Investigations are also commonly announced prominently, even before indictments are obtained – a step that seems calculated to destroy the doctor’s practice, regardless of legal outcomes. Some reports indicate that DEA or State authorities have threatened employees with prosecution if they do not confirm improper practices by the doctor. Do you believe such practices are common?”
Burke’s answer: “I hear the same reports you do – and the irony is that such tactics are unnecessary. Lacking an accepted standard for over-prescribing, the gross volume of a doctor’s prescriptions or the dose levels prescribed to their patients can be poor indicators of professional misbehavior. Investigators should instead be looking into the totality of the case, which can include patient reports of poor doctor oversight, overdose-related hospital admissions, and patterns of overdose related deaths that may be linked to a “cocktail” of illicit prescribing. Especially important can be information gleaned from confidential informants – with independent verification – prior patients, and pharmacy information.”
No formal legal prosecution should ever proceed from the testimony of only one witness — even one as well informed as Commander John Burke. But it seems to me that it is high time for the US Senate Judiciary Committee to invite the testimony of others in open public hearings, concerning the practice of possible bounty hunting among Federal investigators.
C50 Patient, Civil Rights Attorney, Maine Department of Health, and Maine Legislature Collaborative Enacted Definition of Palliative Care
One suggestion that our organization would like to make is altering the definition of “palliative care” in such a manner that it can include high-impact or intractable patients; those who are not dying this year, but our lives have been shattered and/or shortened by our diseases and for whom Quality of Life should be the focus. Many of our conditions may not SIGNIFICANTLY shorten my life, therefore I could legitimately be facing 30-40 years of severe pain with little relief; that is no way to live and therefore the concern is a rapidly increasing suicide rate.
This is a definition that one of our coalition members with a civil rights attorney and the Maine Department of Health agreed upon and legislators enacted into statues in Maine. This was in response to a 100mme restriction. This attorney had prepared a lawsuit based on the Americans with Disability Act that the Department of Health in Maine agreed was valid; litigation was never the goal, it was always patient-centered care.
A. "Palliative care" means patient-centered and family-focused medical care that optimizes quality of life by anticipating, preventing and treating suffering caused by a medical illness or a physical injury or condition that substantially affects a patient's quality of life, including, but not limited to, addressing physical, emotional, social and spiritual needs; facilitating patient autonomy and choice of care; providing access to information; discussing the patient's goals for treatment and treatment options, including, when appropriate, hospice care; and managing pain and symptoms comprehensively. Palliative care does not always include a requirement for hospice care or attention to spiritual needs. B. "Serious illness" means a medical illness or physical injury or condition that substantially affects quality of life for more than a short period of time. "Serious illness" includes, but is not limited to, Alzheimer's disease and related dementias, lung disease, cancer, heart, renal or liver failure and chronic, unremitting or intractable pain such as neuropathic pain.
Here is the link to the most recent update, including these definitions within the entire statute: https://legislature.maine.gov/statutes/22/title22sec1726.html?fbclid=IwAR0dhlwEh56VgZI9HYczdjdyYoJGpMdA9TuuJLlQrO3AsSljIZZG0RICFZc
January 23, 2019
The Board of Pharmacy has had an influx of communication concerning patients not able to get controlled substance prescriptions filled for various reasons, even when signs of forgery or fraudulence were not presented. As a result of the increased “refusals to fill,” the board is issuing the following guidance and reminders regarding the practice of pharmacy and dispensing of controlled substances:
- Pharmacists must use reasonable knowledge, skill, and professional judgment when evaluating whether to fill a prescription. Extreme caution should be used when deciding not to fill a prescription. A patient who suddenly discontinues a chronic medication may experience negative health consequences;
- Part of being a licensed healthcare professional is that you put the patient first. This means that if a pharmacist has any concern regarding a prescription, they should attempt to have a professional conversation with the practitioner to resolve those concerns and not simply refuse the prescription. Being a healthcare professional also means that you use your medication expertise during that dialogue in offering advice on potential alternatives, changes in the prescription strength, directions etc. Simply refusing to fill a prescription without trying to resolve the concern may call into question the knowledge, skill or judgment of the pharmacist and may be deemed unprofessional conduct;
- Controlled substance prescriptions are not a “bartering” mechanism. In other words, a pharmacist should not tell a patient that they have refused to fill a prescription and then explain that if they go to a pain specialist to get the same prescription then they will reconsider filling it. Again, this may call into question the knowledge, skill or judgment of the pharmacist;
- Yes, there is an opioid crisis. However, this should in no way alter our professional approach to treatment of patients in end-of-life or palliative care situations. Again, the fundamentals of using our professional judgment, skill and knowledge of treatments plays an integral role in who we are as professionals. Refusing to fill prescriptions for these patients without a solid medical reason may call into question whether the pharmacist is informed of current professional practice in the treatment of these medical cases.
- If a prescription is refused, there should be sound professional reasons for doing so. Each patient is a unique medical case and should be treated independently as such. Making blanket decisions regarding dispensing of controlled substances may call into question the motivation of the pharmacist and how they are using their knowledge, skill or judgment to best serve the public.
As a professional reminder, failing to practice pharmacy using reasonable knowledge, skill, competence, and safety for the public may result in disciplinary actions under Alaska statute and regulation. These laws are:
AS 08.80.261 DISCIPLINARY ACTIONS
(a)The board may deny a license to an applicant or, after a hearing, impose a disciplinary sanction authorized under AS 08.01.075 on a person licensed under this chapter when the board finds that the applicant or licensee, as applicable, …
(7) is incapable of engaging in the practice of pharmacy with reasonable skill, competence, and safety for the public because of
(A) professional incompetence; (B) failure to keep informed of or use current professional theories or practices; or (E) other factors determined by the board;
(14) engaged in unprofessional conduct, as defined in regulations of the board.
12 AAC 52.920 DISCIPLINARY GUIDELINES
(a) In addition to acts specified in AS 08.80 or elsewhere in this chapter, each of the following constitutes engaging in unprofessional conduct and is a basis for the imposition of disciplinary sanctions under AS 08.01.075; …
(15) failing to use reasonable knowledge, skills, or judgment in the practice of pharmacy;
(b) The board will, in its discretion, revoke a license if the licensee …
(4) intentionally or negligently engages in conduct that results in a significant risk to the health or safety of a patient or injury to a patient; (5) is professionally incompetent if the incompetence results in a significant risk of injury to a patient.
(c) The board will, in its discretion, suspend a license for up to two years followed by probation of not less than two years if the licensee ...
(2) is professionally incompetent if the incompetence results in the public health, safety, or welfare being placed at risk.
We all acknowledge that Alaska is in the midst of an opioid crisis. While there are published guidelines and literature to assist all healthcare professionals in up to date approaches and recommendations for medical treatments per diagnosis, do not confuse guidelines with law; they are not the same thing.
Pharmacists have an obligation and responsibility under Title 21 Code of Federal Regulations 1306.04(a), and a pharmacist may use professional judgment to refuse filling a prescription. However, how an individual pharmacist approaches that particular situation is unique and can be complex. The Board of Pharmacy does not recommend refusing prescriptions without first trying to resolve your concerns with the prescribing practitioner as the primary member of the healthcare team. Patients may also serve as a basic source of information to understand some aspects of their treatment; do not rule them out in your dialogue.
If in doubt, we always recommend partnering with the prescribing practitioner. We are all licensed healthcare professionals and have a duty to use our knowledge, skill, and judgment to improve patient outcomes and keep them safe.
Professionally, Richard Holt, BS Pharm, PharmD, MBA Chair, Alaska Board of Pharmacy
FDA in Brief: FDA finalizes new policy to encourage widespread innovation and development of new buprenorphine treatments for opioid use disorder
February 6, 2018
Media Inquiries Michael Felberbaum 240-402-9548
“The opioid crisis has had a tragic impact on individuals, families, and communities throughout the country. We’re in urgent need of new and better treatment options for opioid use disorder. The guidance we’re finalizing today is one of the many steps we’re taking to help advance the development of new treatments for opioid use disorder, and promote novel formulations or delivery mechanisms of existing drugs to better tailor available medicines to individuals’ needs,” said FDA Commissioner Scott Gottlieb, M.D. “Our goal is to advance the development of new and better ways of treating opioid use disorder to help more Americans access successful treatments. Unfortunately, far too few people who are addicted to opioids are offered an adequate chance for treatment that uses medications. In part, this is because private insurance coverage for treatment with medications is often inadequate. Even among those who can access some sort of treatment, it’s often prohibitively difficult to access FDA-approved addiction medications. While states are adopting better coverage owing to new legislation and resources, among public insurance plans there are still a number of states that are not covering all three FDA-approved addiction medications. To support more widespread adoption of medication-assisted treatment, the FDA will also continue to take steps to address the unfortunate stigma that’s sometimes associated with use of these products. It’s part of the FDA’s public health mandate to promote appropriate use of therapies.
Misunderstanding around these products, even among some in the medical and addiction fields, enables stigma to attach to their use. These views can serve to keep patients who are seeking treatment from reaching their goal. That stigma reflects a perspective some have that a patient is still suffering from addiction even when they’re in full recovery, just because they require medication to treat their illness. This owes to a key misunderstanding of the difference between a physical dependence and an addiction. Because of the biology of the human body, everyone who uses a meaningful dose of opioids for a modest length of time develops a physical dependence. This means that there are withdrawal symptoms after the use stops.
A physical dependence to an opioid drug is very different than being addicted to such a medication. Addiction requires the continued use of opioids despite harmful consequences on someone’s life. Addiction involves a psychological preoccupation to obtain and use opioids above and beyond a physical dependence.
But someone who is physically dependent on opioids as a result of the treatment of pain but who is not craving the drugs is not addicted.
The same principle applies to replacement therapy used to treat opioid addiction. Someone who requires long-term treatment for opioid addiction with medications, including those that are partial or complete opioid agonists and can create a physical dependence, isn’t addicted to those medications. With the right treatments coupled to psychosocial support, recovery from opioid addiction is possible. The FDA remains committed to using all of our tools and authorities to help those currently addicted to opioids, while taking steps to prevent new cases of addiction.”
Above is the full statement, find full statement with options for study requests: https://www.fda.gov/NewsEvents/Newsroom/FDAInBrief/ucm630847.htm
Maryland’s co-prescribing new laws/ amendments regarding benzos and opioids
Chapter 215 AN ACT concerning Health Care Providers – Opioid and Benzodiazepine Prescriptions – Discussion of Information Benefits and Risks
FOR the purpose of requiring that certain patients be advised of the benefits and risks associated with the prescription of certain opioids, and benzodiazepines under certain circumstances, providing that a violation of this Act is grounds for disciplinary action by a certain health occupations board; and generally relating to advice regarding benefits and risks associated with opioids and benzodiazepines that are controlled dangerous substances.
Section 1–223 Article – Health Occupations Section 4–315(a)(35), 8–316(a)(36), 14–404(a)(43), and 16–311(a)(8) SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, That the Laws of Maryland read as follows: Article – Health Occupations (a) In this section, “controlled dangerous substance” has the meaning stated in § 5–101 of the Criminal Law Article.
Ch. 215 2018 LAWS OF MARYLAND (B) On treatment for pain, a health care provider, based on the clinical judgment of the health care provider, shall prescribe: (1) The lowest effective dose of an opioid; and (2)A quantity that is no greater than the quantity needed for the expected duration of pain severe enough to require an opioid that is a controlled dangerous substance unless the opioid is prescribed to treat: (a.) A substance–related disorder; (b.) Pain associated with a cancer diagnosis; (c.) Pain experienced while the patient is receiving end–of–life, hospice, or palliative care services; or (d.) Chronic pain
(C.) The dosage, quantity, and duration of an opioid prescribed under [subsection (b)] of this [section] shall be based on an evidence–based clinical guideline for prescribing controlled dangerous substances that is appropriate for: (1.) The health care service delivery setting for the patient; (2.) The type of health care services required by the patient; (3.) and The age and health status of the patient.
(D) (1) WHEN A PATIENT IS PRESCRIBED AN OPIOID UNDER SUBSECTION (B) OF THIS SECTION, THE PATIENT SHALL BE ADVISED OF THE BENEFITS AND RISKS ASSOCIATED WITH THE OPIOID.
(2) WHEN A PATIENT IS CO–PRESCRIBED A BENZODIAZEPINE WITH AN OPIOID THAT IS PRESCRIBED UNDER SUBSECTION (B) OF THIS SECTION, THE PATIENT SHALL BE ADVISED OF THE BENEFITS AND RISKS ASSOCIATED WITH THE BENZODIAZEPINE AND THE CO–PRESCRIPTION OF THE BENZODIAZEPINE. (E) A violation of [subsection (b) OR (D) of] this section is grounds for disciplinary action by the health occupations board that regulates the health care provider who commits the violation.
4-315 (a) Subject to the hearing provisions of § 4–318 of this subtitle, the Board may deny a general license to practice dentistry, a limited license to practice dentistry, or a teacher’s license to practice dentistry to any applicant, reprimand any licensed dentist, place any licensed dentist on probation, or suspend or revoke the license of any licensed dentist, if the applicant or licensee: (35) Fails to comply with § 1–223 of this article.
8–316. (a) Subject to the hearing provisions of § 8–317 of this subtitle, the Board may deny a license or grant a license, including a license subject to a reprimand, probation, or suspension, to any applicant, reprimand any licensee, place any licensee on probation, or suspend or revoke the license of a licensee if the applicant or licensee: (36) Fails to comply with § 1–223 of this article.
14–404. (a) Subject to the hearing provisions of § 14–405 of this subtitle, a disciplinary panel, on the affirmative vote of a majority of the quorum of the disciplinary panel, may reprimand any licensee, place any licensee on probation, or suspend or revoke a license if the licensee: (43) Fails to comply with § 1–223 of this article.
16–311. (a) Subject to the hearing provisions of § 16–313 of this subtitle, the Board, on the affirmative vote of a majority of its members then serving, may deny a license or a limited license to any applicant, reprimand any licensee or holder of a limited license, impose an administrative monetary penalty not exceeding $50,000 on any licensee or holder of a limited license, place any licensee or holder of a limited license on probation, or suspend or revoke a license or a limited license if the applicant, licensee, or holder:
(8) Prescribes or distributes a controlled dangerous substance to any other person in violation of the law, including in violation of § 1–223 of this article;
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect October 1, 2018.
Approved by the Governor, April 24, 2018.
2023.06.04 14:10 mdsmeudeus 3rd June London, Gold Circle A: My RWT Experience
These kind of detailed posts were very useful to me before my concert so I thought I'd make one as well!
Warning: very long lmao Queue
I went solo and had a general admission Gold Circle ticket (A), which means my gate would open at 5PM. I got to the queue around 3:30PM, and there were a lot of people in front of me already, but I wasn't too worried. Since the space for the queue was still quite empty behind me, I was able to sit for a while until more people started to come and the organizers were asking people to clump together so everyone could fit on the space they designed for the queue. At that point, sitting wasn't really an option anymore (that was around 3:40ish) so the rest of the queue time was standing. I'm not sure what happened, but we only got in at 5:30 instead of 5. The queue started to move and at first they scan your QR Code, then you pass through a security gate, and then you scan your QR Code again to get into the stadium. They didn't make a security search at all, which I found kinda weird given the scale of the event (you'd think security would be tighter). Waiting in the venue
Got in, found my entrance and realized how good of a spot I was in! I'm 183cm tall so I could clearly see the stage and the screens (which I'd say are quite important) and could somewhat see the central platform as well. I was also relatively close to the circle she walks around with the dancers (although she only does that once T-T) so it was amazing to see her that close to me! I wanna say tho, the stage is very tall and for a considerable time she is far back on it, so even if you get barrieclose to barrier she will be quite far imo (unless you get CR barrier and she goes to the middle of circle, then I imagine shes much closer!!). While waiting for the concert to start, I started to worry about needing to go to the restroom and getting hungry, at first I thought I would be fine without both but yea, I was wrong. The crowd started to get bigger so I just asked the people in front of me if it was fine for them to hold my spot for a little while and they were super sweet about it. Did my business, got some fries and water and headed back to the floor. Now, if you can, please don't sit while waiting on the floor.
It makes moving and standing around you so much harder than it has to be!! You occupy double or even triple the amount of space, and make everyone around you having to be twice as aware of their steps otherwise they could be stepping on your hands, hair, clothes etc. Everyone is tired af from waiting, so let's just work together and make it less painful for everybody!! If you feel like you really need to sit, I'd recommend bringing one of those foldable stools: they make it easier for people to stand and move around you, and there's no danger of people stumbling since you'll still have some height and won't occupy as much floor space. I saw quite a few people having them and I think it's a good way to do it! Additionally, bringing a fan was a LIFE SAVER!!!! Mine is now a must to any gig I go to. I'm someone who gets hot really easily, so the fan made my night soooo much better. (It doesn't need to be the Renaissance or Heated fans, get yourself any fan you can, they all work just fine. I got mine from amazon, it was 6 pounds and works wonders. It's also not huge, so I didn't need to raise my arm and fan myself from the top bc of the lack of horizontal space -- which is what people with big fans had to do --, I could just fan myself normally!!)
By the way, if you're someone who can't handle much pain, 100% go with comfy shoes. You'll stand for a long time AND (hopefully...)
dance for your life, so it's much more intense than a regular clubbing night. A girl besides me came in with boots and changed to tennis shoes, so that's an alternative as well! This was my view of her btw! Concert
I won't talk much about the Bey herself, she's more than amazing and we all know that. The whole show is beautiful, including the interludes which are jaw-dropping (which is why i think having a good view of the screens is important, those visuals are EVERYTHING). I wish I could go again and again and again and again. Now, the rumors are true, your ears might suffer!!! I felt the beat move my chest just from the vibration but that felt good, the issue is rlly the ears. Of course in a concert is normal for the sound to be very loud, as the artist and music has to be heard by everybody despite the crowd noise. But the bass/beat was like punching my ears, that's how I can describe it at least. Luckily, I had read some people complaining exactly about this on this subreddit, so i was kinda ready. Instead of buying earplugs (I don't rlly have money for that...) I used some tissue paper and I swear it worked wonders. You just need to cover your eardrums and the punching stops. Also, the crowd noise is much more muffled but I still heard the songs and Bey's voice loud and clear (at least most of the time lol)! The performance itself is AMAZING. She's a professional and knows what she's doing at ALL TIMES. It was so good but so good that I wish the venue would prohibit cellphone use so everyone could enjoy it 110% instead of filming it and diluting the very moment they're experiencing + blocking the view of other people (especially shorter ppl!!!) That being said, the crowd was... ok? Even in the most hype/high-energy moments (formation, savage, heated, ahap, etc) it felt quite lacking. I'm a frequent solo concert goer, and up to the RWT I'm mostly reliant on the crowd's energy to really enjoy a performance. Almost all concerts I've been to had crowds that weren't as energetic as I was, and, as a very shy person myself, I felt very limited by that. However, I payed some good money to be there this time, and that was Beyonce herself on front of me so I finally set myself free from that and danced and screamed and vibed regardless of the ppl around me. Couldn't even tell you if they were bothered cuz I was so focused and loose that I think I wouldn't have noticed anyway tbf. From around the last half/third of the show, I noticed a girl behind me was dancing and screaming just like me so at least we vibed together the rest of the concert. It was great! The dancers and band are insanely good!! Such skillful people and delivered everything one could ask for. Sometimes they would block the only angle I had of Bey and i wasn't even mad cuz each person on that stage is pouring their soul out through their artistry. Beautiful. Alsooo, Blue was there again and she was so great! She gets better every night and it's so cute to see Bey's reaction to her own daughter owning her movements in front of such huge crowds <33 Leaving
Leaving for me was as straight-forward as getting to the venue. I walked for both instances as I live relatively close to the Tottenham Stadium. Tbf coming back home was much harder cuz my feet were on fire but I was so numbed by the quality of what I had just witnessed that I didn't even mind lmao. However I did see that for people who needed trains it was REALLY packed!! Maybe it can be easier to walk a little further away and catch a bus, as I saw some people doing that as well (google maps is quite reliable, and it gives you many alternative routes for what you need. I'd def recommend it if you need it). Final notes -
Perfomance 10/10 - Experience 7.8/10 - My fav moment is the whole Plastic Off the Sofa / Virgos Groove / Move / Heated act. Although the AHAP + Pure/Honey moment is a close second (that fit is SO GOOD). - A little sad that Thique and AUIYM didn't make the cut, and that heated, move and POTS were cut in half. I get it tho. - Stage and fashion are beautiful, it leaves you mesmerized! - I NEED A LIVE ALBUM ASAP. I wanna relive this experience and the way she bends these songs live is even fresher than the studio album itself. NEED IT. - I'll say it again: If i could i would go again and again and again. Get different seats/areas, and just experience this fantastic performance in every way there possibly is.
submitted by mdsmeudeus
to beyonce [link] [comments]
2023.06.04 13:45 Marcel_7000 Newbie Question: Why do you think many bands have "ugly" album covers, do they follow a Methodist inspired philosophy were "Visuals" don't matter? (Yuck, Aerosmith, Mercury Rev, Descendents)
I'm not saying everybody does this. Again, usually heavy metal album covers are quite elaborate. What I'm saying is that it seems some bands just don't care about visuals. For instance, the cover of Yuck's debut album is a what looks like a poorly drawn monster.
The concept of "Craftsmanship" comes to mind. It's not that the choice of visual is wrong or ugly. It's that no effort is put in developing the concept and make it better or nicer. Yuck could have hired a local artist to draw a much nicer "monster" cover or better yet done a slightly different concept that might have been more representative of the band.
To me it seems like bands like Yuck don't care about visuals nor do they care about developing their concepts fully. I've seen this with the Descendants as well is that the second album, "I don't want to grow up" they could have easily hired a local artist to draw a nicer cover of Milo. Where "craftsmanship" is demonstrated. But instead they went with a scribble.
This brings me back to Methodism. It was studying Protestantism in the United States, I stumble upon Methodists who are one of the main religious groups. To them visuals draws you away from God. Hence, they encourage their members to be as plain as possible when it comes to their dressing and their church ornamentation. In fact, from their churches are plain and simple, there's no icons and their members dress simple as well.
Maybe, there's a connection between DIY( Do it Yourself) type of communities and Methodism. I'm not saying that these DIY bands explicitly knew this. But rather they were were part of a larger culture(Methodism is one of the main religions in the US) which is telling them that visuals don't matter. Also Yuck are British but they were trying to imitate American bands from the 1990s.
submitted by Marcel_7000
to LetsTalkMusic [link] [comments]
2023.06.04 10:55 gffyhgffh45655 Will adding an antenna help modem receive extra bands?
Hi i am from UK and I try to set up a home broadband myself and at the moment i got a 4G modem netgear LM1200 , i found this modem does not cover a LTE bands (B32) that my networks provider is using .
Will adding an antenna help in this case to what i thought “improve the speed by the also capturing B32 bands”?
submitted by gffyhgffh45655
to HomeNetworking [link] [comments]
2023.06.04 10:25 sadbabylynn Advice on how to approach doctors
Hi all I am new to the sub and have a burning question regarding how honest I should be with my doctor. TLDR: I have a big nose and am trying to take advantage of my insurance. Should i tell my doctor?
Context I’m a lady who has a really big nose… I am really beautiful regardless and my nose suits me yada yada… I get nose filler to diminish the large hump on my nose and recently went to a new doctor for this (due to his experience on face balancing). Well, this doctor asked if i had a deviated septum, to which I said “a small one i think” (based on prior knowledge from visiting 2 plastic surgeons regarding my nose). This Doctor then proceeded to exam my face and stuck two q-tips up my nose opening my nasals to show me how i am suppose to breathe. I was in shock and didn’t realize how poor my breathing was. This Doctor then told me that my ‘nose bone’ is in the shape of an ‘S’ as well as telling me that i have an over growth of cartilage in the bulbous of my nose. This doctor recommended i go see a plastic surgeon named Dr. XYZ. I began noticing how gosh awful my breathing truly is and spoke to my personal practitioner telling him about what this doctor has told me and so my practitioner referred me to a nose/ears/throat doctor. The objective of the referral is to get me on the road to a septoplasty and/or deviated septum repair (covered by insurance). My main concern is I have taken what doctor #1 has told me to heart. I want a reduction on the bulbous of my nose as well as a shaved nasal bone- for aesthetic purposes though.
I understand I am taking advantage of the so called ‘system’ but the first time I wanted a nose job was when i was 3 years old.
I have always been the family favourite due to my “middle eastern nose”.
I have been teased my whole life, i would look in the mirror at age 6-8 and just cry asking the universe why me. in high school the popular boys use to say “she’d be so hot if she had a nose job”. I don’t know how many people know or care to know, but nose insecurities are linked to eating disorders and I currently weigh 93 pounds at age 27, my bmi is shameful.
I don’t mean to sound condescending and everyone is beautiful and unique but i feel so held back in life because of my nose. As awful as it is, i envy those woman that honour their prominent noses and look so strikingly beautiful. I wish they felt how ugly and disgusting i feel which is so wrong and horrible to say but i’ve been stuck in a loop of sadness and self pity since I was born.
I apologize for sounding condescending and vain, I apologize for victimizing myself and not being able to love this beautiful face of mine. my boyfriend has a big ol dominant nose and i’ve never seen anything sexier, but i just can’t live with mine. He loves mine, everyone does, it’s what makes me unique they say but i hate it.
On to my question, When i have the privilege of speaking to the Nose/Throat and Ear doctor should I honestly tell him my intentions? Should I truthfully tell him I would rather mouth breathe my whole life than to be stuck with this horrendous nose of mine? Should i tell him the personal information like how i have social anxiety and can’t look people in the eyes because my nose haunts me? Should I tell him I don’t even want kids because how dare I give them my big ugly nose? should i tell him that i want a deviated septum recovery in hopes that i come out of it “more beautiful”. I hate myself foe the words i have said abs the question I asked but I need help, i’ve tried to end my time here because of my nose twice now and i don’t want to have false hope going into this surgery just to be disappointed after the fact. (i understand 100% that i will never like or love my nose, before or after any surgery, i am aware that it will never be ‘small enough’ in my eyes, i know that this body dysmorphia that i will live with for the rest of my life)
I just need to know, if you were a doctor, would you help me if i shared this with you? would you go the extra mile to approve my appearance? would it be strictly for functionality of my nose?
submitted by sadbabylynn
to cosmeticsurgery [link] [comments]
2023.06.04 10:20 duncan_chaos Fantasy Name Generators (Day 4 of 30 Days of RPG Generator Sites)
Probably the best known generator site, Fantasy Name Generators
does more than fantasy names, having sections for real names, places and pop culture. Plus longer description generators and the "Other Names" category, covering anything from Apocalypse Names
("Mankind's Disgrace", "
The Omega Event") to Music Band Names
("Razor", "Sloppy Sisters"), Board Game Names
("Cryptic Crypts", "Peril") to Superpowers
("Vibration Manipulation", "Hydrokinetic").
The strength is the sheer variety of names. The pop culture section provides names and ideas for many one shots and niche games, with areas for Doctor Who, Shadowrun, Hunger Games, Dune, Star Wars, Wheel of Time and many others.
Have you used Fantasy Name Generators to name a character or NPC?
submitted by duncan_chaos
to rpg_generators [link] [comments]
2023.06.04 05:30 PunkrockPopeye Beat Em'!
| || | submitted by PunkrockPopeye to funny [link] [comments]
Sometime among the events of the very first Kinder Cosmic...
The director of the United States Space Force marches back and forth before a gathered group of several hardened space marines all standing at attention within a large training room as he addresses the group with a general Patton like speech.
USSF Director: Ladies and gentlemen...We are at the precipice of the dawn of a new age!
*The group murmurs amongst one another curiously.
USSF Director: Time and time again threats from opposing galaxies, dimensions, and outer worlds; some beyond the very realm of human comprehension have descended upon our little blue marble suspended in space and threatened our quality of life, our society, our safety, our sovereignty and our very existence!
*Several members of the group shudder and gasp as the director continues his sermon.
USSF Director: If the citizens of this United States, no...The very world itself are to maintain our status qu-
*The group diverts their attention behind the director towards the sound of a loud, laborious sigh.
*The director shoots a disapproving glare at the alien grey known as Alpha as he continues to speak.
USSF Director: As of late, the only force standing between the citizens of this planet and total annihilation has been...
The lady astronaut and appointed liaison to the greys; one Luna Valentina gently pushes the little grey alien known as Jorg towards the middle of the room as she whispers in his earholes.
Luna: ...Go ahead, Jorg!
*Dressed in a bright red silk dress and miniskirt with a purple bandanna tied tightly around the crown of his head; Jorg stares at the hem of his dress with either side clasped tightly within his hands as he swings his hips from side to side and hums happily as the dress flutters back and forth.
The USSF Director sighs apathetically as he continues to speak, pointing at the little grey now standing beside him.
USSF Director: W-What...
*The Director shields his mouth and whispers to Alpha and Luna as Jorg continues swaying unmoved and unbothered.
USSF Director: What th-....What is this?
*Luna laughs and smiles as she replies patiently.
Luna: The only way I could get him to cooperate is if I let him wear his dress!
*The Director stares at Jorg still humming and fluttering from side to side and then Alpha confusedly.
Alpha: He thinks it makes him stronger...
*Luna giggles as she follows Alpha’s words.
Luna: He...he doesn't understand how feminism works!
*The Director stares at the flamboyant grey and then Alpha once more.
*Alpha throws his hands up as he replies.
Alpha: Who the hell am I to tell him otherwise? As far as I know it probably does!
*The USSF Director sighs frustratedly as he quips.
USSF Director: Jesus fucking Christ...Can he fight wearing it?
*Alpha smirks mischievously as he speaks.
Alpha: ...Jorg? Jorg can fight in anything, anywhere, at anytime!
USSF Director: Fine...Well I guess we'll conti-
*Suddenly the Director is interrupted by a massive, muscled and imposing Sergeant who addresses the group obnoxiously.
Sergeant: Why is that little alien wearing a fuckin' miniskirt!?
Luna snaps defensively.
Luna: HE'S IN TOUCH WITH HIS FEMININE SIDE!
*A private nearby mutters knowingly.
Private: Well, I heard that lil' shit is completely unhinged!
*The group of hardened space marines murmur amongst one another as Luna plants her hands on her hips and speaks once more.
Luna: NO HE ISN’T! HE SAVED YOUR IGNORANT ASSES!
*The Sergeant points at the preoccupied grey as he speaks once again.
Sergeant: That scrawny, 80 lbs, ugly ass little critter? Saved what? Ru Paul's drag race?
*The private glares at the Sergeant standing beside him confusedly as he continues to speak.
Private: Where the hell have you been man!? You didn't hear about what happened in Tulsa?
*The Sergeant cuts a sidelong glance at the private as he continues to speak.
Sargeant: Stationed abroad... No phones, or internet, or TV, or electricity, or running water...not even a fuckin working toilet! So no...I don't know "what happened in Tulsa".
Private: ...Oh. Well I HEARD he leveled half a city fighting some interstellar Lovecraftian planet killer...
USSF Director: OFFICIALLY THAT WAS A LEVEL 4 EARTHQUAKE!
Private: SURE BOSS! whatever y'all say, it's not like it hasn't been cycling all over Tiktok for months...
USSF Director: RUSSIAN PROPAGANDA! A DIVERSIONARY TACTIC TO UNDERMINE UNITED ST-
*Alpha sighs again loudly.
*As the group continues to bicker incessantly the USSF Commander from "Kinder Cosmic: Paradise Lost" strolls into the training room and smiles with a large grin as he leans against a supply depots consignment widow and addresses it's quartermaster casually.
Commander: Has it started yet!?
QuarterMaster: ....Has what started yet?
*The Commander grins mischievously as he continues to speak.
Commander: Say...Are you a bettin' man?
Quarter Master: On what exactly?
Commander: Costello over there of course!
*The Quarter Master stares at the grey still preoccupied with his pretty dress and then the Commander once again.
Quarter Master: That sick lookin, effeminate little space midget against ALL OF THEM!?
*The Commander smiles knowingly.
Commander: You bet your ass!
*The QuarterMaster doubles a glance back and forth between the grey and the Commander as he speaks.
QuarterMaster: How drunk are you?
QuarterMaster: How much do you wanna put down on him?
*The Commander reaches into his pocket then slams several stacks of money upon the window's table as he speaks.
Commander: My ENTIRE goddamned pension!
*The Quarter Master stares at the little grey smiling as he swings in his pretty red dress and then the hardened military veterans and finally, the grinning Commander once more.
Quarter Master: You're on!
*The USSF Director silences the gathered, bickering and murmuring group as he interjects.
USSF Director: QUIET!
*The group of military commandos quickly stand at attention as the USSF Director commences pacing and continues his addressment once again while Luna smiles knowingly and Alpha shakes his head from side to side...also knowingly.
USSF Director: THE POINT IS! That we're facing a potential threat that is completely out of human understanding, the very laws of physics itself and our current martial capabilities!
*The USSF Director points at the greys; Alpha’s arms folded as he stands like a solemn statue and Jorg still hyperfocused as he busily plays with his red dress.
USSF Director: Although they ARE friendl-
*Alpha’s face sours distastefully as he hisses underbreath.
*The Director darts a sharp glare at Alpha who returns it with a twisted, smug expression and then at Luna who shrugs her shoulders casually.
USSF Director: ....Although they ARE NOT THE ENEMY we can not let the future of humanity...
*The Director stares at Jorg who is still absolutely lost within his own world as he continues to speak.
USSF Director: ...Rest upon the strapless shoulder blades of one four and a half foot; morally and mentally compromised little...whatever in the hell this thing is.
*The Director points towards Jorg as he flutters and sways repeatedly.
*Luna retorts defensively as Alpha comments sarcastically.
Alpha: Well...I mean, he's right. Man's still kinda a misguided idiot but when he's right he's right!
*The Director glares at Alpha once more as his subordinates murmur and contemplate his directive aloud amongst one another.
Private: We are so, so, so completely and utterly screwed...
*The Sergeant standing besides the private shrugs apathetically as he speaks.
Sergeant: I don't see what the big deal is...
*The director marches to and fro once again as he continues to speak.
USSF Director: That being said! The ONLY WAY to adjust our combat to this new enemy is simulated combat WITH THE ENEMY!
Private: I'M NOT FIGHTING THOSE THINGS!
*Alpha smiles slyly and quips sarcastically as The Director retorts with a commanding tone.
USSF Director: Oh yes you will private! Unless of course you want... AN EXTRA WORK DETAIL!
*The Director grins as he continues to speak.
USSF Director: Besides! You'll only be facing a single extraterrestrial opponent today, Alpha has adamantly refused to participate in this exercise...
*Alpha retorts sharply.
Alpha: I said, "You can go fuck yourself", that's what I said.
*Luna erupts with a riotous laughter as the USSF Director glares at Alpha in return.
*The Sergeant points towards Jorg still playing with his fluttering dress.
Sergeant: And lil' Miss Doubtfire over here? HE'S supposed to be our opponent!?
*Luna beams with pride as she retorts.
Luna: I wouldn't underestimate Jorg! He's wildly talented!
Sergeant: At what!? Martha Stewart style homesteading?
*The group snickers as Luna giggles and returns a mischievous grin and then quips once more.
Luna: THAT TOO!
*Alpha clarifies casually as the group murmurs and looks on at the little grey still lost amongst the surrounding atmosphere.
Alpha: Consent for Jorg is kind of a non-issue, he's barely aware of where he is half the time. When goaded he does have a certain instinctive enthusiasm for martial combat under the right conditions. I don't even know where he learned it, he just came back one day and knew it innately. Like a telekinetic amalgamation of something between Ong-Bak and Jet Li...
*The Private stares at the little grey in suspended disbelief.
Private: Under...what conditions?
*Alpha grins knowingly; as he responds.
Alpha: Basically...You've got to manage to piss him off.
Private: "Piss him off?"
*The Sergeant cracks his knuckles as he smiles belligerently.
Sergeant: Well this should be easy!
*Alpha shrugs unknowingly.
Alpha: Maybe...Sometimes it is and sometimes it isn't! To evoke this reaction from Jorg or to "Piss him off"; it is like this ingrained psychological trigger. It isn't so much guided as a form of premeditated anger as a kind of pro-active defense mechanism. He's not even really fully aware when he does it. I think it may be a kind of "Fight or Flight" reaction he just does. Except Jorg...well...Jorg pretty much always chooses to fight.
*The privates eyes widen curiously as he stares the little grey up and down before him.
Private: Is he...is he dangerous!?
*The USSF Commander laughs heartily as he slams his hand upon the provisional warehouse window and retorts excitedly.
USSF Commander: YOU CAN BET YOUR ASS HE IS!
*The QuarterMaster glares at the USSF Commander as he chimes in.
QuarterMaster: I wanna replace my bet!
*The USSF Commander replies snarkily.
USSF Commander: TOO LATE ASSHOLE!
*Alpha, Luna, The Director and the group of soldiers all divert their attention towards the Commander and QuarterMaster until Alpha continues speaking.
Alpha: Jorg!? Dangerous? I mean...IF YOU DESERVE IT then I dunno...
*Alpha shrugs apathetically.
Alpha: ...Maybe? I really doubt he'd actively kill anyone though.
*The private throws his hands into the air and addresses Alpha frustratedly as the group murmurs amongst themselves once more.
Private: THE FUCK YOU MEAN "MAYBE" AND YOU "DOUBT HE'LL KILL ANYONE"!?
*Alpha shrugs once more...
Alpha: It's Jorg...Jorg is Jorg! You'll see...
*The private stares at the two greys one after another then retorts underbreath as he turns to walk away.
Private: I'm so not fuckin doing this...
USSF Director: MORE WORK DETAIL!
Sergeant: Well I think they're full of shit...
Private: THEY TORE APART AN ENTIRE MILITARY BASE "JUST BECAUSE".
Sergeant: Of Non-combatant "week-long warriors" I bet! Might as well be a buncha national guardsmen...I mean...JUST LOOK AT HIM!
*The Sergeant points towards Jorg still swaying giddily.
Sergeant: ...There's no way in hell that little queer fella could take a seasoned soldier!
*Luna retorts defensively.
Luna: JORG ISN’T GAY! HE'S JUST SENSITIVE AND HE'S VERY SPECIAL!
*Luna cuts her gaze towards Alpha seeking confirmation.
Luna: He isn't...is he?
*Alpha shrugs unknowingly and apathetically as the group murmurs amongst themselves once more.
*The Private suddenly turns then approaches a series of lockers and containment bins stowing riot gear, defensive equipment and padded suits much like one that would be used to disarm a bomb or train a K-9 attack dog as nearly all of his peers follow suit...
Private: I'm not fucking with this lil dude without my PPE!
*The Sergeant snorts obnoxiously in response as he watches.
Sergeant: I don't need that crap...Besides, it's hard to move or fight with all that bullshit on! Whatchu gonna do? Bumper car bang him to death with it?
*The Private shrugs undisturbed.
The crowd gathers all around the little grey warily; some armed with things like MMA gloves, hand-wraps, Batons and extended martial defense metallic rods as they all approach the grey from all angles.
Suspicious and cautious at exactly what the little grey might do and exactly how he might respond.
That is all but one, the boisterous military Sergeant who readies himself and then throws the very first strike at the seemingly defenseless and unsuspecting Jorg.
Without ever even lifting his eyes from the hem of his dress, in a matter of moments warping the surrounding spectators very perception of time; Jorg shifts his head slightly towards the left as the Sergeant's fist narrowly misses the grey by a hair's length.
*The USSF Commander slams his hand upon the provisional warehouses window once more as he retorts giddily.
USSF Commander: HAH!
What happens next can best be described through the conveyance of a matter of collective very short-lived and somewhat difficulty perceived moments.
The next soldier and the next and the next and the next; all of them simultaneously rush towards the little grey slinging their fists and their weapons towards the inattentive and unbothered little grey.
Jorg bobs, weaves, and feints his big grey bandanna wrapped head not unlike a hyperactive, super-powered Muhammad Ali; as fist and all flies from every perceivable angle, not ever touching him...not even once, his attention still diverted towards his fluttering dress all the while.
Another military combatant rushes forewords and thrusts a kick towards the grey; to which he spins out of reach with seamless grace as yet another kick comes flying from it's opposing direction to which the grey quickly ducks then loops his body around from underneath...still playing with the hem of his pretty red dress still humming to himself gleefully as Luna erupts with laughter.
Sergeant: What...what the hell IS THIS!?
Luna: I TOLD YOU!
Private: He....He never even LOOKED at us...NOT ONCE!
*The Director stares at Luna and Alpha then questions them curiously.
USSF Director: Why isn't he defending himself?
Alpha: ...Probably because Jorg doesn't see any of you as a threat.
*The boisterous military Sergeant walks towards Jorg then plants a single finger upon his forehead then slowly pushes him backwards; to which Jorg sways back then forwards then rests in the exact same position of which he'd originally been.
Sergeant: What do you mean he doesn't see us as a threat?
*Alpha responds casually.
Alpha: I mean exactly what I said! Jorg only reacts when driven towards it from an outside stimulus; when he himself, someone he cares about, or perhaps even others are under certain conditions of diress such as a threat or pressure or the friction of oncoming conflict. It is very difficult to tell exactly when this trigger will set off from an outside perspective but FOR JORG these lines are ingrained within his very being. It's like a reflex, he doesn't even have to think about it.
Private: How is it he can move so quickly like that? I could barely even see him doing it!
Alpha: Part of it is because Jorg instinctively compounds his telekinesis with Kinetic energy. The other is because he's clairvoyant, prophetic even. This doesn't just apply to the precepts of time or it's passage through the universe itself but also to an outside stimulus. But just like almost all things concerning Jorg; he isn't fully aware of what he's doing and what he does it its all interdependent on outside stimulus and outside perception and interpretation. In short, Jorg is like a living mirror in everything he does and reasons for doing them. A reflection of one's self whether they even realize it or not. He could punch through a two inch steel wall or bulletproof plate glass window faster than you could blink if he wanted to...
*Alpha shrugs casually.
Alpha: ...Only problem is it takes alot for Jorg to actively feel inclined to do so. Well...sometimes. All that being said apparently he sees absolutely none of you as an inclination for him to act...and so...he doesn't. He doesn't see any of you as a threat!
*The Sergeant fumes angrily and frustratedly as he stares at the preoccupied little alien frustratedly and then speaks angrily.
Sergeant: WHADDYA MEAN "HE DOESN'T SEE ME AS A THREAT"!? I'M A GODDAMNED NAVY SEAL! I DID TWO TOURS IN AZKABAN!
*Alpha replies to the Sergeant flatly and unflinching.
Alpha: Exactly what I just said...Your limited human capabilities and physicality to Jorg is a non-issue. You're not big enough, strong enough, forceful enough or physically capable through your own recognizance of being a perceivable threat to him.
*The Sergeant stands from the opposing side of the playful grey in the little red dress then angrily unbuttons and unholsters his service weapon as he holds it in both hands, pointed towards the ground.
*The USSF Commander laughs a riotous laugh as he spectates from the warehouse window some distance away then pounds the desk upon it once more as he goads the Sergeant playfully.
USSF Commander: YOU GET EM HOSS!
*The Commander quickly turns towards it's QuarterMaster then whispers as he winks towards his glare.
USSF Commander: ....Fucking idjit!
*Luna’s eyes widen with worry as she begins to speak.
Luna: I WOULDN'T DO TH-
*Alpha calmly places a gentle hand upon Luna’s shoulder as he knowingly interjects solemnly yet very mischievously.
Alpha: Nah....Let em'.
The Sergeant steadies his firearm upon the grey methodically as all of his compatriots watch onwards nervously.
And what happens next, again...Can best be explained by a breakdown of a series of events that through our perception of time unfolded within a matter of moments.
...But to Jorg himself? Well, that's another matter entirely.
Just like one perceptive light switch suddenly being flicked on from deep, deep, deep within Jorg’s psyche. The little grey suddenly raises his head; his black, saucer shaped eyes widened with a perfectly aligned subconscious awareness. One of them twitching erratically above a maddened grin as above and all throughout this training room; the loud deafening roar of electric guitar reverberates one ear-splitting and most deafening melody.
Loudly cutting through the awkward silence not unlike a high-powered circular saw this melody is that of the song "Beat It" the cover of an infamous Michael Jackson tune preformed by the band "Fall Out Boy". https://youtu.be/Qt54wA7Z2LY
And as this guitar melody drones and roars throughout the intercom and sirens of the facility all around; As Alpha smirks smugly and Luna laughs...and then gasps. What follows suit could be quite accurately articulated as a series of movements so perceivably fast, powerful, and deadly accurate that one could quite convincingly say that Jorg DID move faster than a human could blink.
He quickly utilizes his telekinetic energy with one hand to jerk the firearm out from within the Sergeant's grasp not unlike a vaulted football ripped from between a running back's fingers. And as this pistol flies and spins towards Jorg he launches himself into the air, quickly preforming a spinning back kick that smacks against the gun sending it ricocheting and flipping once more until it hurtles directly dead center of the Sergeant's face sending him spiraling and sprawled out upon the ground nearby while the gun itself deflects, is thrown against a nearby wall and then misfires.
Space Marine: SHIT...MY LEG!
And as the lyrics of the song echo and vibrates all throughout this training room, quaking its walls and cushioned floormats with every progressing spoken word; the frightened private quickly turns to sprint in the other direction, absolutely ANY direction away from Jorg.
But little did he know; it was far, far, far too late...
Jorg harnesses his telekinetic energy to rip the man's legs out from beneath him, as he does Jorg quickly sprints forward, leaps into the air again like a telekinetic grasshopper then dead drops his knee into the private's back.
As Jorg "ground and pounds" the back of the privates combat protective headgear repeatedly in rapid succession; not unlike quick repeating Wing-Chun punches into the back of the man's head, striking and bouncing his forehead off of the training floor's cushioned material all to the rhythm of this melody. The surrounding marines look around at one another, murmuring in a stunned confusion as the private cries for help.
Private: G-G-GET I-
*WHACK! *BANG! *POW! *WHOMP! *THUMP-THUMP-THUMP!
Private: GET IT OFFA ME!
*The USSF Director points at the private then addresses the fearful combatants sternly.
USSF Director: ...WELL!? HELP HIM!
*One of the remaining combatants turns to kick Jorg off of the private when the grey quickly stops then pivots as if in anticipation of said strike; catches the man's ankle then smiles with a malevolent grin before twisting it with a loud *CRACK!
*Luna squints her eyes closed and winces painfully as Alpha grins a grin very much reflective of Jorg’s and they both comment.
Alpha: Fuck em'...
Elsewhere at the provisional warehouse window the USSF Commander slams his hand down upon the table once more as he also comments; smiling at the QuarterMaster with a shit eating grin all the while.
USSF Commander: That looked like it HURT LIKE HELL! GET EM' HOSS!
*The QuarterMaster also comments, sneering distastefully.
QuarterMaster: I fuckin' hate you...
Elsewhere amongst the whirlwind of rapid, successful strikes and all to a melody; Jorg now stands his miniskirt fluttering in training room's AC cooled air along with the motion of his movements with the Marine's now broken ankle held between the palms of his hands; the man still wailing with pain.
In an amount of time accumulating to less than the passage of a few seconds; the grey spins and leg sweeps the other man's remaining limb, tossing him upwards into the air before kicking him in the abdomen with a telekinetically reinforced strike that sends the man hurtling into and bouncing off of the nearest wall.
As another approaching soldier moves in to strike Jorg the grey quickly hops a foot into the air once more; then quickly plants a deflective side kick in rapid, fluid succession into the center of the man's chest which sends him staggering back just a few paces.
*The soldier hardens himself as he pounds his chest then closes in on Jorg once more.
Space Marine: IS THAT ALL YOU GOT!?
And as this melody continues to pound with a thunderous roar all throughout the training room; Jorg smiles a sadistic smile.
While the man races forwards to preform a takedown upon the little grey, Jorg quickly and acrobatically dips his head and upper abdomen towards the ground. With a certain level of martial flexibility mirroring that of a Shaolin Monk the grey lifts the pad of his foot from behind towards where his head originally was, arching it upwards and from behind his backside with his torso now angled downwards, he then slams the bottom of his foot into the Marine's forehead; stunning him instantaneously.
Jorg quickly rights his equilibrium and with a fluid, unceasing movement uses that very same leg to plant a telekinetically charged front kick into the man's sternum; sending him flying backwards and crashing into yet another padded wall.
Space Marine: YOU CRAZY LITTLE SHIT!
A remaining marine shouts at Jorg and then races towards him from a flanked position sending his own angled "axe kick" towards the grey's abdomen.
And as this melody pounds and reverberates the ether all around from every perceivable direction; without so much as a moments hesitation, forethought, or consideration Jorg side steps then archs his own leg around the own man's "Axe Kick" locking it into place.
*The Marine's eyes meet the grey's; whose deep, darkened saucer shaped eyes are deadlocked onto his own. Shining with a glossy, detached madness as the grey's smile widens. And with their legs locked in place, Jorg intentionally restricts the man's movement; the Marine's remaining free leg trembles as he utters words of fear and astonishment.
Space Marine: Oh....SHI-
*Before the man can even get the words out the grey hops into the air with his remaining leg with the other still locked in place, then uses his free leg to dropkick the soldier dead center of his chest with another telekinetically reinforced strike before quickly releasing his leglock to send the man vaulting into another padded wall not unlike a human bullet.
And as this resounding melody finally tolls onwards towards it's completion; the little grey still stands in the middle of this training room. In the exact spot in which he'd originally began; surrounded by moaning, bloody, blackened and bruised human cadavers.
Who at this point are each and all very, very much alive; though perhaps their pride...not so much.
*Luna shakes her head from side to side as the USSF Director speaks.
USSF Director: Well...we're never doing that again!
*Alpha stares at the director and smiles with an air of apathy.
Alpha: I could have told you but you'd never have listened...
*The private spits a mouthful of blood onto the ground as he slowly gathers his strength to try to lift himself from it, next to the still unconscious Sergeant lying face down on the floormat beside him.
Private: We are so...so...so fucked.
*At the provisional warehouse window the QuarterMaster counts out the last of his debt and then slams it upon the table towards the USSF Commander's outstretched smile now grinning from ear to ear.
USSF Commander: It was nice doin' business with you!
QuarterMaster: Shut the hell up...
2023.06.04 05:26 unfortunate_tadpole Does anyone here know / or have any experience with NJ Medicaid with covering Top Surgery?
I'm going in for a consultation soon and I'm really excited but it's been very nonspecific or non-answers towards to the question of cost in my emails and phone calls. They keep saying it'll be covered, but they won't clarify and I have no idea if that means everything is fully covered like other surgeries I've had, or just a fraction of cost is going to be covered? I'm moving out soon and I'm just really nervous about taking on anymore debt and googling it hasn't brought up any consistent information. I'm already floundering to cover transportation cost and I don't have anyone to rely on financially so I'm only asking out of fear 😭
submitted by unfortunate_tadpole
to ftm [link] [comments]
2023.06.04 05:22 Traditional-Plan-854 I got approved for OHIP to cover my breast reduction and I got the news about 2 months ago!!
I got approved for OHIP to cover my breast reduction and I got the news about 2 months ago!! Unfortunately OHIP will only cover the breast reduction portion and not the liposuction of the breast which is $5,500. I’m in a really difficult position because I’ve pushed the date too much since I still can’t afford paying that much and my back and shoulder pain have only been getting worse. I am a university student, that is not able to get a job at the moment because of other unrelated health issues and my parents are not willing to help because they are helping me pay for my tuition and needs.
I’ve read a lot of stories from others that they were able to get the whole surgery covered by OHIP. Does anyone know how they might have done this? Or does anyone have tips on what I should do?
submitted by Traditional-Plan-854
to Reduction [link] [comments]
2023.06.04 05:04 oobanooba- Venlil Metal Ch.2 - We’re not all bad
well, we're back again. now with more characters! Enjoy.
for the universe And u/VeryUnluckyDice
for implanting a tumor into my brain, go read his story 'Playing by ear' if you haven't already! [First]-[Next]
----- Memory transcription subject: Anaw, Venlil citizen Date [standardized human time]: October 23, 2136
It was one of those brief moments when I was on my own. Just after I separated from my working herd but before I joined my familial herd. I bought some nice fruit salad from a place down the street. As I made my way to my way to the plaza I saw that musical duet was performing there. The duo was made up of a venlil and a Krakotl. And they were performing a popular pop song by some band, ‘I love you like the Herd’ by ‘The Sneeples’ I think? To be honest I wasn't too familiar with the current trends in music, I've always listened to what my mother listened to. Never gave it much thought really. I noticed how many people had stopped to listen to them play. I want people to see me like that! It would be so cool! To be a star, to guide the herd instead of just following it? Wouldn’t that be spectacular? Or even impress Vemly…
I figure I should find a seat, realizing there isn’t any room in the plaza itself. I have to search Elsewhere.
I look round the corner to see… a human! I have never seen one in person before but here? the closest shelter is a city over. And they seem to be alone. Which seems unusual. They don't seem to notice me so that's good. My curiosity getting the better of me, I made my way to a seat where I could watch the predator without being noticed.
The human was holding their head in their hands, their gaze presumably cast down toward the concrete tiles of the plaza though I had no way to be sure thanks to the glossy black mask that covered their face. They didn't seem to be moving aside from one of their legs bouncing seemingly in time with the music.
My meal was almost finished when suddenly the predator rose from their seat and started walking towards the buskers. At their full height, they were quite tall, but maybe my shorter-than-average stature was to blame.
Their approach caused the gathered crowd to scatter most people. those that remained kept their distance. When the human arrived at the buskers' setup the krakotl singer faltered and forgot the lyrics. The human tilted their head at this and seemed to study them for a moment before pulling out their pad and touching it to the tip receiver before turning to leave. If a predator can appreciate our music they can’t possibly be so bad right?
Someone must have called the exterminators because exterminator officer Ezin and two other officers arrived on the scene. The exterminators showed up almost too quickly. usually, they’re really slow, like that time when-
The exterminators raised their flamethrowers toward the human
“Predator! You’re coming with me” Ezin yelled at the human.
The human raised their hands and was quickly restrained by the two officers, with the head exterminator turning to the crowd.
Ezin addressed the crowd
“Civilians! Thanks to my hard work the predator has been restrained and you are safe once more!” It doesn't seem like the predator didn't do anything wrong… why are they being taken away?
My need to find out what is going on overriding all my better judgment I decided to follow the exterminators to the Deep Lake office.
But first I’m finishing my fruit salad. Yummy yummy!
I arrived at the exterminator's office and headed up to the front desk. There was a snowy white venlil at the counter.
“You here about the recent incident?” she droned, without even taking her eyes off her pad. There has been an incident?
“No I'm just here about the human from the plaza” I responded
“Just saying yes would've wasted much less of my time sir” the venlil responded, only now seeming to have found the time to look up from her pad.
“Just wait here and someone will be with you in a moment” She pointed to the seats set up at the side of the room. They were all empty.
even I couldn’t find any more reason to talk to this person so I sat down at the end. These chairs really aren't very comfortable… no matter, ill be through in a jiffy. Maybe I’ll have a look at these pamphlets to pass some time.
I reach over to the stand picking out the first one available, ‘What to do If a predator moves into your apartment?’ No thanks, I've had enough stress already. ‘Top 10 signs that your human is actually plotting to eat you!’ In the future even the pamphlets are clickbait. Go back to writing bleat posts. ‘Rainbow socks to be banned in Deep Lake Area’ What are socks?
I spun the stand around and spotted a hand-drawn-looking pamphlet. My curiosity piqued I opened it up. ‘Exterminator Ezin for emperor’ The Venlil don't even have a president. How can you get a role that doesn't exist? And I'm pretty sure you won't become emperor by winning an election. Anyway, what time is it? I feel like I’ve been waiting for more than a claw, I should really be home by now.
“Anaw, come on up” It was the senior exterminator Koll. I have seen him a couple times on the local news giving important announcements. If you've ever seen a buff venlil, you haven’t. Not until you have seen Koll. It's been said that he once fought an entire squadron of armors, bare-paw, on his own, and won. After which he retired to live a more peaceful life on venlil prime. Though that’s hard to believe, When I saw him in person, standing in Infront of me? I could believe it.
Koll asked me to give a brief rundown of the whole incident, a request which I had no trouble complying with.
After a moment of contemplation koll spoke “Well, That does it then, the incident was clearly bogus and the human will be free to go.”
Koll gestured for me to follow him. We walked down the hall and then to the cell where the human was being held.
The predator looked up at Koll and then at me. Prompting Koll to start inputting the code on the cell, Koll broke the silence.
“Well predator, looks like a witness showed up and your stories match, you're free to go, get out of here.”
The senior exterminator left the room, leaving me with the predator… alone.
The predator rose to their full height. Turning their head right at me. I've actually never met a human before. What do I do? Are they plotting to eat me? Maybe I should've read that pamphlet.
“Hey, thanks.” the predator spoke softly. Their voice was bassy and smooth, not nearly as loud as I expected. I thought predators were supposed to growl or be aggressive! They probably don't want to scare me. I'm still really afraid though. Is that rude? Am I a bad person for being afraid?
They continued in their soft inflection.
“I don't think Sargent Fluff for brains would've let me out any time soon, so seriously, thanks for the help” Sargent fluff for brains? Are they talking about Exterminator Ezin?
I finally mustered up the courage to speak to the human
“n-no p-problem h-human”
The human lifted one hand to their mask, presumably where their chin would be. This gave me a chance to get a good look at them. The flesh of their paw, which I think they call hands, was a smooth pinkish-white, each finger being topped by a wide flat claw that was pink almost to the tip of their finger. Where they became white. Their glossy black mask covered their face entirely but left the back of their head exposed. the human had wavy yellow fur that reached all the way to their shoulders. They were wearing a thick top garment in navy blue, it had sleeves that reached all way to their wrists and had a hood that the human wasn't currently using. Their bottom garment was the same color but seemed to be made out of a rougher material.
The human stuck out their hand In what I recognized to be a greeting gesture.
“I’m Colton by the way. It's nice to meet you”
I placed my paw in their hand and they shook it up and down very gently as if they were unsure about the action themselves.
“I- I’m Anaw” my voice quivered
“It's nice to meet you, Anaw, though I have some belongings I have to collect”
Colton began walking to the front desk of the building. Curiosity once again won out over my need for sleep and I followed the human as they approached the desk. The white venlil was still there, and still seemed to be distracted by their pad, doom-scrolling Bleat probably. The attendant looks up from their pad and looks completely uninterested in the predator staring down at her. She looks back down making a clear effort to ignore the human.
“Can I get my guitar back now?” Colton asked the attendant.
“Confiscated weapons will be kept as evidence.” the attendant droned.
“My guitar is not a weapon! It's a musical instrument. It's personal, I need it.” pleaded Colton.
This finally made the lady look up from her pad with curiosity. Apparently thrown off by the human's response. The human wants an instrument back? That means that this human must be a musician!
At that moment Exterminator Ezin stepped out of his office, Now that he was out of uniform the full mass of his grey was on display. He wore a bandage around one of his paws. Seems like his shift was over and was on his way out. How do you even pack so much wool into an exterminator uniform?
The Exterminator must have been listening in on the conversation because he smirked almost predatorily.
Ezin spoke “Predator if you can somehow prove that primitive club isn't a weapon,”
Venom laced his tone, “Then you can have it back.”
The exterminator raised his bandaged hand toward the human.
“But I doubt you'll be able to.” Ezin gloated with the confidence of someone who knew they were untouchable.
Colton didn't give the exterminator the chance to goad them further and made for the exit. Shoving their clenched fists into their pockets. If the human is a musician, then they must know a lot about music! Vemly is really into human culture, if I could learn all about human music or even learn to play some then she would definitely be impressed!
I followed Colton out of the exterminator's office and steeled my nerves. I have to ask them if they could show me some human music! And then I can ask them to teach me? Before I could change my mind I yelled out.
The human stopped.
“C-can you show me?.. Your Human music?”
submitted by oobanooba-
to NatureofPredators [link] [comments]
2023.06.04 04:32 Majestic-Run3722 Talking Heads
Does anyone know if the band has ever covered Talking Heads?
I am watching “Stop Making Sense” and just read some articles that Anthony and John were both influenced by them. More so Anthony, who said it changed his life, and he inducted them into the Rock and Roll HOF.
Two of my other favorite bands cover Talking Heads, so just curious if anyone knows whether the Chilis have covered them.
submitted by Majestic-Run3722
to RedHotChiliPeppers [link] [comments]
2023.06.04 04:28 Independent_Arm Updated OC: Renaru Kaenshita.
Name: Renaru Kaenshita.
Age: 15. (18 by the end of his story.)
Birthday: June 21st.
Weight: 110 lbs.
Eye Color: Red-Orange.
Hair Type: Long and wavy, mostly tied back in a tiny ponytail as the rest is left free to crackle and billow in the breeze. His hairstyle was inspired by a character he watched in one of his favorite shows.
Hair Color: Orange and Red, sometimes changes color depending on his mood, a trait he got from his mother.
Distinct Physical Characteristics: Has a bevy of scars all over his arms, legs, and chest from the Redirection Surgery, covers them with compression bands and a shirt.
Quirk: Inner Inferno.
Quirk Type: Emitter.
Quirk Description: Using his breathing, Renaru can generate flames from his hands and feet! This quirk can also conduct flames through weapons that he can hold and other weapons! But the drawback is quite severe. He can run out of breath and needs a few minutes to get it back. As well as an intense physical drawback known as Quirk Palsy.
As an added insult to injury, Renaru's Quirk Redirection Surgery made his flames work in concert with his heartbeat, meaning that if he somehow has the fire in his heart die, he dies. Thusly, if he were to have his quirk taken, it'd kill him.
During the warmer seasons, his hair which is usually glowing with his flames, is put out to avoid overheating. His mother does the same thing.
Quirk Palsy: A rare dysfunction in quirks that inhibits the user through usually harmful and detrimental ways. Very similar to normal disabilities like Cerebral Palsy, although it's more commonly genetic. In Renaru's case, Inner Inferno as it was when he was little would've killed him through burning him from the inside out. As a result of the Quirk Redirection Surgery his arms and legs are weakened and the muscles need stretching. Not only that but it gives him an unsteady gait and shaking hands, making it harder to button things or zip things. Although, he can learn.
Personality: A very headstrong and passionate young man with an unbeatable will and 'Everything will be okay!' outlook on life. However, his confidence hides his rather... naïve traits. He seems to get along well with anyone he meets, but he is prone to intense bouts of anger. Not only that but he has an ever-present need to prove himself to anyone. He has a kind soul and always sees the best in everyone, much to his family and friends's fears and worries.
Renaru's worst trait has to be that he never gives up or gives in. No matter what happens and even if he's close to death he pushes himself further, because in the words of Rocky Balboa...
"It's not about how hard ya hit, it's about how hard you can get it and keep moving forward."
He has a strong moral compass and tries his best to be the best hero he can be. He also refuses assistance with things he's working on in Occupational Therapy and Physical Therapy.
His worst fear is losing anyone he loves. Also water, he is DEATHLY afraid of water. He has an EXTREME hatred of those who treat him as weak and unequal that aren't his friends. He's okay when he knows they come from a place of genuine concern.
Likes: His mother, Tempura, Manga, Ibara.
Dislikes: Being held up or being helped, falling, and water.
Motivation for being a Hero: He wants to help his mother by making enough money for her to live comfortably when she's older, also to prove that guys like him can make it to the big leagues.
Backstory: Renaru was born to Tekka and Akihito Kaenshita, with her being the younger sister of Endeavor and Akihito being a son of a long line of mercenaries that stretch back to the days of the Feudal Era.
The same day he was born was the day Akihito was arrested for his mercenary activities, leaving Tekka to raise her son by herself. While she was raising him, she became a member of I-Island's R and D department so that Renaru's band costs could be free of charge as well as surgeries.
Also, while living in a tiny neighborhood, he became friends with Ibara Shiozaki, who would later become his best friend and love interest. Of course, he gets referred to UA for his future schooling and ends up in the Special Exam.
Note on how he got into UA:
UA has Special Exams for kids like him.
There're only two special slots in the entire school among the Heroics Classes. The examination is run by Ectoplasm and is evaluated by the two main hero class teachers.
Every year, they have at least two candidates like Renaru, and the exam is actually pretty easy in comparison to the other exams the Recommends and the Standard students have to take. It's basically a Written Exam and then the Quirk Assessment and a Condition Assessment.
To compare the Heroics Class slots to the Gen Studies and Support, it's way smaller.
Gen Studies has a lot of students with this condition.
Support has four.
Heroics, as part of an initiative in the higher levels in the Hero Public Safety Commission, has generously (read: Begrudgingly.) opened up two slots for each entering hero class. Aizawa of course picks the less obvious one of the two, while Vlad King is stuck with Renaru.
Most of his gear brings out his latent potential.
His bands increase his strength so he can hit harder and move better.
- Alpha is thick, more padded. Limited movement for maximum support.
- Beta is less so, allowing for more flexibility and movement.
- Gamma is like they aren't there, there's barely any issues with stability or movement.
His sword is the only weapon that can properly guide his flames, as it has for generations of Kaenshita swordsmasters. His armor is lightweight but hard enough for impacts to not injure him too badly.
Relationship with Family.
Tekka Kaenshita: His mother and him are extremely close. Being the only parent around in his life constantly, Tekka is extremely protective and quick to anger. Although she means well whenever she protects her boy, she has to understand that she can't keep protecting him forever. She loves him more than anything or anyone else, often deciding things without his permission.
Akihito Kaenshita: Renaru only had pictures to go off when he was a kid, only his mother would visit his father in Tartarus and not really tell Renaru why he had to stay away. He's used to not having a father in his life and why start now if he's chosen the prison lifestyle?
Enji Todoroki: Renaru's Uncle on his mother's side. Estranged. They don't like each other and possibly never will. Feels like he needs to prove himself to his uncle to even get a foot in the door in the hero world.
Shoto Todoroki: Estranged Cousins. Renaru and Shoto are cordial to each other but it's clear that they both were raised differently. They're two sides of the same coin, but they spend little time together.
submitted by Independent_Arm
to BNHA_OC_Characters [link] [comments]
2023.06.04 04:11 Bucksyrup Q from a breadwinner - Best HMO for your family (Siblings included)
Hello. So I have HMO as a benefit from my job. My parents are included in my HMO as well as dependents (free). My parents also have their own HMO through their employers. The three of us are protected. However, i have 3 siblings, age 20-24 that are all in college and/or unemployed. They are not covered in any of me or my parents free HMO.
I am not sure how much i can comfortable pay for one, but in the past two years my siblings have been confined, need surgery, etc. i think i really need one for them.
My question: is there a group HMO out there for families that are good but does not break the bank? Idk yet if I can have them added as dependents on my HMO because last I checked only parents or partners are allowed. I don’t need a long plan too, something annual (which i think HMOs are annual naman?) kasi they are all in college and about to graduate naman so probably will have HMO in the next few years.
submitted by Bucksyrup
to phinvest [link] [comments]