Ascension patient portal

Everything about the game of Ascension!

2013.01.24 18:41 1337GameDev Everything about the game of Ascension!

This subbreddit is intended for all talk about the board game of Ascension and it's expansions. This also includes the video game. *[I do not own the rights to Ascension or its images/likeness.]* The official web store: *[© 2010-2011 Gary Games, Inc. All Rights Reserved.]*

2011.11.05 18:15 capnbozzy Freedom Earth - Creating a World that Works for Everyone

Freedom Earth is a community dedicated to consciousness development and free living. Our goal is to raise awareness about the problems that face our world, and work toward establishing a more healthy, conscious, and connected society.

2010.06.08 15:03 NippleNutz Your android related questions here.

The place to get help for questions you have related to your Android device and the Android ecosystem.

2023.05.28 18:01 Coffee_mug_Musings How many times should Melissa McCall been fired? Possible spoilers.

I LOVE Melissa and I adored her character, but I just finished the series last week and I was thinking about the sheer number of times she should have been fired!
This is a playful discussion, as I said I really enjoyed the character and the actress.
Here are my top 3 reasons that Melissa should have been fired:
She let her personal issues with Peter (granted I am not saying he's not an a*s) get in the way of his care (after he went through the hellfire/portal) she just straight up stabs his chest with a huge needle (It looked bigger than standard maybe an 18g?) and pumps him full of the 9 herbs after knowing it was going to put him in even more excruciating pain (after what Chris went through) This is a huge no. If you're in the medical field you cannot let personal experiences or feelings trump patient care and comfort.
She constantly gave other people including teenagers access to private medical records. "I shouldn't let you in..." **hands over the key**
She did medical procedures no R.N. has been trained to do in many cases. I've got clinical experience (a whole housefull of medical people including: paramedics, EMTs and nurses) and there were so many times I was like, "Hey, girl - you probably shouldn't be doing that..." Of course she saved the patient but it was alarming unless she had advanced degrees.
What's yours?
submitted by Coffee_mug_Musings to TeenWolf [link] [comments]

2023.05.28 16:26 Famous_Specialist_14 How to view ielts results online in different ways?

How to view ielts results online in different ways?

First of all, we should know how long it takes to get the IELTS results.
  • If you have given your IELTS test on the computer which is the CBT (computer-delivered test), your results will come after five or seven days of your test. When your results become available, your test centre will notify you, and you will receive a link to view your IELTS scores.
  • If you have given the PBT (paper-delivered test), your results will come after 13 days from the day you gave your last test. On the 13th day after your test date, they will announce the result on their official website. Therefore, If you need a fast result for the IELTS test, you can opt for IELTS CBT. To know more information about IELTS exam, visit this article The most 7 questions about IELTS
IELTS students or candidates do get confused or worried if their IELTS results are delayed or withheld. We will talk about a couple of reasons for that.
As we all know, it usually takes 13 days for a result to be delivered for a paper-based test, whereas for a computer-based test, it usually takes from 3 to 7 days. However, in both cases, the IELTS results could be delayed so why is that?
Your result may not be issued. You may wait 13 days after your test and your result will not be issued in the case the IELTS test partner decides that it is necessary to review any matter associated with your test to assist any investigation you may be required to provide a writing and speaking samples. However, it happens in exceptional circumstances and you can also be required to retake the IELTS test components but it happens quite rarely.
So, we can say that there are two main reasons for that.
  • One that they want to check your test again.
  • Secondly, they are doing quality control checks on how the test is managed that you have appeared in then.
  • Other reasons for your test cancellation could be that your test result may be canceled after it has been issued.
Get yourself prepared with an online private tutor.
You may be required to retake one or more IELTS components if any irregularity is identified; your results might be cancelled and you might need to take your test again or part of your test again if there are any problems with your test. Irregularity means that something in your test management was not usual or not acceptable. This also means that if any information or data provided from you or your agent to the Recognizing Organization has been altered in any way, your original test result will be cancelled. So be careful and provide the right information and only use reputable agents while booking your IELTS test.
  • Now, what can you do once your IELTS test result has been delayed? There is no fixed time limit for IELTS test results so just wait and be patient If your results have been delayed. Not all students receive their results within just one week or a couple of weeks, for some, it might be longer than a month or even three months. But usually, three months happen in a rare case where there is some kind of an issue with your test, test result, or the information you have provided at the time of registration.
However, can you take your test again?
  • Sure, you can take your test again in the meantime if you have not received your test result and once you have received the result of both the test, you can choose which one is the highest
  • and you can use that result as long as it has been accepted. It is recommended that if your results have been delayed, you just need to wait and be patient and it will email you if your results are withheld or cancelled. If you do not get this email, check your spam folder or contact the test center.
So now how to check our IELTS test results online?
Generally, for both CBT and PBT, you can check your results on the Test Taker Portal.
  • Log in to the Test Taker Portal to preview your results.
  • For 28 days, you will find IELTS results online but unfortunately could not be used as an official confirmation of your performance. Usually, when you apply for institutions of intent to travel abroad, you need original copies of your Test Report Form (TRF). They will not accept photocopies.
  • IELTS results will not be disclosed through email or over the phone, so you can collect a paper copy of your IELTS test score (TRF) from your local British Council centre 13 workdays after your paper-based test or 3-5 workdays after your computer-delivered test.
  • Whether you have taken a paper-based or a computer-delivered test the centre where you took the test can directly send the Test Report Form (TRF) to the institutions to which you are applying.
  • But you should make sure to give the full postal address of the institution you are applying to when you book your test.
submitted by Famous_Specialist_14 to fgywgduiA [link] [comments]

2023.05.28 09:12 O__OO_O_O_O Is this good for 2 months? I play around 30 mins a day.. (I get 1.5 billion cpc).

Is this good for 2 months? I play around 30 mins a day.. (I get 1.5 billion cpc). submitted by O__OO_O_O_O to CookieClicker [link] [comments]

2023.05.28 03:57 depmuls light spotting ??

im 13+5 and i just peed, wiped and saw light pink. ive also been cramping a bit today. i was just wondering if any of yall experienced the same thing and if everything was fine. i’d call my ob, but its 9pm, and i messaged on the patient portal, but it usually takes 2 days for them to answer. figured id ask here because google has a variety of answers that are either calming or worry-some lol
submitted by depmuls to pregnant [link] [comments]

2023.05.28 02:19 jbsfk DND 5E Online MST Game, Weekly, Saturdays, 8:30 pm, two campaign options (Either sandbox or Metroidvania-Style Play) - New players welcomed

I am a DM with about six years experience and after concluding a wonderful campaign of three years with another online group, I'm looking to start again. The game uses a combination of Roll20, Discord, and dndbeyond, voice only to start.
Once players are picked, we'll schedule a prompt session 0; ideal goal is to start one week from this posting. I'm itching to play.
The inciting adventure is a test play to determine if the group assembled wants to play beyond that.
Two options I want to gauge with the reddit audience:
Option A: Open-ended sandbox game, starting with the fall of an oppressive ruler over a continent. The world has opened up to two more continents, and the land now freed of an oppressive ruler with many sentient races scattered in diaspora or living outright underground, the land has become free real estate (obvious colonial themes, this scenario is very morally gray, if not dark gray, to the question of who has rights to the lands) - the party begins as people navigating this new world and picking sides. There are many evil groups and factions, but your enemy is who you choose, and generally in this world, the more problems you solve, the more you cause inadvertently. Pick your allies carefully, and your enemies even more so. If I had to name an inspiration for aspects of this, it'd probably be Dragon Age and Game of Thrones.
Option B: Metroidvania, survival, minor horror. What started as a mission to take down some bad mage-sort that you may have a grudge against, or you had an ulterior motive for taking this mission, goes wrong. You began working with one of the most powerful factions in the world, The Black Guard, and you see them get mowed down like nothing. Your target flees through a portal. You had to choose to follow or die. Now you are in some sort of demiplane... or is it? You're trapped. Magical doors bar you in some sort of prison... but fortune favors you and you escape. You are now in some sort of underground mega dungeon. Your goal is to find some important survivors, find your target, learn about what this place is and what is being planned with it, but most important of all... you need to get out of there. The inspirations here are Metroid, Hollow Knight, Resident Evil, Made in Abyss, and even Tears of the Kingdom.
Both adventures start at level 3. If you want to play, I'll give more detailed lore notes.
If you want to play, please message me or post here the following information:
Which Campaign you prefer and why you're drawn to it
What do you bring to the table... Why are you a good player?
A Character Concept (doesn't have to remotely resemble what you eventually use)
What are you hoping for in the Game
What you don't want to see in the game
An affirmation that day and time work
About me: My name is Josh. I'm 31 with a family of five. I am a busy dad. I work in education and have coached many youth activities including drama and speech (as well as starting a DND club once-upon-a-time). I am patient with new players. Saturday nights are my designated time for tabletop roleplaying games and that time is open. The inspirations listed above are some media I really enjoy.
DM Style: I play RAW. I am not an antagonistic DM and if I bend RAW, it's usually to your benefit. I seldom let Rule of Cool dictate things beyond what's realistic, but still allow for some aspects of that. My previous players have praised my campaigns for being good at incorporating backstories, having difficult-but-memorable encounters, and being filled with very fun lore. I am generally at my best with horror themes, but am fine outside of them. I like serious stories with the fun, silly side coming out through the characters.
This game will not have overt or descriptive sexual content. I prefer a diversity of age representation, if possible.
submitted by jbsfk to lfg [link] [comments]

2023.05.28 02:08 weekendpigeon What are Trace Ascites in Peritoneal Cavity and should I be concerned?

29 year old female. Went to ER yesterday due to appendicitis-like symptoms at 2 week post op appendectomy. Got a CT of abdomen and pelvis, bloodwork, and Urine tests. Doctor said it looked fine but this was before the test results had been finalized.
12 hours later tests became available on my patient portal and CT says normal but it does say “Peritoneal Cavity: Trace Ascites”. What is this and could this be as a result of my appendectomy? I had bad right-sided abdominal pain again today. I did a quick google search and most of what I found point to cirrhosis? I appreciate any input - thank you!
Here are my possibly abnormal results in case they are relevant:
CT Scan - Peritoneal Cavity: Trace Ascites
Blood - BUN: 20 mg/dL
Urine - Protein UA: 30 (1+) mg/dL Urine - Squamous Epithelial Cells, Urine Sed, Automated Count, Qual: Few/HPF Urine - Mucus, Ur Sed, QL, Automated Count: Present/HPF Urine - Amorphous Crystals, Urine Sediment, Automated Count, Qual: Few/HPF
submitted by weekendpigeon to AskDocs [link] [comments]

2023.05.28 00:42 tobirama66 Twilight Forest mod conflict

I don't know if this post would belong to this sub, but I am currently playing in a world with a friend and Twilight Forest portal isn't working.
We are running:
Twilight Forest 4.2.1468 TLSkinCape 1.30 GeckoLib 3.1.40 Forge 43.2.8 betterfpsdist mod 1.19.2-1.7 Gothic 1.0.0 SmartBrainLib 1.1 Age of Weapons Reforged 0.7.0 Journeymap 5.9.4 Advent of Ascension 1.19-2-3.6.13 Just Enough Items
Some might be irrelevant, but since IDK what isn't working I added all of them so if someone, anything that might help is useful information.
submitted by tobirama66 to Minecraft [link] [comments]

2023.05.27 23:44 Kylechs This is what my DUTCH Plus Test revealed.

For 3 years I've been dealing with Emotional Numbness and Sexual Dysfunction that all started after an intense and chronic episode of stress, depression, and anxiety. My emotions are blunted both positive and negative. I can't feel sexual arousal, desire, pleasure, or thoughts. I have erectile dysfunction and reduced sensitivity to my penis.
The emotional numbness and sexual dysfunction have been the most bothersome symptoms.
However other symptoms I've been having in addition to all of this are: brain fog, muscle tension, and a suppressed appetite.
I did the DUTCH Plus test that my Functional Medicine Practitioner ordered and this is what the results revealed:
1) High morning cortisol with decreased waking response decreases appropriately throughout the day
2) Estradiol (E2) above range
3) Estriol (E3) above range
4) Androsterone above range
5) Testosterone above range
6) 5b-androstanediol high end of range
7)Estrogen metabolism 2-OH to 2-MeOH 63.9%, 16-alpha 19.4%, 4-OH 16.7%
8) Saliva cortisone total above range
9) Saliva cortisol total within range
10) Pyroglutamate low end of range
11) Homovanillate low end of range
I just read this from the report on my patient portal. I follow up with the Nurse Practitioner in a few weeks. Could any of these results correlate with my symptoms?
submitted by Kylechs to anhedonia [link] [comments]

2023.05.27 23:29 remorseless_skeptic Do I have Schizophrenia?

Age: 41 Weight: 223lbs height: 5' 11"
Drugs taken: Effexor, Abilify, finasteride for balding. I'm also supposed to be taking a statin, but I've forgotten about it lately.
So my first indication that I might have something wrong with me related to schizophrenia was when I had a very stressful job. I felt like I was aware of what people were saying even though I had ear plugs in. I didn't know if I just had very good hearing or what, and I let it go. I was around 35 at the time.
When I was 36, I got kicked by a horse. My depression got very bad at the time, because I couldn't exercise, and I was fighting it too. I got sent to an orthopedic doctor to discuss surgery and he ended up hurting me severely. It seemed on purpose. At first I was in denial about it, but I knew he hurt me, and it just got worse and worse. I ended up in more pain than I'd ever been in in my life, and I was raging over it when my mental health fell apart completely. I couldn't even get out of bed. My leg wouldn't work. I think I passed out because I lost complete track of the first day. I thought I reported it as assault on the same day, but it was actually the next day. As I was going through this, I know I sent a lot of messages to my doctor on the patient portal, but I can't remember most of what I said at the time. I was just too screwed up. I went back to try to read over it and it all ended up getting deleted. It's a long story. I'll never know much of what happened. I don't know if it was to cover it all up or what. Maybe they just wanted me to let it go, or they were mad at me, and wanted to mess with me.
Anyway, from what I can remember, I was hearing voices all over the place. It was my doctors discussing me, my dad saying things I will never talk about, etc. It was a madhouse. I was extremely paranoid and thought the cops were after me, people were vandalizing my house, and a lot of other things like that I’ve forgotten now. My brain kept “resetting” like my awareness would come and go. It was very strange and I can’t really articulate it well. My house mate said she came in and observed my leg was swollen and I was asleep drenched in sweat. She also realized I needed fluids, since I had no come out for days, and tried to give me some. I do remember denying it. I don’t know why. It’s like I just had decided to die.
After 4-5 days I was finally able to stand on my messed up leg and got out of bed. I started confronting the things I was paranoid about, and I made a doctors appointment. They saw me the same day. I went in thinking I might have a knee infection and/or I might be dying. I had no idea. It was a very short appointment and the NP didn’t even look at my knee. She was more interested in my AH and paranoia. She prescribed me an antipsychotic that I went to go get, but my insurance hadn’t OKed it, so I went back home with nothing. I realized I hadn’t been drinking anything and drank a ton of milk. Aferwards, I felt I was doing much better with my paranoia and my AH subsided, but I still had some.
I was still extremely mad about the doctor hurting me, but I was trying to let it go. It’s a long story that doesn’t matter much in being able to tell what’s wrong with me, but I got into legal trouble being mad about it.
Some of the AH continued. Mostly right after I woke up. I would wake up to tons of voices all at once, but I could understand them all, which makes no sense. I didn’t really believe them or anything. I just found them annoying. Over time the AH changed. I stopped hearing it only when I woke up, and I started hearing it throughout the day. I wasn’t at all paranoid, however. It was a narrator saying what I believed to be guesses about what people, and even dogs, were thinking of me. I still didn’t believe it.
I went to a couple different psychiatrists and got prescribed various antipsychotics. They mostly didn’t seem to help, and had terrible side effects. I ended up on Zyprexa, which did help. It made me fat, however. I also had no motivation. After taking it for quite a while, I decided to do an experiment and titrated off to see if I still needed it. I was hoping I would lose weight and regain some motivation. I didn’t. I went for a month or two without any AH problems, and when they first started, I didn’t really care. I figured I could handle it because it was just mildly annoying anyway.
As my AH came back, it was all about all the legal trouble I got into, the doctor hurting me, etc. Apparently, the part of my mind that hears this nonsense is still very obsessed over it, even though I had mostly moved on. Anyway, it really started messing with me. Instead of being what I felt were guesses about what people were thinking of me, it was complex thoughts with unique identities. They don’t say stupid things like, “Kill yourself” or “Kill someone” etc. It has never been that. I am now 41 and this is what I’m experiencing. The voices are also hostile towards me and point out terrible things I’ve done that I never even remembered, etc. I’m not a terrible person, but they are things I’m ashamed of that I don’t really want to think about. They are also probably pretty normal. They were making me mildly paranoid so I went back on Zyprexa. I had a psychiatric appointment 3 days later and told her that I went back on my Zyprexa because the voices were messing with me. She asked me if I’d like to try Abilify and I ultimately agreed. It’s not working at all yet, however.
What disorder does all of this most fit? I’m looking for an expert… I know that most mental health professionals will be sure it’s a variety of things. I’ve heard a lot of different diagnoses. What is it really? What medications might you recommend?
Edit: I forgot to mention I do feel dead inside. I don't know if that's depression or evidence of schizophrenia.
submitted by remorseless_skeptic to AskDocs [link] [comments]

2023.05.27 21:36 lucasAK2004 Operation Snow Eagle: Chapter 12

This one took a bit longer to write, mostly because it's longer and I was working a bit on chapter 13 as well. I hope you guys enjoy. Criticism and grammar corrections are appreciated.

Chapter 12

Patrick stood in front of the large building that sat at the center of the compound. He guessed that it had to be at least three stories tall and had a large garage door that was wide enough to fit a small jet. Whatever sat inside was the biggest mystery about the Da’Kar, the question they had been asking since they were first found on Earth; How had these interlopers arrived here with seemingly century old technology? It was quite an amazing opportunity to be among the first humans to find out, so when he was given the opportunity he volunteered his squad.
The mission itself was fairly simple, accompany an envoy for a week in Da’Karen territory. Of course they weren’t alone, a squad of marines were assigned to the other diplomat plus a translator for each of them.
The twelve of them stood by in front of the large building, just waiting for the order to go in. Tanner especially seemed excited for what lay beyond, quite frankly they all were. Soon enough a familiar Da’Kar approached them, it was the one named Chilluukik; He was some kind of noble or scientist, Patrick didn’t really know which. “Goodmorning, it is a pleasure to meet all of you as well as see a few that I’ve previously met.” Chilluukkik said that last part while gesturing to Patrick and his squad.
Patrick's diplomat, a woman named Sophie shook Chilluukik’s hand softly and introduced herself. “Sophie Lacelle, and this gentleman right here is Edward Teach.” After Sophie, Edward also shook the Da’Kar’s hand. “And I am Chilluukik, I am the head scientist here at this outpost.”
The garage-like door proceeded to open and everyone was invited inside. The room seemed rather plain at first glance, typical storage-like barebones deal but Patrick noticed how the location was actually defended. Two fortified positions were built on each side where Da’Karan soldiers were entrenched. They seemed to have larger versions of the steam rifles usually seen with their other troops. These rifles were bolted down into the floor and attached to much larger tanks. With no cover possible, it would be like walking in front of a second world war German machine gun nest.
In between them, a reinforced metal door was the only other notable thing in the room. Chilluukik grabbed everyone's attention and made them all move to the side. The secondary metal door opened with a wince, metal grinding on metal, revealing an archway with an eerie blue glow emanating from it. Chilluukik stepped in front of the device and faced the group.
“Come, right this way.”
Without another word the Da’kar stepped through the archway, sinking into the blue hue and disappearing without a trace. A marine was the first to follow, leading his group through the archway. Patrick was close behind, he paused a moment before stepping into the haze. A strange sensation flowed over his body, as if he were submerged in water; instinctively he held his breath as he stepped through.
It took a moment or two for his eyes to adjust to the dim lighting but soon it was clear that he was no longer in the same room he was in just a moment ago. Cautiously he took a breath, the air was thin and stale. The room they were standing in was some kind of workshop, strange tools were placed haphazardly around and there seemed to be machines all around with many intricate gears. Chilluukkik stood patiently as everyone passed through the arch, once everyone was through he addressed the group.
"Welcome to Charsier, the capital city of the Da’Kar. You are currently standing in my lab where I spent many years developing that portal you just walked through."
Now everything about their sudden appearance on earth made sense, for all intents and purposes the Da'Kar really did appear out of thin air. Patrick's mental list of strange things that have happened in the past month or so just kept growing. At this point the idea of a portal let alone actually going through one barely phased him. Tanner however, was awestruck as he usually was when it came to dealing with the Da'Kar. At least someone was enthusiastic about this whole ordeal. Edward stepped forward and spoke.
"Are we currently underground? It's somewhat hard to breathe, and the air seems stuffy."
"Yes, Charsier is almost entirely carved out of a mountain. Most of the city is underground, only military personnel are permitted to surface on a normal basis." Chilluukkik answered.
Edward thought on that for a moment, he opened his mouth as if he was going to say something but he hesitated. Instead he settled with a single word response. “Impressive.”
Chilluukkik clasped his hands together and spoke before any other questions could be asked. “We best not waste time, there are a lot of things to do today. Mainly you are all going to meet the matriarch and the council, but first I would like to go over a few things that you must abide by. First and foremost the proper greeting especially to those in power should be a bow, we are not accustomed to the physical greeting that is your ‘handshake’. Second, as you are strangers to our land it is best to avoid interacting with the general populace to avoid creating any unintended offense. If you must, it is best that you consult your guide that each group will be assigned before interacting. Lastly, it is not recommended to stray away from your guide as many of our cities can be labyrinth-like and it can be very easy to get lost even if you become familiar with an area. Are there any questions before we move forward?”
The room fell silent, Chilluukik waited a few moments before continuing but no one spoke up. He awkwardly cleared his throat and spoke again.
“Excellent, follow me so we can get you all situated.”
Chilluukkik led the group out of the tight lab and onto some kind of underground street. There were a number of Da'Karen guards on a perimeter, blocking and redirecting any civilians trying to pass through. Surprisingly very few actually stopped to ogle at the group of strange beings, most were just content with minding their own business and going on with their day. Though the occasional glance was fairly common.
Patrick took note of how gloomy the atmosphere of the city felt. Perhaps it was just this section but everything seemed to be built for more practicality than any kind of visually pleasing architecture. Though Patrick supposed that maybe this city was quite beautiful to the Da'Kar. Dim, damp, and tight must be all the rage in that case. It wasn’t really the best explanation he could’ve come up with.
A tram sat in the middle of the street awaiting to transport them to a different location in the city. The group gathered infront of the tram and a guard opened one of the side doors, allowing everyone to file in. The step onto the tram was larger than strictly comfortable, of course it hadn’t been designed with a human’s smaller stature in mind. That being said the tram was quite roomy and comfortably fit everyone inside.
The sudden acceleration of the tram surprised Patrick, a few of them who weren’t paying attention even stumbled a bit at the impromptu movement. Their ride was short lived however, only lasting a minute or two. The sight that met them once they stepped off the tram put the previous tunnels to shame. Designs and patterns were carved into the walls, neatly trimmed moss adorned the ceiling, and there was nearly double the space. Chilluukik grabbed the attention of the group and stuck a hand out to a grandiose doorway.
“Welcome to the imperial palace! It is the largest single structure in the entire city. The palace holds all the council members and the matriarch as they all have to be ready at a moment’s notice in the case of a national emergency. It is also where you all will be staying while you are in Charsier. Unfortunately I must ask that all soldiers surrender their weapons to the armory while on palace grounds as only the royal guard may be armed in the building.”
“What’s the point of an armed escort if they can’t even be armed?” Edward grumbled. Sophie leaned over to the American diplomat to comment. “I’m sure the royal guard will offer plenty of protection. Besides, cooperation shows trust between our governments, no matter how little.” Chilluukik glanced at the two, their conversation wasn’t exactly quiet. Nonetheless Chilluukkik continued the tour, seeming to ignore Edward’s comment.
They were led into the building and took a hard left to a hallway with several armed guards. At the end of the hallway was a reinforced steel door where an older Da’Karen soldier waited. Chilluukkik exchanged a few words with him in their tongue before turning to the group, specifically addressing Patrick’s squad and the marines.
“This is Quarter Master Arluirik, he will be in charge of storing your weapons. Don’t worry, once you leave they will all be returned to you.”
Arluirik took a bow as soon as Chilluukik was finished speaking and approached Patrick. Patrick sighed and turned to his squad. “Condition four, drop flaks as well, there’s no reason for us to be all armored up right now.” Patrick’s squad began unloading their rifles and taking off their combat gear; However the marines opted to just give up their rifles. Arlurik and another Da’Kar collected the weapons before bringing them behind the steel door. As soon as the steel door was sealed, Chillukik began walking back to the main entrance to which everyone followed.
“It is time that you meet the matriarch, as she does not speak your language, I will act as your translator for this meeting.”
Sophie spoke up. “We do have our own translators. While your assistance is appreciated, it’s a bit redundant.”
Chilluukkik sighed, though Patrick couldn’t tell if it was from annoyance or maybe something else. Da’Karen mannerisms would be something he’d have to pick up on and learn, especially considering the circumstances. “I would prefer that I be the translator. I’m sure your translators are plenty proficient, however I personally want to make sure that there is no confusion or misunderstandings. She is the single most important Da’Kar after all.”
“We’d rather not step on your toes then, we’ll proceed how you wish.” Edward responded.
Chillukik stopped the group in the middle of the entrance hall, for a few moments they stood in awe of the structure around them. Several ornate pillars lined the walls, five gold crests hung high above an archway that was guarded by tens of soldiers, the floors were of polished marble, and the lights shone brighter than anywhere else they had seen in the city. Chilluukik moved the diplomats to the front of the group while everyone else stood behind them shoulder to shoulder.
Once everyone was in position, Chilluukik nodded towards one of the guards. A moment later, said guard shouted something causing all of the Da’Kar in the room to snap to attention. Both Patrick’s squad and the marines took the que, going to attention themselves. A figure flanked by two guards appeared in the archway, they slowly walked across the hall to the two diplomats. Patrick could only assume that she was the matriarch, as she was dressed in an extravagant gown and sitting atop her head was a gold crown encrusted with a single blue gem.
As soon as the matriarch got about a meter away from Chilluukik, he took a bow and stepped to the side. The matriarch then approached the diplomats and they exchanged bows. She spoke in her alien tongue and a moment later Chilluukkik spoke up with the translation.
“Welcome to Charsier, we are happy to have you here. I am Shilluukkik, if there is anything you need during your time here let me know. You are our honored guests.”
Sophie was the first to speak. “Thank you, it is an honor to meet you madam. I am Sophie Lacelle, the representative from the nation of Canada.”
“And I am Edward Teach from the United States of America. It’s a pleasure ma'am.”

Arluirik and his assistant placed the human weapons on the table. Most of them were similar to the ones obtained from the crashed flying machine, however one looked very different. It was considerably larger and even had a handlebar attached to the side of the barrel. Che’quea picked it up to inspect it, it was almost twice the weight of the other rifles. He noted that it shared a few similarities with the mounted gun they also had captured.
“Was there any trouble with them handing over their weapons, Arluirik?”
“No sir, a few of them even dropped off their armor.” Arluirik held up a helmet with the distinct human pattern on it. Che’quea placed down the weapon and grabbed the helmet. Despite its relatively small size, the helmet had some heft to it. Whatever strange material it was made of was very dense, though he doubted that it could stop very much in terms of projectiles. Che’quea ran his fingers across the fabric cover, it was unlike any cloth he had seen before and was very finely woven.
“I want a detailed sketch of this pattern, I believe it is some sort of camouflage. We won't be able to replicate the material but perhaps we can use this pattern.”
“Yes sir.”
Che’quea placed the helmet down and pointed to the large rifle. “I want that to be analyzed the best you can without damaging it, the humans should be busy for at least several hours so take your time and get every detail. Learn what you can about this equipment, I want a report before the day is over.”
“It will be done sir.” Arluirik saluted Che’quea then waved over several other officers and they got to work. No matter how the situation went with the humans they were going to get something out of it, even if it was a few drawings.

Yesterday played through Patrick’s mind. While at first he was amazed by all the things he saw and the people he met, it started to get menial after the first few introductions. The whole day was just a bunch of formalities that he just didn’t really care for. Meeting the council was the worst of it, he couldn’t even remember a single name there if his life depended on it. Near the end of the day the Americans had split off from them and they went to meet their guides. The one his group was assigned was a young Da’Kar by the name of Sruri.
Apparently she worked under Chilluukik for a time but decided to pursue a different career around the time the portal opened. Patrick didn’t know the details but it did make him wonder why she left. It wasn’t really his business, perhaps she just didn’t like being a scientist or whatever she did. When they first met here she seemed to be very reserved, only speaking a few words at a time. Now that the initial meeting was over and it was a new day she had opened up a bit.
The tram lurched to a stop, dragging Patrick from his thoughts. Wolf, their translator from the US air force, spoke up. “Sruri says that we’ve arrived.” Everyone stood up and filed out of the tram. They were deep within Charsier, the tight tunnels were almost suffocating. Crowds of Da’Kar stood next to a train stop, barely heeding the group of humans any attention. It reminded Patrick of human cities where everyone just wanted to mind their own business and get on with their day.
In fact, the only one who seemed interested in them was a child who couldn’t stop staring. Patrick gave the child a soft wave and smiled. The kid shyly hid behind what Patrick assumed to be one of their parents. He must have been a strange sight to them, perhaps he had scared the child by mistake. The supposed parent took notice and looked over at Patrick, as soon as their eyes met his the Da’Kar quickly looked away. It was strange, all the civilians seemed very jumpy whenever they were around. Patrick thought back to what Chilluukik had said about not interacting with people who weren’t directly involved with diplomatic proceedings. David leaned over and whispered to Patrick.
"I can’t say I like the kind of looks we’re getting.”
“It’s best to just ignore it. People will be people, alien or not.”
David leaned back and looked forward as the train pulled in. The doors opened and people started flowing in. By the time Patrick’s group had made their way inside, the train was completely packed. If he didn’t feel claustrophobic before, he certainly did now. A loud yelp sounded out quickly followed by Martin speaking quickly.
“Ah shit, I think I stepped on someone’s tail. Wolf tell them I'm sorry, it was an accident.”
Just as the door closed, Patrick got forcibly squeezed between Tanner and some poor Da’Kar. Any attempt from the civilians to avoid the humans was now futile, it was an uncomfortable situation for everyone. Hopefully it wasn’t going to be a very long train ride, Patrick was getting hot and he could only imagine how the Da’Kar felt with all that fur. After a few minutes, Patrick felt something tugging on his shirt. He turned his head to see a familiar Da’Kar child trying to get his attention. Curiosity must have gotten the better of them, they spoke something.
Patrick felt somewhat bad about not being able to understand or even reply to the kid in any meaningful way. He thought for a moment before ruffling through his pockets for something that might interest the kid. Patrick pulled out a pen and a notebook. He opened the notebook and showed the kid how it worked. The kid’s eyes widened as he saw Patrick draw a few lines. What really seemed to excite the kid was when he handed the items over so the kid could try it themselves. Patrick watched the kid draw to their heart’s content, it was something to take both of their minds off of the train ride and pass the time.
Before Patrick knew it, the train had begun to slow as they neared their destination. The kid’s tail drooped and he wore a disappointed look. Timidly, they went to hand the notebook and pen back but Patrick stopped them. Patrick gently pushed the items back to the kid who now seemed confused. “Keep it kid, I think you’ll enjoy it a lot more than me.” The kid took a few moments to process Patrick’s intent, when it finally clicked the kid jumped with glee and hugged Patrick. He got a few looks from the Da’Kar in the train, however they seemed more surprised than the sour glances they had previously been giving him.
“What did you do to make him so happy?” Tanner asked.
“Hearts and minds, I gave ‘em a little gift.” Patrick smiled back. The doors opened and the pressure was finally released. Stepping out of the train, Patrick noticed that the air wasn’t nearly as stale as it had been in Chasier. Every breath was almost fresh and refreshing. They had only been on that train for maybe thirty minutes, perhaps now they were closer to the surface. The train station here seemed a lot less packed as well, Patrick was thankful for that much at least.
“Wolf, could you please ask Sruri where we are now?” Sophie asked. Wolf relayed the translated question to Sruri to which she answered with a brief response.
“This city is called Strulkurig, apparently it’s a very important city to them.”
Initially, the city seemed very similar to Charsier; Long tunnels stretched for seemingly miles. However, after just a few minutes of walking they arrived at an opening to a gargantuan cavity. It was in the shape of a dome, reaching nearly a mile across. At the top there was a large hole leading all the way to the surface, and at the bottom was a lake that took up most of the cavity. The vast majority of the city seemed to be built into the walls of the cavern, only slightly built onto the lake itself. Large metal supports lined the walls, assumedly to ensure the structural integrity of the walls. The amount of engineering that went into all of this must have been immense.
Sruri began speaking and a moment later Wolf started with his translation. “Most of the cavern is natural, the location was ideal to provide a central water source to the other cities. In fact, eighty percent of the water the Da’Kar uses is sourced from this spring.”
“And how many cities draw their water from here?” Sophie asked.
“Nine, including Strulkurig. The reservoir is extremely deep and is naturally replenished via surrounding groundwater.”
Patrick could see how important that this city remained protected. If that water supply was contaminated or poisoned it would be catastrophic for the Da’Kar. The fact that they were allowed into Strulkurig at all showed quite a bit of trust. Though Patrick couldn’t help but think that all this openness was an effort to draw their attention from something else. All this effort to build their cities underground, and for what? The Da’Kar were hiding something, or perhaps they were hiding from something.
Their first stop of the day was a ration center. It looked like any other cafeteria from earth. though instead of a wide selection, premade rations were handed out. The amount of food per meal seemed like the bare minimum, just enough to survive on. Sruri walked over and grabbed one before showing it to the group. Wolf was quick with the translation, he seemed to be getting better at the language. “She says that this is a standard civilian ration, about one thousand calories and each person gets two per day. Each ration is carefully constructed to sustain the nutritional needs of the average Da’Kar adult. However, there is rarely enough for everyone. It’s not uncommon for them to turn down many when the day’s rations are depleted.”
Patrick looked to the line that extended out of the building, there was a concerning amount of children in that line waiting to get their rations. It made him uneasy knowing that many of those children wouldn’t even get to eat, especially the ones farther back in the line. It was already clear to Patrick that whatever the Da’Kar were going through, they needed the support from humanity. Tanner began to pull out some of his MRE’s but Patrick stopped him.
“Put it away, you can’t feed all of them. After this mission the supplies from the US will come in, then there’ll be enough for everyone.”
“What if they don’t make it that long? Half of these people are practically skin and bone.”
“There’s nothing we can do at the moment and I need you to be on your top game for the rest of this mission. Save your food for yourself.” Patrick commanded sternly.
Tanner begrudgingly stuffed the food back into his backpack. They were there for only a few more minutes before departing to their next location. Throughout the day they went from place to place, each looked more sorrowful than the last. What really broke Patrick was when he saw kids working in factories, they couldn’t be much older than the kid he met on the train. Patrick couldn’t imagine what could have led to the Da’Kar using these methods. They were either really desperate or had some really messed up morality. The one saving grace about it was that they seemed to take the kid’s safety as priority, having an adult supervisor watching over them constantly. Though, that still didn’t excuse child labor. If it was up to him, Patrick would give all the resources his country could offer to get these kids out of the factories.

Patrick laid in his bed, it had been almost an hour but he just couldn’t sleep. It was still pretty early in the morning but he figured that he wasn’t going to get much rest anyways. He slowly slipped out of the Da’Karen bed, it was large and square in shape. The one thing that made his stay in the Da’Kar world bearable, there was plenty of space to sleep. Patrick pulled on his uniform, making sure to be especially quiet as to not wake his squadmates.
The apartment building was just as quiet, it seemed like it was too early even for the Da’Kar. Patrick stepped outside, taking in the fresh morning air. Unlike most other Da’Karen cities, Khomtotm was mostly above ground. Patrick certainly wasn’t complaining, for almost a week they had been exclusively underground. He strolled down a street that had a thin layer of snow that had fallen throughout the night. The air was still and cold, if he closed his eyes he could almost imagine that he was back home. He walked until he arrived at an overlook that gave an amazing view of the relatively flat lands nestled by a massive mountain range.
Looking to the left, far in the distance, Patrick could just barely make out the structures Charsier. Panning right, he could see Strulkurig with its few surface buildings that surrounded the hole. Finally he looked over to the right towards Eathlond. Patrick had remembered that the Americans would be there today, as that was the last city they were going to visit. Patrick had to do a double take as he saw large black plumes of smoke emanating from the city.
He knew the Da’Kar relied heavily on steam but he had never seen steam engines produce that amount of exhaust. His heart began to pound as he thought he could identify several fires throughout the city. Patrick stepped away from the overlook and began walking back to the apartment building. Then as he thought more about what could be going on in Eathlond, he ran. It could be some kind of misinterpretation but he didn’t want to take that chance.

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submitted by lucasAK2004 to HFY [link] [comments]

2023.05.27 20:37 FairyDustSailor I might flip a table

I can’t even believe this shit.
I had developed new mets in my right lung. I also had some mets pop up in my left lung. Biopsy of a tumor on the right side showed it to be TNBC and I was put on Trodelvy.
I had a PET CT to see if the Trodelvy is working. The shit on the right side had shrunk. The shit on the left side had grown. WTF.
So doc sent me for a bronchoscopy to snatch some cells out of these spots on the left side. The pulmonary surgeon that did the scope also managed to snag a sample out of the pesky subcarinal lymph node that has shown activity.
The pathology report just posted to my patient portal. Non-small cell carcinoma, CK7 positive, CK20 negative.
I’m not a smoker. I used to smoke literally 2-3 cigarettes a day, but sometimes went months with no cigarettes, when I was in my early 20s.
What. The. Fuck. I know non-small cell is most common for people that didn’t smoke or were never daily smokers. It’s just not what I thought I was going to see. Then again, I probably shouldn’t be surprised by anything at this point. I had kidney mets two years ago and supposedly that pretty much never happens with breast cancer.
At least now I know why those spots aren’t responding to Trodelvy. Now I guess we have to add something or change treatments again.
submitted by FairyDustSailor to LivingWithMBC [link] [comments]

2023.05.27 20:13 Jupin210 [PI] Long ago, you tricked a demon into giving you immortality. Enraged, the demon placed a curse on you. Every door you walk through takes you to a different place, but never where you want to go. Several years later, you're just trying to get back home.

Original Prompt:
Feedback welcome!
— — — — —
“It has to work. Needs to work,” I said. I stared at the base of the contraption praying, hoping, pleading.
Things were never meant to turn out this way. Immortality… well the downsides were easy enough to anticipate. Crops had become poor in quality, famine and poverty had swept through our lands following the war. The once beautiful and peaceful Castelluccio had been reduced to barren grounds and abandoned homes. I’d lost most of my family, the ones I’d known at least. I still had a few friends alive, but they were not well. And thus the burden of living forever didn’t seem a heavy price to pay.
I looked around the open room. Storms raged outside. This was what I’d been waiting for.
The demon I had tricked had also placed a curse on me though, any doorway I walk through takes me somewhere I did not intend. I first tore down the doors of my home so I could come and go freely. I was cautious, but not paranoid by any means. I remember the first jump, I had woken up in the night for water and in going to refill the tank I stumbled through the main door instead of the usual broken hole in the wall near the back.
The dials spun rapidly, flickering back and forth in a heartbeat. Echoing thunder and whipping winds made it near impossible to hear the normally loud whirring that was emitted.
Once the first threshold had been crossed, that was it. I was in a completely unknown land, the people around me wore different clothes, they spoke a different language and no matter what I said or tried to do, it was lost on the locals. Like a ghost living in the world of the living, I felt hopeless. I felt alone. So I went through another door. If the first jump set the wheel in motion, well then the second jump set the gauge to top speed.
The green lights along the side lit up one by one. The last step was to wait. Even after years, decades probably of optimizing, we needed a little nudge to get it going.
It had taken some experimentation to see what counted as a door. The classic handle or knob that you turn to then pull or push a door open obviously counted. I turned out that so too did sliding doors, revolving doors, and doors that required the push of a button to open. However, if more than roughly a third was removed or it had no frame, it could be considered a gate, or even simply a gap to be traversed and no longer a door. Pathways with streamers hanging down from the top were fair game and so were some larger entrances when kept open for long periods of time. I was never completely sure, but I suspected it had to do with how it was perceived by those around it.
The winds picked up, it was almost time. “You’re sure about this aren’t you, Edith? You bloody well better be, there’s no second chances here.” Thomas shouted. I was ready, it was what I’d been waiting for.
I had wanted to return home, but misguidedly jumped through every door I could. I didn’t care about where I was, when I was, who I was. I just wanted to go home. The thing about a “home,” however is that it is tied to who you are. Tied to your own identity. What I didn’t realize was that with each jump, I lost a little bit of that, left it behind. And no this wasn’t part of the curse or anything, it was just my own deterioration. Eventually my fixations warped my motives and I was no longer trying to return home. I didn’t stay long enough to identify my surroundings, just long enough to find the next door. It didn’t matter where I was, the only thing that mattered was another jump, racking up the count like on a scoreboard. I was immortal you see, so while I felt pain, it didn’t slow me and so obsession and pain fused together.
“There’s no way we could know, regardless,” I cried back. “This is the best shot I’ll have, it’s what I’ve been waiting for!”
I still remember the feeling of shock and withdrawal that rippled through me as I tumbled out of a doorway landing on hard ground padded lightly by a layer of grass. I turned around to find a lone, tall wooden barn collapsing from a house fire. It was the only building sight. I tried to go through the burning door anyway, but it was Thomas and his mother that pulled me back. I fought them off, but I was weak. They had to rebuild from scratch, and I had no where else to go. It took many years for me to learn to live again, and even then I never returned to who I once was. Thomas was in his early teens at the time and spoke my mother tongue and realized I could continue on here, no longer needing to jump.
Lightning cracked overhead hitting one of the many rods Thomas and I had installed. The wires glowed a faint orange. The rest of the lights turned yellow, then green as each stage came online.
Thomas’ mother was a woodworker and Thomas himself was a genius child prodigy in science. Together they built a functional door replacement that I could traverse through safely and renovated a house to allow for me to live without risk of accidentally jumping through space. Over time I met the local community, I went to markets and joined in festivities, making sure to steer clear of doors. I made new friends and picked up hobbies. While I never explained my curse to either of them, Thomas and his mother raised me as one of their family. Thomas, the bright and upbeat scientist he was, would teach me the things he studied and learned, and his mother got me to help with woodworking.
Arcs of electricity snaked their way up the walls of the portal, lighting up the chamber ceiling. They reached the top completing the circuit.
I had been happy. And yet, I was still cursed. This time it was immortality that came back to bite me. Thomas’ mother had been getting old and sick. She had held up her spirits right until the end when one morning she didn’t rise. The doctors said it was heart disease and that even if they’d caught it sooner, there wouldn’t have been much to be done. Whatever mourning I felt, I knew it had to have been crushing for Thomas. With his effervescence gone was no longer the same energetic boy that had once pulled me from that burning barn. Nothing could pull his mind from his own grief, his own fixation. I was his slow decent, and reminiscent of my own downfall. He mumbled of older, better times. He murmured of days hiking with his mother, of watching her build, and him chiming in with his own design improvements. What I hadn’t expected, was for my own yearning of returning home to reawaken. I didn’t know if it was possible, or if upon reaching Castelluccio it would even be the same place I left… but seeing Thomas like this, well I now knew where I had to go.
I stepped up to the portal. One final system had to activate before it would be ready. I felt cold, shivers resonated within me, tears welled in my eyes, neither were from the chilled air, snapping wind or whipping rain though.
Nikos Kazantzakis once wrote “The only way to save yourself is to endeavor to save others.” When I finally felt it was time, I told Thomas everything. We had been sitting next a warm fire on a clear night as I detailed my journey. Not sure if he was even listening I started getting into the smaller details. I told him of my own parents, and my older brother. All of whom died in a war. I told Thomas of my deal with a demon, of my fears and my submersion into irrationality. I told him of my wish to return home. He waited patiently the whole time, until finally I was done. When all was quiet except the crackling of the fire, he nodded his head. He studied curses and read accounts of spells and magic tombs. I learned everything I could on modern electronics. We spent years building a machine that could that read my cosmic footprint and detect where my home was and create a portal there for my return. I will not try to say I did this to save Thomas from himself, because I did not. I wanted to return to my homeland, but as a side effect, it gave Thomas the purpose he needed.
Everything was ready. It was time. It was what I’d been waiting for. I turned back to Thomas. I stared him in the eyes through vision blurred by tears. “I’ll never forget you, Thomas. Truly,” I said. He knew exactly what I meant and I felt the last dozen years of his life flood through me. “You as well Edith. You saved me. Now do what you have to do.” I gave Thomas one final hug and turned, stepping through the portal without looking back.
I emerged in the late evening, to a town both familiar and distant. Everywhere I looked it was exactly as I remembered it, but somehow as a whole it was much smaller than I remembered. I returned not only to the place I had left behind, but also the time I had left behind. The fields and grass were still barren. The community was a resigned shadow of what it had once been. I sat down and cried. This was what I had been waiting for… but was it what I wanted? I thought this was the right thing to do, and maybe it was, but not for me. I was no longer the person I was when I left. I didn’t belong back with Thomas, I needed to return, but I didn’t belong here either. I realized then, that the path I took, the journey of returning to Castelluccio was what mattered. I thought once more of Nikos Kazantzakis “The only way to save yourself is to endeavor to save others.”
submitted by Jupin210 to WritingPrompts [link] [comments]

2023.05.27 18:03 martusameri How To Start Your Own Practice And Not Be Burned Out By PT Anymore.

I see a lot of frustrated posts by PTs about low salaries/too high of a caseload etc. so I thought I'd post some advice for starting your own practice because I truly believe that is the largely the way forward for our profession as a whole.

All that negativity about shitty companies taking advantage of new grads etc. is completely valid...there are a lot of shitty companies in our field that focus on quantity not quality. I hope I can help some people see that it doesn't have to be that way and that there are other options.
Some background on my practice: I run a small practice (myself, 2 part-time 1099 PTs, and a part-time administrator) in an urban area and I've been in business for 2.5 years. My practice isn't perfect, it's not the end-goal for me, but I take every other Friday off, I treat no more than 10 patients a day, it's all 1:1 care for 60 minutes and I take home about $120K/year pre-tax and I pay my 1099 contractors above going rate. I also take Medicare, I take Carefirst (which is the largest payer in the area) and I accept out-of-network patients from Cigna/United etc. My practice isn't in a big space with lots of overhead. I rent 2 rooms in a community center (very affordable) and furnished the equipment there myself (Crossover symmetry bands, adjustable dumbbells up to 50# each, infinity bands, table, a barbell and some bumper plates...and a few other things...there is a knee extension downstairs and some cardio equipment in the community center) Again, it's not the flashiest clinic and it doesn't have everything I want but it gets the job done.

Advice...I am just one guy with no business training, no mentorship and no business background that did this myself during the pandemic when I couldn't get a job anywhere. It's probably not the perfect runway to success but it's my experience and I hope it's helpful.
**Making your exit**
If you're currently working OP and want to run your own clinic in OP but are afraid of your shouldn't be. They are largely unenforceable legally speaking (they can't stop you from making a living where you live) especially if you don't *actively* solicit your patients to leave and follow you...if they choose to follow you though...who are you to stop them from seeking out care they want? However, if you're uncomfortable with that...then leave your OP job and go work in-patient or better yet, work 2-3 PRN inpatient jobs or homehealth jobs (depending on how many shifts you want.) They pay well and they won't conflict with your OP practice once you get started. I personally like the PRN route becausae you can start dropping PRN shifts as your personal practice gets more popular. That way, you keep your income coming in and it's not as big of a risk as leaving your OP practice all together and starting with nothing. From personal experience...that is very stressful.
*I didn't get to do this route because again, I started in the pandemic with no job. However, if I had to start over again, the PRN route is what I would do.

**Establish LLC**
Some people prefer S-Corp. My understanding is it may be beneficial over an LLC down the road when you're making decent money but it's more complicated and requires more paperwork and that's not what you need right now. An LLC is easy. Just search your state and establish LLC and you can likely make one online in like 30 minutes for $150. You'll get a tax-ID number and once you have that you're ready to rock.

**Open business bank account**
You'll need your tax-ID number for your business. You need a separate account so insurance companies can send you money for your services. Open a bank account for your business and you're off to the races.

**Finding a space.**
I initally worked out of an amazing gym and it was VERY hard to build a caseload because there was no parking and it was in a busy area of downtown so rush hour traffic was awful. Don't make that mistake. Prioritize the following: easy to get to...easy rent. That is what you want. Easy to get to...easy rent. You don't need a massive storefront ATI lease when you're starting out on your own. Look at community centers...consider renting space from a gym (as long as it fits into those three rules).
*Easy parking. Easy to get to. Cheap rent.
-Try not to pay >$700/month for your space if it's just 1 office room.
-It doesn't need to be big. The most effective part of PT is 1:1 time, your hands, your knowledge, your rapport with the patient, your ability to diagnose and treat what they have going on...flashy equipment is nice but it's expensive and when you're starting don't need expensive thing :)
- Don't do a percentage of revenue (or if you do, put a very short term on 3-4 months just to help you get going.) Even if you only pay $15/session...once you are seeing 15 sessions a week suddenly you're paying $1,000/month for rent. Don't sacrifice your long-term success for short term comfort.
***********ADDED: Do not be afraid of the big PT companies. I set up shop DIRECTLY across the street from both a Pivot and an ATI because the space fit the three rules above. Pivot is a little hidden within the large building across the street but ATI has a storefront presence you can see from the road and I do not...I'm hidden within a community center across the street. On paper that sounds pretty bad. They are both within 100 meters of my clinic and I do not care. I couldn't handle the ATI volume if it came my way anyways. My schedule is full of people that specfically *do not want* the high volume PT experience. The space fit the rules above and I didn't let the larger companies scare me away.
So this is a big you take it?
-Medicare: I would highly recommend taking Medicare...and just pay someone a few hundred dollars to get you set up...don't bother doing it yourself. Medicare patients love and need physical therapy...Medicare typically pays pretty decent ($100-$115/session at 4 codes in 54 minutes.) Also, these patients typically come to PT in the hours that are typically slow (11am-3pm) and they are an easy demographic to market to because they don't typically have to pay for care. It can take a month or 2 to get set up with Medicare so start the process right away once you find a space (even if you haven't started treating there yet, you can get the ball rolling with Medicare once you signed a lease/rental agreement.)
-In-Network Private Insurance: By using Google you can typically find the marketshare of different insurance companies in your area (for example, how many people have Carefirst versus Cigna etc.) I google searched my city and that healthcare insurance marketshare and eventually found the answer. If 10% of people have Cigna and Cigna sucks (which they do) then don't waste your time taking them right can take them later if you want (probably don't though.) Once you know who are the big dogs in your area...look up their fee schedules for physical therapy codes and see if they are worth your time. Sometimes this can be challenging to do. You sometimes need to start the credentialling process to see the numbers...once you get the numbers from can always decline and not sign the contract. I'd say if they pay less than $90/session you probably can't be in-network with them if you're treating 1:1 for an hour. can bill 5 codes/hour with private insurance (AMA) if they aren't following Medicare rules. Medicare is 4 codes in an hour (54 minutes.)
-Authorizations: You do need to understand and take the time to know which plans require authorization. Call the insurance companies to get the answers if you can. For instance, in my area...anyone with a Carefirst plan that starts with MYY needs an auth. I missed that a couple times and ended up treating people for free :/ that'll happen but try to minimize it when you're starting out.
- Out of Network Private Insurance: Great option here. Out of network insurances will typically pay $140-160+/session. I am out of network with Cigna/United/AETNA because their in-network rates are laughable/depressing (still haven't figured out which....maybe both???) Yes it means it's a bit harder sell because patients have to use their out-of-network benefits and typically have a deductible but oftentimes patients do see the value of 1:1 care and they are willing to pay cash-rates for a short period of time until they hit their deductible and their insurance starts to cover some of the care.
So in overview...I'm in-network with Medicare and Carefirst (Carefirst has 80% marketshare in my area) and OON with Cigna/AETNA/United. I wanted to take Medicaid but I can't because it's illegal to charge a cancellation fee for this group. Since I treat patients 1:1...unfortunately I can't afford to just have cancellations that I don't charge for. It really sucks and I wish this wasn't the case but that's the system we live in right now.
My reimbursement breakdown is the following:
Medicare pays me about $105-115/session, maybe around $130/eval.
Carefirst pays about $95/session (just barely what I need to run the business)
Cash patients: $150/eval $135 treatment
OON patients: Around $140-160/session

Don't do it yourself. Just don't do it. Don't do it. I'm highly recommending you don't do it. Please don't do it. You will hate your life and be bad at it. I use a company called Big Sky Billing. They work with people just starting up and they also work with large companies. They charge me 5% of whatever I get reimbursed by insurance and that is well worth the time of not calling insurance companies, resubmitting when I forget a modifier etc...following up on late reimbursement etc etc etc. They also helped me understand out of network billing. They are wonderful. I highly recommend you do not do your own billing.
Don't try to do everything. You are good at treating people. Outsource the things you're bad at it. You're bad at billing.
Set up your own google gmail with your company [[email protected]](mailto:[email protected])
I use a google voice number so I have a separate line for my business that people call and it rings on my cell phone. It's cheap and easy.

You may not need an admin from the start. I didn't use one till I was seeing 20 sessions/week and it really freed me up to start seeing more people. The main benefit of admin is that someone answers the phones, they do your auth's, they check and verify people's insurance benefits and they can also do scheduling. I recommend finding someone that wants to just work part-time and be a 1099...for instance, a stay-at-home parent who only wants like 10-15 hours/week is perfect.
Okay so you have your are in the process of have a biller set the heck do you get patients? What you do have right now is time. So wield it. Contact community centers around you, gyms around you and offer to give a 45 minute workshop on something...falls risk prevention for the older folks, the importance of strength training (and how to do it) for our older folks...easy tips for treating back pain...make flyers on Canva and post those things EVERYWHERE...go into coffee shops...gyms...whatever just leave them wherever you can..
Google My Business: Most important thing you can do. Most patients don't want to go far so they google "PT near me" and then that little map comes up on Google maps with the pins. Google My Business is how you put your pin on that map. It's freaking free and it's the best marketing. Make sure you fill out the whole profile (rank will be better.) Then, once you discharge patients...MAKE SURE YOU ASK FOR REVIEWS. It feels awkward at first but you have to do it. Patients read reviews to figure out where to go. I email them something like the following after discharge: Hey X once again it was great to see you and I'm so happy you're feeling better and doing so well. If you're open to it, there are two or three amazing ways you can help a small business. 1) Writing a google a review (link here)...patients often don't know the difference between PTs or where to go and reading about your experience will literally make all the difference in who they seek out for is also just incredibly helpful for a small business in getting the name out ahead of some of the larger corporations. Second - if you have a portal where you can drop a line to your doc...they don't know the difference between where people can get PT...hearing about your experience with me can actually literally change who they refer patietns to in the future. Thirdly...simply just mentioning your experience to your friends and family is hugely helpful. Of course, please don't feel any obligation to do this. I hope whenever you're around you feel comfortable popping in and saying hi! It's always great to see familiar friendly faces and I love hearing how you're doing. Wishing you well.
Website: Don't worry about SEO. I'll probably get crucified for this but you just can't compete with the big companies pouring money into it. You're not going to rank in the first page on Google anytime soon. Don't waste your money on it (at least for now.) You want a website that looks nice and is up so that when people find you (through more organic means) they can go to your website and see that you're legit. I use squarespace. It's super easy...pretty affordable and looks good.
Social media: Make an account and start posting. Post on NextDoor and whatever apps you can. Don't sound desperate (nobody wants to go see someone who is desperate for patients) just announce your services and that you're looking forward to contributing to the community.
Docs: Don't buy them lunches. Don't do that. They often don't care and they won't refer you many people but it IS Helpful to go to their offices...just don't spend a ton of time and money on them. Go there, find the names of the docs...go to the front desk and say something like the following: Hey there - I'm a new PT in the area and I've worked with a few of Dr. X's patients...I just wanted to drop off some more cards for them to help with their PT they have an administrative assistant I could chat with for a moment?" Sometimes you get to talk to them sometimes you don't. Either way, your cards are now in their office. Some of those visits won't lead to any patients but some of them will. Once you get a patient from them...make sure to fax the progress note and maybe even drop by the office with a hand-written note saying "thank you for sending over X (even if they didn't an the patient just found you mindful of HIPAA don't use the full name) we are working on xyz and they're doing better already...I look forward to working more with you in the future, here's my direct line if you have any questions" and sign your name/numbeemail. I got this tip from a friend and i'ts very helpful.
Gyms: Go talk to the owner or manager. Let them know you're a new PT in the are and you're looking for a good gym to send your patients to. This will make them very happy. Ask about their trainers...who is good with working with older adults? Who likes athletes? Show interest in who would be best for your patients...THEN ACTUALLY REFER YOUR PATIENTS TO THEM and when you do, make sure you ping the patient to let them know to tell the manager that you worked with them and recommended they go there. They will now think of you when they have people in pain. The more you give, the more you will get in return.

**Paying PTs**
In the future I plan on hiring W2s and having full time PTs. But honestly, that's a bit much for me to wrap my head around right now. I have a toddler and things are busy enough without all the complications that go into W2 hiring. I decided to start small, hiring 1099 contractors and paying about $50/hour. I used Square to pay them and it was incredibly simple. Write up a contract (or now you can probably have ChatGPT do it and then have a lawyer look over it) get their info and put it into Square and then you can now pay them for their time. I pay them per risk because you're only paying out money when you have money coming in (although yes it can take a while for insurance to pay you but typically it's like 4-6 weeks.)
**Wrap up**

Yeah that's a fair amount. I just kind of wrote this off the top of my head because honestly, there is a lot of negativity in this channel and I hope that maybe we can turn some of that around. This list isn't everything... but it's a large part of it. I really think the future of our profession hinges on how many of us are willing to be independent providers and not work for big corporate mills. I cannot tell you how many patients see us and are so thankful to just have 1:1 attention. It makes such a difference in their outcomes and how you're able to change their life and relationship to their body.
I'm just a guy who came out of school in February 2020. Turns out...really bad time to start looking for a job. No business background, no family in business, no mentoring, no training. Just figuring shit out because I literally had no other option. It felt like drinking out of a firehose at first. I had a baby on the way and no job and no money coming in. Really not great. I don't say that to brag. I say it because if I had any other option at the time I would have jumped on it and probably been really unhappy with a low paying high volume job but I would have justified it because of the security it provided me. I would never have started down this path if I had another option because I was too afraid of what went into running a business and I doubted my own capacity. Now, I am so happy I did what I did and I would never go back to working for a big company. The way I did this is not the only way to do it..some of you probably have better ideas..but I do think it's a pretty decent one and it's approachable for those who don't know what the heck they are doing. Or at least I hope it is.
DM me for questions. Happy to help out.

You can absolutely do this and I hope you do.
submitted by martusameri to physicaltherapy [link] [comments]

2023.05.27 16:56 Nopani Cleared out the orc horde on impossible... oh yes.

submitted by Nopani to TheresmoreGame [link] [comments]

2023.05.27 11:13 SyracuseStan Is my doctor, insane? Atomoxetine?

tl;dr: I've asked repeatedly about changing my medication because my Armodafinil/Modafinil prescriptions have mental side effects. The doctor won't prescribe Adderall, because "the treatment shouldn't change the patient's personality", while she's ignoring everything I'm telling her. Two appointments and an "emergency " portal message, which took her 4 days to answer, she recommends Strattera, which seemed okay until I searched for the genetic name Atomoxetine. It might be good she waited until it was too late on the Friday assignment of a holiday weekend to reply. This stuff can cause fatigue, drowsiness, or insomnia. ANGER, motivation, lack of motivation, lack of an erection, or priapism. Hypertension is apparently an issue with it, another reason she gave for not prescribing Adderall. While it may seem like I'm jonesing for Adderall, I don't like the effects of that either, I used to break my tablets in quarters, and I'm literally asking about the minimum dose in XR.
*Backstory: A few months ago Adderall was hard to get, and my center KEPT trying to give me appointments with its new doctor. The new doctor gave me both Armodafinil and modafinil. It keeps me awake really good, however it saps everything. I'm bored and have little motivation to do anything I used to. I'll even start things and become nihilistic partway through and quit, even sex. Her first suggestion was Xyrem. I'm old and have to go to the bathroom a couple times a night so I'm not thrilled with that. Next solution was just to reduce the Armodafinil, because I'm in so much it's not as effective 🤨 the big issue is modafinil making me intolerant. I can feel it building, know it's a problem, and sometimes mitigate it. Once it kicks in then it becomes "they're fucking assholes, they deserve this shit". Many days I've frantically waited for the office to open to call about changing medication only to have it kick in and not because it's "no longer a problem". She had some issue with Adderall and will not prescribe it, I've asked 3 times for a low dose which I know cuts back on these side effects, maybe I just became used to it after over a year on it. The intake nurse at the center, also a patient, which mentioned that because she's never seen anyone on both Armodafinil and Modafinil, confirmed she doesn't give Adderall. So main story... *
submitted by SyracuseStan to idiopathichypersomnia [link] [comments]

2023.05.27 07:10 Proletlariet Baymax Saved


"Hello, I am Baymax, your personal healthcare companion"
Baymax is a healthcare robot created by Tadashi Hamada, a student at the San Fransokyo Institute of Technology. After Tadashi’s death, Baymax took Hiro, Tadashi’s younger brother, as his primary patient. When Hiro decided to build gear to become a superhero and bring the man who caused Tadashi’s death to justice, Baymax joined him, along with Tadashi’s former classmates, to become Big Hero 6, San Fransokyo’s premier superhero team.
According to side material, Baymax is 6’ 2" normally and 6’ 5" in the armor, though he sometimes seems to be larger than that.
Hover over the feat for the source. This is the list I’m using for the episodes.



Rocket Fist







Ultra Armor



Rocket Fist






Medical Usage

Medical Tools

Knowledge Database

Misc Functions

Overdrive Mode




"I cannot deactivate until you say you are satisfied with your care"
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2023.05.27 05:54 Kylechs This is what my DUTCH Plus Test revealed.

For 3 years I've been dealing with Emotional Numbness and Sexual Dysfunction that all started after an intense and chronic episode of stress, depression, and anxiety. My emotions are blunted both positive and negative. I can't feel sexual arousal, desire, pleasure, or thoughts. I have erectile dysfunction and reduced sensitivity to my penis.
The emotional numbness and sexual dysfunction have been the most bothersome symptoms.
However other symptoms I've been having in addition to all of this are: brain fog, muscle tension, and a suppressed appetite.
I did the DUTCH Plus test that my Functional Medicine Practitioner ordered and this is what the results revealed:
1) High morning cortisol with decreased waking response decreases appropriately throughout the day
2) Estradiol (E2) above range
3) Estriol (E3) above range
4) Androsterone above range
5) Testosterone above range
6) 5b-androstanediol high end of range
7)Estrogen metabolism 2-OH to 2-MeOH 63.9%, 16-alpha 19.4%, 4-OH 16.7%
8) Saliva cortisone total above range
9) Saliva cortisol total within range
10) Pyroglutamate low end of range
11) Homovanillate low end of range
I just read this from the report on my patient portal. I follow up with the Nurse Practitioner in a few weeks. Could any of these results correlate with my symptoms?
submitted by Kylechs to FunctionalMedicine [link] [comments]

2023.05.27 04:04 petitelegit NYU Langone Post-Covid / Long Covid Clinic Experience - from OG 2020 Longhauler

Hi! March 2020 longhauler still here, still queer, still very much not okay, and, after a long posting hiatus, I thought I would crawl out of my humid cave for a sec to offer a firsthand account from the NYU Langone Post-Covid clinic in case anyone is wondering.
Tl;dr: While your mileage may vary, I just went and was pleasantly surprised. Based on the care I've gotten in my long haul tenure, my expectations were in the toilet and I fully anticipated this being a total waste of time, but was glad I went. I'm still managing my expectations; it remains to be seen whether I can endure repeated trips into the city and whether anything actionable will come of them. But so far I'm experiencing a higher quality of care than what I was getting including feeling heard and validated and having my care considered holistically (in the sense of the whole person and all body systems and medical issues informing each other) and coordinated in a way that relieves of some of the burden on my end and thus would recommend them to anyone.
I landed on NYU Post-Covid after hearing good things, hearing disappointing things about OTHER post-covid clinics from other longhauler friends, and having NYU recommended to me by my dentist. They accepted my insurance and my copay was same as a specialist visit. I took their soonest appointment which was several months out but, unprompted, they actually called me to let me know they had a cancellation and offered sooner availability (kind of unheard of.) As is often the case, they send you emails beforehand inviting you to get set up in the patient portal and fill out an extensive pre-visit questionnaire. The first appointment was an in-person intake with a Nurse Practitioner. The building seemed new and upscale, and I was surprised to be one of very few people in the waiting area. The receptionist was kind and accommodating when I needed to sit and use an iPad rather than standing to sign the forms they were asking for. The NP spent an hour with me, took vitals and a thorough medical history (including symptoms during acute infection vs. persisting issues), answered all my questions, made several referrals (cardiology, neurology, rheumatology, ob/gyn, psychology, pulmonology, and rehab/PT), and ran bloodwork at the end (including labs I asked about/requested) right down the hall. They asked if I drove myself there (I couldn't) and, knowing that I don't live in the city and the travel was taxing on my system, without my asking, they offered to try to minimize in-person demands (trying to make specialist appointments virtual or at locations closer to me when humanly possible.) They said they would try to maximize efficiency for the times I did need to come in, so for example, helped coordinate two in-person appts on the same day when I need to return in July for a Pulmonary Function Test and to see a resident doc.
They set expectations at the beginning of the appointment by communicating that long covid is still something they're learning about, but went out of their way to tell me, "you're not crazy" and that they are seeing other OG long haulers with issues similar to mine. After what we've been through, a little validation goes a long way. I asked about a wheelchair fully expecting they would refer me back to my primary about this, and when they asked very matter-of-factly why I needed one, I felt myself tense up a bit - the PTSD from the medical gaslighting is real - but she listened thoughtfully to my explanation and without hesitation responded, "we'll order one to your house." I could have cried. She worked with me to decide which type of chair would be best and put the order in on the spot. The med supply company contacted me same day (though my insurance found a way to ruin it, but that is a story for another day.)
My NP patiently answered all my questions and added some labs I brought up to the standard bloodwork, which was done down the hall by a lovely phlebotomist who was good at her job and expressed compassion for what we go through. I got the results within hours in the patient portal, which is mercifully clear and, save for a minor snag, easy to use, unlike my usual medical group's patient portal, which was apparently designed by deranged chimpanzees. Today I had to follow up because the handful of specialists they referred me to were supposed to reach out to me within the week, but I hadn't heard yet. Once I did that, the person I spoke to said she just messaged every single one reminding them to reach out, and I got a call from one within a couple hours.
The last piece of this that excites me is - they said when I return in person for my appointment with one of the residents, they will likely invite me to participate in research studies if I'm interested.
To sum it up: I found them overall to be helpful, responsive, and compassionate, and I'm cautiously optimistic. They are busy and human and this is not a panacea; you may run into some of the same bureaucratic issues and inconveniences that arise at other practices (ie. long wait times for appointments, having to follow up on things) but you also may experience a higher quality of care and/or the revelation of being truly heard by people who believe you, have seen others like you, and who've chosen to devote themselves to this cursed disease. They seem to get that bedside manner and care coordination are important parts of the equation for us, and that meant a lot to me. The rest remains to be seen! I'll do my best to provide some updates when I can. Love to you all. *slithers back into bottomless abyss*
submitted by petitelegit to covidlonghaulers [link] [comments]

2023.05.27 00:07 ralo_ramone An Otherworldly Scholar [LitRPG, Isekai] - Chapter 5

Ienus Rob, einus Elincia,” I said under the attentive glance of Elincia’s emerald eyes. I am Rob, you are Elincia.
Elincia nodded across the campfire and a smile of satisfaction tugged at her lips. Her features had a strange timeless look to them that made me doubt her age. Her skin was smooth and fair, yet, her smart eyes were wise beyond her apparent age. Ultimately, my lack of vocabulary and the memories of my mother’s chancla prevented me from asking.
Eique nus?” I asked, hesitantly.
“Elincia,” she answered.
Ieque nus?” I asked again.
Elincia clapped exactly two times, a gesture I quickly recognized as some sort of unspoken ‘good job’. It was funny that Elincia celebrated even the smallest of my successes. Kind of cute even. If I had to venture a guess, she had already worked with small children before. Maybe she had a little sibling, or a child.
Conditions fulfilled.
You have obtained a new skill.
Scholar unique skill [Master of Languages] acquired.
As always, the System prompt startled me. My brain was once again kneaded like dough and stretched like noodles, to the point I was about to lose balance. The sensation receded after an instant and I found a mint grammatical framework carved into my brain. Common. I couldn’t speak it because my inner dictionary was empty but strangely enough, I knew how to arrange sentences.
New mental note; ask Elincia if everyone in this world felt the same after learning a new skill. As far as it didn’t leave permanent neurological damage I was kinda okay with it. I decided the System wasn’t as bad as I initially thought.
Blinking repeatedly, I waited for the sensation of having an empty dictionary engraved in my brain to disappear. But it didn’t. Whatever change the System had made to my brain seemed to be permanent, which was worrisome in its own way. The perspective of a System that could control my brain was creepy to say the least.
“It is what it is,” I sighed.
Taking advantage of my new skills was the only reasonable course of action, so I started pointing at things, prompting Elincia to say their names in Common. Myinch meant tree and also wood depending on the context. Jilp meant stone. Sje meant floor, ground, and the lowest part of something. Sa’ meant branch and twig. Tsuil meant knife, blade and eyelashes for some reason. Feeding the empty dictionary inside my brain felt as good as eating the golden fruits. Was this the System’s true power?
From time to time, Elincia stopped paying attention to my demands and surveyed our surroundings. Given her bow skills and the agility she displayed during the fight with the Black Wolf, I assumed she was a Hunter or an Archer. And if my RPG knowledge was translatable to this world, she also had some sort of vigilance skill. Whatever it was, no monsters came near the camp.
After exhausting all the material objects around us, I went for more intangible things. I pretended to eat from a plate. A timid smile crept on Elincia’s lips as I mimicked, but she managed to remain stoic. Ma meant eat. Kwut meant sleep. Jik meant drink and read. ‘Drinking a book’ was technically a correct sentence in Common.
I learnt about twenty common verbs when the System popped another sudden prompt in front of my face.
New word learned!
Words learned: 301
Rank: Twaddling Toddler
My brain, assisted by [Master of Languages] compiled meanings and conjugations at a record speed as Elincia taught me words and concepts. I was so immersed in the activity that I didn’t notice the passage of time. From time to time, Elincia’s face relaxed and she seemed to enjoy our conversation just to return to her cautious ways a moment later.
“I’m not a monster, you know?” I said in broken Common when I ran out of concepts to mimic.
Elincia shrugged her shoulders, raising a wall between us once more.
“We are in the Farlands, you better start assuming everyone you meet here is a Mimic. Even if you are not a Mimic, you can be a Bandit or something worse,” Elincia said as if it was the most obvious thing. “But I don’t expect a Scholar to understand how to survive in the Farlands.”
“How do you know my class?” I asked, ignoring her derisive tone. There was something behind Elincia’s snarky attitude other than common mistrust. At least she was trying to use simple language to talk to me.
“You have a skill called [Master of Languages], that’s how you are learning Common so fast. I might live in the butthole of the kingdom but I’m not that ignorant,” the white-haired woman shrugged her shoulders again. It seemed like my time of asking questions had run out. “I need answers. Who are you? Where are you from? What’s that thing strapped to your chest? And remember, if you lie to me I’ll leave you here.”
Despite the fact I spent the last years constantly receiving shit from my former boss, I wasn’t a fan of being threatened. Instead of snapping back, I took a deep breath and pondered over my answer. There was a time for snarky comments and a time for using my brain. And I couldn’t ignore the fact the System had told me to hide my place of origin.
[Awareness] flooded my brain with possible explanations. Maybe the inhabitants of this world knew about dimensional travelers, and they didn’t like them.
Luckily, I was a great liar.
“I’m Robert Clarke, a humble Scholar from the City of Light,” I said, extending my hand towards Elincia. She looked at me like I was crazy, so I explained. “You would grab my hand. It’s a greeting from my land, to show each party is unarmed.”
Elincia didn’t move from her seat.
“Stupid. You can’t tell what skills someone has with a handshake,” she said, ignoring my greeting and keeping her hands under her cloak. I hoped she wasn’t pointing at me with a hidden mini crossbow. “I have never heard of a City of Light, sounds fake.”
Expecting at least the benefit of the doubt seemed to be asking too much and my blood was starting to boil. People around me always regarded me as a relaxed dude, however, even I had a limit. And my limit seemed to be stranded in an unknown forest with ravenous beasts trying to eat me.
“Look, lady, I was peacefully surveying a property when I fell through a trap door and woke up here in the middle of the Farlands with only an obscure warning from the System. I have killed creatures I didn’t know existed. I’m hungry, I’m thirsty, and I’m fucking tired,” I said, indiscriminately mixing English and Common. I was starting to lose my temper. “So, if you could stop giving me shit, I'd appreciate it.”
Elincia recoiled and I instantly regretted my words. I wasn’t making a good case to win her trust. Unexpectedly enough, the woman raised her hands with her palms forward, her face suddenly showing signs of regret.
“You are right, I’m sorry. You have only helped me and I took my frustrations out with you… and I’m sorry you can’t return home, you must be going through a lot right now and I’m not helping,” Elincia said with an apologetic tone. As the words came from her lips, it became apparent I wasn’t the only one going through a lot.
The conversation died and the only sound that disturbed the forest silence was the cracking of the logs on the campfire.
“Let’s start again,” Elincia stood from the boulder she was using as a seat and limped to the campfire. She sat next to me and awkwardly extended her hand. “Elincia Rosebud, Alchemist level twenty four. Don’t you dare say anything about my last name if you know what is good for you.”
My jaw hung open for a solid second before I could react and shook her hand. It was soft. I pantomimed zipping my mouth shut and Elincia gave me a confused expression. The woman tilting her head was the most delightful gesture I had seen in my almost thirty years of life. She didn’t seem to understand what I was doing so I showed her the zipper of my jacket.
Elincia was beyond fascinated by the mechanism to the point she leaned over me to have a better look. When I offered her the jacket she flatly refused, hiding her hands inside her cloak once again.
“Looks expensive and I probably don’t have the money to pay for it if I break it,” she shook her head energetically.
Suddenly a shadow settled on Elincia’s face so I changed the subject.
“Where are we anyway?” I asked.
Elincia grabbed a small branch and drew a few lines on the ground.
“We are in Ebros Kingdom's northern frontier, about three weeks away from the capital, in a remote shithole called Farcrest under the rule of Marquis Astur, protector of the frontier and bla bla bla...” Elincia pointed out with her stick.
The Farlands encroached all the northern and western part of the kingdom. I unintentionally frowned at the notice we were in a kingdom. I wasn’t eager to deal with royalty on top of the already dangerous monsters, I just hoped their laws regarding foreigners were not brutal.
Elincia noticed my gesture because she quickly added. “Living near the Northern Farlands isn’t all that bad. It’s been ten years without a Monster Surge so you could say it's a peaceful place.”
If the Black Wolves weren’t ‘all that bad’, I didn’t want to imagine what kind of abomination inhabited the ‘quite bad’ places. Well, that was a partial lie. The mere idea of seeing dragons and other mythical creatures from Earth was hyping me a bit more than expected.
My expression must’ve given me away because the woman instantly scolded me. “I’m not saying the Farlands are a safe place, they are no place for a Scholar no matter how adventure hungry you are.”
Under Elincia’s harsh eyes was a quite protective personality.
“I had enough adventure for a lifetime already,” I lied.
“Pff, typical Scholar, going out to see the sun for half a day and calling it ‘adventure’,” Elincia mockingly said despite having scolded me two seconds earlier but when I turned to reply I saw the mischievous smile on her lips. She was teasing me.
“For your information, I already killed a Corrupted Bear and an Elder Black Wolf. Un-fucking-scratched,” I opened my arms for Elincia to see my wound free body.
“Aaand, unsurprisingly enough, the Scholar blatantly lies like a typical Scholar,” Elincia crossed her arms under her cloak and glanced at me with her deep emerald eyes. “So… you found the camping gear before or after crossing the magical trapdoor?”
The woman’s skeptical tone returned and a mask of mistrust took over Elincia’s face again.
Then it hit me. I was an Earthling molded and used to the customs of my own land. Back on Earth, meeting a random person on a trekking trail was just a chance of engaging in small talk. The possibility of finding a stranger with nefarious intentions was real but slim at best. However, the same rules didn’t apply in this world.
“The trapdoor took me to a near perfect copy of the building I was surveying. All the camping gear belonged to the owner of the cabin except for my shoes and my pants,” I explained.
“And you couldn’t return through the same trapdoor?” Elincia continued relentlessly dissecting my story. Maybe the fact I wasn’t suspicious of Elincia was a suspicious gesture per se.
“Do you think I would be here if the trapdoor was a two-way portal?” I pretended to be deeply offended.
“I guess not?” Elincia doubtfully conceded. “Scholars are well known to poke their noses into dangerous places from time to time. When they are not locked up with their books, they like to peek into places full of mystery like the Farlands where the magic runs free and lawless.”
That was quite an accurate description of myself.
“I’m more of a teaching focused Scholar,” I replied, trying to deflect her accusations.
But she had a point. When I was a kid I dreamed of being an explorer Indiana Jones style to discover forgotten temples with magical portals to other dimensions. Then I learned there was nothing left to be unearthed. However, I was here, in a magical world with a woman who had never heard of planet Earth. It struck me as funny, little Robby wouldn’t believe what awaited him in the far future.
Elincia suddenly perked up and glanced towards the forest. I thought I saw a glint of mana swirling around her emerald eyes but before I could notice, it was gone.
“We overextended our stay, we have to go,” Elincia stood up, putting her weight on her healthy leg. The sun was high in the sky but I knew from experience that afternoons were short at that point of the year. We only had a few hours to leave the forest behind before dusk.
“I saw like three dead Black Wolves down the ravine,” I said, suddenly remembering the mangled corpses I had found earlier.
“Yeah, one or two days old corpses. Nothing to worry about, I’ll get you out of the woods before anything could find us,” Elincia shrugged her shoulders as she quickly put out the campfire.
We scavenged the few things in Elincia's camp that survived the Wolf’s raid and started walking south. Elincia led the march and guided me through the forest until the terrain became rockier and rougher and the trees more scarce. Even with her wounded leg, she didn’t complain once.
As we left the trees behind and we reached the skirt of a steep rocky hill, Elincia slowed down and pointed towards a hidden path between two rocks.
“Black Wolves didn’t usually venture out of the forest. If you ever get lost in the Farlands, stay out of the forest and next to the mountains unless you know exactly where you are going,” Elincia said with her pedagogic tone of voice. “And avoid fighting at all costs unless you know you can win.”
“Now you sound like my mother lecturing me before going camping,” I said, enduring the slope of the hill with the help of [Improved Stamina]. At that point I loved the System as much as I hated it.
“I get that from time to time,” Elincia turned around to give me a tired smile. As we crossed the hidden path between the rocks, Elincia suddenly stopped. “It was fun to teach you how to speak Common, and sorry for being an asshole, Robert Clarke. I think this is our goodbye. If you hug this mountain you will reach Farcrest by tomorrow.”
“What? Why?” I asked. The woman’s sudden goodbye caught me off guard, I was under the impression we were going in the same direction. “You aren’t going to Farcrest?”
The light on Elincia’s face faded away as she shook her head
“I’m here to gather herbs and I can’t return empty handed,” the woman sighed with a sad expression. “And before you come up with any Scholar solutions, yes, I already tried to buy the ingredients back in Farcrest but with the war in the western frontier, prices are sky high.”
I closed my mouth. To her credit I was totally going to say buying the ingredients and taking advantage of her class seemed wiser than venturing into the Farlands.
“But you are wounded…” I objected, I was starting to like the girl and her blunt yet genuine style.
“One of my kids is sick. I can’t leave without ingredients to brew the medicine,” Elincia cut me off, panic almost showing on her face.
My heart sank. Despite having a sick child at home, Elincia had taken the time to patiently teach me the basics of her language. It might be a long shot but my backpack was full of the Alchemical ingredients I had looted the day before. I pulled out my backpack and revealed the inner pockets filled to the brim with high magical concentration herbs. Elincia let out a small squeal and her eyes twinkled upon seeing my stash of weeds.
A special skill wasn’t required to see that my loot was valuable.
“I’m willing to part with some herbs in exchange for a guide, what do you say?” I tried to sound as if I wanted to do business instead of handing herbs out of pity.
“Dire Cress, Moon Laurel, Deadman Nettle, Red Rat-tail…” Elincia listed the ingredients as I opened the pockets of my backpack. Then, suddenly, she rubbed her eyes and let out a sigh full of relief.
Elincia looked at me with her red eyes and smiled.
“We have a deal, Scholar Robert Clarke.”
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Discord Royal Road
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2023.05.27 00:03 the_blood_collector Saint Raymond Blood Drive- Save a Life 5/30
Blood donors are a big deal to patients, especially around holidays, when donations tend to drop. Show the world what a Big Deal Blood Donor you are by saving a life at the upcoming St Raymond Catholic Church Blood Drive!
Please sign up to give blood at our blood drive on 5/30/23 beginning at 9am, so you don't miss out on 2 thank-you gifts. Your donation is urgently needed so that patients don't have to wait for care they desperately need.
Click Here to Schedule your Lifesaving Appointment!
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2023.05.26 22:41 Traditional-Tale4557 Birth Control

Hi everyone, I was diagnosed with PCOS this past year and my doctor decided to changed my birth control. After trying two different kinds, my body finally responded well to Slynd. I realized I was on my last pack and getting low at the beginning of last week, so I asked the doctor to call in a refill. I get it through some mail-in pharmacy, so I had to call them and check the status. They said the doctor declined the refill and said it was “too soon” for another refill… but I am totally out? I checked everywhere to make sure I’m not crazy and misplaced packs… but there are none. I sent a message on TUESDAY in the patient portal explaining this to my doctor. Hadn’t heard back yesterday (Thursday), so I called the office. The receptionist said the doctor should send a response by the end of the day. She didn’t. I still haven’t gotten a response today, even. All this to say, I’ve been out for a few days now and I’m worried my hormones are gonna get all jacked up and make me have all kinds of weird side effects from them. I don’t know if I’m being dramatic or overthinking this, but should it be okay? I am trying to be patient, but I’m so frustrated.
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2023.05.26 22:32 AnonymousWeb ATF Approval Surprise: Suppressor Serial Number Mismatch at Gun Store

Hey everyone,
I wanted to share a rather unexpected experience I just had. After patiently waiting for my ATF Form 4 approval (although a rather short 215 days for a trust transfer seems better than usual), I received the highly anticipated email for approval, I excitedly headed to my local gun store to collect my new suppressor.
Everything seemed to be in order initially; the serial number on my approved paperwork matched the box the suppressor came in perfectly. However, upon close inspection, I found out that the actual suppressor's serial number was off by a few digits.
A bit flabbergasted, I immediately informed the store staff. It took a while, and several meticulous checks including browsing the eForms portal, making phone calls, and searching around the store before they discovered what had happened: my suppressor was actually in a store in Missouri!
Somehow, a swap had occurred at some point, and it went unnoticed until now. Talk about a strange mix-up! I can't express enough how relieved I am that I took the time to verify the serial number against my paperwork before leaving the store.
Luckily, the store is planning to remedy the situation. They'll coordinate with the Missouri store to ship the correct suppressors to their respective owners. In the meantime, I guess I'm back to waiting again. The manager was very apologetic and said I should have it next week and he would give me some ammo for my troubles.
Always double-check your serial numbers, folks. You never know when an odd misstep like this could happen. Stay safe and shoot quietly!
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