Infusion max nitrous oxide

Greetings, Reddit Ensemble!
Eligible Cars:
Slot 1 (Race #1) / Slot 2 (Race #7) / Slot 3 (Race #15):

• Lamborghini Aventador LP 780-4 Ultimae (5 Gold Star Car, Tier 5)
  
• Lamborghini Aventador LP 780-4 Ultimae (Top 10) (5 Purple Star Car, Tier 5)
  
• Lamborghini Huracán Performante (5 Gold Star Car, Tier 5)
  
• Lamborghini Huracán Performante (Top 10) (5 Purple Star Car, Tier 5)
  
• Lamborghini Murciélago LP670-4 SuperVeloce (4 Gold Star Car, Tier 5)
  
• Lamborghini Murciélago LP670-4 SuperVeloce (Top 10) (4 Purple Star Car, Tier 5)
  

Only 1 car per make/model should be allowed.
Races:

Race Type	Amount
Sprint Races	1
Speed Traps	2
Relay Races	11
Total Races	60

Rewards:

Reward	Amount
Cash	3 000 000
Gold	510
Bronze Keys	1405
Gold Keys	20
Rare Fusions	15
Epic Fusions	13
Stage 6s	4
Blue Elite Parts	100
Pink Elite Parts	20

No Prize Car
Stage 6s distribution:

• If we assume that this Trinity Cup is the same as the one from season 167, the stage 6s will be for:
  
  • Race 22's stage 6 is for the 1st slot.
  • Race 32's stage 6 is for the 2nd slot.
  • Race 39's stage 6 is for the 3rd slot.
  • Race 60's stage 6 is randomly given to 1 of the 3 cars, that's because it's a Relay Race and features all 3 cars.

Notes:

• Make sure to get either the Lamborghini Aventador LP 780-4 Ultimae or the Lamborghini Huracán Performante, because for whatever reason the gold star Lamborghini Murciélago LP670-4 SuperVeloce is not listed as an eligible car in the European Invitational: The Grand Finale event. The data is taken from the files, so nothing is 100% confirmed!
  
• The gold star variants of the cars will be pullable via the Rare Imports. Each car will cost you up to 70 gold keys (for loyalty), the maximum total for all 3 cars is 210 gold keys.
  
• The purple star variants may or may not be on sale for real cash.
  

Stage 6 Effects:
Lamborghini Aventador LP 780-4 Ultimae (Gold Star):

• Full S5s - dynos at 9.763 with the following tune:
  
  • NOS - 150/2.0
  • FD - 2.00
  • Tires - 53/47

Part	Dyno (sec)	Improvement (sec)
Engine	9.264	-0.499
Body	9.391	-0.372
Tires	9.464	-0.299
Transmission	9.510	-0.253
Nitrous	9.534	-0.229
Turbo	9.548	-0.215
Intake	9.637	-0.126

Lamborghini Aventador LP 780-4 Ultimae (5 Gold Star Car, Tier 5) Maxed Tune and Shift Pattern:

• PP - 713
  
• Evo - 2155
  
• NOS - 188/4.0
  
• FD - 2.00
  
• Tires - 53/47
  
• Dyno: 7.564
  
• Test Run: 7.320
  
• Shift Pattern (Perfect launch, early shift into 2nd at 10 mph, shift into 3rd at around 2500 RPM, shift into 4th at around 5000 RPM and NOS, rest perfect shifts)
  

Lamborghini Aventador LP 780-4 Ultimae (Purple Star):

• Full S5s - dynos at 9.623 with the following tune:
  
  • NOS - 150/2.0
  • FD - 2.00
  • Tires - 53/47

Part	Dyno (sec)	Improvement (sec)
Engine	9.232	-0.391
Body	9.262	-0.361
Tires	9.332	-0.291
Transmission	9.353	-0.270
Nitrous	9.393	-0.230
Turbo	9.402	-0.221
Intake	9.497	-0.126

Lamborghini Aventador LP 780-4 Ultimae (5 Purple Star Car, Tier 5) Maxed Tune and Shift Pattern:

• PP - 713
  
• Evo - 2208
  
• NOS - 188/4.0
  
• FD - 2.15
  
• Tires - 53/47
  
• Dyno: 7.458
  
• Test Run: 7.253
  
• Shift Pattern (Perfect launch, early shift into 2nd at 10 mph, shift into 3rd at around 2500 RPM, shift into 4th at around 4000 RPM, NOS at around 7500 RPM, rest perfect shifts)
  

Lamborghini Huracán Performante (Gold Star):

• Full S5s - dynos at 9.766 with the following tune:
  
  • NOS - 304/4.2
  • FD - 2.83
  • Tires - 12/88

Part	Dyno (sec)	Improvement (sec)
Nitrous	9.379	-0.387
Body	9.514	-0.252
Tires	9.561	-0.205
Intake	9.571	-0.195
Transmission	9.594	-0.172
Engine	9.660	-0.106
Turbo	9.712	-0.054

Lamborghini Huracán Performante (5 Gold Star Car, Tier 5) Maxed Tune and Shift Pattern:

• PP - 714
  
• Evo - 1851
  
• NOS - 448/5.5
  
• FD - 2.70
  
• Tires - 14/86
  
• Dyno: 8.102
  
• Test Run: 8.097
  
• Shift Pattern (Perfect launch, good shift into 2nd and NOS, rest deep good shifts)
  

Lamborghini Huracán Performante (Purple Star):

• Full S5s - dynos at 9.686 with the following tune:
  
  • NOS - 336/4.1
  • FD - 2.81
  • Tires - 12/88

Part	Dyno (sec)	Improvement (sec)
Nitrous	9.282	-0.404
Body	9.429	-0.257
Tires	9.484	-0.202
Intake	9.490	-0.196
Transmission	9.552	-0.134
Engine	9.573	-0.113
Turbo	9.628	-0.058

Lamborghini Huracán Performante (5 Purple Star Car, Tier 5) Maxed Tune and Shift Pattern:

• PP - 714
  
• Evo - 1872
  
• NOS - 473/5.6
  
• FD - 2.69
  
• Tires - 14/86
  
• Dyno: 8.061
  
• Test Run: 8.057
  
• Shift Pattern (Perfect launch, good shift into 2nd and NOS, rest deep good shifts)
  

Lamborghini Murciélago LP670-4 SuperVeloce (Gold Star):

• Full S5s - dynos at 10.717 with the following tune:
  
  • NOS - 96/6.0
  • FD - 2.58
  • Tires - 52/48

Part	Dyno (sec)	Improvement (sec)
Body	10.099	-0.618
Tires	10.363	-0.354
Transmission	10.413	-0.304
Nitrous	10.539	-0.178
Engine	10.591	-0.126
Turbo	10.609	-0.108
Intake	10.613	-0.104

Lamborghini Murciélago LP670-4 SuperVeloce (4 Gold Star Car, Tier 5) Maxed Tune and Shift Pattern:

• PP - 713
  
• Evo - 1504
  
• NOS - 380/4.0
  
• FD - 2.00
  
• Tires - 52/48
  
• Dyno: 8.915
  
• Test Run: 8.584
  
• Shift Pattern (Perfect launch, early shift into 2nd at 35 mph, early shift into 3rd at 76 mph, perfect shift into 4th and NOS, rest perfect shifts)
  

Lamborghini Murciélago LP670-4 SuperVeloce (Purple Star):

• Full S5s - dynos at 10.639 with the following tune:
  
  • NOS - 101/6.0
  • FD - 2.55
  • Tires - 52/48

Part	Dyno (sec)	Improvement (sec)
Body	10.007	-0.632
Tires	10.294	-0.345
Transmission	10.325	-0.314
Nitrous	10.457	-0.182
Engine	10.526	-0.113
Turbo	10.528	-0.111
Intake	10.532	-0.107

Lamborghini Murciélago LP670-4 SuperVeloce (4 Purple Star Car, Tier 5) Maxed Tune and Shift Pattern:

• PP - 713
  
• Evo - 1537
  
• NOS - 395/4.0
  
• FD - 2.00
  
• Tires - 52/48
  
• Dyno: 8.847
  
• Test Run: 8.522
  
• Shift Pattern (Perfect launch, early shift into 2nd at 37 mph, early shift into 3rd at 72 mph, deep good shift into 4th and NOS, rest deep good shifts)
  

Links:

• Information about Update 4.5 via the data mine - click/press (Text Version) and click/press (Chart Version)
  
• Information about Update 4.5 via the official CSR2 site - click/press
  

I've created a Ko-fi, because I don't want to limit the information that I provide with a pay wall. I'm thankful for all your support thru the years. I'll be more than happy if you can support me even further. Here's the link - click/press (Now you can use also Apple Pay and Google Pay).
Thank you for your support and time!
Happy racing and stay safe!

currently on infliximab every 4 weeks (max dose) and 22.5mg of prednisone had 7 infusions still not in remission (still bleeding)for colitis doctor wants to add methotrexate and another loading dose has anyone been through this with success.

Today in my shift I encountered a woman who was trying to pressure me into ringing in cold brew instead of frap roast for her frappuccino. She told me that we did it here, then at another store, and asked me what the big deal is. So I told her.
-frap roast comes in pre portioned packets of powder that are then mixed with water.
-cold brew is a specific type of coffee bean, roasted in a particular manner before being shipped in large bags. We then have to grind them, set them to brew for 20+ hours, then portion the cold brew out into kegs.
-nitro is cold brew infused with nitrous air to enable the caffeine to go into effect faster.
There is a significant price and quality difference between frap roast and cold brew. It doesn't matter if another store did it, or if a barista at this store did it. It's not Starbucks standard either way. It's not something that we're allowed to do, or even supposed to do.
-even then, there's not a function in the order monitor that allows me to ring in such a modification.
I told her I wouldn't risk getting in trouble and putting my job at jeopardy over breaking Starbucks standard for a customer who insists she's had that drink before and won't accept no for an answer.
She responded, grumbling something. I couldn't quite hear it thru the headset but it sounded like she said own drink made how she wants won't get me fired.
Maybe it will. Maybe it won't. But we're not finding out at my expense. Especially when I love coming in to work with my coworkers and connect with some really fun regulars.

Test Bank for Dental Instruments 6th Edition by Boyd
Table of content

1. Basic Dental Instruments
   
2. Enamel Cutting Instruments
   
3. Local Anesthetic Syringe/Components and Nitrous Oxide Sedation
   
4. Evacuation Devices, AiWater Syringe Tip, and Dental Unit
   
5. Dental Handpieces
   

Its Very Help Full Test Bank For Nursing In Sale

I’m embarrassed and ashamed of it. But I want to stop. I have no idea how it’s impacted my health but I want to do my best to move forward and repair any damage I’ve done to myself. Any advice is appreciated.

I’m embarrassed and ashamed of it. But I want to stop. I have no idea how it’s impacted my health but I want to do my best to move forward and repair any damage I’ve done to myself. Any advice is appreciated.

I’m embarrassed and ashamed of it. But I want to stop. I have no idea how it’s impacted my health but I want to do my best to move forward and repair any damage I’ve done to myself. Any advice is appreciated.

This is gonna have some heavy spoilers. Story and Gameplay. This is the only warning I will give. Leave now or forever hold your piece.
I want to clarify something. You can sing praise for a game but still find issues with it. I love Skyward Sword and A Link Between Worlds. However, Skyward Sword suffers from pacing issues and reusing two bosses as mini bosses later on. A Link Between Worlds suffers from... well.. you know honestly nevermind ALBW is flawless lol (I joke). My point is this though.... Tears of the Kingdom has some really great gameplay and overworld but is very lacking outside of that. I'll be breaking this down into 5 sections. Each section able to score a max of 2 points. 0 points means it fails that category greatly. 1 meaning it did good stuff but didn't blow me away. Gameplay Game Gimmick Soundtrack Enemy/Character Variety Story.
Gameplay - The gameplay is some of the best in the series, the way to explore the overworld and the amount to the overworld is stunning. It's amazing how they fit all of this in one cartridge and then make it run on the technology it's played on. A toaster could play this game. Which is not to knock this game at all. The game has a gorgeous art direction. Which makes up for what "good" graphics are considered in modern times. Traversal in the overworld has never been better in an open world game. Cooking could use help streamlining it if I'm honest. I'd prefer for there to be a menu that opens at a cooking pot rather than having to scroll through a bunch of stuff at the inventory menu. Now here comes some of my main issues with the game... Dungeons - I miss dungeons feeling like they mattered tremendously. rather than being a checklist. I think a reason why people like the great plateau and the great sky island so much is because it's like a miniature version of the old games. They are paced really well and the shrines matter more there because you get a cool zonai hand ability or in other games "items". Which in turn allows you the ability to explore the starting area in better unique ways similar to how when you got a new item in the other games that lets you explore the open world even more. I feel like the dungeons in the game would've been more relative and mattered more if the ability that you got from them was more unique in how it effected how you explored the world as much as the zonai hand abilities. The dungeons felt better than the Divine Beasts.
Combat - The combat for both BoTW and Tears of the Kingdom is probably some of the weakest in the entire franchise outside of the 2d games. Wind Waker you could learn an ultra spin attack. Twilight Princess you learned a multitude of different sword combat. Majora's Mask had different masks of letting you transform into different races to fight as. Ocarina of Time had a multitude of itemsand magic able to be used in creative ways. Skyward Sword had motion control combat which when it works.. it works very very well. (when you get good at it, you can do it very quick) Botw and TOTK - while having a multitude of different weapons... fails to make the combat for them unique. It's the same -dodge- -flurry rush- or -parry- or -Updraft into the sky then bullet time-. You can in ToTK infuse arrows but that doesn't make it feel different from BoTW with the arrow types. I will say the infusing does wonders for some ideas like flamethrower shields and whip swords. However it doesn't feel inherently different from each other or unique enough to be amazing. I'm not expecting Dark Souls or Devil May Cry level combat. I'm expecting at least what other Zelda Games brought to the table when they had 6 years to improve on it. BoTW has the excuse of there's a bunch of different weapon types. However, ToTK doesn't have an excuse for this The only thing I can say is... why is there only one fighting technique you can learn in this game? Why can't you learn from each of the different races/clans. Zora could teach something with spears. Goron could teach with two handed heavy weapons. Rito with bows. Gerudo with one handed swords. Zonai could do something with magic or technology. You could maybe find a hylian training manual that teaches you stuff like the "Ending Blow" from Twilight Princess. Have the Sheikah teach something like Mortal Draw. Make these races feel unique with different fighting styles. Except all we can learn is the Yiga skill. The Gerudo even offer to let you train with them! It just feels like a major missed opportunity. I would've loved the combat to feel special. It's something i get bored with very very much....
Overall Gameplay get's a score of 1 out of 2 points. The overworld is great and exploring is neat. The dungeons are an improvement but lacking in overall impact, and the combat is really leaving a lot to be desired.
Game Gimmick - The Zonai hand is a great improvement over the Sheikah Slate. The amount of stuff you can do with ascend and Recall is crazy. That's not even touch ultrahand and fuse. It's truly great and while i do miss stuff like the hookshot, beetle, and the spinner. I find that zonai hand adds a lot that makes the game last for a long time. The sage abilities are annoying to activate and don't change a whole lot outside of Tulin's ability. Game Gimmick gets a solid 2. I have nothing I can say is bad with it mostly. I could try and nitpick it but I found myself using each ability multiple times. Unlike the sage abilities which i try to use a lot but are annoying to activate.
Soundtrack - I find myself having a hard time remembering any of the songs from both BoTW and Tears of the kingdom. A lot of the songs from BoTW return and a lot of the songs from BoTW were covers/remixes of songs from previous games. I honestly find it kind of lacking. I think they need to stop trying to do the minimalist style and go back to the styles of skyward sword, twilight princess, oot, albw, etc. I can't even remember the boss themes. When I can remember the other games themes for the bosses over this. I expect better out of the Zelda team.
Soundtrack gets a 1. While no song is amazing no song is bad. They are just... not memorable.
Enemy/character variety - The enemy variety is greatly stepped up compared to BoTW and that is great. I like seeing the Gibdos(redeads), the like-likes, the flying monsters, some new undground creatures, horroroblins, gloomhands. All great new inclusions. Although I finding myself still running into 90% bokoblin varients and lizalfos. Which... just aren't really that great to fight. The new bosses are nice but... they all are mechanically the same *hit weak point aka the eye most of the time* *slash them to death*. I'ts been a long time since Queen Gohma from OoT. Can we not get any more creative then that? I liked the temple bosses but the overworld bosses lack interest. I do think that the Molduga got improved since BoTW due to bombs not being able to be tossed onto the sand anymore. Makes you have to think more with how to beat them. The others just... are the same formula. I expect better when the temple bosses are so great. Phantom Ganondorf is dope too btw.
Characters are done extremely well. I do wish almost every character had a unique look at every town and stable. A lot of the characters that aren't story relevant look very dull. I get they are just npcs but the Zelda games are known for the iconic looking characters and i want to remember all of them but some just aren't memorable... which sucks. Still some of the best character work though in gaming when you got characters like Riju, Tulin, Josha, Purah, Robbie. I'm gonna save talking about Link until story....
Overall Enemy/Character Variety get a 2.
Story - This.... is gonna be a very long drawn out discussion on the story. I'm gonna first overlook it as just a sequel to BoTW and nothing else. None of the previous games as there is still a large disconnect between the two when ToTK is meant to be a sequel. The biggest grievance I have (besides Link, which we'll get to him...) is the lack of continuity. Riju hardly comments about the Thunderhelm when you get it from the Yiga. The Divine beasts aren't mentioned. None of the new sages comment about the divine beast helms and how similar they are to them. None of the sheikah tech is mentioned from BoTW why make these new towers when the others already exist that do the same thing? What happened to the divine beasts? They didn't go underground because we go underground and don't see them. Even if they were dismantled that's a lot of sheikah tech that is just used on towers that is then missing. These divine beasts are the size of mountains. those just don't go missing. The biggest issue is hardly anyone references what happened in BoTW but no one goes into detail... it's just so disjointed. It's like BoTW just doesn't matter at all. Why does Yonobu not have the Daruk's protection anymore? Why does Riju not Mention Urbosa or even her own mother? No mention of Ravali at all. Mipha is mentioned but that's unavoidable when they have a full on statue and brother dedicated to her. I'm sorry, I get they wanted to make this game standalone as well as a sequel but you need to make the first game matter in some way. So some kind of reference outside of a town to the first game. Only reason why I can think everyone has amnesia is maybe when Zelda goes back in time that changes the events of BoTW but then that makes another timeline split (not to mention all the timeline splits that should have happened during Skyward Sword). Which I have a feeling Nintendo wants to avoid more timeline splits. I just have a hard time believing this is in the same world as BoTW outside the same characters and map.
So what about the story itself? It's... fucking weak. Rauru is maybe the most memorable from the memories? But then I have to ask.... why the fuck are we doing memories again and they are so much worse then in BoTW. They aren't an effective story telling rule. It's kind of like just looking up where cutscenes are at. Which is boring. I want to play these events. Not just see them. What's the point of playing the game then? I can just look up all these cutscenes and get the same affect for the story then go play a different game that has better gameplay than ToTK. It's not impossible to tell a cohesive story with a freedom exploring game. Look at any GTA game. Look at Red Dead. Look at Fallout. Look at Elder Scrolls. Look at Batman Arkham Knight. Look at Dying Light. I'm sorry but story wise ToTK is very weak compared to any other open world games. Hell Elden Ring which has minimal story telling does it better than ToTK. I have a hard time caring about these characters when I know all of these characters are fucking dead. I don't care about Rauru, i don't care about Sonia/Sophia (what the fuck was her name again)? Mineru is about the only one I should care about in all honesty from the memories and she only shows up like twice. I hardly care about Zelda because well.... Let's talk about Link finally... the weakest part of the game.
Link... I'm sorry but humming while cooking and giggling when jumping while shield surfing isn't a personality. The man shows no other personality outside of those very very minor situations. He looks barely chocked at memories. His body language is so lacking what a normal persona has. I'm sorry but him being raised in a military family isn't an excuse. Many military family kids that go into the military are still human who laugh, smile, cry, and get upset. They don't just lose what makes them human. This Link is the least human out of the Links. Look... when the intro to the game happens and Link fails at doing the last military job he was assigned which is protect Zelda and he fails at doing it. You'd think he'd show some kind of angesadness/emotion when he wakes up... but he doesn't... he just goes about his day. Then you go through all the memories and every time one ends... he just does the pikachu shocked face and goes about his day like nothing happened. He doesn't even tell anyone else that is looking for Zelda when he finds out she's turned into a dragon. I was expecting at least in the final memory for him to look upset or something when Zelda finally appears as the light dragon. Maybe have him cry. But instead he is a stone wall. If any of you disagree with me by saying "well Link has never had a personality" allow me to show you this . This is Link showing actual distraught when something happens to His Zelda. Shit still makes me tear up... but where is this heart with ToTK Link. And if we're to believe that Zelda and Link are dating in ToTK why the fuck is he not crying? That's his girl man. That's the person he loves... yet he doesn't show any signs of sadness. And before you all say he's stoic I'm sorry but again. Military men would cry if something happened to their wife like this.
I know some people are gonna claim that a majority of the story is hidden behind notes but im sorry. If we give heavy criticism to other games for doing that then we must be fair to even Zelda games when it comes to that.
Overall... I can't. I can't give the story a 1 or 2. The characters outside of Link are great but... great characters can't carry a story. It's like when you have great actors in a very shit movie. They're gonna kill the role they have but that doesn't keep the movie from being shit.
Games are 75% gameplay 25% story most of the time and Zelda Tears of the Kingdom fails with it's story. For me that makes it a 0.
The overall score I give ToTK is a 6 out of 10. I'm not saying the game is bad by any means I just don't think it deserves game of the year where it fails to improve on the previous Zelda games and even BoTW. The story is the weakest part even when looking at it under a microscope of just BoTW's Sequel. Not even taking into account it's connections and flaws to the other games.
I do hope the Zelda Team writes a better story for in the future but that is my score for the game that ultimately... No one will care about.

Dreams stay as dreams?, here's the Summary:

1. Tempest 4:

Elite 4 License: T1 Time Trial: 11.900s (¼ Mile) T2 Time Trial: 9.000s (¼ Mile) T3 Time Trial: 8.000s (¼ Mile) T4 Time Trial: 10.000s (½ Mile) T5 Time Trial: 8.000s (½ Mile)
Elite 4 High Stakes: T1 Keyshia's Hyundai Ark Performance Veloster: 12.200s → 12.000s → 11.900s → 11.700s (Pink Slip) T2 Bryce's 2008 BMW Z4M Coupe: 9.100s → 8.900s → 8.800s → 8.600s (Pink Slip) T3 Thunder's 1970 Dodge Charger T: 8.100s → 7.900s → 7.800s → 7.600s (Pink Slip) T4 Daniel's 2016 Dodge SRT Viper ACR: 10.300s → 10.100s → 10.000s → 9.800s (Pink Slip) T5 Victor's Mercedes SLR 722S Roadster McLaren: 8.000s → 7.800s → 7.700s → 7.500s (Pink Slip)
Tempest's Crew Name: Samantha (White, Blonde, Blue Eyes, Black Cap, Black Jacket, Red Lipstick).
Her Cars: T1 Samantha's Mazda MX-5 Miata T2 Samantha's Honda Civic Type R T3 Samantha's Toyota GR Supra [T3] T4 Samantha's Nissan Skyline GTR (R33) T5 Samantha's Mazda RX-7
Arc's Order: T3 → T1 → T4 → T2 → T5
At the end, she admitted that she was Noro's old best friend.

1. Tempest Finale It was revealed that Shax has a father named Max, and he's the Tempest's Boss. You have to beat him with only using given car: T5 2007 Porsche 911 Turbo (997) [Best Time: 4.800].

Very Weird Shift Pattern (For Pink Slip): Launch 10000rpm, immediately nitrous while shift to 5th at the same time (spam tap) If you're late, it could be 4.9xx, or even worse (5.xxx).
It has 100 races (3 of them are Max's). He said on the beginning that you hurt Shax long ago, and he will do the payback against you. He mocks you everytime when you tried to start a race, and after you finished a race (this is very frustrating).
Jess told you that both the Porsche and GT-R were rivals when she was young, so that they are absolutely fast now.
Because Shax and Max are both British, all races are 1 Kilometre instead of ½ Mile.
Tempest Finale: T5 Max's 2007 Nissan GT-R (R35): 7.000s → 6.500s →6.000s → 5.000s (Pink Slip) [All 1 Kilometre].
Note: He did 0-200 km/h in just 0,2 seconds, also his top speed is 900km/h (Pink Slip)
Max's Appearance: Very old British bald man with black sunglasses and wearing classic tuxedo.
When you actually got his GT-R (R35), the best time will be only 7.100s (½ Mile). Also your fully maxed Porsche will be only 7.000s (½ Mile).
I will post more about my other CSR2 dreams other than Tempest.

I had my procedure yesterday. The doctor was running late so I had to wait about 45 minutes longer than I expected for it to begin. I also opted to get nitrous oxide for the procedure. It was $100 extra but I thought, why not? Well, I started the nitrous and when it started doing it’s thing, I got extremely nauseous. I opted to stop the nitrous.
The doctor numbs me up and starts. He does the left side with no issues. As he is about to start the right side, the fire alarm goes off. He keeps going because it’s not like we can stop or anything. Then we start hearing sirens in the distance. Then someone on staff walks in, while I’m displayed in all my glory, vas hanging out and all, and she says we have to evacuate. My doctor responds, “Not until we finish the procedure.” I wonder if he was rushing because I certainly was feeling some pain at this point, but I just wanted it over.
Anyway, he finishes, I get dressed, and we evacuate the building. My wife took a picture of me walking out of the building with several fire engines behind me.
The procedure was fine considering everything and I have been in very minimal pain on my right side since. Haven’t needed any pain medication for it though.
It was definitely quite the experience.

Female
36
5’4
170lbs
Ulcerative colitis that has been in remission for 3.5 years
Entyvio infusion every 8 weeks (last one on Wednesday)
50mg desvenlafaxine er
Yesterday I noticed a swollen lymph node on my neck, didn’t think much of it but thought it was odd given that I am not sick.
Then i noticed one right next to my ear and a huge one right under my ear. I did have a mole scraped (that was all clear) two weeks ago on that side but it does not look infected. Then an infusion of Entyvio on the same side on Wednesday but have never had swollen lymph nodes from it.
When should I go to the doctor about them? I am at my max out of pocket but I am unsure if it is necessary at this point.

Hi all,
MAOIs are the only class of meds that I haven’t tried yet— for background, I’ve had severe depression since childhood, have been in therapy and treatment for the last 8 years but haven’t found anything that has made a sustainable difference in my depression. I’ve been on around 30 different psych meds from various classes, I tried rTMS, and I tried ECT. ECT helped while I was doing it 3x a week but once we taped off, the depression returned almost immediately. None of the meds made any difference at all in my depression.
A few years ago, I was also diagnosed with severe refractory gastroparesis, a motility disorder (basically my stomach is partially paralyzed and can’t really break down food normally because of the delay in gastric emptying.) Thankfully, since I had surgery my gastroparesis is not as severe as it used to be, but it definitely is still there. I’ve had stomach issues since I was 4 years old and diagnosed with IBS-C, but I do wonder if I actually just had gastroparesis already in childhood, and it just worsened after various things— the gastroparesis symptoms got worse after I had my gallbladder removed as a teenager, and then worse again after an anorexia relapse (from which I have recovered from at this point!)
Since my stomach had trouble breaking things down because of the paralysis, sometimes food goes through me almost completely undigested. I never considered that this could be happening with medications as well, until I was prescribed iron supplements to take because I had developed severe anemia due to the gastroparesis. I took the iron supplements for 6 weeks, and they did not make a difference in my iron levels. Not only that, but I could literally see them in my stool, still undigested. (sorry for the poop talk lol). Eventually I got iron infusions, and they worked very quickly. I’ve also realized that a lot of my chronic illnesses have been “treatment resistant” and don’t really respond to standard medications— I’ve been on almost every medication on the market for chronic migraines and nothing made any a difference at all until I tried some injectable medications. I was also put on tons of Klonopin and Ativan when I was a teenager, and no matter how much I took, they didn’t do ANYTHING. However, Xanax did (though I became addicted quickly.) I’ve also been on many stimulants, and even on the max dose of Adderal, I feel no difference. I’ve been told that these responses or lack there of are not really typical, so I wonder if they’re related to the gastroparesis, or in any way connected to whatever reason my depression is treatment resistant as well.
Do any of you also have treatment resistant depression and gastroparesis, and do you think the GP is why you haven’t responded to any medications? Do you think I should go straight for the Emsam patch because of this, to see if it makes a difference when the drug is not administered orally?

I would like to start off by apologizing for this text wall. I have been to countless doctors and specialists the past 3 years doing nothing but tests of all sorts. I spend every single day worrying about my health and completing ocd routines to make myself not get “sick”. It’s exhausting to say the least. I am going to be as detailed as humanly possible and I’m sorry if it seems like I am rambling.
I am a 28 year old male, I weigh roughly 215 pounds and just over 6 ft tall. I have been obese/morbidly obese my whole life until 2021. At my biggest, I was roughly 360 pounds. Since a child I have had asthma, depression, anxiety, and OCD. I haven’t treated the asthma in years, but I feel as if I might need to again.
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DX:

• -Asthma
• -Chronic Sinusitis (confirmed on multiple MRI’s across a 3 year span)
• -Panic Disorder, GAD, OCD, PTSD (Possible Convergence Disorder)
• -Still currently testing for neurological/autoimmune disorder
• -Bilateral Intermediate Granulomatous Uveitis
• -Vitamin D Deficiency

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Other possible relevant medical instances

• -Two concussions
• Dart was lodged in my back when I was 17
• Either stung by scorpion or bit by spider in my sleep which resulted in enlarged arm and severe pain
• Possible overdose on clenbuterol in high school when someone gave me a full syringe full to “lose weight”.

My medications I take include…

• Omeprazole 20 mg (Tapering from 40 mg) ED
• Lorazepam .5 mg as needed
• Prednisolone Acetate Suspension Drops ED
• Flonase
• Vitamin D3

Smoking Status:

• 1 pack a day from 18-22
• Heavy vape user from 22-28 (Quit 3 months ago)

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Past Drug Use:

• Cannabis: Heavy user for about 7 years
• Alcohol: binge drinker throughout college. After graduation social/weekend drinker. Currently I rarely drink
• Cocaine: somewhat regular for 3 years in college. Mainly weekends. Also sprinkled it on marijuana blunts so I guess I technically smoked crack
• Nitrous/LSD/Shrooms/Ecstasy: occasional I would say, but not recreational. Off and on for a couple years in college
• I have done no recreational drugs in the past 5-6 years

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In 2020 my anxiety and panic disorder got extremely out of hand during the beginning of Covid and right after the death of my little sister.
I began to have the following symptoms

• migraines
• constipation
• vertigo
• balance issues
• increased anxiety
• tinnitus
• diplopia while I was laying down.
• The diplopia I experienced then started to progress from only when I was laying down to constantly unless one eye was closed.

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I saw an eye doctor and my PCP who recommended I see a neurologist. The neurologist said he suspected a “convergence spasm” that gave me nystagmus.
About a week later, the left side of my face became extremely weak and practically paralyzed so I went to the hospital. Apparently I suffered a neurological attack caused by demyelinating plaques scattered in various white matter regions of my brain.
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Brain MRI
“The cerebral parenchyma shows multifocal discrete areas of increased signal. Intensity scattered throughout various white matter locations in the brain including the pontine tegmentum, the right periatrial white matter, the right frontal lobe white matter as well as the left inferior lobe white matter. These areas show mild facilitated diffusion. There is no associated mass effect. Following infusion of contrast agent, there is significant enhancement of the lesion in the right periventricular white matter and right supraverntricular white matter with faint enhancement in the pontine tegmenjtum.”
Spinal MRI

• Congenital Spinal Stenosis
• Mild Disc bulge at T11-T12
• Minimal Disc bulges at L4-L5
• Mild disc bulge and small broad based protruding central disc herniation at L5-S1
• Mild multilevel facet arthropathy

Chest Xray
-Unremarkable
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CT Angio Head And Neck
Unremarkable/No Stenosis/ No aneurysm
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Lumbar Puncture
-There were no O bands in my spinal fluid, and the only abnormal finding was nonspecific mild elevation of protein.
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BLOOD TESTS
Lyme, CRP, ANA, ACE, Sed Rate, Treponema Pallidum, Hep B, JC virus, Myelin Basic Protein, MOG Antibody, NMO/AQP4 all fell within normal range or negative
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TREATMENT
I was treated with high dose IV steroids for about 5 days in total and my face went back to normal about 95%. About two months later my double vision subsided, but I now developed light sensitivity and floaters.
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REMAINING SYMPTOMS

• Headaches compatible with Migraine, especially upon exertion of my neck. Just laying flat on my pillow or sitting up in my bed will give me a migraine behind my eyes and in the back of my head. Often times on one side of my head, other times like a headband.
• Tinnitus
• Floaters
• Cold hands and feet
• Back Pain
• Reflux since February
• Chest Cartilage Pain/Burning (relieved temporarily upon cracking sternum)
• Occasional Dizziness and almost the feeling of like I’m not in control of my body

My neurologist sees no need to further test anything. My opthamologist suspected neurosarcoidosis and I just recently retested ANA but it came back negative again. After the initial brain MRI, I would receive them every 6 months and each one got better. The lesion in the pons has cleared up, and smaller lesions have appeared in other white matter locations. I have another follow up with him in October.
Am I Just destined to be left in Limbo? Not knowing what happened to me and living in fear of symptoms reappearing has made me feel terrible. My contamination OCD, anxiety, and stress levels have been through the roof. I am unable to relax. I wash my hands upwards of 20 times per day, I disinfect my phone whenever I leave my home, I’m afraid of anything positive happening in my life due to the fear of something shitty happening right after. I lost my mother when I was 18, my sister in 2020, and my dad last year. I really only have myself because my grandmother is in Florida and I have to be strong for my grandfather who was just recently diagnosed with aggressive lymphoma. I have been taking him to his appointments and will be taking him to chemo. It’s just hard when I see so many different doctors without answers. So far I’ve seen 3 neurologists, 4 eye doctors, Endocrinologist, without any solid answers. It’s frustrating. I am extremely grateful that nothing debilitating was found, but I want to know how to heal my symptoms. Did we cover all of the bases? Did we miss anything?