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mistasangel · 2 years

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Monster High Fanfics

been working on a lot of them lately and one is with them all grown up with children of thier own, I can post an updated OC list if you want to see which ones I gave children to. Working on a NSFW Jackson Jekyll fanfic and my OC Amber gave him a massive hickey,lol I also have quiet a few same sex couples in some of the stories. Also on wattpad I have two SFW fanfics and you can find them by using the user name I have here as it’s the same there. I need to work on my Valentine Fanfic, I stopped at the point where it’s discovered he in fact is the new lunar god and a real road block in Sunfire’s crazy adoptive Aunt and Uncle’s scheme. I do have a story where Holt Hyde gets alot of attention much to Jackson’s annoyance and I have a few of them where Jackson and Holt are seperated from eachother making them thier own person, I also say they are brothers when like that. For the Hickey or Love Bite as some call it, I’m trying to picture Jackson trying to explain that one when it becomes visable and the reactions the others would have to it,lol I also have a fanfic with Invisi Billy and my OC Becca Cohen and let’s just say Scarah Screams is not to fond of her...and Cleo DeNile is not to fond to my OC Lyla Tigre,lol Also Lagoona doesn’t like my OC Eella Moray either, can’t help it thier boyfriends found those girls interesting,lol Lyla gets alot of attention since she actually plays sports with the mansters and her favorite to play is Casketball. Have quite a few Neighthan Rot fanfics as well, he’s always paired with my OC Alana but don’t worry she gets along with Frankie Stein as they are often seen hanging out together when Alana is not with Neighthan.

Here I’ll list the Children for you

Jayson Jekyll- Son of Jackson Jekyll and Amber Boltz

Heidi Hyde-Daughter of Holt Hyde and Amber Boltz (they are seperated hence the two different children.

Evan Valentine: Son of Kieran Valentine and Sunfire Appollo

Hellah Burns-Daughter of Heath Burns and Sophie Wesker

Loralei Webber-Daughter of Gillington”Gil” Webber and Eella Moray

Anju Gorgon-Daughter of Deuce Gorgon and Lyla Tigre

Sebastian Cohen-Son of Invisi Billy and Becca Cohen

Pawl Wolf-Son of Clawd Wolf and Centra Spencer

Storm and Nova Cohen-Daughters of Judas Cohen and his partner Tayler Jackal (both OC’s of mine)

Jareth Rot-Son of Neighthan Rot and Alana Jackal

Liam Geiss-Son of Porter Geiss and Spectra Vondergeist (she was the surragate as Porter has a partner named Loki Booreagard and they wanted a child so Spectra stepped in and helped them)

Lynx Tigre- Son of Tay Tigre and his partner Ketsu Marsh (agian both OC’s of mine)

Tsunami Kane- Son of Mako Kane and Lagoona Blue

Rodney Taur- Son of Manny Taur and Iris Clops

Moanique DeNile-Gorgon- daughter of Deuce Gorgon and Cleo DeNile (I felt bad breaking them up so I had him help her out by being the one who donated so she could have a baby with him and at this point her and Lyla get along with eachother)

Pawlette Wolf- Daughter of Clawdeen Wolf (adopted daughter to be exact)

Elmyra Dracula- Daughter of Draculaura and Kiren Valentine (Like with before he’s her doaner)

Lola Stein- Daughter of Frankie Stein (she built herself a daughter when she was ready to have children)

Lucas “Luke” Spirit- Son of Johnny Spirit and Operetta (We need a doll of Johnny Spirit)

Bryant Mortovich- Son of Sloman “Slo Mo” Mortovich and Ghoulia Yelps (his last name may be spelled wrong)

Luann Stripe-Daughter of Toralei Strip and Tay Tigre (he’s her doaner before anything is said as he is gay, it doesn’t mean he can’t help you by doanating)

Isaac “Ike” Bominable-Burns- Son of Heath Burns and Abby Bominable (again he’s her doaner)

I may update the list later as there are more I have yet to name and make profiles for. As for some of the same sex couples having children, two have special ablites that allow them to have children where as Spectra helped Porter and Loki have a child. Storm and Nova Cohen are often in some kind of trouble with the others usually bailing them out. Jayson Jekyll is Autistic and Lynx has ADHD. Jayson can’t stand loud noises,slimey textures and the only ones who can touch him are his family and friends, he freaks out if a stranger goes to touch him. He even freaks out if a doctor goes to touch him, his dad usually has to go in with him to keep him calm so he can get his check up. Jayson is also verbal meaning he can communcicate with you. Heidi is usually the one who calms Jayson down when he freaks out and she uses her noise cancling headphones to help him block out loud noises so he calms down. I have ADHD and I know someone who is Autistic, so I created these two this way for a reason and yes I was bullied for having ADHD as the idiots never took the time to do research on it so they thought I was to stupid to learn anything, fooled those idiots though, I’m way smarter then they thought I was. Also the person I know who is Autistic yeah they get picked on to so i made two special characters to help get to know these two spectrum disorders...and as Lady Gaga would say, I was born this way. Lynx’s dad Ketsu also has ADHD and if you read the story “Horror Movie Magic” On wattpad, when he comes in he and the other explain what ADHD is and how it affects a person, in the story with Jayson, now that he’s a teenager, he’s the one who comes out about Autisum and tries to help the others understand it and how it differs from person to person and how some are not verbal and can not communicate and how frustrating it is and Heidi shows how being willing to work with them is a learning experience for you and how you can help them as she works with her brother when they are much younger and works with him as a teenager as well. I can not stand bullies and do not like seeing people with Autisim and ADHD picked on just because one does not understand what is was and I just love the idiots who think a mental illness is contagious and try to avoid the person all together...newsflash for you idiots its not contagious the person is born that way and sometimes it’s not caught until way later in life. Ketsu’s ADHD wasn’t caught until adulthood much like mine was but his sons was caught when he was in 4th grade. Jayson’s autisim wasn’t discovered until he was in 5th grade. Also I read some head injuries can acually cause ADHD like symptoms and may eventally lead up to a diganoses of it. I’d rather take the time to learn about what a person has rather then jump to conclusions are treat them badly because I don’t understand it, it’s much easier for me to sit down and do research on what they have and get an understanding of it that way I get an understanding of them and what they have to go through with it. I’d rather treat everyone equally and like a human being, I’d rather reach out and help someone rather then push them away. So even though they are O.C’s created by me, Ketsu,Jayson and Lynx are special to me. Keep in mind everyone is special and unique in their own way. Be Yourself no matter what anyone else says, you are you, you are special in your own way, you were born the way you were. Monster High teaches us about acceptence, how everyone is different and how to be yourself. Writing is an outlet for me and it helps me express myself and I love it when my writing also helps others. Another thing about me is, your sexuality doesn’t matter to me, you are a human being and deserve to be treated like one and that is shown with Heidi when her brother comes out as gay, she loves him no matter what,He’s her brother and if anyone picks on him because of it they end up dealing with Heidi and she’s not to pleasent when pissed off. Lyla is protective of her brother as he’s openly gay and still gets idiots on his case...Manny Taur but after Lyla beats the crap out of him he let’s Tay alone. Oh and how does Lyla beat the crap out of Manny with her being way smaller them him, size doesn’t matter, she takes him down during football (or what ever it’s called in the monster high world) practice and beats the ever loving crap out of him for him bullying her brother Tay. Amber Also beats Manny up when she catches him picking on Jackson Jekyll, she also has to pull Jackson out of his locker but she still beats Manny’s ass for it. So yeah to these girls size does not matter...him picking on thier loved ones was his downfall. Sophie also beats the catnip out of Toralei because she get’s Heath into a whole heap of trouble and it did not sit well with Sophie who can mutate her hands into weapons, she can also mutate her body covering it with armor like skin so yeah Toralei doesn’t damage her at all. Fighting doesn’t really solve anything but in thier cases it teaches the bully what happens when you mess with some one they care deeply about. Edit :I updated the list.

#Monster High #ADHD #autisim

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hiimsociallyawkward · 3 years

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a servant of two masters

hi friends welcome back to me aimlessly ranting about merlin. up today we have 4.06 and this episode. wow. literally just the title gives me everything i need and i'm absolutley here for the chaos that will ensue. hi bestie @lady-ofmagic-andstars

i love them in their capes

i want a cloak

dude the 'oh it's not gonna happen' and then it happens trope is so dumb but i laugh every time

notice how the knights ripped off their capes

dude people are falling off of horses and out

MERLIN

ok ok but how is he injured. ik this is rated for kids but i really dk how badly merlin is injured. it looks like just his shoulder but he shouldn't be almost dying like his yk?

:,) arthru making jokes

ok but i love arthur taking care of merlin

alskdjflsadk them trying to make jokes to make each other feel better :,)

stop arthur. stop telling the truth merlin's not dying here 😭

bestie vibes only deadass

HAHA

a s s

side note, the site i get my screenshots from- this picture has 61 views while others average maybe like 10-15?? perverts HAHA just kidding

sok i'm actually really curious as to what merlin's injury is

alsdjf;lasdfjsaldfjsaldf merlin making the rocks fall

idk if it's jut the angling but i felt like the enemies were way too close for merlin to create an entire rock barrier. i don't have any screen shot evidence but so you're just going to have to take my word for it

ok but like who even are these men. they were working for morgana trying to capture arthur?

and what's morgana going to do once she has arthur? kill him and take his place on the throne? remember how well that turned out last time she tried that? no one wanted her. idk idk morgana is just confusing as to what she wants

pls die agravaine

haha strangely fond of the boy? there's nothing strange about it

ok i laughed but i also felt bad when morgana splashed merlin awake and flailed around like a fish

dude merlin is so snarky here and i'm HERE for it

ok i like the knights being competent. thank you thank you

and now they're riding back into camelot with their capes on? you're telling me they traced back their steps to find their capes, dusted them off to make sure that they weren't too dirty and didn't have any leaves or branches still sticking to it before riding back to camelot? iconic

poor gaius. ok he's the worst but he does think of merlin as his son and this makes me sad

ok i have a dumb question. do you think merlin understands whenever other magic users are casting spells? ok i feel like this is a dumb question now. but like, is magic a language? are all incantations in a different language, so when other person who knows magic is watching you- they know what you're trying to do and such? i feel like "of course they'd know" but i'm basing that assumption on hp where everyone knows that alohomora is alohomora and where everyone knows that lumos is lumos. but what about here? does merlin know what she's incanting? can he slightly understand it even if he's never seen/done it before? is magic a language like latin, and even if you aren't completely fluent, you and parse together things and make an assumptions?

arthur is just so sad here

i just, i have to have these here

yes bby figure out that we have a traitor

gaius is not slick in the slightest. yes. look at the traitor king

wow morgana being able to bond with the snake? i wonder how

ok question, does the fomorroh have some sort of loyalty to whoever calls them?

✨kill arthur pendragon✨

ok that snake going in his neck is actually scary

pretty castle counter: 5

btw this is actually my zoom background sometimes. it depends from call to call but it changes between this pretty castle and peeta mellark

G E O R G E

ok i've seen all the tumblr posts but it doesn't get less funny. the 'merlin's missing and we can't find him so we're going to replace him with another manservent dressed EXACTLY like merlin so arthur feels better' makes me chuckle every time

i would like to have that for breakfast

i like the loyalty arthur thank you. i love the loyalty pls. i love that they're friends. like, i love the romance but i love just people being friends too

ok this whole scene. arthur wanting to look for merlin because he has to at least try, gwen just wanting arthur to be careful and to come back to her, gwaine being buds. i love all the friendships in this and just yes thank you

ok ok ok ok ok ok ok ok i'm not at the hug scene yet but i know it's coming and i'm beyond excited

ok this sound track is so cute.

saldkfj;asldkfjasldkfsd

matching icons for you and your best friends

deadass if someone wants to change their tumblr icons so we can match hmu bc i'm 100% down with that

another pretty castle scene

SASSY MERLIN PLS

ok ik this is dumb to comment on because i feel like it's not tremendously hard to execute but i love the differences that colin made in regular merlin and fomorroh merlin. it's the best

they say it later in the episode but i find it hilarious how bad of an assassin merlin is

dude pls you're pouring poison in front of EVERYONE else?

BOG MAN. ok guys i'm calling you guys bog mans now.

ASLDJFALSDFJS THE JEALOUSY SCENE

i am cringey but laughing at the same time you don't understand why am i this childish

ok but arthur is being so sweet right here. i feel like he's not trying to be showy in front of gwen, i feel like he wants merlin to rest and that's so sweet. he's so patient right here and i love him

i miss the gwen and merlin friendship actually

dude merlin is roasting gaius so hard today

leon geeking out over weapons is so cute. omg he's such a tiny nerd i love him

laskjflasdfj THIS SCENE. this makes up for the stew jokes that i may or may not still be mad about

i love that the knights LITERALLY turn a blind eye it's actually hilarious

LOOK AT MERLIN BEING COMPETENT?? HE'S SO SMART WITH THE ARROW RIGGING THING

it's literally treason leon pls and you're laughing you're the best 😭😭

i wish we had a pervical back story arc

ok i think it's dumb that i laughed when merlin ducked but i stand by that

ok why do i feel bad for arthur a little. he's talking abt some semi-deep stuff. not deep deep but like, he's trying to ask for advice from his friend, his close advisor. he would've never talked to merlin like this is season 1-2 but here he is, talking about trust. and MERLIN is trying to MURDER HIM. yes. i admit it's a little funny when i'm just watching merlin trip over things and such, but when i listen to arthur talking i feel slightly sad

literallly. merlin's passed out on the floor and arthur doesn't even think anything is wrong

gwen's face when she knocked merlin out is so cute

oop. why is arthur standing in agravaine's door way like an absolute robot

cyes arthur. figure him out

i hate agravaine. i just want arthur to be happy. he's only trusting agravaine because agravaine is family.

stfu agravaine 'you're all that's left of my dear sister' SHUT THE FRONT DOOR

ok there's a repeat of the castle from earlier but i'll spare you

pls this bath scene is so awkward. tt not being able to trust anyone anymore and we're laughing at merlin but arthur's talking so sad and deep

pls this bath scene is so awkward. that's all the notes i have

again, i miss gwen and merlin

merlin is MONCHING on those berries. i'm craving berries now

ok but like. yk that pouch that gaius is using to make the forromoh dormant? what if merlin tucked it in his neckerchief as a precaution. i'm just saying.

aslfkjasdaskdjf the tavern

yall why did merlin have to stop his horse to drink the potion

i want the knights to have a cool band name or smth yk what i mean?

i like that merlin is still a little in the camelot red. it's not the same shade but yk what i mean

HAHA LEON AND PERCIVAL BEING PUSHED TOGETHER. I JUST KEPT ON SCREAMING SUBTEXT SUBTEXT

damn morgana wants RESUKTS. i dont blame her

the frist interaction with merlin and morgana in the hut is so awkward. pls.idek how to comment on it

deadass morgana's dress is so pretty.

magic fight! magic fight!

stfu 'rightfully mine' pls

hehe there's a leaf in his hair

ok i feel like i should've commented more on the magic fight but idk bro

so ik that colin was in this whole episode but it really only just now feels like merlin is here and i think that's fun

arthur is the cutest. i'm loving this dynamic you have no idea. i live live live live LIVE off banter. pls

guys i'm sad apparently i can only put 10 pics in a post but pls enjoy this one pic of arthur right here 😭

ok idk abt you but i'd love to hear jokes abt brass

agaragvaine pls die already

YOU'RE SUCH A PERV LITERALLY

AWAY

NOW

dude that last scene was actually really pretty and i'm sad that i can't attach it now

anyways thanks for reading my long ass rambles. but i'll be back next week to the secret sharer i'll catch you on the flip side

#merlin #merlin bbc #colin morgan #emrys #morgana pendragon #king arthur #bradley james #gwen pendragon #angel coulby #morgana #katie mcgrath #gwaine #percival #elyan #leon #gaius

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pomrania · 5 years

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hello! i've noticed you sometimes post about dnd stuff and ik this is kind of a weird question and i apologise if you've covered it already: how do you/would you, as a dm, deal with death of a pc? would you try to set things up so that the others can resurrect them, or have the player create a new character, etc? (if this is the case, any tips for smooth integration into the party?) thanks :)

So, a lot of this depends on the party level. There’s a bunch of spells that are explicitly designed to bring a character back to life; and if there’s someone in the party with access to those spells, then the onus is on that person to use them appropriately. If you’re a level-20 party with a cleric, and NOBODY has any spells to bring back a dead character... well, that’s kind of digging your own pit to fall into.

At a lower level, though, that really depends on the DM, and also the nature of the campaign. If you’re doing a gritty “anyone can die” game, then if a character fails their three death saving throws, boom, they’re gone. If you’re doing a high-magic campaign, where there’s a lot of high-level magic users in the background, then it would be perfectly reasonable to require the party to bring their dead comrade to a temple, and then pay whatever price that temple requires for the resurrection. (Traditionally, the “price” is something along the lines of “undertake a quest for us”, which I think is both fair in-’verse, and also good for gameplay.)

As for what I personally would do.... Well, I don’t like character death, in games or in stories. I would bring the character back, but at a price (which I would discuss privately with the player). Maybe that price is some of the character’s capacities; maybe they’re now in debt to an NPC who saved them; maybe it was some arcane or eldritch force that brought them back, and now they have to deal with whatever THAT thing might be.

There’s also the fairy-tale route of “go on a quest to bring this character back to life, and the player of the dead character can have a temporary character who’s along to help you or as a guide”.

Getting new characters into the party, at its base, is pretty much the same whether it’s an old player’s new character after their previous character died, or a new PLAYER joins your game, with their new character. The simplest thing would be to say that the characters are already more-or-less acquainted, so however the player describes their character OOC, the other characters would have that knowledge without metagaming.

It all depends on what exactly “smooth integration” means to you. Do you WANT to just get on with the game, albeit with a different party member? Do you WANT to act out the process of accepting a new person into your adventuring party? There’s no right or wrong answer here, so long as everybody’s cool with whatever gets settled on.

It’s possible to pick and choose stuff from there too. So, let’s say that Sandy just likes doing the dungeon crawl, and finds it boring to have the characters go through introductions; but let’s also say that Pat loves playing out the process of getting to know a new character. Let’s say that Robin is just joining the gaming group, and is already on good terms with the other players. The party is currently five levels deep in a dungeon, and Robin’s character shows up as a lone adventurer. We can have it that Sandy’s character and Robin’s character already know each other, are good friends, “what are you doing here, if I’d known you were headed this way we could have been together this whole time”. However, Pat’s character does not necessarily have to know Robin’s character, or even TRUST Robin’s character, so long as there is sufficient reason for them to work together.

#gaming #original content #not a reblog

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pervincetosscobble · 7 years

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finished my young justice rewatch here are some Thoughts And Feelings (this is a very long post sorry to mobile users)

let me begin this post by saying bart allen is my one and only true ultimate favorite, and also if you’ve ever wanted to see (um, hear) me cry you can do that now thanks to bart allen

i was surprised by how much some of my opinions/faves changed tbh? i was. god, i was 13 the first time this show aired and 15 when it ended, so it tracks that now, 4-6 years later (???!?!?!?!?) things won’t be the same, but some changes were. significant

i’m adopting conner, for starters

conner loves sociology. pry this headcanon from my cold dead hands, motherfuckers

conner also knows a lot of really weird pieces of trivia

conner was a good student but also didn’t care about school

i remember not being really into conner/m’gann the first time around but i was kind of taken in by them in s1? these two kids trying to find their home in a world that wasn’t made for them.

conner and m’gann had a lot of date nights themed around Get To Know Earth Culture

some of these involved bioship travels and, like, day trips to paris just because they could

some of these were like. improv lessons and pottery classes.

i’m also still not super happy about the hints that they get back together post-s2. like. i hope they become friends again, that’d be good, but i refuse to believe conner would be okay with dating her again after what she did the first time.

point that has only just occurred to me: in the beginning of s1 conner is vastly uncomfortable with telepaths. by the end he’s totally okay with it because of m’gann. and i’d bet money there’s a point somewhere mid-timeskip where, because of her, he was no longer okay with them anymore.

one the note of the timeskip: five years seems RIDICULOUSLY long to me, especially considering that every plot-significant change happened “in the last few months.” like, what was the goal? aging dick up to nightwing? five years is SO MUCH missing lore, so many stories they could’ve fleshed out. make it two years. hell, if two is a squeeze, i could’ve gone for three. but five years?? nah, dude.

the best thing about the timeskip was domestic wally/artemis, which, like, i was totally enamored with them, so much, and their relationship development, and everything about them

i also liked kaldur’s character a lot more this time around, although i’ve got to say i’m not wild about them basically fridging tula?? (i’ll admit to not being super familiar with aquafam lore, so i don’t know how true to the comics that is, but they didn’t have to do it in the show) like, i know that it turns out he didn’t really go mad with manpain grief and turn evil, but i think there’s an equally powerful story in tula being injured and recovering in a world where she thinks kaldur abandoned her, in kaldur having to lie to her face instead of using her memory as justification

in general i think s2 could’ve benefitted from some trimming? i love all the freshmen, i really do, but it wouldn’t have been the worst thing if there were a few less of them.

alternately - and i know, networks and whatever - if s2 had been two seasons, or even had half a dozen more episodes, i think it would’ve benefitted from that, too

gotta say, the light gets old real fast. or at least, like, the whole “everything got super fucked” “no, everything went exactly as we planned it” things. like, you’re telling me the team never once threw them a curveball. never. really

13yo dick’s shenanigans and wordplay were a lot funnier when i was 13

now that i am an adult i feel..... a little more skeevy about canon-era jaime/bart than i did when i was 15 and i actually knew 13-year-olds who were dating 16-year-olds and saw nothing wrong with it? but i maintain that they have a solid friendship and definitely end up dating once they’re in their twenties

zatanna is my hero

this show vastly, vastly underutilized raquel. it’s a damn shame.

you know who else was great? mal. mal definitely saves puppies in his spare time and knows three languages and at least seven forms of martial arts and every teammate’s abilities and fears and favorite colors and everything there is to know about karen

artemis/zatanna is good

you know how jade just showed up and was like “yo roy look at our daughter”?? i like the idea of jade just, like, casually dropping lian’s existence into daily conversation.

“i miss alcohol now that i’m pregnant,” jade says. artemis chokes.

“this mission can’t take too long, i told the babysitter i’d be back by 9,” cheshire says. “the what,” sportsmaster shouts.

i still ADORE the runaway team, including og!roy, and man, i didn’t come out of this rewatch shipping a lot, but i love the idea of the runaway squad being kind of a tangled poly mess. ed is dating roy and asami, tye is dating asami and virgil, asami loves all her boys and understands why roy isn’t interested, etc.

like this fic for the disney film descendants

but also, like, in general, i really fucking love these kids

this show has a lot of really weird dad plots, which is strange for me bc my dad and i used to text after every episode, but also in general it’s interesting seeing the vast range of potential dads. for instance:

clark “i didn’t ask to be a dad” kent, who eventually transitions into an apparently passable dad? it’s not clear

black manta, who is morally a shitheel but also one of the most supportive dads on this show

barry, who definitely wanted to be more of an uncle than a dad

lex, who wanted to buy his genetically-experimented kids’ love

ollie, who really had a hell of a time

and of course dinah, who is the best mom and probably the best parent on the entire damn show

(also bruce, who didn’t do much dadding, but damn if i didn’t tear up at him talking to dick/tim/babs before he left earth)

gar logan is the team’s adoptive little brother. all of them, but especially the original six. and probably also zatanna and rocket.

i’d be able to go into more detail if we had more goddamn information about who joined the team when, which we don’t, because five year timeskip

but anyways since gar and m’gann are pseudo-siblings they’re closest, and then gar also loves conner, because who wouldn’t love their sister’s cool boyfriend?

conner is overwhelmed and kind of pleased by this

after conner and m’gann broke up gar was very worried that his sister’s cool ex-boyfriend wouldn’t want to hang around him anymore

conner did. conner and gar are basically brothers.

gar loves the entire original team, period

also i wanna throw it out there: ik there was a show-specific comic tie-in. i have read none of it. so if i say anything that doesn’t mesh with that it’s because i don’t care a ton about the comics? the show is probably better anyways

god i think that’s just about everything? so to wrap up this extremely long post i’m gonna go out of bulletpoint style here

i’m excited for s3! i really am. i can’t wait to see what they do with it. but also i’ve been convinced since i was 15 that the very last scene, with darksied and apokalips (which i deffo just spelled wrong but anyways), that scene only exists bc the producers were like “fuck it, we’re getting cancelled, might as well go all in” and just threw garbage in to make it seem like there was a conspiracy

like, this is a deep cut here, but there’s an episode of phineas and ferb that ended with a “next time” that was a series of nonsensical dramatic scenes, and then they tried to make an episode out of it and it was basically gibberish, and i’m really concerned that’s what’s going to happen here

but tldr i did enjoy this show a lot, and i’m glad i had the chance to rewatch it, and if anyone has their own thoughts to share y’all are welcome to hit me up!!

#textposting #THIS IS SO LONG I'M SO SORRY #i have a LOT of thoughts and feelings about young justice apparently!!

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titheguerrero · 5 years

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Dander Up, Down, and All Around

Today's topics: VA health care politics; a clear-eyed and sane report from a bastion of managerialism, with related observations on innovators trying to create real bottom-up value.

It's the last day of the year, so let's get this done. Owing to various largely unforeseen challenges, happily now largely behind us, this "Dander" series was interrupted for some time. Apologies to anyone who noticed. In any case, to refresh: as Chief Blogger and FIRM president Dr. Poses has indicated often enough in these pages, health care developments raising our dander are still everywhere, all the time, and on the increase. Nothing particularly new here. Certainly not new since the 2016 election.

Except that in our current situation--inter-woven social (read: inequality) and political (read: everything inside the Beltway morphing from mere swamp to crazed greased pig trough)--the health sector is triply hard-hit. Really, it gets old to keep on playing nay-saying Cassandra. It's not normal.

Thus today in America the patient can't catch a break. For health care probably more than in any other first world country where budgets are still overstretched not to mention much lower, and where technology is just as uncooperative. Will the yellow-vests to come out on the streets over it, as they recently did over social engineering from the folks who gave us Freedom Fries? (Maybe up to three guys: John Roberts and Trump's two new USSC nominees, as ACA makes its way to them yet again.)

No need to hyperlink the following examples. Everyone's immersed in them.

Obamacare imperiled by twisted politics and jurisprudence, even though its recent mild decline in enrollments probably means little or nothing and the body politic wants it.

Ultra-right wingnuts flexing muscle by urging the dismissal of the capable (and quite religious) head of the National Institutes of Health. Why? Stem cell research, a promising technology that's run afoul of some ideological right wing evangelical cant.

Net-net, IT's impact on health care, coming as much from the well meaning elitist left as from the elitist right, still negative. It enriches tech- and health-organizational CEOs while patient satisfaction, provider satisfaction and life expectancy all three tank. (I know, it's complicated--we also got that opiate crisis.)

Corruption in government, tech, hospitals and big pharma: can you spell "conflict of interest"? Read pretty much any recent posting in Health Care Renewal.

I could waffle on and on. But instead of that let me focus today on one thing that's got my dander up and another that's actually tamped it down a bit.

The VA, yet again. No doubt, forever. Or, Why's the VA Such a Punching Bag?

Dr. Poses has been feeding me troves of data and news about the VA. I'm happy now to report just a few highlights. Oh, wait: lowlights. Dreary as ever. Ever since our Fearless Leader fired the capable David Shulkin, the question rings ever louder, "how bad can it get?" We now know the answer seems to be: bottomless pit.

Here are some of the lowlights. Bear in mind that, rightly or wrongly (we think mostly wrongly), Shulkin is now being blamed for all these deficiencies at the VA. Despite the facts that he was hamstrung from the get and that the VA was, like the EPA and others, one of the places where tge White House allowed chaotic privatization to run amok. We're in a fun-house mirror version of Ronald Reagan's "government is the problem."

Suicide Watch. Under this administration, while suicality remains rampant among veterans of recent Forever Wars, the VA has fallen down grievously on the job of addressing it. Last month's report from the government's own GAO confirms this.

Privatization Writ Large. Privatization initiatives, so dear to the hearts of cronies and lobbyists, are already in big trouble. Trump's own hand-picked successor to Shulkin recently had to admit to Contress the “The [VA] was taken advantage of because of the hasty nature that took place when the program was put together." Not budget dust, either: the agency paid out nearly $2B-with-a-'B' in unnecessary fees for these private booking "services." (In fairness let's put a little parenthetical note in here. As a former employee I know the VA itself causes unnecessary care delays. Service-connected disability ratings impede scheduling, as do salaried physicians' myriad ploys for putting the brakes on their own performance.)

Privatization Writ Small. Still, this privatization thing is a great example of two-wrongs-don't make-a-right. ProPublica informs us that what's "actually happened in the four years since the government began sending more veterans to private care: longer waits for appointments and, a new analysis of VA claims data by ProPublica and PolitiFact shows, higher costs for taxpayers." Can the VA claim better outcomes using any parameter at all? I think not.

Mar-A-Lago. Lots more VA stories are leaking out. None are especially edifying. But in some ways the most alarming and tawdry among them is that surrounding the troika of unelected Florida golfing buddies. For months or more now they've been calling a lot of that agency's shots. Direct line to the White House, demonstrable responsiveness on the part of VA apparat. Maybe the crowning glory in this administration's reputation for cronyism, this group--comics mogul Ike Perlmutter (you can't make this stuff up), Palm Beach MD Bruce Moskowitz and lawyer Marc Sherman, collectively known as the "shadow rulers"--have pushed a lot of policies and expenditures for the VA with zero expertise. Unless a lousy golf handicap counts as expertise. Democrats have vowed a response in the new Congress, and we can only hope Speaker Pelosi prioritizes that. I think when it comes to Pelosi versus Ike's Marvel Avengers, the lady wins hands down. The conservative (and probably still somewhat Moonie) Washington Times reports this will happen in the first half of 2019--both from the GAO and the House Oversight Committee. These guys are super bad COI news, having weighed in with their scant expertise on way too much down to VA job candidates.

The worst-of-the-worst for this poor agency is how the Shadow Rulers have gummed up its use of technology, especially IT. A little background: the VA was the one organization within the entire US Government that developed, back in the day with its VISTA technology, a fairly creditable in-house electronic medical record. VISTA, along with DOD's AHLTA (get it?) were supposed to play nice together but, despite billions in earlier expenditures, never did. VISTA might have survived but, starting with Shulkin (and probably predecessors) got deep-sixed by the bogus attractiveness of private-side EMRs. GE had its hands in there for a while: it deserves what it got. Now Cerner, the main vendor rival to the privately-held Wisconsin cult vendor Epic, has the inside track for crafting a workable EMR for the VA. But the Boys from Mar-A-Lago want to micro-manage this? Why? Earlier this month ProPublica disclosed part of the reason based upon FOIA-obtained emails. The doc among the troika has his own mobile app. Here's how it went down.

[N]ewly released emails also detail Moskowitz’s effort to get the VA and Apple to adapt his app. As a VA IT official described it in a May 2017 email, 'We are utilizing the native iOS mobile app, Emergency Medical Center Tracker, that Dr. Moskowitz developed.' VA health officials offered their own ideas for how a collaboration with Apple could benefit veterans, such as working on credentialing, data exchange and analytics, and suicide prevention research. But Moskowitz rejected the VA doctors’ ideas in favor of his own. 'These are good areas but not the emergency ones which my group of experts have identified,' he said in a May 2017 email. 'I sent an email to outline the recommendations.'

'Nuff said. As someone who cared for thousands of veterans, I can't begin to describe how galling this is, even if the new guy, Wilkie, says he's trying to right the ship. While blaming his predecessors. If these gentlemen from Florida--that bastion of fair elections and cost effective medicine--were instead gumming up Medicare, threatening the health of parents and grand-parents of business leaders, dot-commers, millennials and trust-funders, we'd have heard a lot more hue and cry about the VA and its shadow rulers. Now I Pat Down my Dander. Soothing Words from Unlikely Places. Oddly enough, the worlds of IT--absent the shameful events described above in connection with the VA--and management are beginning to pull themselves out of their torpor. Under the dual impact of the HITECH and ACA enactments, the IT and management communities strove for years to accommodate to this brave new world of individual mandates and EMR meaningful use, and the result was rather anechoic. One heard little complaining about the baleful effects of the IT pall dropped into the doctor-patient relationship. That's changing now, and the signs are everywhere, though sometimes hard to parse. Nailing down the how and why of this change can be difficult, but the effects of "unusability" are emerging into a vocal majority consensus. "Thought leaders" such as Robert Wachter and Donald Berwick have exerted part of this impulse to call a spade a spade in the interest of QI, citing, among other things, generational change. Smartphone users and tech-savvy students and house staff are much less likely to tolerate the Some of those properly impatient young innovators--and I don't mean the septuagenarian Moskowitz--went on to found start-up companies that are starting to move tecnology out of its old, enormously dreary meaningful-use rut. They're bringing patients--"engagement" the new meme--back into the narrative. What is this new narrative. The rather staid and managerialist health IT society, HIMSS, has this to say, couched in classic bureau-speak jargon, in its 2019 conference agenda, "6 Health Information and Technology Topics to Immerse Yourself in at HIMSS19." Translations into English follow.

Strategic Patient Experience Improvement (help the doctor with her workflow)

Aim for Secure Accessibility (make everything more secure)

Mapping a Vision to the New Consumer Landscape (improve revenue cycles)

Moving Precision Medicine into Primary Care (make "precision" medicine, whatever that is, or at least AI, work better--maybe with smart guidelines--for primary care providers)

Contextualizing AI for Healthcare (ok, we know that AI is really important)

Exploring the Pharma-Provider-Payer Relationship: the Last Step to True Value-Based Care (get everybody working together better now that fee-for-service care is giving way to bundling)

Stripping away the cant, these are actually pretty lofty goals and show HIMSS coming into its own. Charge capture, upcoding, and dashboards for managers watching 30-day readmission tallies begin to sound so 20th century. Care coordination from the bottom up, not just the top down, begins to appear more attractive as studies start to show that top down doesn't always work all that well. (Caveat: read the whole piece, not just the online abstract. JAMA is behind a paywall.) And the leadership is coming in some cases from outside classic health IT vendor-land, notably from innovation centers cropping up among many providers and payers.

Meanwhile, on just about a daily basis I learn about a new start-up addressing these issues, often based on newer concepts and approaches to workflow as ecological reflection of a unified community-wide integrated health care system.

Moving from encouraging specifics about health care realities and IT start-ups addressing them, to the more general and philosophical matter of why it's taken so long to get to this place, I conclude by drawing the reader's attention to some recently emerging, and highly salutary, public intolerance to bullshit. (Can this be a result of the clearly emerging disgust with insufferable politicians broadly speaking?)

The problem of obfuscation using bullshit, though it goes well back into the mid-20th century, was most famously addressed in the elegant short book On Bullshit published well over a decade ago by emeritus Princeton philosopher Harry Frankfurt. The latest incursion of vocal objection to nonsense in health care comes from a source that some might've considered heretofore unlikely: a couple of senior Wharton management professors. Though Lawton Burns and Mark Pauly barely mention their Princeton forebear in a secondary footnote, they nonetheless deserve an enormous shout-out for bringing attention to Detecting BS in Health Care. No paywall: use the link and download it now.

Burns and Pauly bring out all the other B's: to start with, buzzwords, bullets (silver), best (practices) and bandwidth. Lots of others. The one B they like: bottom-up. So do I. Hard to know how firmly the Burns and Pauly tongues were planted in the Burns and Pauly cheeks, but by cracky they surely know they're right about this. Common sense solutions so clearly and frequently give way to self-dealing and managerialist me-tooism in health care. Those who benefit from such nonsense have been called out often in this blog. But we can hope they now know not only are a few doctors now on to them, but some clearer-headed individuals from the management establishment as well.

Article source:Health Care Renewal

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