I (19M) and my girlfriend, soon to be fiancé (20F) have known each other for 4 ish years, and started dating about 2 years ago. She’s always struggled with weight but I didn’t care as I love her for who she is and how we are as a couple. When we got together, she worked in health care (and still does) and was making good money. I, on the other hand made next to nothing as a supervisor at a BBQ restaurant. Flash forward to 7 ish months ago, the hospital that she is working at gave her a MAJOR pay cut, whereas her father helped me get a really good paying job in a pipe yard. So I made more money than her, and since I don’t have a car payment like she does (I own my 2 trucks outright), and don’t have as many expenses as she does, I help her out. She’s been trying to lose weight for years now, and I help pay for a lot of it. I even buy her the KETO friendly food (which is absolutely expensive) so she can meal prep. I don’t mind doing this, as I make a good living and don’t have many expenses. Well 4 months ago she heard about a surgery that costs roughly $3,000 called a gastric sleeve. Now personally I don’t like the idea of her having a surgery that would remove a portion of her stomach, and place her on short term disability at work, and I vocalized that I think it would be a enormous financial strain on her, especially since I was leaving for basic training around that time and couldn’t help out with her other expenses. Well this is where things got dicey. Her mother agreed with her about the surgery, as well as her friends, but her father and I were in agreement that at very least she should wait until she has a better paying job (Her parents and I have a great relationship and they consider me family, and still do after all this). I ended up getting tired of everyone trying to convince me to be ok with the surgery, and to which I finally said “Look, I don’t care about how you look. I think your beautiful no matter what. If you want to have the surgery than f***ing do it.” Well she went to the clinic and was told it would take away 20% of her stomach. Ok fine. I even allowed her to use my CARE credit with the agreement that she would pay it off monthly, without delay. Flash forward again to 2 months ago. Basic training was kicking my ass, and all of a sudden, I got sent to the on base hospital where I was eventually told I was being sent home for a liver issue. I was devastated, but it meant I would be home a few days after the surgery to help take care of her. Well come to find out, the doctor lied to her and actually took 80% of her stomach and the surgery costed more than we were told, but that’s not even to most messed up part. My girlfriend still has a car payment, insurance, animal expenses, ect. And her short term disability would pay her just enough to cover these things for the 2 months she’s out of work. Well in order for the short term disability to kick in, the doctor that preformed the surgery needs to send some kind of documentation to her work. We found out today that they did not in fact do that. So her car payment is next week, and she can’t receive a disability check, and I don’t get paid for another week so I cannot help her out. She called me, absolutely pissed, saying “I should have never gotten that surgery. How am I going to pay for my car now?!” To which I responded “I knew that place was shady and I told you this would become a financial nightmare and that you shouldn’t do it. I told you just to get another gym membership with me” which she pretty much said she agreed. AITJ

Posting again because no one responded yesterday lol
I (27F) have had sleepiness issues my whole adulthood. I’ve talked to a few doctors about several different things and no one has made any progress.
More detail on symptoms: I struggle at least once per day with an extreme and sudden onset of sleepiness. I say sleepiness because it doesn’t always feel like fatigue. Some days my body feels physically fine, but I could fall asleep at my desk at work any minute. Some days I really do start falling asleep at my desk, or even standing if it’s bad enough. Other days it does feel like fatigue and my whole body is exhausted, along with the feeling of sleepiness. Naps don’t help me feel better. I sleep through the whole night, sometimes 8 or more hours, and always wake up feeling tired. I know some amount of tiredness is normal, but sometimes when it hits me it is impossible to fight, and that doesn’t seem normal.
What I already know/doctors have already tried: I have done a sleep study and it doesn’t seem to be narcolepsy. I slept through the night at the clinic and they saw that I got barely any deep or REM sleep. It was almost a whole night of light sleep. Based on what my Fitbit tells me, this is the norm for me. I fell asleep and slept through all of the naps for the narcolepsy test (5x45 min naps) the day after I spent the night at the clinic. I didn’t remember dreaming at all. I will say though that I stayed on my SSRI during the study because I could not afford to stop them, but the doctor said he wasn’t sure if that would have made much of a difference. I have also done blood tests for iron levels, thyroid, metabolic panel, liver panel, etc etc all the basics. Nothing stuck out. I have tried one sleep medicine and that did not help. I was really groggy when I woke up in the morning.
Right now I take fluoxetine and bupropion and that has been extremely helpful in managing this, but I still struggle sometimes. I take those in the morning so they do not interfere with sleep.
Anyone have suggestions for what to try next??? I am stuck and so are the doctors I have talked to so far. Hoping someone can at least point me in the right direction.

Hey beautiful people! I just took my 5th shot. I am down 9.5 pounds. I feel like it's slow and steady!
I was curious how long you all stayed at 2.5. My doctor wants to keep me at this dose to protect my kidneys and liver.
30/F SW 200 lbs. CW ~191lbs. PCOS, insulin resistance. Not T1/T2 diabetic.
Thanks! :)

Just looking for FWB and if it comes to more then definitely open for a relationship. Hosting for now but can definitely travel to hang out, As far as sexual interest goes I’m looking for slim and smooth bottoms. Bonus if you’re a twink or femboy. I also prefer anyone around my age or younger btw. Friend wise though I’m into cars, gaming, and Star Wars. If Im not at work then I’m usually just being a homebody and gaming or binging some new show I found lol. If curious to see more I have pics on my profile. If you’re interested, message and let me know what you’re into right now, maybe a new game you just bought? Also curious to get out more, wouldn’t mind an extrovert to balance me or an introvert to make me have even more of an appreciation for home ;)
Dealbreakers: Age and being slim

Hi All! I know that I should just go to the doctor but I have a super high deductible and I’m hoping to advocate in the right areas. Any insight is helpful on what these recent symptoms may mean?
I’m overall healthy. 30 year old female, 5’ 3” with fluctuating weight depending on activity level but currently 138lbs. Pretty active - run 3-5 times a week and walk at least 2 miles most day in addition.
Past blood tests highlights/health highlights: positive Anti smooth muscle body titer - 2x - (last time checked last year because no concern by doctor), on 1/7/23 - elevated ALT (47 IU/L), T4,Free(Direct) Result: 1.81 ng/dL. Past history of HPV, HSV-1, abnormal Pap smear but now resolved, large gall stone, resolved fatty liver, high anxiety, adhd (take 30mg of vyvanse not every day), past sleep apnea had surgery but not sure if is completely resolved, and severe night teeth grinding (grinding through night guards), sometimes gets flushed in high stress or quick temperate change, higher heart rate while exercising (even prior to beginning vyvanse).
Symptoms: two weeks ago had a debilitating headache for 2 days (don’t usually get headaches), was getting dizzy when standing up and laying down, possible Oral lichen planus (seems unrelated to past HSV-1 as it’s not open sores but swollen tender areas of mouth) following a very horribly run half marathon (high stress?)
Was feeling much better with less dizziness until today. now a very achy body (like all parts of my body don’t feel great), feels like what it does when febrile and nausea with slight change in bowels.
Ugh typing all of that was even stressful. Overall, whenever told of these possible issues, I never had any associated indicators that stuck out to doctors. Just supposed to get my gall bladder out but I don’t have any apparent symptoms.
Possible issues: autoimmune hepatitis or other autoimmune? Hormonal something?

I have high cholesterol and am currently taking atorvastatin 40. My most recent blood test is showing I could have some liver damage due to high SGOT numbers. (I haven’t spoke to the doctor about it yet. I just got the results.)
I asked my doctor for a ApoB test and he declined and said that the basic panel is fine. I think the statins are ruining my liver and want to know ApoB and sdLDL-C.
Also he convinced me to take the pills everyday as I was skipping them on the weekends and my levels went up! How do I convince him to give me the advanced cholesterol test?

This might turn into a rant.
I have been dealing with pretty severe hot flashes for the last couple of years. I believe that they were somewhat bearable when I was taking 100mg of amitriptyline. Then earlier this year I developed a slightly elevated heart rate, and my dose was reduced to 50mg per day.
Since then, the hot flashes are awful. I don't sleep well (I tend to wake up around 3am and can't fall back asleep). I recently went to my GP and described the situation to her; after listening to my heart she felt I should just go back up to 100mg Amitryptiline per day.
So I then described this to my psychiatrist (the doctor who prescribes the Amitryptiline). She felt that Gabapentin might help with hot flashes. I am now on 1200mg Gabapentin per day, and I still have miserable hot flashes. I asked the psych if I can go back up to 75mg Amitryptiline a day, she said only if she has a note from my GP clearing me for that (because heart rate).
Both doctors said I should talk to my gynecologist. Well, today I saw the NP at my GYN office; she suggested I "eat sweet potatoes and tofu", and I should try Estroven.
I honestly wanted to bang my head against a wall. Sweet potatoes? I mean, I'll try, but it just seemed so unhelpful. The NP kept interrupting me, wouldn't let me finish a sentence, and I was done in under 2 minutes.
What gives? I just don't feel like I am getting the care I need.
My GP is on vacation, but hopefully next week she'll write the note to my psych, so that I can try going back up on the Amitryptiline.
I asked the nurse about the new medication for hot flashes (fezolinetant), but she said there wasn't enough research, and "it would destroy my liver". Plus, HRT is out because my mom had breast cancer, and I had a lumpectomy (atypical hyperplasia).
Do I just have to accept that hot flashes are part of my life?

So to start form start, I have always had a feeling that something is wrong with my heart. Since childhood I had this feeling beacuse of some pain that happens sometimes in my left chest.
So few Months ago while I was a sleep I was awakned by the pain in left side of the chest, I thought its a heart attack and I stood up quickly. After that my heart started beating faster and faster (which I didn't knew at that time is known as palpation and is normal is stress response). This solidified my belief as I thought may be I body isn't getting enough oxygen and heart is beating faster to compensate for it and I am going to die any moment now. But after a minute or so it slowed down as thought I have survived a heart attack. Next day I visited a doctor he checked my ECG/EKG and said it's completely normal and gave me medication of anxiety, which I dint followed.
Same happened to me few more times and then I went to the city for few days (as I live in ruler area and most of the facilities aren't available here). I got my self checkup by a cardiologist. All tests (ECG, Holter, EchoCardiogram) came normal, and he too gave me anxiety pills and Petrol for SOS. This happen happend to me again and I rushed to the hospital in emergency and they did a test for Trop-T and it came negative. So in the end my fear was cleared and I came home. I have more episodes of palpations and I calmed myself by says it's just anxiety and my body will take time to get out of it.
Then last month I had a blood test, in which there were signs of infection because of abnormal neutrophils and lymphocytes and platelets count was 80k and liver enzymes were also high (This report was faulty which I didn't knew at that time). I decided to go back to the City for complete checkup because I was too worried. I wasn't able to sleep that night even though I knew I have to drive next day. I was having thought like I have liver cancer or something else of that sort.
I repeatd the blood tests and came to know the report was faulty I also did various tests to check the liver (Hapititus B, C, ANA etc) and abdomen ultrasound. I came to know I have fatty liver grade one, so nothing to worry about and blood also showed no infection so I was relieved.
But then I know I am feeling numbness in my hands and legs from few days and stiffness in the neck which I thought may be due to infection but when I came to know there is no infection this worried me that there is something wrong with my nervous system. I remember that I had a headache few days ago and I thought something is worng with my Brian. I started to link totally unrelated symptoms and worrying about something which wasn't even there. Instead of taking it as normal headache I linked it with the numbness and drew a conclusion. I felt shortness of breath and blackness ( which I now think was totally my creation). I had checked by the neurologist, I had a CT Scam, X ray of Cervical and Complete Cervical and Spine MRI. Turns out I have straighning of curves and schmorl's nodes. I had physiotherapy for that.
But the numbness was still there. I went to a physican, he prescribed me vitamins ( I thought he is dumb, he didn't get my point and gave prescription as a formality). One night I felt my toung is getting swollen and throat area is getting weak and again blackness( again I think mind creating). I went to hospital at night in emergency wing and had my self checked by an ENT Doctor. She said everything is fine.
I am a vegetarian from last 3 years, and and someone told me B12 is present mostly in animal products. I had my vitamins checked. Turns out I have severe deficiency of Vitamin D3, B12 is and Folate are at lower ends of normal. I check symptoms of D3 deficiency and they include numbness and week muscles. So I was relieved.
Now I try my best to not realte symptoms unnecessarily and I am taking D3 medication weekly along with Calcium daily. I don't have any numbness, no pain and no blackness.
But still sometime something is wrong, even after these many tests and spend so much money and visiting so many doctors, sometimes I feel something is worng. .
Any thoughts ? Any Suggestions ?

I have been seeing a Hematologist due to high white blood cell count and a bunch of other symptoms. My first appointment went very well and he seemed very capable. My second appointment he talked over my anemia (one of my symptoms) and the treatment that had been given and then tried to dismiss me like It was the reason I was there for the appointment! I had to explain to him my symptoms and issues because he didn’t have any notes. I then had to tell him all of my numbers from my blood work because he wouldn’t look at it on the computer. He then changed his mind on the next diagnostic test he wanted to do because it would be “difficult” and asked me to get blood work and a CT.
I got the blood work and the next day started experiencing terrible pain in my side, to the point of falling and throwing up when trying to stand. I went to the hospital and they did the CT and said my spleen is slightly swollen at 12.2cm and my liver is swollen at 22.2 CM, as a 22F this is pretty large. They sent me home with pain meds for one day and told me my hematologist would have to prescribe more.
I made the pain meds last 4 days because of being scared to take them and ask for more. On the 4th day I had to call out of work the pain was so bad. I called the doctor, explained that I went to the hospital and got the scan done, and she tells me he didn’t even want to send the referral for another 3 MONTHS and they said they would look over the scan and get back to me, 5 hours later they tell me my spleen isn’t swollen and my liver barely and the only thing they are willing to do is tell me to put arthritis cream over the area.
I have been suffering for 3 years already without help because of a fear of doctors, it took a lot to be able to start taking care of myself. The doctor has stated he believes I have Myelofibrosis, a type of cancer that effects the bone marrow. Why isn’t he in any rush to help? I’m so confused and worried at this point. Should I try to see another doctor?

So last night I was in the ER. I really need to vent and could use words of advice & encouragement.This last month roughly I've been on prednisone to treat sun related rashes/photosensitivity related to my HCQ. I'm on my second round tapering down and feel completely awful. Yesterday and today I have had horrible lower back pain, numbness, Tingling, and achyness in my arm and chest. I had two instances where the pain was so severe I verbally yelped, it felt like my appendix was going to explode. I understand not all my symptoms could be related to my disease, but the overall body aches are debilitating. The intense heat is causing me to suffer even indoors, and I need to be able to work to pay my bills.
My imaging came back mainly normal except the fact I have hepatic steatosis and an enlarged liver. My SVO2 levels were really low, but the doctor didn't see any concerns with that. I've had pain around my liver area for a while now, but my gastroenterologist told me to go to a rheumatologist. Now my rheumatologist is saying to go to a gastroenterologist and pushing back even though I saw him within the last year. He ruled out everything and told me not to come back. My rheumatologist thinks none of the pain is related to my diagnosis, and I feel like I'm going insane. I asked for any sort of clarification on why they had this reasoning and they said "it's just not" and cut me off. I'm not saying the rheumatologist is wrong by any means, but they just flat out refused to help me or hear me out.Thankfully, I live in Minnesota and got accepted into the Mayo Clinic and get seen in less than a month, but I'm scared that I'm going to get dismissed again.
I feel like a ping pong ball getting thrown left and right, and it's so emotionally draining to feel disabled at a desk job. I had to leave work early yesterday because even with Tylenol the pain felt like someone shoved a knife through my lower back, radiating down my legs to my toes. It then progressed to under my left ribcage and was an intense stabbing pain. My arms have also been extremely sore too, it feels like someone yanked them super hard or dislocated them.
I'm struggling feeling like such a burden to my fiancée and family, they constantly are watching me suffer and don't know what to do. Does anyone have any suggestions on how to navigate new specialists and have reccomendations on how to prepare? Also, if anyone has suggestions on pain relief I would greatly appreciate it. Tylenol and Diclofenic haven't been getting rid of my pain entirely. The ER didn't give me any sort of pain medication and basically threw their hands in the air. Sorry for the long post, and thank you to anyone who made it this far. I appreciate any and all support/feedback.

Female 28 years old Duration of pain one and a half years Weight : 130 Height : 5ft I had an X-ray, they saw a stool burden, I took laxatives they didn’t help, had a colonoscopy and EGD. They found nothing. They stopped accepting my insurance, switched to doctor that accepts insurance. I got an ultrasound done on my abdomen mostly my liver, gallbladder, etc but not in the area that is bothering me. He has said the insurance won’t accept an MRI or CT scan. He keeps saying I just need more fiber. The pain comes and goes and it’s getting worse. It does leave if I have a full bowel movement but then comes back and moving my bowels becomes difficult. The pain is also spreading throughout my abdomen, I now feel pain in my upper right area. What do I do? If I go to the hospital will they give me a scan? I’m so tired of being in pain.

I'm 33 weeks pregnant and have had elevated liver enzymes since 19 weeks. They creep higher every week. I also have tenderness under my right rib. My doctor is monitoring closely.
My blood pressure is currently fine, though 👏, and no protein in urine. I had high BP at the end of my last pregnancy so I'm keeping an eye on it. I'm being induced at 37 weeks out of caution because they don't know what's going on with my liver.
I know elevated liver enzymes are a key part of HELLP.
For those of you who had HELLP, what were the first signs (laboratory or physical etc)? When or how did your doctors find out?

hese are concepts ideas I had for an Metal Gear (1987) remake which I would dub as Metal Gear Solid 6: Outer Haven. Metal Gear 2: Solid Snake (1990) would be called Metal Gear Solid 7: Zanzibarland. Both games would be long and give a lot of depth on Solid Snake's past and his relationship with Big Boss, Campbell and Gray Fox. Another game I would push for is Metal Gear Solid: The Philanthropy Chronicles.It would allow players to play as Solid Snake and his supporting cast after the events of Metal Gear Solid 2. Snake’s mission to continue taking out metal gears and track down the Patriots along with Revolver Ocelot. It would lead up to the events of Metal Gear Solid 4: Guns of the Patriots. I will be working on Metal Gear Solid 7: Zanzibarland concepts soon.
The concept for a Metal Gear Solid 6: Outer Haven (MGS6: OH):
I know its long as Metal Gear (1987) would have to be a game that is remade from the bottom up. A remake of Metal Gear 2: Solid Snake would be easier since it was a rock solid game. One wouldn't have to change much from it just expand on the story, elements and characterization it has already. I would love to get feed back from fans here.
Story:
The storytelling aspect is inspired by how MGS (1998) told its story. The game would start with Otacon, a ghost writer that wrote the novel of Snake’s exploits and those that work with Snake during Operation Intrude N313 telling the events of Metal Gear Solid 6: Outer Heaven to journalist they trust. We learn that Snake is paradon for his crimes and is buried as a war hero next to the grave of Big Boss. Given a Medal of Honor award and other awards from other countries for saving the world several times. The world is now knowing about his story and thus even more interested to learn of Snakes exploits during his youth. David Hayter voice being used as a recorded message from a dying Solid Snake giving accounts on what happened in Metal Gear Solid 6 and 7 along with most of his life. Snake hopes that his message and story will inspire others to be better and fight for what is right.
David Hayter wouldn’t voice a young Solid Snake as I feel a voice actor that is younger but can emulate David Hayter mannerism and his voice should do it. A young Solid Snake having a hint of innocence, nativity, vulnerability and self doubt at times.
David Hayter would voice Solid Snake in Metal Gear Solid 7: Zanzibarland since Snake is supposed to be older and wiser. David would be able to give us this voice range and kick it out of the park including the duel against the real Big Boss.
Plot:
The year is 1995, the Soviet Union has collapsed and the Cold War is now over. The threat of nuclear war is gone and the world embraces this newfound peace. However, this peace is short-lived as there are those that don’t want it. The world is engulfed with the threat of terrorism and rogue states that want to get their hands on nuclear weapons. The free world is now being threatened once again. The US Government works to combat this threat with its covert U.S. Army unit known as Fox-Hound under the leadership of the legendary war hero known as Big Boss. However, when a government agent goes missing during a mission…The agent last reports a weapon that can shake the foundations of the world known as “Metal Gear”. Big Boss sends in a rookie but talented Fox-Hound agent known as Solid Snake to learn of this new weapon. Will Snake learn the truth about this new weapon or will the world find out what Metal Gear will do if it's unleashed?
Mission:
Like MGS3 there would be a Virtuous Mission in MGS6:OH.

• Solid Snake is sent in by Big Boss to sneak into Mother Boss from MGS5 via Los Angeles Class (Block 3).
• Mother Base is set to be demolished by Outer Heaven forces as they move their forces and operations to mainland Galzburg, South Africa.
• Snake’s mission to find and rescue Gray Fox and any of the kidnapped scientists that work for Dr. Madnar. Find out what Metal Gear is and take them to the extraction point aka an Helicopter Pad not in use by Outer Haven units. Afterward, deploy the fulton recovery device for extraction
• Snake learns Gray Fox is being held in South Africa at the Outer Haven main base along with Dr. Madnar and his top scientist team. His low level assistants were to be executed by Outer Heaven soldiers via demolishing Mother Base. Last, that Metal Gear is also in South Africa and that Outer Haven is planning to use a custom made ICBM nuclear tipped missile potentially on any country that threatens them.
• The mission goes bad when Snake is about to have the scientist air lifted off the ground via fulton recovery devices. The scientists are brutally gunned down by Outer Haven Elite soldiers.
• An enraged Snake takes down the Outer Haven soldiers that approach him using his hybrid but deadly CQC system and tries to air lift himself via fulton recovery device. However, he is ambushed by a masked Venom Snake aka The Masked Phantasm.
• Snake puts up one hell of a fight, hitting Venom several times to where the point where Venom can only praise Snake’s skills. However, he loses when Venom plays mind games with him including stating his full code name and kicks up off the rig.
• Mother Base is destroyed by Venom and his men. Snake is adrift at sea until he is saved by the Los Angeles Class Submarine (Block 3) that helped him infiltrate Mother Base. He is later taken back to the states for a debriefing on what happened while he recovers in a hospital.
• In this mission, Snake only has Big Boss communicating with him and does not get much support. He is given only a trap gun, his CQC knife and basic first aid kits.
• The suit he wears is similar to his sneaking suit from MGS. Only this suit is design to swim on to the Mother Base elevator platform and sneak around on the surface at night

Main Mission:
This is where Snake goes to South Africa and has to get to Outer Haven which is a vastly HUGE heavily defended base. Potentially the best soldiers and mercenaries in the world work and defend the base. It is an official mission sponsored by Fox-Hound, NATO, CIA, NSA, UN and top members of the US Government. This means Solid Snake gets a load of equipment, gadgets and weapons for the mission.

• The briefing section for the main mission would give Escape from New York vibes. Big Boss, Lt. Colonel Roy Campell and other government officials brief Snake on his mission. It is here Snake sees his weapons, equipment and gadgets he will have for Operation:.
• Snake mission is the following: 1. Rescue Gray Fox, Kyle Schidener and Dr. Madnar. 2. Investigate War Crimes committed by Outer Haven. 3. Aid Resistance Fighters in any way possible. 4. Rescue any other hostages on the base. 5. Destroy Metal Gear and Neutralize the threat Outer Haven poses to the world. 6. Terminate the Masked Phantasm (Venom Snake)
• He is air dropped in South Africa by an C-130 gunship (Reference to Metal Gear NES/MGS3) and is ordered to meet with an Resistance fighter before moving into an areas destroyed by Outer Heaven forces via horse back
• This intro game would be similar to Rambo 3 and gives a hint on what Solid Snake will be going up against as travel though the beginning of the game seeing Outer Heaven air force units from a distance bomb villages
• The main mission would be a large map to roam around. The location being Galzburg, South Africa where the main base of Outer Haven is located at.
• When Gray Fox is rescued, he will provide support and be Snake’s mentor.
• Level boss battles will be intense and hard
• Last, Entering Outer Haven HQ will be intense and the final battle as well.

Gameplay would be a mix between MSG 3 and MSG 4 and MSG 5. It takes influence from other games like Red Dead Redemption, Splinter Cell and Grand Theft Auto video games along with new mechanics. The concept is to give the game a war survival horror like vibe if you’re spotted by the enemy or having trouble surviving in the wilderness.
MSG3 gameplay elements

• Like MGS3, you could change your camouflage and blend into the environment, camouflage meter, survive off the wilderness and eat foods.
• Finding food in the wilderness would boost Snake’s stamina and also assist with him getting his LIFE up when he rests. However, they would not boost his LIFE up like military rations or other foods (Three-Five star food) found in the supply depots or mess halls at Outer Haven bases would.
• The first aid system from MGS3 would play a part in the game. Solid Snake would be able to heal his wounds or stop bleeding like Big Boss did in MGS3 many decades ago. So having first aid items will be vital.
• The game would have different rations from different countries that Snake can eat from if he takes it off an Outer Haven soldier or from their supply depots. Military rations help heal Snake LIFE and give a small or moderate boost depending on the quality of the ration. (ex. American Military rations would give a moderate boost to Snake LIFE but would give a small boost to his stamina as he isn’t in favor of the rations taste. Russian rations would only give Snake a Small boost in LIFE and small boost in stamina due to its taste. Call back to MGS3. French Rations would boost Snake’s LIFE and Stamina completely which would be a call back to MSG4.)
• Different foods found on Outer Haven bases can boost Snake’s stamina up and LIFE better than Rations such as the Calorie Mate, Curry, different sodas, snacks, etc. Also, three or five star meals found in Outer Haven mess halls scatter through-out their many sub bases or garrisons. P.S. I want to have a scene where Solid Snake finds a Calorie Mate and speaks to Big Boss about it and the two have an interesting conversation about it. (Lol)
• Snake can sabotage enemy supply deports and armories to reduce the enemies ability in fighting him if spotted.

MGS4 Gameplay elements-

• Over the shoulder gameplay
• First person view and aiming down the sights
• A fluid polished gun gameplay mechanic
• Customizable weapon system, weapon attachment, swapping out and fixing inventory slot for weapons and/or inventory
• Psyche meter, this goes down when Snake is spotted too much and takes too much damage
• Currency system to upgrade weapons and get ammo when Snake runs into Resistance fighters weapon vendors
• Solid Snake having the option to assist resistance fighters or continue with his mission
• Aiding resistance fighters will help Snake during take segments of the game. They will return favors to Snake by giving him rations, weapons, other foods and ammo
• Saving hostages at Outer Haven facilities will also assist Snake and give him items or information
• Polished CQC system
• Being able to pick up ammo and weapons of dead enemy soldiers. No ID tags for the weapon.

MGS 5-

• Polished CQC and fighting system
• Being able to operate vehicles, tanks, apcs and infantry fighting vehicles. However, enemy forces will start to respond more aggressive call in armored units or gunships to Snake out
• Ride horses
• Weather and day changes at random times, Snake can use this for his advantage
• Enemy checkpoints and small bases that Outer Haven use as buffer against intruders and Outer Haven resistance fighters
• Call in support from local Outer Heaven Resistance fighters (only if you assisted them in them battles, gained their respect and they’re nearby to help)
• Gunship helicopter patrols
• Air assault units
• Armored convoy patrol
• Snake can sabotage mini Outer Haven bases, outpost and can knock enemy communications which makes it harder for enemies to call for back up
• Sabotaging Outer Heaven outposts and their infrastructure will cause Outer Heaven to move their forces out to confront the Resistance fighters thus giving Solid Snake a chance to get past them
• Snake can smoke his Lucky Striker cigarettes to bring up his Psyche or allow time to pass by similar to what Venom Snake did with his E-Cigars in MSG5

Splinter cell element-

• The game would allow players/Solid Snake to use stealth mechanics similar to that game to get by or attack Outer Heaven soldiers
• This also means hiding in the shadows and sometimes staying out of the light

Grand Theft Auto elements-

• Like GTA games, if you do too much damage to the police they get more aggressive.
• It would be no different when you fight Outer Haven soldiers as they will start to send in more elite soldiers with better weapons and armor.
• They will also be able to be armored units or mechanized units and gunships would be sent to kill Snake.
• Worse, Air strikes and heavy artillery strikes as well. Some OH units would deploy bi-pedal armor vehicles and jet packs along with guard dogs.
• This would strongly support the stealth element of the game and give it a war horror movie vibe if you get spotted by the enemy. It doesn’t matter how many good weapons you have on you. You will be overwhelmed by Outer Heaven soldiers and will die if you get spotted multiple times.
• This would be similar to what you see in GTA if too many law enforcement agents continue to swarm on you

New Gaming mechanics -

• Non-linear gameplay- meaning random patrols of Outer Soldiers can occur the closer you get to Outer Haven HQ
• Open world map. Goal is to give fans the immersion that the red dead redemption games gave. Basically the Outer Heaven is like a large country in and of itself
• Game would reward you for not being spotted and embracing the stealth elements of the game. This means you will encounter less Outer Heaven patrols in the game and they won’t be heavily geared up when doing them
• If Snake gets spotted too much in the game, Outer Heaven soldiers will be more hype vigilante, heavily armed and geared up. They will change their patrol tactics to make it difficult for Snake to sneak around. Worse double up on patrols or have support from armored units, gunships or unmanned drones.
• Stealth take down system. Snake can perform lethal or non-lethal takedowns rambo style when his enemies get close. The players can make the decision on which take down to use.
• Snake can switch his fighting system from CQC to the various martial arts he knows. If multiple soldiers are near him he can use CQC or use standard martial arts when fighting enemies that can counter his CQC based attacks.
• He can use a CQC take down on enemies not paying attention to him or other forms of melee takedowns.
• This is to showcase how skilled Snake is when it comes to fighting
• Different locations have points that are controlled by the Outer Haven Resistance fighters and Outer Heaven soldiers
• The game will reward players for assisting Outer Heaven resistances and sabotaging Outer Heaven bases
• Liberate occupied villages under Outer Heaven soldiers occupation or avoid them, go though abandoned villages or resistance fighter controlled villages
• The closer you get to Outer Haven, the more patrols and mini bases run by Outer Heaven soldiers you will encounter. This means the game will get very difficult real quick.
• Outer Heaven patrols will be random at time depending on how many times you have raised the alarms or not during your mission
• Caution mode would contribute to this but there will be more patrols if you cause yourself to enter caution phase too much
• The travel to Outer Haven’s main HQ is to parallel MSG3 when Big Boss had to travel to Gronznyj Grad. It short, Snake travels to Outer Haven would be an epic long high adrenaline rush journey to defeat Venom Snake and destroy TX-55 Metal Gear
• South Africa’s map would be vast and large. It is filled with its soft and rough terrain. Snake can use this to his advantage but so can Outer Heaven Soldiers
• Players will have the option to either go to Outer Heaven outpost or avoid them by using the rough terrain to get around the outpost
• Gray Fox will assist Snake in certain parts of the game and provide support either though radio or combat support to take down a level boss.
• At times, Snake and Gray Fox would work together to take down Outer Haven patrols
• The final part of the game involves Solid Snake and Gray Fox having to fight hordes of Elite Outer Heaven soldiers as they fight to stop Venom Snake from using TX-55 to fire a completed experimental long range ICBM nuclear missile on the Patriots
• Last, Solid Snake vs Venom Snake. Venom proclaims that he is Big Boss to Snake after taking off his mask and the two fight. The rest is history.
• The final battle is to parallel the battle between The Boss and Big Boss. Intense gunfight and CQC fight between the two. Snake needs to use an experimental rocket launcher made by Outer Haven to kill Venom Snake
• After beating the game, you can play as Gray Fox and see the story though his eyes and how he is informed by the Real Big Boss to assist Snake and help him take down Venom Snake.
• Being able to blend into the environment Rambo/Navy SEAL tier One style to either get past enemies or take them down one by one
• Snake would have a booby trap system inspire the Rambo movies to help ambush soldiers or distract them while they go to aid wounded soldiers.
• Snake can create ghillie suits to hide from enemy soldiers, covertly sneak past them or use it to ambush them
• Players would have multiple options on how to enter Outer Heaven outpost and the main HQ

Weapons

• The weapons in the game will be from late 60s to mid 90s. Weapons form both Soviet Union, Warsaw Pact, China and NATO countries. This goes from handgun, submachines, assault rifles, shotguns, sniper rifles, and anti tank weapons. Last, grenades and mines.
• Weapons can be customizable for Snake to use if he finds the attachment for the weapons or finds an resistance fighter vendor that is nearby to upgrade his weapons
• Enemies use weapons fitted for the environment that they operate it and it's at random the types they use
• Some weapons will be custom built weapons that don’t exist in the real world to be the spirit of the previous Metal Gear Solid game.
• Some weapons will allow Snake to use his CQC techniques or basic melee attacks with weapons

Snake’s Gadgets/Tools for the main mission where he gets official support

• Snake's suit is a combination of late 80s and 90s US Army Special Forces attire but modified.
• 90s tactical vest. It can be upgraded for Snake to carry more ammo and to take more damage as time goes on
• Custom built MP5SD6 with a folding stock, an Beretta 92FS with an tactical flashlight/laser sighting, also can be fitted with an suppressor and MK.22 Trap gun. The weapons are modded so he can use his CQC skills
• A small pack that allows Snake to carry items. This can be increased by upgrading it in the game
• Motion-sensing radar that allows him to track enemy soldiers, a precursor to Soliton Radar. It acts more like a sonar device then radar
• Mountain climbing equipment
• Combat Scuba gear (can be refilled by going outer heaven supply deports)
• Snake has a advanced long range radio and a wireless headset to communicate with his team
• Wire cutters
• Different camouflages and face paint to wear
• Idroid like device but advanced
• Fox Hound adaptation of INT-SCOPE but more advanced and has the ability for Snake to switch to different fields of view including Night Vision and Thermal Infrared. Last, a camera system for Snake to take pictures
• INT-SCOPE can be used to help Snake what tier Outer Heaven Soldier that he is dealing with and help him plan acquiring and allow him to listen in
• Tactical flashlights
• Tools to create ghillie suits
• CQC knife
• Survival Knife used for melee take downs
• Limited Fox-Hound issued MRE rations to restore life and stamina along with restore psyche
• A blue bandana that Big Boss gives him

Vehicles

• Vehicles found in the game are jeeps, armored tank, tanks, APCs, artillery vehicles and helicopters along with jets from the late 70s to mid 90s
• Unmanned vehicles that didn’t exist in the mid 90s

Theme:

• The end of the 80s going into a new era aka the 90s.
• Desert Storm and the aftermath of the war
• The politics behind America being the only SuperpoweHype-power in the 90s
• Child Soldiers, Solid Snake being one.
• NATO, its organization expanding and the conflicts it was involved in though peacekeeping missions
• The fall of the Soviet Union, end of the Cold War, and Post-Cold War politics/events
• The rise of new technology, internet, movies, music CGI and upcoming digital age in the 90s
• The rise of global terrorism and rogue states
• The threat terrorism and rogue states pose and the fear of them getting their hands on nuclear weapons. A true big fear of the 90s going into the 2000s
• Coming of age soldiesecret agent/legend (Solid Snake)

Movie Influence:

• The Rambo movie series since Metal Gear and Metal Gear 2: Solid Snake were heavily influenced by the first three Rambo movies.
• 80s and 90s James Bond movies. Mostly Goldeneye since it follows post-cold war.
• Die Hard movies series, gun battles and intensity between the characters and death defining odds
• Hardboiled (1992), the gun battle that Solid Snake and Gray Fox will have against the swarm of Outer Haven elite soldiers would be heavily influenced off the final gun battle from this movie.
• Running Man, the Boss level villains being similar in design to the villains from the movie, only less colorful, evil like, aggressive and more tactical in fighting.
• Face Off (1997) - action scenes
• Escape from New York, since the first game was influenced by the movie. The main mission where Solid Snake goes to South Africa with official support will give off this type of vibes including the mission briefing he is given as he looks at his equipment.
• The Rock (1996), action scenes and the relationship that Sean Connery as John Patrick Mason and Nicolas Cage as Stanley Goodspeed, FBI. Its similar to the relationship Gray Fox and Solid Snake will have.

Game Music:

• The music for the game would be influenced by the previous MGS games, Rambo movies, Syphon filter and action movies from the 90s. Mixed bag of tones to give different vibes for the game
• The music will be atmospheric in nature as you move around Mother Base and later South Africa
• One set of music to make you feel like a spy, other half giving you the false sense of safety, other places the music will make you feel like your in a warzone and/or being chased
• Real world music from the 80s and 90s that players can listen to when they find a Sony Discman D-145 (1995) laying around or Sony walkmans
• Real world music would 80s - 1995, Rock, Pop, Alternative Rock, R&B, Mainstream hits, Rap, Jaxx and etc. Can listen to game music as well on either device when you the player find them.

Characters:

• David/Solid Snake:
• A child soldier of sorts. He spent his life being fostered by different foster parents (Patriot handlers) until he reached the age of 6. After that, Solid Snake was trained though-out most of his life by his many handlers at an US Army run school.
• In the US Army run school (Patriots involvement), he was made to engage in a mix of U.S. infantry, Airborne infantry, U.S. Army Ranger, Green Beret and Delta Force style harsh training. Add in the school making him learn different languages at a young age.
• On days he didn’t do military training, Snake was made to endure intense academic schooling. It was here Snake was pushed to understand the general knowledge of Science, Math, Reading, English, Writing, Workshop Skills at a High School to College level. In addition, understand how to operate most vehicles as well.
• At age 18, he was later placed in the US Army as a 2LT to a Green Beret Unit. The Patriots and his handlers, changed his age date so that he was capable of joining the unit and being a junior officer. He is second in command of the unit and sent to fight in Desert Storm (1990-1991).
• Solid Snake had a short but very successful career in the US Army through the multiple successful missions he completed in that war.
• His missions involved him destroying multiple SCUD launchers, sabotaging Iraqi supply lines, disputing their communication lines, assassination or capturing of top Iraqi officers, and deep reconnaissance within Iraq. His unit would also take part in aiding in liberating Kuwait.
• He is awarded a Silver Star and promotion to Captain before personally being recruited into Fox-Hound by Big Boss himself.
• Big Boss and Roy Campell were coordinating Fox-Hound operations in Desert Storm which is why they knew of Snake’s exploits and saw him as a candidate for the unit.
• Prime Solid Snake is a force to reckon with and is considered to be the best all around Fox-Hound agent along with being the finest practitioner of CQC next to Big Boss and The Boss.
• Big Boss states to Gray Fox at the end of the game that Snake could defeat The Boss with ease had they had fought in a straight hand to hand duel in the 1960s. In short, this is Big Boss way of humbling Gray Fox and telling him to NOT underestimate Snake for when the time comes for Fox to kill him (Metal Gear 2: Solid Snake events).
• Snake’s CQC is unique and deadly in design due to his expert knowledge of various different martial arts from his youth, his mastery of Close Quarter Battle (CQB) and knowledge of CQC handed down to him by Big Boss. Snake incorporates many different forms of Martial Arts to his style of CQC where he adds in striking (punching and kicking), fake or faints, foot work, clinch, ground fighting and grappling.
• Despite being inexperienced, Snake makes up for this by being sure of his skills and not being afraid to pull the trigger. Snake’s real fear is that he is going up against experienced killers and soldiers by himself who can kill him
• Snake’s relationship with Gray Fox is similar to the relationship to what we saw in MGS2 between Solid Snake and Raiden. Only a young Solid Snake is more badass when compared to a young Raiden
• Snake’s relationship to Roy Campell is similar to what we see in MGS. However, the two become friends quickly due to the experiences they share being involved in Desert Storm.
• Roy Campell encourages Snake not to give up and to be sure of himself. He also calms down an enraged Snake when they learn that Big Boss is behind everything.
• Solid Snake's relationship with Big Boss is similar to The Boss and Naked Snake in MGS3 but a lot longer as Big Boss continues to “support” Solid Snake with his mission.
• Fox-Hound, NATO, CIA, FBI and NSA start to put the pieces together that Big Boss is behind everything. He goes off the air and Venom Snake confronts Solid Snake. Rest is history after that.
  Big Boss:
  
• He is the commander of Fox-Hound and re-organizes the covert special forces unit to combat terrorism and rogue states trying to get their hands on nuclear weapons.
  
• This was a fear in the 90s and Big Boss being a legendary war hero made him the perfect pick to be the leaders of the organization again
  
• Under his leadership, Fox-Hound is successful in taking out world terrorists, international arms dealers, their backs and having them arrest by allied countries
  
• Big Boss and Roy Campell are awarded medals for their efforts
  
• Big Boss holds the simulated rank of a One Star General in within Fox-Hound due to his vast war experience, successful missions and saving the world several times over
  
• We learn of Big Boss past and how he was an top NCO before MGS3 before being given an rank of officer
  
• Big Boss personally trains Solid Snake and passes his legacy down to him after Snake accepts an open challenge to spare him and hits Big Boss multiple times before losing.
  
• This is a tradition Big Boss would offer recruits during his command. The challenge was that he would train any recruit as his solo student if they could hit him in sparring. Only Snake was the only recruit to do so in Fox-Hound.
  
• Big Boss does care for Solid Snake in a bizarre way and doesn’t want to see him killed unless it's by his hands which he is secretly plotting to do.
  
• In the virtuous and main mission, Big Boss provides support to Solid Snake by giving him advice from his war time experience, how to survive in sneaking around Outer Haven and how to survive off the land.
  
• During Boss battles, Big Boss goes off the air, leaving Campell to assist.
  
• Everyone becomes suspicious of Big Boss when they discover his spy plane has disappeared off radar and it is not far from Outer Haven.
  
• Worse, when intelligence agencies learn that Big Boss was sending message to Outer Heaven HQ (Gray Fox) but they are unaware of who
  
• They create an warrant for his arrest and the rest is history after Venom Snake dies
  Roy Campbell :
  
• He isn’t a full bird colonel yet and is an Lt. Colonel. He is second in command of Fox-Hound.
  
• Big Boss trusted Campell because of the events they shared in MSG:PO and the vast amount of experience he has in counter-terrorism missions to black ops in taking out terrorists leaders.
  
• Campbell quickly befriends Solid Snake due to their shared war experiences in Desert Storm.
  
• Campbell is a skilled tactician and strategist, and is heavily supportive of Solid Snake. He gives Snake (Player) hints and clues to move around in the game. In addition, information on weapons and vehicles.
  
• Last, he gives ideas on how to destroy level bosses
  Gray Fox:
  
• He was on a mission to assassinate Venom Snake after Big Boss discovered that Venom wants to use Nuclear Weapons against Patriot run countries that would trigger a nuclear war. Of course, official members of Fox-Hound are unaware of this and believe he is investigating Outer Haven to learn if they’re involved with terrorists.
  
• He fails his mission that Big Boss assigned to him and is captured by Venom Snake after losing a fight against him.
  
• Venom spares his life and threatens that if he escape, he will personally take him out next time.
  
• After being feed by Solid Snake, Gray Fox is ordered by Big Boss in secret to assist Snake in taking out Venom and later assassinate Snake to cover up everything at Outer Heaven.
  
• However, Gray Fox is unable to help Snake take out Venom after being cut off by a swarm of Outer Haven soldiers. He instead sacrifices himself so that Snake can stop Venom from launching nukes from Metal Gear TX-55. Later, fakes his death so he could return to the real Big Boss and help with Zainabarland
  
• After beating the game, you can play as Gray Fox and see the story through his eyes. Learn more about him, his fighting style and how he assists Solid Snake
  
• His fighting is mixed between his fighting style as Null (MGS:PO), CQC concepts Big Boss passed to him, Knife fighting style and pro gun fighting skills.
  

Venom Snake/Big Boss:

• Venom Snake would have a huge makeover since the events of Metal Gear Solid 5. He has been given nanomachines so that he can survive future medical surgery and look more like Big Boss and stand in for him.
• The horn in his head is removed which almost kills him but the nanomachines prevent this and heal him. They also grant him superhuman abilities that turn him into a super-soldier of sorts. His bionic hand is replaced with a more human-like bionic hand.
• The nanomachines are a precursor to what Vamp would have many years later. Only Venom’s nanos won’t bring him back from the dead, just heal him faster. However, the side effects is that the nanos in him are making him mentally unhinged
• He is given a new sneaking suit to help harness his new abilities and provide extra protection for him. Snake would need to use an Anti-Tank rifle or Anti-Tank rocket launcher to take him out.
• He is not the same man he was in MSG5. He is more militant towards the Patriots, ruthless and cold blooded. A pure demon at this point and isn’t afraid to commit war crimes or allow his men to do so.
• Venom’s prime mission is to destroy the Patriots and nations they run via nuclear strike using TX-55 Metal Gear. However, he knows that Outer Haven will be hit by NATO countries.
• This causes a rift between Venom and Big Boss. Venom sees Big Boss as being weak and is not willing to do enough to destroy the Patriots and is not willing to do whatever it takes to do so.
• However, the rift is created by Master Miller who kept his promise to help make the sons of Big Boss and Venom Snake stronger then Big Boss
• The rift gets so bad that Big Boss suspects Venom is not being loyal to him anymore and sends in Gray Fox to find out what Venom is doing leading to Metal Gear (1987) events and to assassinate him. Fox fails and loses to Venom in a fight. Venom shows mercy and has Fox locked at a maximum security brig at the Outer Haven prison site.
• A Venom Snake respects Solid Snake as he sees how skilled he is but he also plays mind games with him by hinting his relationship to Big Boss.
• He now wears a mask when he goes out in battlefields to fight aside his men so as to keep Big Boss identity hidden. He is dubbed the Masked Phantasm by world intelligence agencies. As far as the world is concerned, nobody knows who the Masked Phantasm is. Some people think he is a student of Big Boss due to CQC abilities. Near the end, he takes the mask off to reveal to Solid Snake who he is Big Boss (fake one).
• Last, we will know of the tragic story of Venom Snake and how really wanted to be a doctor after his contract with Militaires Sans Frontières end.
• Sadly, no one will ever know about Venom Snake and the man he was before his tragic events.
• He will apologize via radio to Big Boss asking his forgiveness and informs him that Solid Snake is not a man but a demon of their own making. Last, he correctly predicts that Snake will defeat the Patriots and do what they failed to do right before the Outer Haven based self destructs.

Supporting Characters
Kyle Schneider

• Developer of Outer Haven and help with building the base. Later, becomes the leader of the Outer Haven resistance force in South Africa after learning of Outer Haven’s war crimes in the region.
• He is captured and the resistance fighters try to scramble to rescue him. They agree to help Fox-Hound and Solid Snake in exchange for the safe return of their leader
• Knows where most of the weapons, foods and other important items are on the base will inform Snake on where to find them.
• Also inform Snake of where vital security checkpoints are and more are located at.
• Is caught in the explosion when NATO destroys what is left of Outer Haven. He is saved by the Real Big Boss.
• He will tragically become the Black Ninja and this leads to the event of Metal Gear 2: Solid Snake where he will seek revenge against the world for what has happened to him.

Jennifer Schneider

• She is the sister of Kyle Scheider. She took it upon herself to go and rescue her brother despite not being a soldier or warrior.
• She disguises herself as a nurse and sneaks into the base. She assist Snakes with information and where weapons are at.
• The original game doesn't say what happened to her. So I have her help Solid Snake escape and they watch Outer Haven from a distance get destroyed with NATO delivering air strikes on reminding Outer Haven bases
• She is present when Solid Snake is giving a medal for completing the mission by President Bill Clinton
• The two have a brief relationship before he moves to Canada to be an undercover CIA agent
• Snake helps her find a job in America for her helping him and getting her a green card to stay in America

Diane

• A Goth Punk rocker that has a band called Thin Wall. She performed for Outer Haven several times and knows about the base
• She assists Snake with giving information on Outer Haven bases and the main HQ. Also, info on the mercenaries that operate the bases and informs him of the weakness of the Bosses in the game.
• She has a crush on Solid Snake and is in her early 20s.
• She is present for Solid Snake getting a medal for completing the mission

Drago Pettrovich Madnar

• The developer of the first Metal Gear. His project, himself, his scientist and his daughter are taken hostage by Outer Heaven soldiers
• He is being used to complete TX-55 Metal Gear and develop an custom built nuclear tipped ICBM that can be fired from Metal Gear
• Informs Solid Snake on how to take out Metal Gear He is taken off base by Jennifer after Snakes saves him
• He informs the US Government to send Snake his regards fos saving him

Ellen Madnar

• The daughter of Dr. Madnar. She is being used as a tool to force Dr. Madnar on continuing his work on TX-55 Metal Gear
• She is saved by Snake and escorted off the base by Jennifer
• She is present for Snake getting a medal for completing the mission and stands in for her father

Tech (Original)

• Expert in science, engineering and responsible for making all of the gadgets Fox-Hound has
• He is also aware of the weapon systems, gadgets and tools that Outer Heaven Soldiers use
• Son of Donald Anderson
• Gameplay mechanic, he is charge of saving the game for you when you contact him
• Would return in Metal Gear Solid 7: Zanzibar Land and Metal Gear Solid: Philanthropy Chronicles to aid Snake. In Philanthropy Chronicles he aids Snake to atone for the sins of his father. He would go into hiring with Snake’s afterwards which is why there is no mention of him in MGS4
• He would leave Fox-Hound after the Zanzibarland incident and work for the CIA as a gadget builder

hi first ever reddit post so let’s dive in…… about 4 years ago i started having some strange digestive issues mainly bloating and and pain all seems to be upper abdomen just above belly button to start off with i was told IBS at this time i had gained a fair bit weight fast forward to around the first lock down i starting having immense pain in abdomen same spot always upper above belly button sometimes moves to left or right docs started a load of tests your basic bloods stool ect to start off with then CT when i was admitted due to pain and weight loss CT showed bowel wall thickening in the left of large intestine so had a colonoscopy from that i was diagnosed IBD indeterminate!!! there was inflammation at the start of my anus but that was it started on meds that never really worked to be honest then kept going back to doctors was then sent for camera down the throat everything all good another round of bloods everything all good again i raised my concerns with the doc about chronic pancreatitis(prolific googler my symptoms seem to match up) docs sent me for CT of the pancreas and a fecal elastase test all good again nothing abnormal symptoms are still persisting upper abdominal pain better in the morning worse around lunch time doesn’t react to any specific food just all food hurt when it’s bad it’s like it comes and goes with no real pattern get really constipated as well undigested food in stool also happens often. does this sound like chronic pancreatitis? i know this is a rant but i am at my wits end it’s affecting my family my career my mental health is shot to pieces i worry constantly to top it all off i lost a very dear friend to chronic pancreatitis early this year to i am back in touch with doctors but having to go through all the same blood tests if they send me for another CT i will crack up they do not seem to take my concern seriously no matter how i approach it only things bloods have ever shown is slightly raised inflammation once slightly raised LDL once and a slightly raised Liver enzyme once all of which have returned to normal level in re test. symptoms consist of mouth ulcers weight loss constipation mucus in stool joint pain upper abdomen pain never below belly button shoulders are always sore i go through really bad stages of fatigue to and my nails look wierd as hell dips and ridges. any words of wisdom will be greatly appreciated bless you all

Hi everyone! I was diagnosed with PCOS back in 2017. I just got new blood work back and my alkaline phosphatase was high. My doctor was unconcerned (not a fan of this doc so looking for a new one)
I’m concerned because this could be a sign of liver or bone issues especially cancers.
Has anyone else seen this or have experience with this?
Note. I’m not a heavy drinker and have never broken a bone.

Recently my sister (26F) went to Urgent care for pain in her lower abdomen and they did a CT scan. They said that she should get her liver check even though it was unrelated with this pain. The doctor mentioned to get it check this year that it didn't have to be right away. We are all concerned.
Does it sound benign?

So my (24) dad (64) was diagnosed with stage 4 pancan last year mets to the liver. It's been a really scary year. But for some reason, up until his last round of Folforinox in May things felt very positive. His PET CTs were good until they weren't. Then his oncologist and hospice doctor totally neglected his ascites and there were too many experiments with his drugs. Trying out fentanyl caused him to lose his appetite - which is so dangerous considering that he was already half his weight - and have crazy withdrawal symptoms. We got off fentanyl and back to his original regime, he's eating again. His oncologist recommended him for a trial for gem/abrax + immunotherapy and the new trial oncologist basically was shocked at his condition, and what he was brought to. Now he's in preparation for said trial, did a biopsy, and will do another CT this upcoming week. But he's so weak.
My mom and I really felt that things would be okay, at least for a bit more time. All of a sudden this rapid decline, he doesn't want to go, and at the same time he's skeptical about going through all of these difficulties. But what if the trial will hurry things up with his end? What if not doing anything will be even worse? I'm not ready to lose my dad.
Would appreciate hearing from anybody whose loved ones went through gem/abrax at a pretty late stage, and maybe any tips or supplements that may boost energy levels? Recently I've been buying him protein-packed smoothies and yogurts and I think they are helping a bit. Looking for ideas around those lines...

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We’ve been providing my dad hospice care for the past 2 months.
He has a stage 4 colon cancer, which spread to liver and his liver is failing for the past 10+ days, but hasn’t failed yet.
Since last 2 weeks - doctor has been saying he can go anytime but he isn’t.
He’s been cheyne stoking since a week, and death rattling since last 48 hours.
He isn’t even in Coma yet - He’s in Semi Coma zone.
He puked faeces yesterday because his tumor completely blocked the colon.
We’re giving him Morphine and haloperidol through PICC so he sleeps all day, but makes some kind of noise which sounds like he is in agony, but he is actually not.
Doctor visited him yesterday and said that he has never seen a patient in such condition go on for so long. He stopped eating a week ago and stopped drinking like 4-5 days ago.
We’re all hoping that he leaves this world, because he’s suffering a lot.
We just want peace for him. Has anyone experienced something similar?

https://twitter.com/JudithMoritz/status/1666741149451649031?t=FfvY3bD7cmxh8YhAI97bOw&s=19 https://twitter.com/tomdunn26/status/1666741012784373760?t=yoqjuHzgC_GSuyNB9Pxlcw&s=19
https://news.sky.com/story/lucy-letby-trial-latest-nurse-baby-murders-prosecution-sky-news-blog-12868375
https://www.chesterstandard.co.uk/news/23575178.live-lucy-letby-trial-june-8---cross-examination-continues/

Child O

Sky News:

Child O was born at the end of June 2016. He died within the first week of his life.
At the time of his birth, Letby was abroad in Ibiza on holiday with friends - including one of her colleagues.
She returned the day before Child O died.

​ Chester Standard:

Nicholas Johnson KC, for the prosecution, moves to the case of Child O.
Letby, in her defence statement, said she did "nothing to hurt [Child O]."
She noted a "change in [Child O's] appearance", but it was "not dramatic".
He had a deterioration and Letby noted Child O's abdomen was "red and distended".
She says she didn't notice a rash on Child O, and no-one mentioned it.
She said the abdomen was "very swollen", and there was a struggle to get lines in. Letby tells the court one of the lines had tissued.
She said one of the doctors had gone out to smoke a cigarette during the time of Child O's resuscitation, and when that doctor returned, they did not wash their hands.
Letby is asked if there is anything she wishes to change in her account of evidence so far. This is a question Mr Johnson asks at the start of most sessions during the cross-examination. Letby says there is nothing.

​

Letby agrees with Mr Johnson it was "big news" to see naturally conceived triplets on the unit, as it was a rare occurrence. Child O and Child P were two of the three triplets.
Messages are shown to the court between Letby and Jennifer Jones-Key from June 22.
Letby confirms when she is back in, adding: "Yep probably be back in with a bang lol"
M Johnson says within 72 hours of that, two of the triplets were dead and Child Q had collapsed.

​ Sky News:

She texted a male colleague - one she allegedly had a crush on - and asked about the triplets.
"Did you want to get involved with them?" Mr Johnson asks.
"I was just making inquiries," Letby tells the court.
The triplets were born with few complications - and one had been moved to a lower grade nursery.

​ Chester Standard:

Letby is asked why she was "so interested" in the triplets. Letby tells the court it was "general conversation" between staff colleagues as it was "something unusual on the unit".
She accepts that all went well with the birth, and accepts that the triplets had been doing well, with Child O being "fine".
Letby accepts that Child O was doing well on the night shift for June 22-23, and had been moved off CPAP on to Optiflow breathing support.
Letby accepts Sophie Ellis's description there was 'nothing concerning' about Child O's presentation.

​

Letby is asked to look at an observation chart for Child O for June 22-23. There is a reading which, the court is told, appears to have been changed from '1430' to '1330'.
Letby says Child O's temperature is a little unstable in the hours prior to 1.30pm on June 23, but accepts he was otherwise "stable".
The court is shown a lab result, that there was no bacterial infection found in a blood sample taken on June 23 for Child O.
A feeding chart showed Child O was "tolerating his feeds very well", Mr Johnson says. Letby agrees.

​ Sky News:

In a police statement, Letby claimed a nurse had raised concerns about Child O's abdomen and said: "I do not accept this was dealt with adequately."
Nick Johnson KC, for the prosecution, now asks her: "You are suggesting there was a problem but you are not in a position to tell us the problem?"
"Yes."
Mr Johnson points out there is no evidence of this in the charts.

​ Chester Standard:

Mr Johnson asks Letby where the 'problem' is for Child O's abdomen that she had said was not dealt with, as there is no data to show it.
Letby says, after looking at the data, she does not know what the problem was.
Mr Johnson says there is no problem shown in the paperwork.
Letby says there was "no formal note" made.
The court is shown Sophie Ellis's note at 7.32am: Abdo looks full slightly loopy. Appeared uncomfortable after feed....reg Mayberry reviewed. Abdo soft, does not appear in any discomfort on examination. Has had bo. To continue to feed but to monitor.'
Letby says the doctor did not formally record it.
Letby accepts a review was carried out at 9am and Child O's liver was reviewed, finding no injury. Letby accepts the liver injury happened 'on her watch'. She says she accepts it happened on her shift, but does not know how it happened.
She denies it happened on her hand.

​

A shift rota for June 23 is shown. Letby was designated nurse for two of the three triplets in room 2 - Child O and Child P - plus one other baby. The third triplet was in room 1, with Child Q and two other babies.
Letby rules out staffing levels as a contributory factor in Child O's collapse or death, or staffing mistakes.
Letby says Rebecca Morgan was a student nurse on the unit. She accepts that the student nurse would not always be in room 2, and would sometimes be chatting to parents.
Letby says the two triplets she was designated nurse for were in the high-dependency room, and if she left the room for a period of time, she would ask someone to 'keep an eye' on them.
A note by Dr Katarzyna Cooke at 9.30am is shown to the court, which included: 'No nursing concerns, observations normal'.
Letby says she left the unit at one point to get donor milk for the babies.
Letby is shown a series of text messages between herself and a doctor prior to 9.30am. Letby expresses disappontment in the message the doctor will not be on the unit ['Boo']. Letby says she got on well with the doctor.
Letby asks if the doctor would be on the unit in the afternoon in the message. She adds: 'My student is glued to me.....'
She adds: 'Bit rubbish that you couldn't stay on nnu'. Mr Johnson asks if Letby was 'missing' him. Letby replies this was the first day back from her Ibiza holiday.
Letby sent a message at 9.55am: 'I lost my handover sheet - found it in the donor milk freezer!! (clearly I should still be in Ibiza)'
Letby is asked if it was a 'busy' morning for her. She says "reasonably, not exceptionally".
Letby is asked how she finds the time to text when at work. She says she would not use her phone at the cotside or a clinical area, but would use her phone elsewhere in the unit.

​ Sky News (Same evidence):

At 9.32am, Letby texted him "Boo" after he said he was not on the neonatal unit.
"Were you disappointed he wasn't there, on the unit?" Mr Johnson asks.
"Yes, I enjoyed working with [colleague]," Letby says.
"Did you want to get his attention?" Mr Johnson says.
"No."
"Is that the reason you sabotaged Child O?"
"No."
More texts are shown to the court.
Colleague (9.33am): I thought something similar
Letby (9.36am): Are you here this aft
Colleague (9.37am): Yes back after the clinic
Letby (9.39am): Have fun
Letby (9.40am): My student is glued to me
Colleague (9.41am): Awww. Could be a challenge
Further texts are shown to the court.
Letby (9.45am): Bit rubbish that you couldn't stay on NNU
"Were you missing him?" Mr Johnson asks.
Letby denies this and says it was her first day back.
Letby (9.55am): I lost my handover sheet - found it in the donor milk freezer!! (clearly I could still be in Ibiza)
Letby is asked how she found the time to send so many text messages when on shift. Letby says staff would often use their phones on the unit - but not when they were at the cot side.

​ Chester STandard:

A feeding chart for Child O is shown to the court. Letby is recorded as signing for feeds at 10.30am and 12.30pm. She says the writing above is not by her, but by Rebecca Morgan. She says if she has signed, then Rebecca Morgan does not need to sign.
Letby denies feeding Child O. She denies overfeeding Child O.
Nurse Melanie Taylor, at about 1pm, entered room 2 and said 'he doesn’t look as well now as he did earlier. Do you think we should move him back to [room] 1 to be safe?'
Letby declined. She said she doesn't remember being very dismissive.
Letby says "That's Mel's opinion" to the evidence that Melanie Taylor had told the jury she felt Letby was 'undermining her authority'.
She adds that Melanie Taylor had the right to override that and 'take Child O off her'.
Letby denies she had sabotaged Child O, or that this would have meant Child O would have 'escaped her influence'.

​

Letby denies she 'lied' to the doctor colleague about a 'trace aspirate' for Child O at 12.30pm.
Mr Johnson says he is mistaken, as a doctor's note records '0 bile' for the 'trace aspirate'.
Letby says the 160-170 heart rate for Child O, as recorded by the doctor, is higher than normal, and higher than ideal. Mr Johnson says the abnormal readings start, on the observation chart, 180bpm.
Letby had recorded 'tachycardiac' for Child O. Letby tells the court when she reviewed Child O, there was a spike in the heart rate, and in her opinion, Child O was tachycardiac.

​

Mr Johnson says Letby made a 'false, lying entry' in a different chart. A blood gas chart is shown to the court for Child O.
Mr Johnson asks where the lying entry is on the chart.
LL: "I don't know."
Mr Johnson points to the 'CPAP' note on a column. Letby says Child O had some CPAP pressure. Mr Johnson says Child O had not been on CPAP breathing support for "hours and hours".
NJ: "You were covering for air you had given him, weren't you?"
LL: "No."
An x-ray report for Child O is shown, including: 'Moderate gaseous distention of bowel loops throughout the abdomen.'
Letby is asked why she wrote CPAP in her notes.
LL: "I can't answer that now, I don't know."
Letby says she does not know if Child O might have been on some CPAP pressure via Optiflow.
Letby denies 'forgetting to make a false entry on the observation chart'.

​

Letby is asked about messages exchanged between her and a doctor when, at 2.30pm, she was recorded as taking observations for Child O.
The messages were sent at 2.20pm and 2.23pm.
Child O collapsed shortly after 2.40pm. In her defence statement, she said the doctor colleague was on the unit at the time.

​ Sky News:

Mr Johnson continues to take the court through what happened on the afternoon of 23 June 2016, the day Child O died.
The colleague whom Letby allegedly had a crush on came to intubate Child O.
The pair exchanged a series of Facebook messages between 2.08pm and 2.37pm, discussing the procedure - and the male colleague's lunch.
Letby disputes she was on the unit at this time, hence why the two were texting.
Medical notes show Letby was allegedly attending to Child O at 2.30pm.

​ Chester Standard:

Swipe data shows Letby has arrived on the neonatal unit from the labour ward at 2.39pm.
Letby says she cannot say, definitively, where she was at that time. She denies 'nipping out' of the neonatal unit to make it look like she was elsewhere at the time Child O collapsed.

​ Sky News:

Lucy Letby is asked why she took a break at the time Child O desaturated so significantly that the on-call doctor was required to attend.
"Breaks were allocated by the shift leader and I had to be guided by them," she says.
She returned to the unit at 2.39pm. Shortly after the on-call doctor left Child O, he collapsed.

​ Chester Standard:

The doctor's note is shown to the court: 'Called to see [Child O] at ~1440 desaturation, bradycardia and mottled...'
Letby says she believes she called the doctor to the nursery room. She denies it was to get personal attention; Letby says it was because he was there to assist Child O.

​

Letby says a 20ml saline bolus was given to Child O in response to a poor blood gas record. She says there was a delay as there was an issue with getting the line for Child O. She says she believes the bolus, which has 'time started: 1440', was in response to Child O's collapse.
A doctor's note recorded for the '~1440' collapse: '10ml/kg 0.9% sodium chloride bolus already given.'
Letby agrees the two desaturations for Child O that day were "profound" ones.
Letby's note: 'Approx 1440 [Child O] had a profound desaturation to 30s followed by bradycardia. Mottled++ and abdomen red and distended. Transferred to nursery 1 and Neopuff ventilation commenced. Perfusion poor'
Letby, when questioned, says babies would "frequently desaturate", to this level, and this happened prior to June 2015, and "often".

​

Letby says the redness to the abdomen on Child O was abnormal, and the description of mottling was normal.
Mr Johnson says during the intubation, Dr Stephen Brearey, in evidence on March 15, said Child O had a rash on his chest, on the right side, about 1-2cm in size. He said it was an "unusual" rash that was initially pupuric, and it later disappeared.
Letby says: "I don't believe that's what I saw. I saw mottling. If that's what Dr Brearey saw, then if that's what you could take as being true, then yes."

​

Mr Johnson says when the doctor went to see Child O's parents, and during that time, Child O desaturated again, for the final time.
Letby says she does not remember this declining moment, but said she put out a crash call.
LL: "I remember the death, but not this precise moment where he declined and I put out a crash call."
Child O was intubated and efforts were made to resuscitate him. Letby says she did not recall seeing the rash disappear. She says she did not see what Dr Brearey and Dr Ravi Jayaram had seen.
Letby says she did not pull an NG Tube out of Child O's stomach.
An x-ray report for Child O is made at 4.46pm. It record: 'NG Tube in situ with its tip close to the cardia, this should be advanced by 10-15mm.'
An earlier x-ray report said the NG Tube was 'in a good position'.
Letby says a dislodged tube would still drain, as it would still be in the stomach.
Letby says the tube could be moved during the intubation process at 2.40pm.

​

Mr Johnson says Child O's mother, in agreed evidence, said her baby was 'changing colour' with 'prominent veins.' She says she later saw that in Child P.
Letby says she didn't see that herself.
The father of Child O said 'you could see his different veins - it looked like he had prickly heat, like something oozing through his veins'.
Letby says she did not see anything like that.
She accepts she saw a red-purply blotchy rash and a red abdomen.

​

In police interview, Letby said she believed she had done chest compressions and drew up some drugs. Letby says after looking at records, she now believes she was just involved in medications.
Mr Johnson suggests Letby is distancing herself from the CPR so it could not be said she caused the liver injury to Child O. Letby denies this.
Letby says she "does not know" how Child O got the liver injury.

​ Sky News:

Lucy Letby is accused of distancing herself from Child O's resuscitation because of the liver injury he sustained at some point during her shift.
"You don't want to have any connection between you and the liver injury because you are now running the case it was the CPR that caused the liver injury," Mr Johnson asks.
"No," says Letby.
Mr Johnson then asks: "How did Child O get that liver injury?"
"I don't know."

​ ChesterStandard:

Letby denies injecting air into Child O to cause an air embolous, or inflicting a liver injury on him.
NJ: "These things all happened on your watch, didn't they?"
LL: "Yes."
Letby says she disputes an account that Dr Brearey told her not to come in after that shift.
NJ: "Were you bothered by what you witnessed?"
LL: "Of course I was bothered."

​

Messages are shown between Letby and the doctor from 9.14pm on June 23:
Doctor: 'Your notes must have taken a long time - Had you documented anything from this morning?'
LL: 'Only a little. Had the other 2 to write on as well and sorting out the ffp etc. Left signing for drugs until tomorrow'
A nurse also messaged Letby: 'F***in hell, what happened?'
LL: 'Can't Think straight so took a while'
LL: 'Blew up abdomen think it's sepsis'
Letby says it's not a term she uses often, but she had seen it before.
LL: 'Had big tummy overnight but just ballooned after lunch and went from there'
Letby tells the court that is what she said, having been reviewed by a doctor and Child O had a loopy bowel. She says she is referring to distention found prior to 8am.
LL, at 9.33pm: 'Worry as identical'
Mr Johnson: "Were you setting up a false narrative here?"
Letby: "No, that's not what I'm suggesting at all."
NJ: "You had already set your plan in motion by pumping air into [Child P] before you left."
LL: "No."

​ Sky News (Same Evidence):

"I am also going to suggest you are telling your friend [...] lies in these texts," Mr Johnson says, before showing another text.
Letby to Colleague 2 (9.16pm) Had big tummy overnight but just ballooned after lunch and went from there
Mr Johnson suggests this was a "not accurate" reflection of what had happened on the night shift.
"I believe he had had an enlarged abdomen overnight," Letby says.
Letby then expressed concern in a text to Colleague 2 about Child O's triplet.
Mr Johnson accuses Letby of "trying to create in the minds of other people" that there would be a similar problem with Child P.
"No, that is not what I am suggesting," Letby says.
"Because that is what you were planning," Mr Johnson says.
"No, it is not."
"Because you had already put your plan into motion by pumping air into Child P before you left."
"No."

​ Chester Standard:

Letby is asked to look at a Datix form she had written [a form used by staff when issues have been highlighted, such as clinical incidents], on the documentation ['Employees involved' has Letby's name].
The form said 'Infant had a sudden acute collapse requiring resusctiation. Peripheral access lost.'
Dr Brearey said the information in the form was 'untrue', and he said he didn't believe at any point IV access was lost.
Asked about this, Letby says: "Well, that's Dr Brearey's opinion."
The form adds: 'SB [Brearey] wishes amendment to incident form - Patient did not lose peripheral access, intraosseuous access required for blood samples only.'
Letby says she does not believe her Datix report was untrue at the time.
NJ: "You were very worried that they were on to you, weren't you?"
LL: "No."

​

Child P

Mr Johnson turns to the case of Child P, triplet brother of Child O.
Letby, in her defence statement, denies hurting Child P. She said she did not recall having an argument with nursing colleague Kathryn Percival-Ward about working in room 1.
She said she was in conversation with student nurse Rebecca Morgan when Child P collapsed.
She said it was "chaotic" with all the staff arriving to resuscitate, and Child P was too poorly to be transferred to room 1, so was kept in room 2.
Child P's stomach was 'red'.
She says at some stage she pricked herself with a cannula needle and needed to go to A&E for treatment.
While there, she said she fainted, she believed due to stress at the time of the past few days, and had not eaten.
She said she had 'forgotten' she had taken a handover sheet home with her.

​

An examination of Child P at 10am on June 23, 2016 was "unremarkable", the court hears. Letby accepts that. She adds there was nothing of note during the day.
Mr Johnson suggests Child P worsened after Child O passed away. Letby agrees.
A 6pm feed for Child P is signed by Letby, and she says the writing above is not by her.
Dr John Gibbs had reported in his 6pm review for Child P that the baby boy was doing well. A blood sample taken at 6.35pm taken to a lab showed no signs of infection.
Letby denies overfeeding Child P 'at some point' between 5pm-8pm on June 23.

​

The cross-examination continues in the case of Child P.
Letby agrees there were 'no problems' at the time of the handover for Child P on the night of June 23. She recalls the x-ray taken shortly after that handover.
The x-ray report said: 'NG tube in satisfactory position...gas-filled bowel loops throughout the abdomen, through to the lower rectum, with no evidence of obstruction and no plain film signs of perforation'
Letby denies pumping Child P with air.
She agrees this was a deterioration for Child P.
Medical expert witness Dr Owen Arthurs had previously told the court this image was "quite unusual" for a baby of that gestation.
Letby says she cannot comment how the gas got there, only that she did not put it there.

​

A 14ml aspirate is recorded for Child P at the time of handover at 8pm.
NJ: "That was your doing, wasn't it?"
LL: "No."
NJ: "On your way home, you were sowing the seeds with your colleagues?" Mr Johnson refers to the 'Worry as identical' text message Letby had sent. "You were feeding a false narrative, trying to divert attention away from your homicidal activities?"
LL: "No."

​

5ml of air and 2ml of milk is aspirated from Child P at 7am.
"How much milk had [Child P] been fed overnight?"
Letby said Child P had been fed prior to midnight. She says if the NG Tube is in the stomach, air would come out.
Letby disagrees that Child P was well at the morning handover time, as Child P was 'nil by mouth'.
A police interview had earlier said Letby saying Child P was stable and well.
Mr Johnson suggests Letby is deliberately making the appearance of Child P worse now than at the time she gave her police interview.
LL: "No."

​ Sky News:

By the end of the night shift of 23/24 June 2016, the prosecution claims, Child P was "comfortable, settled and seemed like a well baby".
Lucy Letby is asked if she agrees with this.
"At 8 o'clock in the morning?" she asks.
"Yes," says Mr Johnson, the prosecution barrister.
"I am not sure. He had just been reviewed by the registrar."
Mr Johnson alleges that "whatever had been the problem had resolved itself" by the time Child P was handed back into her care on the morning of 24 June.
"No, because he had been placed nil by mouth," Letby says.
"Yes, but he was a well baby by the time he was handed over to you."
"I disagree, a baby nil by mouth is not a well baby," says Letby.
Letby is accused of making Child P sound worse to explain what happened to him during her shift on 24 June.

​ Chester Standard:

The day shift for June 24 is shown to the court. Student nurse Rebecca Morgan is on the rota. Lucy Letby is the designated nurse for Child P in room 2. The other surviving triplet is also in room 2, with designated nurse Christopher Booth. Child Q is in room 1 with two other babies. Three babies are in room 3, and three babies are in room 4.

​

Letby rules out staffing levels as a contributory factor in Child P's collapse and death.
She also rules out staffing mistakes.
She says there were "some issues with the chest drain", but "cannot say" how much of an effect that had on Child P.

​

By 0639, Sophie Ellis’ nursing note recorded that “abdo has been soft and non distended. 25ml of air aspirated by SNP Kate Ward. NGT placed on free drainage”.
Mr Johnson says Letby created a false nursing note at 8am to say: "...abdomen full - loops visible, soft to touch." He says that is not the picture from 6.39am.
Letby agrees that is not the same as Sophie Ellis' note.
Sophie Ellis's note for June 23 for Child O: 'Abdo looks full slightly loopy...abdo soft.'
Letby says her observation for Child P that morning was what she saw. She informed a doctor an hour later about the abdomen observation. She denies a suggestion by Mr Johnson that she is lying.

​

Letby says she escalated the observation to the shift leader.
Mr Johnson asks if Letby knew what she was telling her friend, the doctor, at this point. Letby does not recall.
The message shown to the court, sent at 8.04am: 'I've got [child] and [Child P], [Child P] has stopped feeds as large asps.'**
Mr Johnson asks why Letby is lying about having the first child, whose designated nurse was Christopher Booth. Letby says she would have to check the paperwork, as she may have been assisting.
Letby's follow-up message, at 8.19am: '...I'm ok, just don't want to be here really. Hoping I may get the new admissions...'
Mr Johnson asks why Letby didn't raise it with the doctor colleague who was coming into work.
Letby says the doctor was not present in the neonatal unit that day. He went to the children's ward.
Letby denies the observation was a 'fabrication' as Dr Anthony Ukoh saw loops as well.
She said the context of 'don't want to be here really' was what she had seen earlier with Child O.
Mr Johnson refers to Dr Ukoh's note of observation at 9.35am: 'Abdomen moderately distended/bloated; soft'. Mr Johnson says there is no mention of loopy bowels. Letby: "No."
Letby says Dr Ukoh might not have recorded it.
NJ: "Or you have misrecorded it."
LL: "No."

​

Within a few minutes of Dr Ukoh reviewing Child P, Child P collapsed.
NJ: "That has to be your doing, doesn't it?"
LL: "No."

​ Sky News:

Letby (8.04am): I've got [Child P and his triplet brother]
But data from the unit shows she was only looking after one baby - Child P.
Twenty minutes after Letby allegedly saw the "loopy bowels" she also sent the following text to her colleague.
Letby (8.19am): I'll be watching them both like a hawk. I'm ok, just don't want to be here really. Hoping I may get the new admissions.
Child P's collapse "had to be" Lucy Letby's doing, the prosecution claims.
"No," she says.
A student nurse says Letby left the nursery around this time, Mr Johnson says.
He claims she did so to distance herself from his collapse.
"Were you worried that Child P was high risk?" Mr Johnson asks.
"When I took over his care that day? Yes."
"But you left him."
"I don't agree, I've not said that I left him."

​ Chester Standard:

Mr Johnson says Rebecca Morgan's evidence was Letby had left the room at the time of collapse.
Letby says from her recollection, she was in the room, and is "quite clear" on that.
Letby's note for the desaturation: '...[Child P] had an apnoea, brady, desat with mottled appearance requiring facial oxygen and Neopuff for approx 1min. Abdomen becoming distended.'
Mr Johnson says the note is deliberately written to make it look like the Neopuffing made the abdomen become more distended.
Letby agrees.

​

Dr Ukoh, the court is told, gave evidence to say Child P was in a very different condition between 9.35am and 9.40am.
He also said Letby was "very keen" for the doctor colleague to be called. Letby says this was because he had been present for Child O's deterioration. She adds it was one of the other doctors who suggested getting that doctor.
NJ: "Were you trying to attract [the doctor's] attention?"
LL: "No."
NJ: "Did you enjoy being in these crisis situations with [the doctor]?"
LL: "No....[doctor colleague] and I were friends.
NJ: "Something to share?"
LL: "No."

​

Child P desaturated again at 11.30am. He was given adrenaline and he was paralysed with a drug to aid ventilation as he had been 'fighting the ventilator' with his breathing.
A note in Letby's handwriting is shown to the court. It details the efforts to resuscitate Child P. It was found at her home. Letby accepts she had put it there.
LL: "I collect paper and that's where it ended up...I have difficulty with throwing anything away, particularly paper.
NJ: "Is there anything comforting in keeping the paper?"
LL: "I keep paper yes, from a variety of different sources." Letby clarifies she does not include bank statements in that.
Letby was recorded by a nursing colleague as saying for Child P: "He's not leaving here alive is he?"
Letby disputes that. "I don't recall the conversation."

​

Child P's final collapse happened at 3.14pm, just after doctors had reviewed him. Letby says she cannot recall shouting for help, and cannot recall Child P's breathing tube being dislodged.
NJ: "The problem happened just after everybody left, just after you had said 'He's not leaving here alive is he?'"
LL: "I don't agree I said that.
NJ: "Is this another case of bad luck, that is happened just after everybody left?"
LL: "Yes."
NJ: "Did you enjoy making predictions when you knew what was going to happen?"
LL: "No."

​ Sky News:

Lucy Letby allegedly told her colleagues, when Child P desaturated: "He's not leaving here alive, is he?"
Staff on the unit have previously said this is not something that would have normally been said in a professional context.
At 12.28pm, Child P's oxygen levels dropped for a third time.
This was when the two on-call doctors (including the one Letby was allegedly "sweet on") had gone to the tearoom for a quick break.
Then they heard Letby calling for help.
When they returned, Letby was standing over Child P.
"I can't recall that now, but that's what they say," Letby tells the court.
"There was a problem with his breathing tube, do you remember that?" Nick Johnson KC asks.
"I don't remember that from my memory now."
The baby had been unable to move, so could not have dislodged it himself, the prosecution claims.
Letby denies she said "He's not leaving here alive, is he?"
"Whether or not you said that, this is just yet another bit of bad luck that it happened just after everyone else left?" Mr Johnson asks.
"Yes."

​ Chester Standard:

NJ: "You were very excited in the aftermath of [Child P's] death?"
LL: "No, I was not."
Mr Johnson says a female doctor colleague had said she acted 'in a totally inappropriate way'
LL: "No I didn't." She adds that was what the female doctor colleague had said.
Letby says she told colleague Sophie Ellis "out of respect" what had happened.

​ Sky News:

Nick Johnson KC, for the prosecution, says Letby's colleagues have previously said: "You were acting in a totally inappropriate way in that room."
"According to [colleague], yes."
Mr Johnson asks Letby if "you were falling over yourself to tell [colleague] about it?"
Letby says she told her colleague "out of respect" so the staff didn't "walk into the unit and find out".
But Mr Johnson says her colleague was not at work: "Why didn't you just leave her alone?"
"She was asking me," Letby says.

​ Chester Standard:

Mr Johnson said Sophie Ellis had been to the races - "why not leave her alone?". Letby said Sophie Ellis had texted her first.
Mr Johnson: "Did you enjoy the drama?"
LL: "No."
Letby's response to Sophie Ellis: 'Just blew tummy up and had apnoeas, downward spiral. Similar to [Child O] x'
Mr Johnson said the message were identical to the one for Child O.
Letby said that was what happened, his tummy blew up and he had apnoeas.
NJ: "Your portent of doom had fulfilled itself, hadn't it?"
LL: "No."
NJ: "At your hand."
LL: "No."

​

Mr Johnson clarifies from a text message sent to a doctor colleague, Letby did have two designated babies at the start of that shift, one of whom was Child P.

Child Q

He now turns to the case of Child Q.
Letby, in her defence statement, said she cannot recall much from the shift given what had happened in the previous days.
She said she did not understand why feeding was continued for Child Q when it was not being digested.
Letby said Child Q was sick and when she arrived, from the records, she aspirated 'air+++' from Child Q. She says she does not know how that air got there, and she did not cause it.
Child Q was not put on a ventilator as there were concerns over NEC.
She did not deliberately retain a handover sheet for Child Q.
Letby says she would like to amend the statement, to say she was on duty after June 25, 2016.

​

Medical expert witness Dr Dewi Evans was challenged by the defence on his use of the word 'crashed' for Child Q, saying that was a 'gross exaggeration'.
Letby says a more appropriate word for what happened to Child Q would be "deterioration".
A doctor colleague had referred to the event, in a message, as an 'acute deterioration'.
Letby said that would be accurate.
She said the difference would be a crash would require a crash call being put out.
Mr Johnson says Child Q was transferred to nursery room 1.
NJ: "He was in a serious condition after that, wasn't he?
LL: "No I disagree."
NJ: "He needed one-to-one care, didn't he?
LL: "Yes, he was assessed as ITU care."

​

The rota for June 25, 2016, at the beginning of the shift, is shown to the court.
Child Q was in room 2, designated nurse Lucy Letby. One other baby is in room 2, with a different designated nurse.
Letby was a designated nurse for a baby in room 1. Two other babies are in room 1. Three babies were in room 3 and four babies in room 4. Nurse Mary Griffith had designated babies in rooms 2, 3 and 4.
Letby rules out staffing levels or staffing mistakes or medical incompetence as contributory factors for Child Q's collapse.
Letby agrees Child Q required some breathing support at birth.
She also agrees Child Q "made good progress" after birth, according to Mr Johnson.

​

Letby says, "other than some temperature issues", the overall condition of Child Q was positive.
Child Q was looked after by Samantha O'Brien on the night of June 24-25, and Child Q was being fed 0.5ml of milk every two hours at 3am, 5am and 7am.
A blood gas reading at 6.58am was "very good", Mr Johnson says. Letby agrees.
Letby adds there had been a 'slight increase' in the lactate, and the pH reading was slightly lower, but accepts it was a good reading overall.
Letby said at the time of Child Q's handover on the morning of June 25: "There were concerns for his abdomen and his feeds." Asked who else had raised these concerns but her, Letby replies she does not know.

​

Letby had previously told her defence that, due to temperature concerns and aspirates, she wanted Child Q to be reviewed by doctors before feeding at 9am on June 25.
The neonatal schedule shows Letby made observations for the designated baby in room 1 at 8.30am. She also co-signed for medication at 8.32-8.34am for a baby in room 3.
At 9am, Mary Griffith is doing observations for a baby in room 2. An unsigned entry is made for Letby's designated baby in room 1 at this time. Also at this time, Letby is recorded doing observations for Child Q.
Letby says she does not recall doing the observations or being interrupted.
Mr Johnson says he uses the word 'interrupted' as swipe data shows Mary Griffith entering the neonatal unit at 9.01am. He suggests Letby pumped Child Q with some clear liquid while Mary Griffith was out. Letby denies this.

​ Sky News:

When her colleague left nursery two, Letby pumped Child Q with a "clear fluid", the prosecution alleges.
"That didn't happen, no," Letby says.
Nick Johnson KC says giving Child Q milk wouldn't have been an option because the infant was only being fed 0.5ml every few hours.
"If he vomited a large amount of milk it would be very obvious something was wrong," Mr Johnson says.
"Yes," says Letby.
"And that is why you chose a clear fluid on this occasion."
Letby denies this.

​ Chester Standard:

Letby is asked why she has only done 'half a job' for the 9am June 25 observation for Child Q.
LL: "I can't explain why I haven't filled the saturations."
NJ: "You were interrupted by Mary Griffith, weren't you?"
LL: "No, I don't know why those weren't filled in."

​

Letby said she left room 2 to go to room 1 as she needed to attend to cares for the other designated baby just after 9am.
Mr Johnson says that is a lie.
Letby says the baby didn't need a nappy change, but that baby "was an intensive care baby who needed regular attention".
Letby agrees she had not filled in the saturation readings, but otherwise 'the job was done' for Child Q's 9am observation.

​

Letby says she was not present in the room at the time Child Q vomited. She says she cannot recall aspirating air from the NG Tube afterwards, but may have done so.
Letby's nursing note: '...mottled++. Neopuff and suction applied....air++ aspirated from NG Tube.'
Letby says that information may have been relayed to her. She says the air in Child Q might have come from the Neopuffing process.
Letby agrees it could be dangerous if the Neopuffing and suction was done if there was clear liquid in Child Q's system. Letby said Child Q had vomited over his bedding.
Child Q, in a doctor's notes, had “just vomited” and his oxygen saturation dropped to the “low 60s”.
NJ: "There was a concern that [Child Q] had inhaled some liquid, wasn't there?"
Letby replies that is a concern any time a baby vomits.
The doctor's observations with Child Q continue for 53 minutes.
NJ: "This was no everyday, minor desaturation, was it?"
Letby replies it was not serious enough to require an emergency crash call.
NJ: "You pumped him with a clear liquid, didn't you?"
LL: "No."

​

Messages sent to a nursing colleague from 1.13pm are shown to the court: '[Child Q] on CPAP'
'Minna has taken [other baby] off me so just got him. Almost had a tube earlier but gases improving'.
Letby denies the event was 'trivial', saying Child Q had deteriorated but it was not on the same level as some of the other events that have been discussed, and did not need a crash call or resuscitation efforts.

​

Nurse Amy Davies recorded on June 25, 2016 for the night shift that Child Q had "settled".
NJ: "He became much better, hadn't he?" Letby agrees.
NJ: "A child that was put in your hands in good condition, left your hands in a ventilator in intensive care, but by this time was returning to normality."
Letby says by the night shift, Child Q was still on a ventilator and had a poor blood gas record on 6.23pm.
NJ: "You had nearly killed him, hadn't you?"
LL: "No, I hadn't nearly killed him."
Letby says she was later concerned she was being blamed for something that did not happen, by leaving the nursery room unattended.

​ Sky News:

Letby says she "walked in on a conversation" between colleagues and became "concerned I was being held responsible for something that did not happen".

​ Chester Standard

NJ: "The truth is that you pumped him [Child Q] with liquid and air?"
LL: "No."
NJ: "Because you tried to kill him?"
LL: "No, I didn't."

Court is adjourned, resumes tomorrow 10:30 am local time

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