What are the main causes of choking spells in adults. How can you prevent choking incidents at home. When should you seek immediate medical attention for a choking episode. What are the different types of choking spells and their appropriate responses.

Understanding Choking Spells: A Comprehensive Guide

Choking spells can be frightening and potentially life-threatening experiences. They occur when a foreign object becomes lodged in the throat or windpipe, obstructing the flow of air to the lungs. This comprehensive guide will explore the causes, prevention strategies, and emergency responses to choking spells in adults.

Common Causes of Choking in Adults

Choking can be triggered by various factors, including:

• Large pieces of food
• Swallowing pills
• Talking or laughing while eating
• Excessive alcohol consumption before or during meals
• Difficulty swallowing (dysphagia)
• Eating too quickly

Understanding these causes is crucial for developing effective prevention strategies and reducing the risk of choking incidents.

Recognizing the Signs of Choking

Identifying a choking episode quickly can be the difference between life and death. Here are the key signs to watch for:

• Inability to speak
• Difficulty breathing or noisy breathing
• Weak or ineffective coughing
• Skin, lips, and nails turning blue or dusky
• Loss of consciousness
• Universal choking sign (hands clutching the throat)

Is it possible for someone to choke without displaying these signs. While rare, some individuals may not exhibit all these symptoms during a choking episode. It’s essential to remain vigilant and trust your instincts if you suspect someone is choking.

Prevention Strategies for Choking Spells

Preventing choking spells is far easier than dealing with their consequences. Here are some effective prevention strategies:

1. Cut food into small, manageable pieces
2. Chew food slowly and thoroughly, especially if wearing dentures
3. Avoid talking or laughing while chewing or swallowing
4. Limit alcohol consumption before and during meals
5. For those with difficulty swallowing large pills, consult a pharmacist about crushing options or liquid alternatives
6. Stay focused while eating and minimize distractions

Can these prevention strategies completely eliminate the risk of choking. While these strategies significantly reduce the risk, it’s important to remain cautious and prepared for potential choking incidents.

Types of Choking Spells and Appropriate Responses

Not all choking spells are created equal. Understanding the different types can help you respond appropriately:

1. The Heimlich Choke

This occurs when a large piece of food completely blocks the airway. The person cannot speak or cough. This is a medical emergency requiring immediate action:

• Perform the Heimlich maneuver (by a caregiver or self-administered)
• If unsuccessful after two attempts, call 911 and continue the Heimlich while waiting for help

2. The Damn-Near Heimlich Choke

In this scenario, a pill or small food particle partially obstructs the airway. The person can breathe with difficulty, often making a “heeee” sound, and experiences alternating coughing and gagging spells.

• The Heimlich maneuver or assisted cough technique may help
• Focus on expelling the obstruction upward, not pushing it further down
• Avoid back whacking, as it may worsen the situation

3. The Foodless Sneaky Choke

This type of choking spell can occur unexpectedly, even when not eating. It’s often triggered by saliva going down the wrong way.

• Encourage the person to cough and clear their throat
• Provide water if they can swallow safely
• Monitor for any signs of distress or difficulty breathing

How do you determine which type of choking spell is occurring. Observe the person’s ability to breathe, speak, and cough. The severity of these symptoms will indicate the appropriate response.

Emergency Response: When to Seek Medical Help

Knowing when to seek professional medical assistance is crucial. Call 911 immediately if:

• The choking spell doesn’t resolve quickly
• The person loses consciousness
• There’s persistent shortness of breath or noisy breathing
• The skin, lips, and nails turn blue or dusky
• The person can’t speak or cough forcefully

Additionally, contact your healthcare provider if you experience:

• Another brief choking spell
• A new, persistent cough or one accompanied by thick sputum
• Fever of 100.4°F (38.0ºC) or higher

Should you wait to see if symptoms improve before seeking help. In cases of severe choking or persistent symptoms, it’s always better to err on the side of caution and seek immediate medical attention.

Special Considerations for Individuals with ALS

For those with Amyotrophic Lateral Sclerosis (ALS), choking spells can be particularly challenging and frequent. Here are some specific considerations:

• Never eat alone if you have even minimal swallowing difficulties
• Work with your clinic team to develop appropriate choking response techniques
• Consider evaluation for a feeding tube if choking becomes frequent and mealtime is consistently stressful
• Be aware of the increased risk of aspiration pneumonia due to food or pills entering the lungs

How does ALS impact swallowing and increase choking risk. ALS can weaken the muscles involved in swallowing, making it more difficult to control food and liquids, thus increasing the likelihood of choking incidents.

The Importance of First Aid Training

Being prepared to respond to a choking emergency can save lives. Consider the following steps:

1. Enroll in a first aid class that covers choking response techniques
2. Learn the proper way to perform the Heimlich maneuver
3. Practice emergency response scenarios with family members or caregivers
4. Keep emergency contact numbers easily accessible

Where can you find reputable first aid training courses. The American Heart Association and Red Cross offer comprehensive first aid classes, including choking response techniques. Check their websites or contact your local health department for class information in your area.

Long-Term Management and Follow-Up Care

After experiencing a choking spell, it’s essential to address any underlying issues and prevent future incidents:

• Follow up with your healthcare provider as advised
• Discuss any persistent swallowing difficulties or frequent choking episodes
• Consider a swallowing evaluation by a speech-language pathologist
• Implement any recommended dietary modifications or swallowing techniques
• Stay vigilant about prevention strategies and maintain awareness during meals

Can swallowing difficulties be improved with therapy or treatment. In many cases, working with a speech-language pathologist can help improve swallowing function and reduce the risk of choking through specialized exercises and techniques.

Choking spells are serious events that require immediate attention and long-term prevention strategies. By understanding the causes, recognizing the signs, and knowing how to respond, you can significantly reduce the risk and potential consequences of choking incidents. Remember, prevention is key, but being prepared for emergencies is equally important. Stay informed, practice safe eating habits, and don’t hesitate to seek medical help when needed. Your awareness and quick action could save a life – perhaps even your own.

Choking Spell (Adult)

Choking occurs when a foreign object becomes lodged in your throat or windpipe, blocking the flow of air. This may be caused by a piece of food or a large pill. A complete blockage of your throat or windpipe prevents air from going to your lungs. If this lasts long enough, the oxygen level in your blood goes down and causes you to lose consciousness.

Home care

To prevent a choking spell, observe the following:

• Cut food into small pieces.

• Chew food slowly and thoroughly, especially if wearing dentures.

• Don’t laugh or talk while chewing or swallowing.

• Don’t drink a lot of alcohol before and during meals.

• If you have difficulty swallowing large pills, it may be possible to crush them, or to get the liquid form if available. But some pills should not be crushed. Ask your pharmacist before crushing any of your medicines. You could also ask your healthcare provider to prescribe another type of medicine in a smaller size.

Prevention

If you have a blockage preventing air flow, you naturally want to grab your throat with both hands. That is the universal sign for choking. If someone appears to be choking and doesn’t give this signal, look for these signs:

• Can’t speak

• Difficulty breathing or noisy breathing

• Can’t cough forcefully

• Skin, lips and nails turning blue or dusky

• Loss of consciousness

If you see any of the above signs, call 911 right away and take first aid measures if you are trained to do them. If you or your family does not know how to give first aid for choking, call your local health department or community center for class information. It could be life-saving.

Follow-up care

Follow up with your healthcare provider, or as advised. For more information, visit the following:

• American Heart Association website (www.heart.org/HEARTORG/) to find a first-aid class near you.

• Red Cross Training and Certification web site (www.redcross.org/ux/take-a-class) to find a first aid class near you.

When to seek medical advice

Call your healthcare provider right away if any of these occur:

• Another brief choking spell

• New cough that does not go away, or is accompanied by thick sputum

• Fever of 100.4°F (38.0ºC) or higher, or as directed by your healthcare provider

Call

911

Call 911 if any of these occur:

• Another choking spell that doesn’t end right away

• Loss of consciousness

• Shortness of breath or noisy breathing

• Skin, lips, and nails turning blue or dusky

• Can’t speak

• Can’t cough forcefully

ALSN – Article – All Choked Up

It’s not uncommon in ALS for something unexpectedly and abruptly to aggravate your airway and throw you into a choking fit. I know from personal experience that these choking, gagging, gasping spells are physically exhausting, frustrating and upsetting for both the choker and the caregiver.

The actions to take for choking depend on the type of choking spell you’re having. For example:

The Heimlich Choke: A large piece of food completely blocks the airway. You can’t speak or cough. This is an emergency! It requires the Heimlich maneuver, either by a caregiver or self-administered, to force the blockage up and out. If not successful in two tries, call 911 and continue trying the Heimlich while waiting for help.

Prevention is the key here. Take care to monitor the consistency of your food. Cut everything into small pieces and take smaller mouthfuls. Bread and melted cheese are especially likely to form large “plugs.” Alcohol, talking or other distractions while eating increase the risk of choking.

The Damn-Near Heimlich Choke: A pill or bit of food sticks in your throat. After a moment you can breathe but with a scary “heeee” sound.

Just as you start getting a little air in, you start coughing and/or gagging again. Over and over.

You can feel the darn thing stuck in your throat teetering between sliding up and making you gag and sliding down and making you cough. Scary, exhausting, but you can get a breath in between coughing spells.

The Heimlich or assisted cough technique may help. Focus on getting the obstruction up and out, not down the throat, because of the danger that it will lodge more firmly or go into the lungs. Therefore, avoid back whacking!

Talk with your clinic team about techniques appropriate for you and your caregiver’s strength. People with even minimal swallowing problems should never eat when home alone.

If you choke almost every time you eat and mealtimes are a dreaded experience, it’s time to get evaluated for a feeding tube. Besides the physical stress of a choking attack, the real danger of suffocation and the loss of calories due to fear of eating, choking can lead to aspiration, in which food or pills go into the lungs and cause life-threatening pneumonia.

The Foodless Sneaky Choke: You’re just sitting there minding your own business or even snoozing when suddenly you’re coughing and choking. A simple swallow of saliva goes awry and sends your larynx (vocal cords) into a spasm that closes off your airway. This is called a laryngospasm and isn’t uncommon in ALS. You fight to inhale but nothing happens. You can’t take a breath, can’t call for help, and panic crashes over you.

After an eternity, you finally suck in a thin, wheezing, tiny “eeee” breath. Slowly the spasm eases. The only thing I’ve found that helps me through these is the hard-learned lesson that they’re intense but short-lived. You’re not really choking, you can get some air, and the spasm will ease in just a moment or two.

Common causes of laryngospasm in ALS are liquid or saliva that went the wrong way into the larnyx, acid reflux disease, smoke, strong smells, emotion, alcohol, cold or rapid bursts of air, and even spicy foods.

Some techniques that may help ease the spasm include:

• Breathe through your nose rather than mouth.
• Pull in a breath from lower down, inflating your belly rather than breathing shallowly.
• When exhaling, very lightly blow out a sustained breath, like a soft whistle without puckering the lips.
• Swallow repetitively.

Caregivers can help by giving calm reassurance, gentle back rubbing (not whacking)and other support in riding out the spasm.

The Phlegm from Hell Choke: You try to clear your throat. Hrrrmph. Hrrrrrrrrmph. No good. Over and over you try to break up and cough out the thick clog in the back of your throat until you’re worn out and gasping.

My treatment is to take a dose of papaya juice or expectorant (guaifenesin, available over the counter) to thin the secretions. Then I lie down (BiPAP on) and have my caregiver do an assisted cough or use a cough assist machine. By lying down, I don’t have to fight gravity to bring the mucus up. Staying well hydrated can help keep secretions thinner.

The Nonchoke Sticker: A pill or bit of tortilla chip sticks on the way down and sits there feeling like a thorn in your throat. This little sucker can hurt for a day or more. After taking a small sip to make sure I can still swallow, I try taking the longest drink I can. Sometimes this repeated swallowing does the trick.

Advice to Caregivers

In any choking situation, fake being calm and quickly go through a list of possible actions. Ask, “Do you need a Heimlich? Assisted cough? A drink? Cough medicine? Suction?”

As with any aspect of ALS, always discuss choking concerns with your doctor. It’s good to practice the Heimlich and assisted cough techniques before you need to use them. For more information on these techniques, contact your local MDA/ALS center or MDA clinic.

Editor’s Note: Diane Huberty, of Fort Wayne, Ind., is a former neurology head nurse/instructor who has had ALS for more than 20 years. She writes  about tips for living with ALS. MDA Medical Director Valerie Cwik and Senior Writer Christina Medvescek contributed to this article.

Symptoms, Treatment & When to See a Doctor

Whooping cough is another name for pertussis (per TUSS iss). It is a contagious infection of the respiratory tract caused by bacteria (germs). The germs spread easily by breathing in droplets from an infected person who coughs, sneezes, laughs or talks close to you. Sometimes, you can catch whooping cough by touching something with the germs on it.

Whooping cough gets its name from the high-pitch “whoop” sound the ill person makes at the end of a coughing spell when he or she gasps for air. Not all people with whooping cough make this sound.

Whooping cough can occur at any age, but is most common and severe in infants and children younger than 4 years old. People who have not been fully immunized (had all of their vaccines or “baby shots”) are at greatest risk.

Those at risk are:

• Infants who have not had 3 vaccines (DTaP) by age 3. Five DTaPs are recommended by age 6.
• Preteens and teens who have not had a booster shot (Tdap), recommended at age 11. Protection from the vaccine wears off over time.
• Adults who have not been fully immunized, including having a booster

Adults can also be carriers. They may not have the symptoms but are able to infect others.

Symptoms of Pertussis

Stage 1: The first several days, your child will have cold or flu-like symptoms, such as a running nose, sneezing and a slight cough. There is little or no fever.

Stage 2: Beginning the second week, the typical “whoop” coughing spells begin and may last for 6 weeks. Some children may make choking sounds instead of the “whoop.”

• During the coughing spell, your child will seem to be choking, gagging or not able to catch his or her breath. His face may be red or bluish in color.
• Very young children may have a pause in breathing (apnea) as the main symptom. Skin color may get dusky or blue.
• The spells can last for more than a minute. A child may have up to 50 coughing spells a day.
• The spells may be triggered by eating, drinking, yawning, sneezing, or breathing in cold air. They can occur at any time but are more often at night and just after waking up.
• Vomiting is common during and after the coughing spell.
• The child will probably cough up large amounts of thick, stringy mucus after the coughing spell is over.

Stage 3: A child may have a cough or “whoop” from time to time for up to a year afterwards.

What to Do

• Pertussis is often scary for both the child and the parent. Try to stay calm.
• Stay with your child during the coughing spell.
• Place your child on his tummy with his face turned to the side. The head should be slightly lower than the rest of the body (Picture 1). This helps the child cough up the mucus without choking on it.
• Keep a bulb syringe or NoseFrida^® ready to remove the mucus (Picture 1).
• Give your child small amounts of foods and liquids often. Clear liquids are usually better to give than milk or formulas. Some examples of clear liquids are Pedialyte^®, diluted Gatorade^®, and clear broth. Often your child will eat better after coughing and spitting up the mucus.

When to Get Emergency Help

Call 911 or go to the Emergency Room if your child:

• Stops breathing
• Turns blue with coughing spells
• Has a seizure
  

When to Call the Doctor

Call the doctor if your child has:

• Coughing spells that last longer and happen more often
• Fever
  • Younger than 3 months of age and has a rectal temperature more than 100.4° F
  • Older than 3 months of age and has rectal or armpit (axillary) temperature more than 102° F that does not come down with medicine
  • 4 years or older, has an oral temperature more than 102° F for more than 3 days that does not come down with medicine
• Decreased appetite
• Trouble drinking liquids, keeping fluids down, or shows signs of dehydration
  • Dry or sticky mouth
  • No tears, sunken eyes
  • Very dark, strong-smelling urine, or no urination for 6 to 8 hours
• Is very weak and difficult to wake

Treatment

• If the diagnosis is confirmed, the doctor will prescribe an antibiotic. It is important to start the medicine right away and give it for the prescribed number of days, even if your child seems better.
• For fever, you may give acetaminophen (Tylenol^®) or ibuprofen (Motrin^® or Advil^®).Read the label to know the right dose for the age of your child.
• Do not give ibuprofen to children younger than 6 months. Do not give aspirin or products that contain aspirin.
• Do not give over the counter (OTC) cold or cough medicine without asking your child’s doctor. They will not help the cough and may be harmful.

Prevention

• Anyone exposed to whooping cough may need to be treated with antibiotics.
• Pertussis can be prevented by making sure your family is up-to-date with vaccines.
• Pregnant women should receive a booster Tdap shot.
• Teach your child to cough or sneeze into a tissue or into his shirt sleeve.
• Wash hands with soap and water often, especially after coughing or touching something that may have the bacteria on it.
• Disinfect toys and other objects that your child coughs on with soap and water or other household disinfectant. The bacteria can live on these things for days.
• Do not share drinking cups, eating utensils, napkins, or other personal items.

What to Expect If Your Child Is Hospitalized

• The doctor will order a test done on mucus gathered with a swab from the back of your child’s nose.
• At first, your child will be in Droplet Precautions. This means you will need to wear a mask when having close contact with your child.
• Your child may be given extra oxygen to help him breathe more easily.
• A heart monitor may be attached to your child because sometimes a child’s pulse may lower during a coughing spell.
• Your child will be given liquids through an IV if he is vomiting or not taking liquids well by mouth.

When Your Child Can Return to School or Daycare

Cases of whooping cough must be reported to the local Health Department. Tell the school or daycare that your child has whooping cough. It is important for school personnel to know so that other parents and teachers can watch for symptoms or get treated.

If your child’s health provider gives the OK, your child may return to school after 5 days of antibiotic treatment. Children who do not take antibiotics, must wait 21 days after the cough starts.

Pertussis (Whooping Cough) (PDF)

HH-I-58 10/13, Revised 9/18 Copyright 1987, Nationwide Children’s Hospital

Coughing Spasms

A coughing spasm is continuous coughing for longer than about five minutes. A cough is your body’s defensive reflex that functions to keep your airways clear of irritating or obstructing substances so that you can breathe effectively. Coughing spasms can make it difficult to breathe or talk during the coughing spell. Severe spells can even cause vomiting, choking, retching, light-headedness, muscle soreness, or turning blue due to the force of the coughing spell.

A cough is a symptom of a wide variety of mild to serious diseases, disorders and conditions. A cough can result from infection, inflammation, trauma, malignancy, airway obstruction, or other abnormal processes.

You may cough after inhaling an irritant, such as dust, smoke or pollen. A cough may also be the result of a disorder or disease, such as influenza, upper respiratory infection, or allergies. A cough can accompany serious and potentially life-threatening conditions as well, including pneumonia, acute bronchitis, bronchiolitis, asthma, malignancy, or congestive heart failure. Coughing spasms can commonly occur with pertussis (whooping cough), asthma, chronic obstructive pulmonary disease (COPD), or allergic cough. Although coughing spells can happen anytime, common triggers may include eating, drinking, yawning, sneezing, or breathing in cold air.

Coughing spasms can be a sign of a serious or life-threatening disorder.
Seek prompt medical care if your cough is undiagnosed, persistent, recurrent, or causes you concern.

Seek immediate medical care (911) if you, your child, or someone you are with, have difficulty breathing or speaking; experience chest pain, rapid heartbeat, grunting noises with each breath, loss of consciousness or passing out, or bluish lips; or are coughing up pink, frothy mucus. The latter is a sign of pulmonary edema and can lead to respiratory arrest. Any sign of blood is a potentially serious problem.

A Neurological Cause of Recurrent Choking During Sleep

J Clin Sleep Med. 2008 Dec 15; 4(6): 586–587.

, M.D.,, M.D.,, M.D., and , M.D.

Kathryn A. Davis

Department of Neurology, University of Pennsylvania, Philadelphia, PA

Charles Cantor

Department of Neurology, University of Pennsylvania, Philadelphia, PA

Douglas Maus

Department of Neurology, University of Pennsylvania, Philadelphia, PA

Susan T.

Herman

Department of Neurology, University of Pennsylvania, Philadelphia, PA

Department of Neurology, University of Pennsylvania, Philadelphia, PA

Address correspondence to: Dr. Kathryn Davis, Department of Neurology, 3 West Gates, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, [email protected]

Received 2008 Apr; Accepted 2008 Jun.

Copyright © 2008 American Academy of Sleep MedicineThis article has been cited by other articles in PMC.

Abstract

We describe a case of nocturnal choking episodes caused by insular seizures. Recurrent choking spells from sleep showed no response to treatment for sleep apnea or gastroesophageal reflux. Laryngoscopy revealed no abnormalities. Although continuous EEG monitoring during events was normal, ictal SPECT imaging showed increased radiotracer uptake in the left insular region, an area involved in sensation of the upper gastrointestinal tract. The episodes remitted after initiation of an antiepileptic drug. Obstructive sleep apnea is the most common cause for presentation to a sleep center, but seizures should remain in the differential diagnosis of nocturnal choking episodes.

Citation:

Davis KA; Cantor C; Maus D; Herman ST. A neurological cause of recurrent choking during sleep. J Clin Sleep Med 2008;4(6):586–587.

Keywords: Insular seizure, laryngospasm, obstructive sleep apnea, and seizure

A 34-year-old man was referred to the neurology service from the sleep center for further evaluation of recurrent stereotyped episodes of choking for four years beginning in 2002. Initially, these episodes occurred only at night, lasting 15 to 45 seconds, causing the patient to awaken with a sense of anxiety and on occasion to jump out of bed. The patient was initially diagnosed with obstructive sleep apnea (OSA) at an outside hospital after polysomnogram demonstrated an apnea-hypopnea index of 6 events per hour. Treatment of OSA with weight loss, CPAP, and upper airway surgery produced no improvement in symptoms. Esophageal pH monitoring was normal and treatment for gastroesophageal reflux was unsuccessful. Laryngoscopy showed no vocal cord abnormalities.

The patient’s choking spells increased in frequency from once per month to 4 to 5 per night in 2006. In addition, he had 4 nocturnal episodes in 2006 suggestive of generalized seizures, with witnessed generalized shaking and postictal confusion. A prolactin level drawn after an episode with loss of consciousness was more than 100. Six months prior to presentation, the patient began having daytime episodes of a choking sensation lasting 10 to 15 seconds, without alteration of consciousness. Prior to referral to our center, EEG and 72-hour ambulatory EEG were normal. Head CT was unremarkable. MRI was not performed because of metal in the patient’s cheek.

The patient was admitted to the Epilepsy Monitoring Unit for continuous video-EEG monitoring for further classification of these events. Several typical events were recorded, but ictal EEG showed no abnormalities. Ictal single photon emission computed tomography (SPECT) showed increased radiotracer uptake in the left insular region (), consistent with simple partial insular seizures. After treatment with the antiepileptic drug oxcarbazepine, daytime episodes remitted, and nocturnal episodes markedly improved in frequency and severity.

Ictal SPECT showed increased uptake in the left insular region (see arrows).

DISCUSSION

Given the prevalence of sleep disordered breathing and current referral patterns, the majority of patients presenting to a sleep center for evaluation of nocturnal dyspnea will have obstructive sleep apnea. In addition to apnea, however, the differential diagnosis of nocturnal choking episodes includes nocturnal panic attacks, laryngospasm, gastroesophageal reflux, and seizure. In the current case, focal seizures appeared to arise from the left insular region, with occasional secondary generalization. Insular seizures presenting with symptoms of upper airway obstruction have previously been described. ¹

Confirming a diagnosis of insular seizures can be difficult, especially if only simple partial (no loss of awareness) seizures occur. Interictal EEG may not be diagnostic; spike frequency can be very low or even absent in extratemporal epilepsies. Because of the deep location of the insula, ictal scalp EEG is usually also unrevealing; only 20% to 30% of simple partial seizures show an ictal correlate on surface EEG.² Prolactin levels may be elevated following complex partial or secondarily generalized seizures, but can also be high after syncope.³ As in this case, focal increases in perfusion can sometimes be seen on ictal SPECT, but regions of hyperperfusion may be large and preclude exact seizure localization.⁴

The insula is believed to have multiple functions subserving movement, sensation, emotion and memory, including a patterned involvement in general and special visceral sensation of the gastrointestinal tract from the tongue extending at least to the esophagus. ⁵ Electrical stimulation of the insular cortex in epilepsy patients undergoing stereotactic depth electrode recordings can evoke pharyngeal or laryngeal sensations of constriction ranging from breathing discomfort to a sensation of strangulation.⁶ Insular seizures often show early clinical symptoms of unpleasant sensations in the throat of variable intensity, followed by facial paresthesias, loss of awareness, and oroalimentary automatisms as seizures spread to mesial temporal regions.⁶

This case demonstrates that insular seizures can present with choking episodes which may be erroneously attributed to obstructive sleep apnea or reflux. When such episodes are stereotyped and do not resolve with CPAP or treatment for reflux, consideration should be given to the possibility of focal seizures even in the absence of EEG abnormalities.

DISCLOSURE STATEMENT

This was not an industry supported study. The authors have indicated no financial conflicts of interest.

REFERENCES

1. Wyder-Westh C, Lienert C, Pihan H, Steinlin M. An unusual cause of stridor in childhood due to focal epileptic seizures. Eur J Pediatr. 2005;164:648–9. [PubMed] [Google Scholar]2. Devinsky O, Kelley K, Porter RJ, Theodore WH. Clinical and electroencephalographic features of simple partial seizures. Neurology. 1988;38:1347–52. [PubMed] [Google Scholar]3. Chen DK, So YT, Fisher RS. Use of serum prolactin in diagnosing epileptic seizures: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2005;65:668–75. [PubMed] [Google Scholar]5. Augustine JR. Circuitry and functional aspects of the insular lobe in primates including humans. Brain Res Brain Res Rev. 1996;22:229–44. [PubMed] [Google Scholar]6. Isnard J, Guenot M, Sindou M, Mauguiere F. Clinical manifestations of insular lobe seizures: a stereo-electroencephalographic study. Epilepsia. 2004;45:1079–90. [PubMed] [Google Scholar]

Laryngopharyngeal Reflux | Michigan Medicine

In adults and children, irritating acidic juices may back up from the stomach into the esophagus (swallowing passage) and throat. This is frequently called gastroesophageal reflux disease or GERD. This condition may occur at any time, but it happens more often when you are laying down. A common anatomic condition known as a hiatal hernia predisposes people to acid reflux. The most commonly recognized symptom of acid reflux is “heartburn” due to irritation of the lining of the esophagus. 

Most people do not know that acid reflux can also cause voice problems or symptoms in the pharynx (back of throat). This can happen to someone even if they are not aware of any heartburn and is sometimes called silent reflux, atypical reflux or laryngopharyngeal reflux. 

The following information is intended to help you understand acid reflux and the steps you may take to reduce this problem. It is important to realize, however, that the healing of the irritated vocal folds, throat, or esophagus will take time, and you should not expect immediate results.

Symptoms in Adults

Symptoms of acid reflux may include: 

• Hoarseness
• Excessive mucous or phlegm
• Throat clearing
• A sensation of a lump in the throat
• Sore throat
• Choking spells
• Wheezing
• A sense of post-nasal drip

Singers will often notice:

• Increased warm-up time
• Sluggish voice (particularly early in the day)
• A sense of a “coating” on the vocal folds

In a small percentage of people, more serious problems result, including: 

• Pneumonia
• Ulcers or granulomas of the larynx
• Vocal fold scarring or a pouch (diverticulum) of the upper esophagus

There is also a small chance of developing cancer in the esophagus or throat due to long-term acid reflux.

Symptoms in Children

In children, the symptoms can be a little different and may include: 

• Persistent vomiting
• Bleeding from the esophagus
• Respiratory symptoms
• Choking spells
• Recurrent pneumonia
• Asthma
• Swallowing problems or anemia. 
• In some cases, unexplained fussiness and crying in children is due to acid reflux

Dietary Factors and Foods to Avoid

Dietary factors often contribute to acid reflux. Certain foods are acids or irritants themselves; others will bring out stomach acid in large amounts. Both should be avoided. 

The following list of foods is especially known to be troublesome: 

• Coffee, tea, chocolate, carbonated beverages, alcoholic beverages, citrus beverages or highly spiced foods
• Hard candies, gum, breath fresheners, throat lozenges, cough drops, mouthwashes, gargles, etc., may actually irritate the throat directly (many cough drops and lozenges contain irritants such as menthol and oil of eucalyptus) and will also stimulate the stomach to pour out acid.  

Being overweight also contributes to acid reflux; if you are overweight, it would help to lose weight. Large meals at one time are troublesome, and so three or four equal, small feedings are preferable to one or two large meals. One should not eat for 2 or 3 hours before bedtime; it is advisable not to lie down right after eating.

Behavioral and Other Factors

As mentioned above, body weight is a significant factor in promoting reflux of stomach acid, and weight reduction is helpful. 

Pregnancy will markedly increase symptoms of heartburn and sometimes throat symptoms as well. This is partly due to the space taken up by the growing infant. One should avoid clothing that fits tightly across the midsection of the body. It is helpful to practice abdominal or diaphragmatic breathing. This means you should concentrate on pushing out the stomach with each breath instead of expanding the chest. Avoid slumping when sitting down. Avoid bending or stooping as much as you can. 

For many people, reflux occurs most often at night and sets up the irritation that continues to bother during the daytime. One of the most important things you can do is to elevate the head of your bed. To do this, use blocks, books or bricks underneath the legs at the head of the bed. The elevation should be 4-6 inches or so, but not high enough that you will slide down when sleeping. Professional singers with acid reflux should consider traveling with blocks in their suitcase for use in hotel rooms. 

The use of multiple pillows to get the head up is not effective because it causes the body to curl unless the pillows are maintained under the shoulders in addition to the head. Wedge-shaped pillows can be helpful in this regard. 

Medications

In addition to dietary and behavioral adjustments, medications are often part of an anti-reflux program. Some are available without a prescription, while others require a prescription. Antacids are commonly used for this problem, and they work by neutralizing stomach acid. Other medications work to decrease stomach acid secretion before it happens and are more effective at controlling symptoms. Medications should be discussed with your physician. 

Several different medications that you might be taking for other medical problems may actually increase stomach acid. These include: 

• Alpha blockers (Dibenzyline), dopamine or calcium channel blockers (Procardia, Cardizem, Isotin, Calan)
• Anticholinergics (Donnatol, Scopolamine, Probanthine, Bentil and others)
• Aspirin or aspirin-containing compounds and other drugs used for pain or arthritis, especially the group called “non-steroidal anti-inflammatory” drugs or NSAID’s, are especially prone to aggravating this problem in some people
• Beta blockers (Inderal, Tenormin, Corgard)
• Progesterone (Provera, Ortho Novum, Orval and other birth control pills)
• Theophyllin (Theodur and other products)
• Vitamin C is also an acid and can cause stomach symptoms

Surgery

In some patients with severe symptoms or complications of acid reflux, surgery can be performed for treatment. If appropriate, your physician will discuss this option with you.

Make an Appointment

Schedule an appointment by calling us at (734) 936-8051.

Breath-holding Spell

Is this your child’s symptom?

• A spell that involves holding the breath, then turning blue and passing out
• Breath-holding spells were diagnosed by your child’s doctor

Symptoms of a Breath-Holding Spell

• An upsetting event happens right before the spell. A common trigger is being angry about parents setting limits (temper tantrums). Another is getting scared. Some spells are triggered by a sudden injury, such as falling down.
• The child gives out 1 or 2 long cries
• Then holds his breath until the lips and face become bluish
• Then passes out and falls to the floor
• Then often becomes stiff. May also have a few muscle jerks.
• Normal breathing starts again in less than 1 minute. Becomes fully alert in less than 2 minutes.
• Only happens when child is awake, never when asleep

Cause

• A reflex response to strong feelings. This reflex allows some children to hold their breath long enough to pass out. Spells do not happen on purpose.
• This happens in 5% of healthy children. Breath-holding spells can run in families.
• Starts between 6 months and 2 years of age. Goes away by age 6.
• Many young children hold their breath when upset, turn blue, but don’t pass out. This is common and normal.
• Frequent spells can happen in children who have anemia (low red blood count). This can happen if your child doesn’t eat enough foods with iron. If your child is a picky eater, your doctor may order a blood test.

When to Call for Breath-holding Spell

Call 911 Now

• Breathing stopped for more than 1 minute and hasn’t returned
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Age less than 6 months old
• Passed out more than 2 minutes by the clock and normal breathing now
• First breath-holding spell
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor During Office Hours

• Never been checked by a doctor for the spells
• Spells happen without a reason (no triggers)
• Muscle jerks during spell
• Picky eater (especially for meats)
• Lots of tantrums trigger the spells
• Spells happen more than once a week
• You think your child needs to be seen, but the problem is not urgent
• You have other questions or concerns

Self Care at Home

• Normal breath-holding spell

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice for Breath-holding Spells

1. What You Should Know About Breath-Holding Spells:
   • While breath-holding spells are scary for parents, they are harmless.
   • Normal breathing always returns on its own.
   • The spells don’t lead to seizures (epilepsy).
   • Here is some care advice that should help.
2. Lie Down:
   • During the spell, have your child lie down.
   • This will increase blood flow to the brain.
   • Remove any food from his mouth.
   • Do not hold your child upright. It decreases blood flow to the brain. This could cause some jerking of body muscles.
3. Cold Washcloth to Forehead:
   • Put a cold, wet washcloth on your child’s forehead. Keep it on until he or she starts breathing again.
   • That’s the only care your child needs.
4. Time the Length of Not Breathing:
   • These spells always seem to last longer than they really do.
   • Time the length of a few spells. Use a watch with a second hand.
   • Breathing almost always returns by 60 seconds.
   • It’s hard to guess at the length of a spell and get it right.
5. Stay Calm:
   • Don’t start mouth-to-mouth breathing. Don’t call 911.
   • Don’t put anything in your child’s mouth. It could cause choking or vomiting.
   • Never shake your baby. It can cause bleeding in the brain.
6. Don’t Give In After the Spell:
   • Some breath-holding spells start with a temper tantrum. Example: your child wanted something and you said “No.” Don’t give in to your child before or after the attack.
   • After spells, give your child a brief hug and go about your normal routine.
7. What to Expect:
   • Spells happen from 1 or 2 times a day to 1 or 2 times a month.
   • Kids outgrow them by age 6.
8. Call Your Doctor If:
   • Spells become more frequent
   • Spells change
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Last Reviewed: 10/17/2021

Last Revised: 09/30/2021

Copyright 2000-2021. Schmitt Pediatric Guidelines LLC.

New Harry Potter | All About the World of Harry Potter |

Spells

Spells:

Combat (striking, and also Aurora)

Impedimenta – a spell that makes the legs wadded – a person cannot stand and move his legs

Taranta Allegra – a person starts an uncontrolled dance (only legs are involved)

totalus – complete immobilization of the body

Incarcero – entangles the enemy, not giving him the opportunity to move

Rictusempra – causes lightning

Mento Menores – causes mortal horror in a person

Stupefay – spell of stupefaction – dumbfoundedness and disorder

apparatus

Achhelitus – a suffocating spell

Tormentio – causes putrefaction

Insendio – ignites objects and people

Deluvium – causes floods

Conjunctivitus – a blinding spell

Disarms the enemy I am from his hands VP

Protego – protective spell: frontal shield

Diffendo – protective spell: circular shield

Enervate – protective spell: energy blocking

Daceo Patronare – Formula of the Charm of Guardianship

Conjuration of the Patronacia 5,000

Finite incantatem – interrupts the effect of long-term damaging charms

Speculi verto – forcibly returns the Animagus to his human form

Riddikulus – turns something scary into something funny, a spell against Boggart Patronus

–

–

drives away dementors

Aurora:

Exitus Vitalis – a spell of coma, any magical creature instantly plunges into a state of lethargic sleep

Laeza Cordis – causes cardiac arrest

Fibrillation Sanguis – shield from Temez Magero

The food cursed in this way grows old in a matter of minutes

Flexio fluctus aeris – air flow.Knocks back the opponent 3-5 meters and turns him off for 5 minutes

Conversio fluctus aeris – Shield from Fluctus Aeris

Hooligan:

Verbositas – spell of talkativeness (half an hour)

Amata sententia – curse of a favorite phrase (the recipient inserts some specified phrase into his speech within an hour)

Plausus – a spell of applause (the recipient claps his hands continuously for 5 minutes)

) – stuttering spell

Perpetua inscriptio – spell indelible (for 3 hours) inscription (for example, on the forehead)

Clato Verato Nicto – Forces to pronounce words backwards for half an hour

9000 formula “Silentium!”) – the spell of silence, the victim cannot speak, whisper, wheeze, only pretend to be a fish

Morpheus charm (formula “Morpheus!”) – forced one hour sleep

Animosus (animosus, wakefulness) – protection from sleep and sleep spells

Furunculus (furunculus, abscesses) – causes abscesses and ulcers – an ugly face up to the Christmas ball

Formositas (formositas, beauty) – a protective spell against the furunculus.

Enchant:

Cold Medicine

Contact type of enchant. Allows you to remove the spells of forgetfulness, the effects of the Cruciatus (it is not known how successful), heal bones, interrupts the action of hooligan spells and heals the consequences of unsuccessful potions. Uses sympathetic magic.
Death Eaters cannot be healed with White Magic. Their physiology and state of mind is so different from ordinary wizards that only a mediwizard who understands necromancy can help cure this or that ailment, as well as remove the curse.Treatment in the hospital of St. Munga and other medical institutions where necromancy is not practiced is fraught with a worsening of the state of the PS with a possible fatal outcome.

Everyday enchantment:

Akzio – alluring charm

Mobilcorpus – moves (levitates) objects through the air

Wingardium leviosa – forcible transportation of the subject (allegedly through the air) after the wand of the cursed

Apparition – (Apparayd) Reparo – restores broken items

Flagreit – mark a place with a fiery cross (for example a door)

Kolloportus – seal a door

Alohomora – print or open doors on Colloportus

Dissendium – Dissendium secret passages

Relashio – signal spell in the presence of proper accompanying effects (explosion of fireworks)

Lumos – lights the light at the end of the wand

Nox – extinguishes the light at the end of the wand

Exorcism exorcism – exorcism , a phantom, or a spirit from the room in which it is now is

Curses:

Unforgivable

Imperio – submission to the will

Crucio – painful shock, torture, which, with prolonged exposure to the magician’s body, can lead to insanity

Avada Kedavra – instant death – carrying out the potential of the soul with the burning of vital life.

Vanguard Mythic Spell Sets … – War Dragons Russia

Vanguard Mythic Spell Sets
Oni – Mythical Warrior
– ⚪ Ferocious Shield (* ferocious shield) – a white-type spell, to activate – 1 fury bar. Absorbs all damage, including super attacks for 5 seconds, and then increases the dragon’s attack to 100% depending on how much damage has been absorbed. The attack increase lasts 3 seconds after the shield has disintegrated.
– 🔵 Blood Fury (* bloody anger) – a spell of blue type, to activate – 1 bar of rage.The dragon gains 3 points of rage, and when buildings are destroyed, it restores HP, depending on how much damage was done. Rage regeneration is slowed by 90% while the spell is activated. Duration 4 seconds, cooldown 4 seconds.
– ⚪️ Derisive Shriek (* ridiculous piercing scream) – a new, white-type spell, to activate – 2 bars of rage. Increases damage to buildings based on the dragon’s base HP percentage.
– 🔶 Resistance to the Elements: reduces the damage received from the attack of buildings with elemental elements by 50% (storms, lightning, turrets, anti-aircraft guns).

Itzani – mythical hunter
– ⚪️ Shadow Strike (* shadow shot) – new, white-type spell, to activate – 2 points of rage. The dragon goes into an invisible cloak and restores shots. After the cloak falls off, it deals damage to nearby buildings that were not previously covered with sand (when the spell is fired, the sand does not disappear). The dragon receives a damage boost (the boost is not applied to each repeated activation).
– ⚪️ Searing Sand is a white-type spell, to activate – 1 bar of rage.The spell launches asphyxiant sand, covering a small radius of action. The spell blocks the attack of buildings, and shots of mages, until one of the buildings is hit.
– 🔵 Bloodlust (* bloodthirst) – a spell of blue type. Immediately increases rage, and restores the dragon’s HP once the buildings are destroyed.
– 🔶Undying Will is a new passive spell. After the dragon has died, it can attack for some time with increased damage and registrant shots.

Jormangandr – mythical wizard
– ⚪️ Tidal Surge (* tidal wave) – a spell of white type, to activate – 1 bar of rage. After a short delay, the struck building takes a percentage of the dragon’s attack as damage, while the dragon replenishes a portion of its maximum health. The spell has a rollback.
– 🔴 Flash Freeze (* freezing flash) – a new, red-type spell, to activate – 2 bars of rage. Deals damage and disables all buildings within range.Frozen buildings take additional damage.
– ⚪️Magic Barrier (* magic barrier) – a white-type spell, does not require rage to activate. Shields the dragon from any damage for a short period of time.
– 🔶 Resistance to the Elements: reduces the damage received from the attack of buildings with elemental elements by 50% (storms, lightning, turrets, anti-aircraft guns).

#wardragonsgame #mythicalvanaguards #mythicalwarrior #oni #mythicalhunter #itzana #mythicalsorcerrer #jormangandr

Personal site – Dryad

Stranglehold

Call Bear

Flash of Life

Elephant Strength

Entangling Vines

Vitality of the boar

Tranquility Totem

Resilience of oak

Natural selection

Complete cleaning

Phoenix Rebirth

Vault

Leaf fall

Summoning Totem

Summon a pack of wolves

Healing Wave

Treatment flow

Forest Protector

Four-leaf clover luck

Mongoose Agility

Green harness

Totem of Power

Summon Griffin

Werewolf Regeneration

Wolverine Rage

Double

Domestication of animals

Forest spring

Chapter 1186. Spells / Warlock in the World of Mages

The former Queen of Silvermoon became the Lady defending the human fortresses in the North. The last hope of humanity soared in the air at that moment, looking down at the army of survivors with a bitter smile.

Alustriel, as the blood daughter of Mystra, had a presentiment that as soon as Mystra died, the heavens would collapse. Despite the fact that she was a powerful legendary sorceress with traces of divinity in her blood, she knew perfectly well that it would be extremely difficult to rule the Northmen without the support of her mother. The Orc Empire loomed somewhere on the horizon …

On top of that, Silvermoon’s Alliance was an association of sorcery led primarily by wizards.The loss of the Weave shattered all their former cohesion.

Fortunately, due to the invasion of the Mages, the Orcs have come to an agreement with them. They did not try to send their troops to destroy the Alliance.

However, after a few days the situation worsened. A terrible epidemic swept through their lands, and the Dark Age knocked on their door.

Alustriel herself was a great lucky woman. Her peak legendary power allowed her to cast spells independently of the Weave, so while she often stumbled as a child while learning, she was able to gain the ability to defend herself. If wizards below rank 20 were without the Weave as unborn embryos, then legendary wizards were at least newborns.They were able to survive the destruction of the Weave.

In addition, the trail of divinity that Alustriel inherited from the Goddess of the Weave allowed her to succeed her mother as Goddess of the Weave. The gods helped to rally Silvermoon’s Alliance again, albeit with difficulty.

However, she was forced to leave most of her land and build this last fortress to protect humans from deadly insect attacks.The inhabitants of this camp were the last life force of the North (apart from the orcs).

“Am I doing the right thing?” “Alustriel was queen in times of peace. Even at such critical moments, she was tormented by doubts and indecision.

– I have news from the south, my Queen!

At this moment, the Old Mage Elminster, dressed in simple linen clothes, appeared from the portal, and, bowing, stood behind her, like a humble follower.

– I have just received confirmation that a beetle nest has appeared a hundred miles south of us.The Gloomy Forest is mired in swamps …

Alustriel’s heart sank into his heels. This was the worst news for this camp! She learned that swarms of these beetles originated from massive hive colonies. The appearance of a nest near the camp meant his death … Soon, endless waves of insects will cover the entire earth and turn it into a barren desert.

– Damn it … We put so much effort to make this place arable … We have already prepared the soil … Just one crop … – She lowered her voice, – It’s too late to move again.We have thrown all our strength into building this fortress … Even if we want to, where should we go? These damn bugs are everywhere now …

Looking at Alustriel’s sad smile, Elminster felt bitter.

– How are the wizards doing? After a long silence, she seemed to have made a decision.

– Still preparing. Even the best of them can only use rank 4 spells so far … and before the disaster, by the way, they were rank 20 wizards, just one step away from becoming legendary … – Elminster sighed.

After the destruction of the Weave, they had to return to their origins, using the elemental particles of the world to collect energy from their spiritual power and use spells.Fortunately, wizards have always researched Arcanists, so finding methods of training in wartime was not a big deal for them.

They got things organized pretty quickly, given Silvermoon’s accumulated information and talents. In such circumstances, even the gods could not resist using the legacy of the Arcanists. The churches did not openly lift the ban on them, because it would tarnish the reputation of the gods, but the research was no secret to anyone.

Unfortunately, all “talented” wizards have been bad when it comes to the legacy of the Arcanists. The convenience the Weave provided them reduced their abilities. Only after losing it did many wizards finally begin to realize how weak they were. With such harsh thoughts, some of the older wizards did not even consider changing their paths. They only thought about suicide.

Despite Alustriel’s unconditional support and Silvermoon’s abundant reserves, the best they could do now was a rank 4 spell. Having been stripped of the Weave, wizards realized how difficult it is to control spells, and how much ability and skill it takes to do so. Many died trying to use new spells.

– Leave the last batch, but take all the others.

It took her a long time to make this difficult decision.A tear rolled down Alustriel’s cheek. She flew up to her army and waved her hand for silence.

– These bugs took everything from us, and now they are following our lives, – her voice echoed throughout the fortress, – A cruel colony appeared not far away, less than a hundred miles from us … We ran out of supplies and scrolls, and we we cannot build another city … Tell me: CAN WE SIT WITH FOLDED HANDS IN FRONT OF THIS THREAT?

Doron gripped his weapon tightly, as if that was the only way he could feel safe.

“So it’s really that bad?” – he felt rage.

– No! I live in this place, and I will never leave it! Jimmy started banging on his shield with an ax.

– NEVER! WE NEVER LEAVE OUR HOUSE!

Terrible screams shook the entire fortress.

– Excellent! I will accompany you on this crusade. Let’s fight for our life! – promised Alustriel.

– FOR LIFE!

The angry soldiers set off.

Alustriel kept her promise and led the army on her white horse. Her divinity allowed her to maintain her strength even after the destruction of the Weave, so the presence of such a powerful leader greatly raised the morale of the soldiers.

…

– Today our team will be in charge of the patrol.

The army moved forward decisively. Unlike the regular troops, Doron’s squad was slightly disorganized. They were in a very bad mood, even with Jimmy’s support.

This city was their last hope. If this hope is destroyed, even Doron will lose her last courage to try to survive in this chaotic world.

– Come with me, Doron. Let’s go on patrol! – Jimmy waved an ax, unable to bear this heavy atmosphere.

– Okay, – Doron didn’t like that suffocating aura either, so he quickly got up and followed Jimmy.

The continent, shrouded in darkness, was full of unknown dangers.Despite the fact that many creatures became extinct long ago, unable to adapt to new conditions, those who managed to survive became much more cunning and ruthless.

Doron had heard of creatures from the Underdark, Dryders and monsters with terrible claws who wanted to use the darkness to break out of their prisons and invade the mainland. They were supported by their own pantheon led by the Spider Queen, Lolth.

Her decision was absolutely correct. The heavenly gods were forced to give way to the Underdark in this Dark Age, because they had no supplies or labor at all, which allowed them to ascend to the mainland. It was rumored that the drow had already built their city on the surface.

Rumor has it that males, along with other species, were considered inferior slaves among the drow.They could be sacrificed to the gods at any time. Despite all this, a large number of wandering survivors of various species sought refuge under the drow’s wing.

“What a pity … Lolth is an evil goddess, and my Lord …” Doron’s eyes sparkled as if he were fighting with himself, but soon this struggle subsided. Despite the fact that the gods lost all their former glory, their decrees still remained significant enough to influence the entire Main Material Level.The battle between good and evil cast a shadow on Doron’s thoughts …

About the energy crisis in Europe or how Putin became the uncrowned king of Europe

The text was published in the “Opinions” section.The editorial position may not reflect the views of the author.

Now only the lazy does not write about the energy crisis in Europe. At the same time, objectivity is usually completely absent in these materials. It seems that the authors of the texts deliberately put blinders on their eyes so as not to see the truth.

When it comes to left-wing publications such as “Details” – an Israeli Russian-language site, everything is clear here: everything related to global left-wing trends is presented in this publication in the spirit of the Pravda newspaper.In general, it is customary to say that the Nazis were the model of lies, led, probably, by a very talented PR specialist Ribbentrop. Although, of course, he, in many ways, only used the “developments” of the Comintern, he used them with great invention. But, undoubtedly, the challenge cup of the main liar of the planet for the last hundred years has been confidently held by the newspaper “Pravda”. So, Details is very diligently using the Soviet experience of its editors. However, practically all well-known players on the media market play here: from NYT to Deutsche Welle.Because the two main reasons for what is happening are exactly what these media are calling for. The first is the coming to power of the Democrats in the United States, the second is the fruits of the demagogic and bureaucratic policy of the EU.

Regarding the second component, the situation, I think, is quite obvious to everyone who closely follows what is happening in Europe. The idea of ​​limiting the use of various types of energy, based on some demagogic postulates, has firmly taken hold of the European bureaucracy, and the entire mass of human plankton who feeds on the poisoned lies of the media.In fact, on the one hand, the slogans of the militant climatologists, who thus provide themselves with an endless stream of grants, have found good ground in the heads of a semi-illiterate European man in the street, whose intellectual level, thanks to the cares of European bureaucrats, is today approximately in the same place where it was in the days of European religious wars. People who do not have the slightest idea of ​​either physics or the climate are firmly convinced that they understand the essence of the problem. No one cares about the fact that predicting the weather for a week is extremely difficult with a probability higher than 50 percent, and for a month it is impossible.But at the same time, you can predict for decades, right? An ignorant person who is confident that he knows the inscrutable ways of the Lord like the back of his hand is a terrible power.

Just as the ignorant ferocity of the fanatics of faith during the years of religious wars was extremely useful to its adherents, so this faith of the current European ignorant crowd in the climatic canon is a guarantee of the inviolability of the throne of the European bureaucracy. For a very long time, the last reasonable proposals on ecology were thrown into the cauldron, and today we are witnessing a total attempt to destroy the basis of civilization, supposedly in the name of man and the planet, but in fact – in the name of the strength of the bureaucratic rule of the European bureaucracy.

Declarations have long ceased to be just some kind of wishes. Over the past five years, there has been a transformation of destructive ideas into destructive actions. Sooner or later, this should have caused a general systemic crisis of Western civilization, which, against the background of a rapidly growing China, more and more hangs on itself chains so that it would be easier for China to bypass all civilized countries combined.

The first wave of this crisis broke out at the beginning of the 2000s, when against the backdrop of the impending and then the ongoing war in Iraq, amid a crisis of oil and gas supply expectations, energy prices skyrocketed.It was then that the question of the price of demagogy of the European bureaucracy arose for the first time. It seemed that both Europe and the United States would pay very dearly for the climate idea, which was adopted by the European bureaucracy in the late 90s, trying to become the main player in the political expanses of Europe. She succeeded, but the crisis was then avoided thanks to new technologies in the United States. Suddenly it turned out that oil and gas can be extracted in a different way and where people are not used to doing it.

I will not touch on the technical aspects of this process, since in this case it does not matter.What is important is that the United States suddenly became almost the main supplier of energy resources, and oil and gas prices simply collapsed within a relatively short time.

Many of us remember that George W. Bush, the President of the United States in 2000-2008, before the war in Iraq, met with Putin, looked him in the eye, and saw a friend in him. I do not want to condemn the American president, he was not the first and not the last one who was deceived in the Russian Dracula. But it is quite possible that Putin really considered Bush his friend – after all, he presented him with a royal gift: the price of energy in the 2000s skyrocketed, and Putin’s power became stronger than steel.And when the American energy market began to grow rapidly, and new methods of oil and gas production ceased to be exotic, and reached a normal technological level, Putin aimed their eagles from the Lubyanka to finance all environmentalists in the world in their crusade against new technologies for oil and gas production. Russia, unimaginably dirty from the point of view of ecology, with entire regions where nature has been killed for decades, if not centuries, has become the main standard-bearer of the fight against new technologies for oil and gas production.

And in Europe, where Putin was actively supported by the local bureaucracy (of course, repeating like an incantation that they protect nature – Long live the newspaper Pravda), the new technology did not achieve much success. But Putin’s long arms could not reach the United States.

The Western community is undoubtedly lucky. US President Obama, who came to power, set his first goal to ruin the middle class through a new health insurance system for all. He, of course, interfered with oil and gas production in the United States, but this topic was on the periphery of his activities.And then Donald Trump came to power, who allowed almost everything.

Total liberalization of the energy market dealt a terrible blow to Putin. It was the total drop in oil and gas prices that was the main blow to the Russian economy after 2016. And although the fall in prices inevitably depreciated American investments in oil and gas production (Russian fields make it possible to produce oil and gas at a lower cost), nevertheless, the production of liquefied gas for shipments in the United States began to grow rapidly.

European bureaucrats accused Trump of seeking to impose a blockade of Russian gas in the interests of American producers. Undoubtedly, there is some truth in this. But there is also one difference. Russian gas through the pipe is, for the most part, the gas of the monopolist. I will not touch on Novotek now – this is a separate topic. Of course, when it comes to liquefied gas, it must be taken into account, but now we are talking about gas supplied through pipes. So, the emergence of American liquefied gas traders is not a monopoly, but a competition of the highest level.That is, economically, Trump’s interests and the interests of gas consumers in Europe coincide. Only Trump’s interests do not coincide, and the interests of the European bureaucracy, for which it is FAVORABLE to work with Russia, are also interesting, in order to strengthen their power, and not with the United States, where they are junior partners. That is why the European bureaucracy was hostile to all of Donald Trump’s initiatives to demonopolize gas supplies to Europe, but calmly turned a blind eye to Putin’s political games with gas.

NEVER met in Europe from the bureaucracy such resistance from the bureaucracy that Putin with his gas pipe did not meet such resistance as Donald Trump, trying to admit American gas suppliers to the European market.I’m not talking about words, but about real actions.

It was President Biden who pressed the main trigger for the current energy crisis. He, who made the main political stake on the environment, as the main feature of his program (like Obama on health insurance), was the one who launched the crisis. He banned oil pipelines, raised tax costs for those who produce, and imposed new restrictions on supplies. The question of supplying liquefied gas to Europe from the United States has left the agenda altogether.And Putin became the uncrowned king of Europe.

Anyone knows that even the strongest bank can collapse if suddenly the majority of depositors decide to urgently withdraw their deposits from the bank. There is a great novel by Arthur Haley “The Money Changer”, which very nicely describes a similar situation, and the measures of blackmailing professional activists with which they force the bank to follow their lead. The same situation happened with gas. When Putin became the main supplier of gas to Europe (of course, under the name of Gazprom), then being a monopolist, he simply “pushed” the market a little.

No one is interested now that this is a temporary phenomenon. Negotiations are underway on the supply of Israeli gas to Europe (the Israeli-Greek-Cypriot project), on the supply of Egyptian gas, etc. It’s all in perspective. And today Gazprom is bullish. And in his situation, it is not even necessary to make special efforts to this: thanks to the European bureaucracy, the stability of Europe’s energy supply system has moved from a “stable” position to a “unstable” position. Gas supplies in Europe are still a market, although the European bureaucracy is so eager for a “new USSR”: in the new State Planning Committee of the EU to decide what goes where! But these are still “wonderful” dreams of bureaucrats.And the market reacts to an unstable state with a rapid rise in prices. Ce la vie.

PS. Dear Readers! If you were interested in reading this article – support its author: 5168 7422 2211 9400. Whoever wants it

Source: analytics.hvylya.net

Magic Capture – Spells – Mods for Skyrim – Mod catalog

• Author
  Leaf16591
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  nexusmods.com / skyrim / mods / 99015

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Description
mod for Skyrim

Mod for Skyrim adds another telekinesis spell, but this time – balanced.Thanks to the “Magic Capture” spell, you can capture an NPC and make him helpless, and then push him back (at a normal distance). The book can be found in Dragon’s Reach, in Farengar’s room.

Requirements : Skyrim + All DLC

Installation : standard

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1.04 Kb
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Swordself

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