hit the turn, they show up. So, there you go. Oh, yeah, yeah, good points. The Glutkin, oh boy, oh boy. Seven-hour points, he's over-costed. Why is he seven-hour points? Okay, we'll talk about his damage in a second. We're gonna let's leave the damage aside. 20 wounds, five-inch move, four up save, nine bravery. And yes, by the way, Jerm said they can deep strike too, right? Yes, keep in mind, play drones can also be deep struck with Lord of the Flexions. I didn't mention it, I was gonna mention it on him, but yes, it's worth mentioning. Okay, so this dude now has the five up.  It will once in a while do a little something, but it's basically worthless because it's a bravery check on 2D6. So congratulations on that. The, he has a bigger mountain of loathsome flesh, effectively, which starts at five mortal wounds, which is cool, fine. He has a mortal fleshy abundance called abundance of flesh, but you can't do it to plague barriers, you can only do it to mortal units, worth noting the difference there. So there's one for your mortals, one for your demons. The base spell only works on demons. This one only works on, this one only works on mortals. Mortals? Yeah, mortals, yeah. I mentioned Brad in the game that we got in, he made the point yesterday that this would be a way to take Blykings up to counting us two models. Yes, yes it would, it would do that. I think that's interesting. Mr. Dijakir said death and demons, the only ones with high bravery. Oh, I mean, sure. All of death, so one whole great alliance. Basically all of chaos is like eight, nine, 10 bravery. So that's two whole grand factions.  A lot of high bravery people in the game. Starborn, Seraphon, rock around on 10s. Like there's a good amount of high bravery in the game. Trust me, as somebody who runs the Slinash army where almost everything is key to rolling 2D6 against their bravery, those abilities are worthless. Okay, great against Iron Jaws or something or Skaven or Kits, you know, those super powerful armies, the last two. Tyler, why do you take this guy? Will you take this guy for the Blitzkrieg? That's it, Blightkrieg, sorry. That's it, that's why you took him. He's a super powerful ability. You can use this command ability at the end of the enemy movement phase. If this unit, end of the enemy movement phase.  If this unit is within 12 inches of an enemy unit, the command must be issued from this unit and must be received by another friendly maggotkin of Nergal unit that is within 12 inches of an enemy unit, not of him, of the enemy unit, right? So he has to be within 12 and they have to be within 12, but they can be far apart. Right. This unit and the unit that received the command can both charge. So an off turn in the enemy movement phase charge that gets around on Lichel, that much like it's a slightly different timing than Ironsons, but it'll have a lot of the same effect right where it's like, oh, you didn't wanna fight the Glotkin and this other Skaven and Orgots. You tried to get into my other unit that you thought you could kill. Too bad, we're coming. Right. We in. Yeah. Okay, if anybody's, if you've played Ironsons, Ironsons, you know how powerful this ability is to charge off turn. It's crazy powerful. The problem is 700 points, woof, right? Yes. But it's a heck of a rule. I felt like the biggest miss in the book point was to me. Yeah. I mean, I don't know if you have ratio wise, but yeah, his, yeah, great war scroll, amazing role. We could talk for a while about it, but yeah, I mean, something I haven't played, I haven't played against him, but he wasn't relevant in the game that it would be played last night. So I haven't really got a feel for this, but yeah, it just feels like it's gonna be very similar to Ironsons and it's amazingly impactful. Ironsons, what do you think this guy should be? Points 700 right now. Probably like 600. He should probably come down 100 points, 600, 620. It feels like he needs to come down quite a bit. Yeah. Like, I think that, yeah, I was thinking around 600 for this guy. Does he make it? But I mean, he's super hard. Like, let's not forget, this guy has 20 wounds all with a five up after save, right? Who does decent damage? He does, yeah, he does. He's potent, but he's just probably not 200 points more potent than a great unclean one. Maybe 620, somewhere in that range, but it does feel like he needs a sizable decrease from 700. He's what he says, heals 2D3, he's assuming you heroic recovery him as well, which is very easily by the bravery of nine. Like, he's not going to die. It is very hard to kill this model, right? If you focus your heroic recovery on this guy, I mean, just good Lord, this dude is hard to bring down. He brings a lot to the table, you know? Blight Creek is a very, like, it's so hard to read because so much of his points are wrapped up in Blight Creek. Right. And, you know, they don't both need to charge the same unit there, Tyler, right? Exactly, yeah. We gotta get some games in and look at some lists and kind of get a feel for how impactful this could be, but yeah, it's fascinating. Yeah. Let's look at his damage real quick. So, against a 4-up save, he does an average of 10 damage just based on his War Scroll, 10 and a half damage. That's just like if you're rolling him straight with no buffs whatsoever, none, okay? If he just all-out attacks, he goes up to 13 damage. So, you know, he does damage, he's a hammer, but I don't know that he's doing 700 points for it. That's the trick, right? That's the trick, right. So, it's tough. That's such a hard points value to justify, right? He's up in like the God level points. And understanding how good Blight Creek is is what this is. And my honest answer is he needs a lot of testing to know where exactly he should go to. Yeah, I agree. Yep. Cool. Cool. All right, Orgots, my dog. Here we go. Oh, yeah.  Orgots, demon spew. This is my, this is my pick of the week, right here. I love how the internet's all agreed. This is, yeah, the pick of the book. Three Hyundai on the points. He's in that perfect realm. We love our 300-point heroes here at Warhammer Weekly. 14 wounds with an eight-inch move and a three-up, beautiful three-up base save. He's a war master, so he counts as a bonus general. He kicks back mortal wounds on his ward save, not disease points. He goes straight to the action and he gives you 10 free command points a game. And against a four-up save, he does an average of seven and a half damage, basically. My man. I love this guy. Points for damage on the grab. This guy on the spreadsheet. This guy is the most efficient in the book. Points for damage. Yep. Yep, he's got big, he's got good number. Like all the Magoth lords now, he's got a good number of Ren 2 damage three attacks, but he also has the axe to back it up. He can kick a fair amount back with his acid ticker. The free command point thing is fantastic. The bonus general thing is fantastic. He's super tough. He takes save stacking really well. Yeah, I love this dude. He's great. Like, I'm so glad to see the Magoth lords actually be worth playing now. It's the most exciting thing because they've been trashed for far too long. So this guy's great. Blowab, he's a caster version, 13 wounds on a four-up. Blowab, Blowab is also 300. What's interesting about him is that he has plus one to cast. Indeed. And he gives neg one to cast to enemy units if they're within range. Yeah, there you go.  This guy's, I experienced it last night. He is quite tanky. Like I said, he tanked five sides and I did four damage to him. Plus two stacking. And I think he was on the round with the four-up ward, the four-up ward rounds. Yeah. And his spell is interesting in what it can do, especially how it tracks along with disease tokens and stuff like that. So, yeah. He's got some play. He's got some play. When I initially read him, I didn't like this guy, but I've come around on him. At 300, I think he's in the conversation. As a spell, you have ways of doing additional chip damage. You know, any time, in each phase in which any wounds or mortal wounds were allocated in that unit, it's per phase on a two-up takes D through mortal wounds. Just more, more mortals, more mortals, more mortals, right? I could get nuts, potentially. Yeah. And again, it depends like, are you using plague drones where you've got some shooting damage? You know what I mean? Yeah.  You shooting phase with some plague drones. You obviously fight the battle shock disease tokens, right? It can add up. We didn't say it was part of the overview, but obviously, I mean, this is such a Johnny book, which I love that they have, yeah, all these combos and it's more than meets the eye, doing so much more with less. Yeah, it's awesome. Yep. So he's got play. Morbidex is my least favorite at only 12 wounds. Does still carry the three-up save. You know, his, he heals half the wounds done to him. Every year. Like that. Which is, which is good at the end of it, because it happens at the end of every battle shock phase.  And he can return nerglings to nerdling swarms. I don't really rate nerglings. Hence that special, that doesn't mean as much to me. The, you know, Morbidex is the most expensive one. He's three 20. It's not a huge difference, but he is the most expensive for the least wounds. He doesn't need to do that. He doesn't do that much less damage than Orgot's. He's five and five instead of seven and five with basically the same profile.  He's, I rate Orgot's like, Orgot's gets a solid nine for me, blow abs and eight. This guy's like a six to me. Still good. I wanna, yeah, I need to see him play dude. To me, it comes back to like we talked about as a distraction piece. It's an absolute nuisance. Cause it's, it's a matter of like these guys, all three of them are incredibly tanky and Orgot's and Morbidex are the most. So may in some situations, you may not need the extra durability that you're getting on Morbidex, but you may need it when he's playing that role. So like to me, it's a matter of how much difference is the extra durability on Morbidex going to matter in terms of him performing his role. Yeah. Does the extra healing end up being a hat on a hat because he's already so tough. Right. That's the question. Suspect, I suspect he's going to be more valuable than people are seeing is my view on him. He's definitely got potential as a really strong, just pinning piece that just holds somebody's like, we fight for the rest of the game now. Right. Pinning, threatening MSU units on backfield objectives, going up to wizards. Yeah, absolutely. Kind of similar to some of the things we talked about with Bastion. Right. Yeah. All right, keep moving. Lord of Affliction, this guy's hot as, I mean, he is so hot right now. Eight inch move, eight wounds, now with a three up save. His damage is like, okay, it's okay. But he is the great mortal hero of the book. He takes command traits and artifacts and holds them really, really well. He can do, he can do mortal wounds in the hero phase, which is cool. He has, when he charges, he can do mortal wounds. If he has the Dolores toxin, he can do them quite effectively on a two up. And most importantly, he can take two units of Puscoil Blight Lords or Plague Drones off-board with him into ambush. All right. When you would, so like, it's just so good. At the end of your movement phase, you can do it. At the end of movement phase, you can set up this unit on the battlefield more than nine small units. If you do so, set up all the units that joined with him on the battlefield, all the other than 12, this unit more than nine small units. He doesn't have the first turn restriction. He just, he's the normal rule. So you don't have to come downturn one. You can come downturn two or three. He can, he's part of your null deploy strategy. He's tough as a coffin nail. Yep. Fantastic. Yep. And that worked a lot, but yeah. And I mean, yeah, we could talk a lot about this guy, but he's going to be everywhere in a tunnel list. Yeah, the general of choice. Yeah, he takes, he's such a good, like he absorbs the commentary well. He absorbs artifacts well. He's mobile. He plays well into the strategy of using drowning men or drowned men so he can be a good leader. When you're, if you're doing a pregame move or to take him off board to protect him against Alpha shooting, he's versatile. He's effective. He's everything you want. And great. He's just great. They're great. I'm certainly the best of us with a go as a general and, you know, on average, maybe the go is going to be more durable in terms of the denying side of the war Lord, the Lord, you know, Lord of afflictions. On average, maybe you're, he's a little more putting at greater risk in your average game than you are your go, let's say, but yeah, in terms of slay the war Lord calculation, but yeah, it's still, he's so durable that, you know, you probably are going to be fine in a lot of cases. Agreed. He's fantastic. Love this dude. Love this dude. Okay. Gut rut spume. The other half of your null deploy strategy. So now four inch move, eight wounds on a four up save is safe to get one worse. You know, he still has his ability to add one days. He's, again, he's like, okay, damage, it's fine. These guys are all okay damage, right? I'm not even gonna call it out because it's just all okay. You know, he can get bonuses to hit heroes, fine, whatever. You're taking him because he has master the slime fleet where he can take three mortal maggot kin of Nurgle units off to board. Units have been reinforced to count as two units. At the end of your movement phase, you can set up this unit. Again, he doesn't have the first turn restriction. Now they do have to be within six inches of the edge of the battlefield.  Yep. Right? I missed that the first time reading it. Yeah, I didn't, I didn't realize. Yeah, it was any of the mortals. Yeah. So not just Blight Kings, like he used to be able to do, but like he can take other heroes off. He can say null deploy Orgots off the board and come in on the side with Orgots. He can take your Rotkovin off because they're mortal. Right? No. Anything, anything mortal. Somebody is on a 130 instead of 160. Yes. They have to be on a one.  He can't because Glockin's on the 160. Glockin is the 130 dude. Oh, is he really? I thought he's on 160. Okay. Yeah, he can take Glockin off because he's mortal. Yep. I was wrong on Glockin's base size. Well, there you go. So I mean, that's the reason you take this dude, right? It's that it's between him and the Lord of Reflections. You can easily one drop, null deploy, zero things on the board. You can even have some Nurglings in there to mess around with people. All off board. I deploy zero units go. Like even if you lose the roll off and like, if you get to go, you make them go first and you're on the board and then you just swarm them. And if it's like a Lumineth alpha shooting strategy, it's like, go ahead, what you're gonna shoot? For me, I'm actually like, if I were doing Nurgle tournament, I'm starting my list with this guy and Orgots or Morbidix. Yeah. Or my like quarter of my army, that's gonna have an amazing roll. Every game that's gonna do work for me, just that alone. And then yeah, go from there. Yep. The Lord of Blights is our next up. He's a, you know, he does have the three up base with seven wounds. So he is relatively tough, what his thing is. He can use the thrice ripened death heads thing for Blight Kings, right? So hence he can give like, you know, a shooting attack to Blight Kings, which is like, okay, it's fine. And again, it's the same thing where it's equal to the number of models in the unit.  Who also has a shooting attack so he can work well with the blow up spell. He can be passing around different shooting attacks either he himself or the other people and synergizes well with the shooting attacks. So you have damaged chances in the shooting phase. Again, more chances to pass disease around onto different units. You're not necessarily attacking, right? He gives like, he gives one model that unit but it's still shooting. It's just shooting attacks getting spread around. And he can fight with Blight Kings, right? He has the chain activation blight thing with Blight Kings. This is my wife coming down and tell me let's go. Okay. Yeah, like we're running over time. I knew this was coming. All right, Kathy, I've been staring at that door. Are you still on? Yeah, we're still on. Yeah, this is still on. We have 10 minutes left. We've been joined, get the dogs in here for everybody who stayed. Yes, we're moving. We're moving, I promise. All right, so I don't see this guy making the cut a lot of times. I agree. Pause up, pause up. There's still these little wound heroes, the dog goes in here. They're the only reason that people come. There you go. This is Aspen. She's very squirrely. Squirrely, squirrely. Give us 10 minutes. I'm not gonna give you 10 minutes, hurry up. Okay. All right, I agree, he doesn't make the cut. Let's talk about Festus. Okay, come on. Does Festus make the cut for you in this? Yes. Kathy gives the vote for him. I think he could, yes. I find Festus one of the most intriguing of the heroes in that range. Let me look at him again. Do I have him here? Where is he on your plagues? Why don't I see him? He's in there. All right, well, so Festus, I mean. Let's try to jump through him. Yeah, yeah. Festus. Like Festus thinks because he can heal and because he's another mortal wound source, right? And because he has a powerful spell. Now it's on a cast value of seven that he's hard rolling against, but giving somebody neg one to save turns out pretty good. And he's 150 points. 50, okay. He was the one that, I think he was the main one that stood out to me in that price range, in terms of like when you're getting to the tail end of your list, maybe you throw a men that last whatever number of points. I agree. He could be part of the, he could be a last choice. He could make the cut. I think the flip side of that is the harbinger who doesn't make the cut anymore because he lost obviously his old ability was pointless. He and like good, he's the other really bad looking model in the unit or in the army because he's still old. He can give you extra command points in one round, which is like, okay. And he can make it so during, he basically has his own roar, right? He has a second roar. It's not that he's completely pointless. I just think the harbinger doesn't make the cut. I think Festus could, Festus can no deploy off by the way with gut run. So he can pop on the side. Now the trick is he's going to be too late to spell cast but it can keep him safe. Sure. So it would depend like I could see if you were able to, one drop, giving first turn away, playing to the double, you bring Festus on. Like into the double turn, he can do some powerful options. Will we do some sample lists?  We will in the future though. We're going to do sample lists in the future. We got to play more games and get more feeling and before we start doing some sample lists. Festus, I think you're right. He's like the, he's like the probably last one. All right, Rob Rigger Sorcerer. We talked about these guys already earlier, but just at the point with these guys is their spell is like, whatever, who cares? Their spell is not good. But when they cast endless spells, they become maggotkin of Nurgle models. Meaning if you put the other end of the portal next to their units, they don't have the three inch prohibition like your units do. So even in the movement phase, because you cast it off in the hero phase and then that thing can sit an inch away from multiple units. And most endless spells don't have to be an inch away from models. They set up and then all of a sudden they're passing out disease tokens. The other end of a mirror. I'll give away Tom's secret tech, which is shards of Valagar. It's a Valagar, yeah. With the two ends of it, right? Cause you can just set them around. Not only does it slow movement and play into your strategy by slowing the enemy down to your level, but it also then puts two little beacons of disease pulse out there. And about shackles through the portal to get the extra range on shackles. Shackles is another one. That's a lot of range through the portal. Yeah, absolutely. Yeah, shackles is another one where it's like three little pulses of disease tokens then. So there are, I think this guy has play. I'm not sure Rock Coven does, but I think this dude is interesting. The Lord of Plagues is a hard pass for me, old drippy. It's a nonbow because I don't see 10 blikings being a thing. Right. Big unit of 10. That's 500 points. I don't really see that, you know, one inch reach, blah, blah, blah, whatever. 40 millimeter bases. Yeah, it's a nonbow with a seven-fold slaughter. No good idea, but just it doesn't actually work in practice, I don't think. And yeah, yeah. So now I agree. I don't see this guy making the cut. Yep. Fecula and the worm spat. Fecula's got some play. I don't want to dive too deep into her, but she's also interesting. She can also taint endless spells, right? Which is pretty good. And the worm spat can protect her. Like they give her a four-up feel, like a four-up bodyguard, instead of relying on her five-up ward, which is interesting. 255.  I mean, that's a, I think that's a pretty good point value getting. I think so, yeah. Like she's a cool wizard. She's a single cast wizard. She can taint spells. It's really a question of whether or not it's worth it to have her bodyguards with her. Sure. You know, like she has a two-cast wizard once again, so she's okay. I could see her making the cut periodically, but yeah, tough choice. All right, Blight Kings and the Blight Lords. We're not gonna have time to talk about the tree controversy. I'm sorry, Tyler. We're gonna have to cut the tree controversy. No worries, yeah. Future Blight Kings are now 250 for four wounds on a four-up save. They're fantastic. They're just fantastic. Because of relentless attackers, at the end of the combat phase, pick one enemy unit with a wound's characteristic of three or less that's within three inches of this unit. Roll one dice for each model in this unit that is within three inches of the enemy unit for each roll that exceeds that enemy unit's wound characteristic, that enemy unit suffers one more wound. Fantastic. Amazing. Not only do they make a ton of attacks, now all at rend one, like this unit, right, makes 25 attacks. So right away, they're kicking off the, pushing you to seven disease tokens. Like this unit, if it bites you, it just immediately pushes you to seven disease tokens. And then at the end of it, God forbid the wither staff be around or it be on the turn where you got plus one of your disease rolls, because against two wound or three wound guys, or sorry, one wound or two wound guys, they then are gonna do an extra, basically seven to 10 mortal wounds between the end of the combat phase and the start of the battle shock phase. And that's what I saw happening. When I like, these guys got into a one, these guys fought Sigvold and just died. When I, like I charged Sigvold in on a short charge and just slaughtered five of these dudes. Okay, but because I ignored their aftersave and they just couldn't hurt me. But they got into a big unit of iron golems and just, just pummeled it. Just right, just because they were just doing eight to 10 mortal wounds to the thing on top of their normal attacks. Right. Just blew it away. So against the right targets, these guys are brutal, right? Yeah, they're not, they're not exactly general purpose, but yeah, they definitely have a role that they can fill in a list. Yes. Oh, yeah. No, I, yeah, we, I think they're, it's weird. It seems weird, but they are probably appropriately costed, 50 or everything. Yeah, 250 feels about right. For four up, five up after, they're so tough. They actually benefit from a lot of the healing. Yeah. Like they're very likely to get the D3 healing and so on. I think, I think we'll see quite a few of them. Yeah. And, and certainly they'll find their way into a lot of lists. For the same reason I do like Puscoil, Blight Lords basically have Blight King on top of a big bug. They have the mortal wound impact hits. So they're doing mortal wounds on the way in. We've talked about the pregame move in Drowned Men. We've talked about the null deployment with the Lord of Afflictions. They go battle line in Drowned Men. They have a ton of attacks, right? Like two of these guys, they're elite. They can issue self-commands. They do 22 attacks between the part of them. And then, so not only do they do impact hits on the way in on the charge, but they also have the Relentless Attackers ability like Blight Kings. Now, they don't get as many because there's only two or four of these guys. Usually you're never gonna take six. They don't have like the, you know, against one and two wound dunes, Blight Kings are really good for three to five mortal wounds. These guys, it's more like two to three extra. So it's two to three on the way in, two to three, or let's call it two to four on the way in, two to three on the way out, you know? But it's strong. I really stand plus with Blight Lords, especially at 220. They're great, again. Agreed, goodbye. High movement, versatility and deployment, effective with the core roll, obvious hammer, tough to kill. Right, very tough to kill, surprisingly, in that first game I played, yeah. Yeah, because I get that Bandis died, which allowed them to get into 10 Vendictors. 10 Vendictors, pretty tough, but it was a series of these sort of these combos, these things going off. So the presence of I cannot use a command ability. Yeah. So I can't plus one save Vendictors, okay? So minus one rend is more valuable, but putting out a bucket of tax is three of them. They do impact hits. They got up the disease points. He, I don't know what he rolled, but he was doing mortals from the disease points, doing mortals from the impact hits. I was left with like one Vendictor. Yeah, it's just mortals on top of mortals on top of mortals with these guys. Charge, disease, realest attackers, yeah. And then they attack on top of that, right? All right, finally the tree. Basically what the tree does now is it gives you contagion points, but not many. It will be FAQ to only be one per tree, not multiplicative, because obviously if you could multiply them, it will be warping. That's the ultimate problem. It will make it so the right play is to just set trees all along the back of your board, every seven inches, like tree, seven inches, tree, seven inches, tree. And people say, yes, you can shut off the contagion points if you move near them.  And if you get three or four of them, suddenly you're getting nine to 16 contagion points a turn, that's way too many. It turns it into way too much of a summoning army. It warps the whole way the army plays. It shouldn't be done. I understand why people want it because it feels like it would turn the summoning mechanic into something real. It's bad for the army. It's warping for the army. You shouldn't be summoning that much. I'm sorry, that's just the way it is. And it will certainly be FAQ just like the harvest was to not be multiplicative. They will clarify. They didn't mean it to be multiplicative. You can tell from the way they wrote. They just didn't think about it. So it doesn't matter what I think. This is the most obvious FAQ in history. There we go. Yes, they're not very good. Congratulations, your free terrain thing is a minor bonus. Which is what terrain should be. Yeah, that's what we should want. Not these luminous pieces.  All right, that's it folks. We did it. Nurgle book done. Thank you everybody. Don't forget to hit like. I gotta go get not killed by my wife who I love very much and who is a very beautiful, wonderful woman. Thank you all so much for coming. Sorry for the early show and the change. I hope everybody enjoyed this. If you've got questions or something we didn't cover, drop it down below, hit like, subscribe, do all the things. Really appreciated everybody. Sorry for the fast time. We'll see you next Wednesday.


Good morning. Welcome to our Medical Student Grand Rounds. Our first presenter is here from the University of Utah School of Medicine, Matt Conway. Matt has been to one-third of all Spanish-speaking countries in the last 10 years and plans to get the rest of them, get up to 100% over the next 10 years. And today he will be presenting a case on acute retinal necrosis. Jordan, thanks for that awesome introduction. I'm excited to kick off Grand Rounds today with an ocular emergency, something pretty interesting, acute retinal necrosis. I got to thank Dr. Shakur. This is one of his patients and he has been pivotal in working through this case. So let's dive in. Day one, case starts out with a 47-year-old male waking up in the morning with periocular pain in his left eye. He also has a vision decrease and a headache. He goes to see his local optometrist and he started on prednisolone for anterior uveitis. He was seen seven days later with no improvement. Day 13, the symptoms are still persisting regardless of treatment and he's referred to the VAER and then subsequently the Moran. His past ocular history is notable for LASIK in 2006, but no other recent eye surgeries or trauma. He has had VZV infection before with chickenpox and shingles. His family history is only pertinent for glaucoma and his social history is pertinent for tattoos without swelling. He has multiple cats and has subsequently suffered several scratches from those cats. He's married with no recent international travel. His ocular vital signs show something very obvious, that decrease in visual acuity in the left eye. He went from 2020 to 2100. He also had a possible APD, but his pupils were fixed after post dilation at the VA. On slip lamp exam, big things that stood out on this patient were the cell and flare in the anterior chamber and the edematous and slightly hyperemic disc in the cell and haze in the vitreous. Let's look at this retina right here. You can see that 360 degree retinal whitening. This picture is pretty impressive in a classic presentation of acute retinal macrosis or ARN. You'll see that intra retinal hemorrhages here and you'll also see the posterior pole is spared. There's also some folding coming off of the disc as well. In OCT shows a little bit better, there was some optic disc edema and some macular edema as well. After seeing this kind of presentation, the differential diagnosis that comes to mind is most likely for a viral retinitis. You're looking at ARN, progressive outer retinal macrosis as in porn, CMV retinitis, ocular syphilis and other infectious etiologies. Because this presentation is pretty classic for ARN, I also wanted to go over real quickly what the other viral retinitis look like. Progressive outer retinal macrosis, unlike ARN, you'll see this in patients that are immunocompromised. ARN progresses really rapidly, but porn goes even faster, which is impressive. Also, big difference between the two, on-slip lamp exam in porn, you won't see the tritist as you'll see in ARN. Then the posterior pole is involved a lot faster because the disease progresses a lot faster. Here's a classic presentation of another one of Dr. Shakur's patients. CMV retinitis, these patients are also immunocompromised. You will see a prominence of hemorrhage as compared to with ARN, a minimal vitritus, and also you will see posterior pole involvement a lot earlier on, and the periphery may be involved early as well. Acute retinal macrosis, epidemiology and etiology, the basics. Let's start it out with this. This usually presents in patients that are 50 and 60 years old. This patient was about to hit his 50s. Most cases are caused by herpes viruses. The most common is VZV, followed by HSV. There are some recent cases. There are case studies that show that CMV and EBV can cause us pathology. The patients are usually immunocompetent, but can be immunocompromised. As you saw, this is what makes it stand out compared to the other viral retinitis. Women and men are also affected equally. Acute retinal macrosis presents as you saw with this rapid onset of pain, vision loss, floaters, and photophobia. It usually presents in one eye, but will progress to binocular to involve both eyes in most cases if left untreated. The vitritus is really common. As you saw in that photo, there's those small foci that are yellow and white. They have those very discreet borders, but they will progress together rapidly if left untreated and coalesce together. The arthritis you'll see is pretty profound. Unlike CMV retinitis, there will be few retinal hemorrhages. People can see discodema, optic neuropathy, and retinal detachment. Diagnosis, with the presentation, most of the time it's just a clinical diagnosis, but further testing is required with an anterior chamber tap. You'll send that fluid off for VZV, HSV, and CMV and toxoplasma, toxoplasmosis PCR testing. It's interesting, atypical toxoplasmosis actually presents a very similar to ARN and can be a mimicker. It's something that you got to test for. Other testing considerations, if the history indicates, you can also get a CBC, CMP, and test for cephalus, tuberculosis, and other etiologies that would cause a patient to be immunocompromised. The treatment for acute red and macrosus is changing a little bit, but the conventional treatment is to use IV acyclovir for five to ten days and then to switch over to oral maintenance therapy for six weeks to three months, depending on how the patient progresses. In the last five years, several studies have shown that if you use oral Valtrex, you can get similar concentrations in the body because of the great bioavailability of Valtrex. This option is a lot cheaper and a lot more convenient for the patient and the health care system. It's becoming more commonplace now. In patients that have severe disease, you will want really rapid treatments to stop the progression of the infection. Intravitral antivirals are key. Key signs that we'll clue you in to use those are optic dyscadema and macular involvement. You can also use oral steroids after the first two days of antiviral treatment. Other really important things that you can decide to add on to patient therapy is antiplatelet therapy to prevent ischemic damage to the retina and optic nerve. Additionally, you can use topical steroids if you have an interior chamber involvement in panutipitis. The major goal of treatment is to spare the unaffected eye considering how many complications you will have if infected eye. This case, protocol was followed, AC TAP was sent for the following and it came back positive for the most classic culprit, VZV. The rest were negative. The assessment for this patient was ARN with panuvietis secondary to VZV. Important distinctions was there was no neurological involvement. This patient was immunocompetent and there was 360 degrees of peripheral retina involvement and dyscadema. For that particular presentation, you want to hit it with the full treatment and that's what we did. As you can see, these are the medications we started or the team started and they added in the introvitial injection to stop the progression of the disease. As I said, acute retinal necrosis is not your emergency and can have many complications as outlined here. The most common is retinal detachment. This will happen in 70% of cases. It happens because of the pathophysiology of the disease. The necrosis retina creates these holes in the retina which allow fluid to enter in and separate the retina and causes detachment. This is exactly what happened with this patient. Two months after the initial presentation, they showed up with new flashes, floaters and vertical and horizontal photopsias. Their visual acuity decreased from 2100 to hand motion only in the left eye. On their exam, they showed inferior detachment, extending to the macula, which I'll show you here. You can see that in this image, there's this nice border here of this retinal detachment, classic presentation. Hard to treat with these patients because of the inflammation that's already happening in the eye. Here's the OCT demonstrating the severity of the detachment as well. Management in this case was classic. Patient underwent retinal detachment repair with vitrectomy, scleral buckle, and silicone oil placement as well as endolaser. Three months later, patient returned to the OR for follow-up and to remove the oil and also had developed a cataract considering inflammation in the steroids that the steroid treatment they've been on. They had a cataract niolail placement. The current status of this case, on Friday, we saw this patient together. A year after the original insult, the patient's left eye has decreased the hand motion and only visual acuity. OCT has showed that the macular dema has been resolved, although there's some temporal atrophy. In the right eye, it has been spared thus far, which is a great relief, and its visual acuity is still 2020. We've continued vialcyclovir treatment so that to prevent further progression of the disease, this is the OCT photos of the retina. As you can tell, this is very significant for fibrosis in the periphery with laser scarring, and it's pretty impressive the amount. It's pretty impressive what ARN can do to a patient. The key takeaways from this case is always dilate the pupil when you see anterior uveitis. Earlier treatment can save vision and also prevent progression to the other eye. Huge thank you to Dr. Shakur, Dr. Orozco Patel, Altman and Bear for your help taking care of this patient and also with your guidance in this presentation. Thank you to the marine photographers for providing these awesome photos. These are my references. I'll leave it open for a couple of questions in the last couple of minutes. Delays in treatment cause progression to the other eye that is not involved, so binocular involvement, and then also if you treat it earlier, you can prevent retinal detachment just because there'll be less retinal holes. With that being said though, barricade laser is really controversial and so that is not necessarily a preventative treatment because it doesn't necessarily prevent retinal detachments. It's kind of a follow the treatment guidelines in hope that there's no detachment and hopefully caught it on the map really enough for that there's no holes and no detachment. Thank you Matt. So our next presenter, Madison Perchick, when she was a kid, was on a trip to Costa Rica and mistook a saltwater crocodile for a log classic, classic mix-up and was almost eaten but was not and with her newfound life went to the University of Tennessee College of Medicine and now she's joining us here at the Moran to discuss a case of a complex patient presentation. Thanks. Good morning. I might or might not need help, maybe not. Good morning everyone. My name is Madison Perchick. Thank you so much Jordan for the introduction. Is the true story about the crocodile? I'm so excited to be with you all this morning and my talk is called A Complex Patient Presentation. So let's get started. Alrighty so our patient is a 49 year old female currently and she has a past medical history relevant for Marfan syndrome. So the first encounter that I could find with this patient in Epic was in 2013. At that visit she was said to be a fake kick on the right and she was symptomatic from a dislocated capsular bag with Phymosis. That same year in 2013 she was also diagnosed with myopic degeneration OU and then in 2014 she underwent an anterior PPV, a lenzectomy and then a sutralis three piece scleral fixated IOL and this top picture on the left is a picture of her retina which shows IOL tilt and also scleral show which is common in high myopes and then the bottom picture is an OCT that is consistent with her myopic degeneration. So a little more about her. After that procedure that she had in her surgery that she had in 2014 she did have an episode of post-operative micro high FEMA and after that episode she really was pretty quiet until around 2019. That's when she started having more issues. So in 2019 she started to have some recurrent micro high femas and in that same year she had her first episode of inflammation. She came to Moran and said that her right eye felt like when she woke up that she was waking up from a steam room. So she was found to have uveitis and she had reactivated uveitis about once years since then but subjectively she said in the last year or so that it's been worse, they've lasted longer and they've been more difficult to treat. Additionally with these episodes of uveitis she's also had intraocular pressure spikes that are semi concurrent with these uveitis flares so it seemed to be responsive to the steroids that were being used to treat uveitis and since then she's been on both steroids and intraocular pressure lowering drops and the optimization of which has been ongoing because as they have tried to decrease her inflammation with steroids that increases her intraocular pressure many times so that optimization has been difficult and notably she also had an episode of her pedicarotitis in 2020 that was treated with oral valtrics and then this picture on the left depicts data from Epic that this line graph was pretty cool I thought that Epic gave it to us and the top line the blue line is her intraocular pressure from 2019 to now and then the bottom line is her right eye's distance vision without correction so I just show this to say that you can see that she had a few spikes of intraocular pressure in 2019 on that way left side but you can see in the last year she's had a lot more problems with it and that has correlated with a decrease in her distance vision as well in that right eye so the differential diagnosis for her at this point was Ugg syndrome versus chronic herpedic uveitis and the uveitis team was consulted for help in the rest of this workup so her labs were notable for a positive ANA but the uveitis team was not super worried about RA or lupus as she didn't show any more systemic signs of these conditions and they did note that her inflammation recurred even on valtrics 1 gram TID which should have been plenty of valtrics to treat chronic herpedic uveitis so that kind of leaned them away from that picture and lastly they did an AC tap which was negative for the viral PCR which was kind of the final step to lean away from that chronic herpedic uveitis and then in 2019 a UBM or ultrasound bio microscopy scan showed haptic ciliary body touch and then this picture on the left is from a study that I found that I thought did a nice job of pointing out these little arrows are representations of where the haptic is and it touching different parts of the uveal tissue and then this is a picture from Moran of our patient with her haptic against her ciliary body so because of this whole picture looking at everything the recurrent uveitis the entry increase in trochlear pressure the micro high femas the ubm results in that negative viral PCR the most likely diagnosis for her at this point was ugg syndrome so in 2022 she had an IOL explanation and she's still faking right now and she had an abinterno viscocanolostomy and agonioscopy assisted transliminal traveculotomy all on the right side and her pre-op distance vision without correction was 2060 and her intracular pressure the day before surgery was 41 and at post-op week when she was hand motion on that red eye and then at post-op week two her distance without correction was 2100 she did pinhole to 2060 and her IOP has been much improved her last visit was 16 but she does still have 3 plus cell so she's still on oral and topical steroids at this point she is on PO valchex and she is on cosop BID still her glaucoma or intracular pressure lowering drop regimen has decreased a lot she was on a combination of I think four oral and drop medications for her intracular pressure so that's improved a lot so this patient has just abundant fascinating features of her ocular history I think I could do 10 rounds or 10 grand rounds of of just this patient but I did want to focus the rest of my time on this most likely differential that is uveitis glaucoma hyphema syndrome so this syndrome was first coined by Ellingston in 1978 he described it as a complication of intraocular lens implants causing a mechanical chafing and the pathophysiology of this is that you have this contact of this intraocular lens with uveal tissue that causes inflammation or uveitis it also causes erosion of that tissue so the blood aqueous barrier is broken down which causes release of pigmented cells red blood cells and white blood cells into the ac and so if you have red blood cells in the ac that would be your micro hyphema and then all of these cells can work together kind of to clog up the travecular mesh work and cause that entries increase intracular pressure that we see with this syndrome and ux syndrome is most commonly caused by ac iols or three-piece sulcus iols but they actually can occur with any type of sort of thick lens even in the back so how do we diagnose ux syndrome as you can tell from this patient it's not always super straightforward it can take years it's a chronic syndrome these signs and symptoms that we see do not always happen at the same time and they these patients can have a lot of other things going on as well so a high index of suspicion is really important but on exam we look for things such as of course the micro increased intracular pressure signs of inflammation like cell and flare or hypopions we can look for iris neo vascularization or iris trans elimination defects which is shown in the picture on the left and we also look for malpositioned lenses or haptics it can even cause vitreous hemorrhage or CME as well if you are thinking about ux syndrome in your differential it's also important to go near the patient in order to look for blood within the angle and hyper pigmentation of the trapecular mesh work and signs of mechanical erosion and then lastly like we've we've been talking about ubm is also a mainstay of diagnosis and it's used to confirm the position of the lens and the haptics and its contact or lack of contact with the uveal tissue so lastly the treatment of ux syndrome it if you can imagine a mechanical kind of chafing of the haptic or the lens on any kind of uveal tissue it's probably not going to fix itself so additional surgical intervention is often the most effective treatment so whether that is in the form of repositioning or explaining or exchanging the lens those are the most definitive treatments but in the meantime again because this is a lot of times not kind of a home run diagnosis and it can take years if it's even on your differential there's a lot of there are a lot of medical treatments that can be done in the meantime to treat the patient so for the uveitis we recommend or it's recommended to give them topical or oral corticosteroids to help decrease their inflammation for the intraocular hypertension or glaucoma of course we have oral and drop medications that can decrease the intraocular pressure it is interesting to that we don't usually use prostaglandin analogs in this case because they have been linked to inflammation and then lastly her for hyphema you can recommend that the patient decreases their activity does head elevation uses cycloplegics and then also topical steroids which if they have a uveitis flare at the same time they might already be on and that is all I have I hope that this case was interesting and that it was a good little concise review of ux syndrome for all of you and I just wanted to take a moment and say thank you to everyone for your time today and I've had such an incredible experience at Moran everyone has been so welcoming to me and I've learned so much and thank you to Moran for the photographers as well those pictures are awesome so thank you so much and I'm happy to try to answer any questions you may have and Dr. Manlis if you're unmuted then you can go right ahead thank you it was interesting when UGG was first described by Ellingson it was very poorly finished anterior chamber IOLs causing UGG syndrome and we see this often in in three piece lenses put in the sulcus but also one piece lenses put in the sulcus which should never be used what would be interesting now is to see if UGG will recur following sclerophyxated IOLs using the Yamani technique and I've not seen a case yet but but it would be very interesting because you know the haptics are not rubbing on the ciliary sulcus they're actually going through the ciliary sulcus but it would be interesting to see with the Yamani technique if we start to get any issues of UGG syndrome with the peripheral optic of the IOL rubbing on either the ciliary sulcus or the posterior iris I'm not aware of cases that have been reported I don't know if anybody else has heard cases of UGG syndrome following Yamani surgery the audience says yes that they have seen it before um for the people on zoom that they have seen it with um specifically with when the IOL is tilted yes please I'm sure you can explain it so so what are the great resources in today's medicine is these blogs that people are on and and you can kind of get the A S C R S listserv and for cornea specialists you get the get care in it and so there's a lot of people they're doing complex anterior segment surgery in that forum and Yamani is not 100% full-proof at preventing sort of recurrence of UGG there are cases where they've used I don't know what we call them they're not endoscopes but what do we call them where you actually can look back there with a scope at the ciliary body and kind of see where these haptics are kind of going through there and there are cases where the haptics are actually still rubbing within that ciliary body and then in a lot of cases it is lens tilt issues and iris kind of ploppiness so the recommendation is to have a PI to try to keep the iris a little bit away from the lens if you can and trying to avoid tilt so that your entry points on Yamani are equal and equidistance from the iris as well but yeah definitely not full proof as go to to say we're going to get rid of UGG by taking the ones out and doing Yamani but yeah so Nick this question is kind of directed to you a little bit Rachel is asking Jacoby Dr. Jacoby if anybody's used the apple Miyake view technique to look at a Yamani surgery to kind of see where these haptics are going and what's happening during that surgery you know when when our dear colleague Alan Crandall was alive he and Bob Sione did some Miyake eyes with us when the Yamani technique was first coming out to actually look at the placement and what we found is that it was a small series it wasn't a large series of eyes but we found that the placement of the haptics was variable and I think as as our techniques have improved and people are getting better at marking exactly where you're you know putting these haptics now that has gotten better but still there's a lot of variability in where those haptics actually end up and if they do go too far anterior or tilt as you mentioned then you can get issues with UGG syndrome still and so I think the key thing to prevent that right now is making sure that you have even placement of those haptics and that those haptics are placed far enough back from the iris that they're not going to cause any significant chafing with that optic that could cause UGG syndrome. Okay our next presenter Parker Cox is also joining us from the University of Utah School Medicine by way of Colorado speaking of blogs he runs a food blog with his wife called your cup of cake I was on it this morning it's extremely impressive lots of one pot meals for the busy people out there and more recently he's been cooking up a case review of acute corneal hydrops. Okay perfect no worries all right well thank you Jordan today I'll be talking about acute corneal hydrops and I've broken up my presentation into two primary categories first just going over briefcase review and then second a general overview of acute corneal hydrops I don't have any disclosures to make today so we'll just jump right in. So the patient that I'll be discussing today is a 46 year old male who has a history of keratoconus bilaterally he did have a penetrating keratoplasty on the left side due to the keratoconus and he had multiple cases of rejection of that graft treated primarily with steroids. He initially presented in March of 2021 a complaining of a week of what he described of plouting in his eye he also had some photophobia significant tearing foreign body sensation stabbing pain and dryness just in that right eye he was using artificial tears but said that he was not experiencing any relief it's also important to note that he was having no symptoms in his left eye. I did include some keratometry of his right eye this is however from 2019 so two years prior to his presentation we see some pretty significant steepening of the inferior cornea he has some pretty high k values and some pretty high stigmatism all consistent with keratoconus. Other history worth noting he does have a medical history of migraine hyperlipidemia gout and hypertension. Family history is significant in his father for keratones as well who also has glaucoma and had a stroke mother with history of heart disease. His social history is rather insignificant with the exception of being a former smoker. That corneal transplant took place in 2006 and he had been using a scleral lens since then he had previously tried rigid gas permeable lenses with minimal success. So he at this presentation in 2021 his visual acuity was pretty poor he was only able to visualize hand motions only. He did have pinhole vision at 2200. Left eye was seeing completely normal no afferent people are defect. IOPs were normal bilaterally and movement of eyes were normal bilaterally. On the slit lamp exam his right contactiva was pretty injected left was normal however he had about a six and a half millimeter area of edema centrally in the right cornea as well as some infracentral microcystic edema on that side. On the left as I had mentioned he had had a corneal graft there were no sutures in place there was a little bit inferior scarring and he had 360 degrees of panace with vasculature limited just to the graft host junction. On that right eye the fundus was unable to be visualized due to the clouding of the cornea mededema and the remainder of the slit lamp exam was normal. So he was diagnosed with acute corneal high drops these pictures on the right side of the screen are not from our patient but just shown for visual representation. He was managed with prednisolone, cyclopenthalate, hypertonic saline drops as well as serial follow-up every four to six weeks for several months. Ultimately prednisolone was decreased and the cyclopenthalate was discontinued as well as the mural. His visual acuity was improving with the use of a contact lens and he was recommended that he has plans for a future keratoplasty on that right side. So his clinical course after all this follow-up over the course of about a year and a half he presented to clinic about two weeks ago reporting that his symptoms have been greatly improved. He does continue to experience a little bit of photophobia and some license to be likely due to the scattering of light through that scar. This picture on the right side of the screen above is a picture of his cornea which you can tell there is some notable scarring as well as a vertical tear and decimates membrane here indicated by the arrows. However as I mentioned his visual acuity was improving he sees roughly 2020 to 2040 with the use of a scleral lens. The slump exam showed some apical scarring however there's no edema. And then I also included keratometry from this most recent visit just to note that he still continues to have some steepening of that inferior cornea. No changes in his astigmatism. So for him long-term management includes just continual follow-up every six months continued use of that scleral lens and then future plans for a possible keratoplasty of the right side. So now I'll transition and just talk about a general overview of ACH. It's important to note that it falls into a category of corneal ectatic diseases and is primarily seen in patients with keratoconus and up to 3% of patients or 2.8% of patients with keratoconus can be seen. However also can occur in patients with keratoclubus and polluted marginal degeneration. It's most commonly seen in male patients more than females and typically between the ages of 20 and 40. Risk factors include atopic diseases, eye rubbing and steep keratometry which we saw in our patient. There has been a few studies indicating correlation with learning disorders as well as Down syndrome. And then as far as the pathophysiology the primary cause here is a tear in the decimates membrane and endothelium which causes an influx of the aqueous humor into the stroma and occasionally the posterior or that stroma causing edema. This picture on the right side of the screen shows just that a pretty significant tear here in the central area of the decimates membrane vertically as well as edema due to that flow of aqueous humor through that defect. I've included a couple of histological pictures just to show what that looks like. Here we see some pretty significant apical thinning of the stroma of the cornea. On this side we have some an image of a patient with a cornea stained with trichrome strain showing a defect in the Bowman's layer indicated by the arrow here. And then this picture at the bottom here demonstrates a patient who had a previous ACH and you see the decimates membrane kind of rolled up here at the edges which can be kind of seen in the chronic patient who is not healed well. As far as diagnosis of ACH typically we rely on the physical exam in which decreased visual beauty is common in almost every patient. You may notice an artificially low IOP due to the corneal edema in the patient and then siddle testing can be beneficial primarily just to differentiate whether or not the aqueous humor is flowing through that break of the decimates membrane versus a corneal penetration. And then as far as diagnosing with imaging modalities I've included a picture of anterior segment OCT. This can be helpful just to visualize a break in the DM as well as here we see into the posterior stroma. It can also be helpful for chronic follow-up of patients just to visualize how well they are healing whether or not the DM has been attached and the presence of scarring as well. In vivo conifocal microscopy can be particular beneficial to visualize at the cellular level some of the damage caused and primarily whether or not there are inflammatory cells. Patients who have inflammatory cells present for greater than four weeks have an association or increased likelihood of having neovascularization which can complicate long-term management. And then of course tomography which I've included just to show how the tear in the decimates membrane can affect changes in corneal thicknesses both on the inside and outside. And so as far as management medical management is our mainstay treatments because most cases resolve on their own in about two to four months. As far as pharmacological measures typically we will rely on ocular anti-hypertensives, cyclopegics, steroids and antibiotics as you'll know from our patient we use steroids, cyclopegics and the hypertonic saline. Surgery is needed usually in patients with pretty significant terrapodestimates membrane in which we can use air and gas for a I don't know if I'll say this right but pneumatic disseminopexy to kind of help alleviate some of that greater tearing. The downside to this is patients are required to lay in a supine position for a prolonged period and there is an increased risk for complications. However compression sutures can be used as well for patients who are unable to tolerate the supine position. And then of course as I mentioned in our patient relying on a future plan for a penetrating keratoplasty in that one side this is the mainstay in treatment for patients with keratoconus seem to have pretty positive outcomes such as the patient that I presented today. I just want to give a special thanks to Dr. Amy Lynn and Dr. Gina Kirchenbaum for helping me find this interesting case and give me some direction on some resources to learn from. I'd be happy to answer any questions today or here's the email if there's questions in the comments afterwards. Thanks so much.


The Vietnam War was over long before GI Joe returned to toy shelves. Vietnam influenced GI Joe in a lot of ways. In traditional warfare, cavalry troops fought on horseback. In Vietnam, the US Army started using helicopters rather than horses to insert troops into the field and to provide close air support for them. The air cavalry was born. For a fast-strike special mission team like GI Joe, the ability to quickly drop troops into combat zones and to take them out again is vital. In 1986, they got a helicopter that could fill the role of the air cavalry. It's time for another vintage GI Joe toy review. GI Joe has had a lot of great vehicles, but the helicopters deserve special recognition. Ever since their first helicopter, the Dragonfly, in 1983, GI Joe has dominated the air. In 1986, while Cobra was still making do with many gyrocopters, GI Joe got an upgrade. The Tomahawk was more than just an attack helicopter. It was a transport, a cargo, and rescue chopper too. It could do anything you needed a helicopter to do. The pilot of the Tomahawk was Lift Ticket. He is the first, and as far as I know, the only, Joe, from my home state. That's right, he's an oaky from Muscogee. Or really from Lawton, which is not anywhere near Muscogee. The point is, he's from Oklahoma. Let's see if an oaky can fly a whirly bird. HCC 788 presents Lift Ticket and the Tomahawk. This is the 1986 Tomahawk helicopter and Pilot Lift Ticket. This vehicle and figure set were first introduced in 1986. They were also available in 1987 and were discontinued for 1988. The Tomahawk is a massive helicopter. The main body is large, and it's extended even farther by the rotor blades. For the most part, in this review, I will keep the main body in frame, but those blades, as you can see, stretch beyond the frame of my camera. The Tomahawk was an upgrade from GI Joe's first helicopter, the 1983 Dragonfly, which was already an impressive helicopter. The Tomahawk had nearly all the features of the Dragonfly and a lot more. One feature it didn't have is the blade spinning mechanism. The Dragonfly's blades would really spin, not the Tomahawk. The Tomahawk takes its name from a single-handed axe used as a tool and a weapon by Native American tribes. In the early 80s, GI Joe ruled the skies. They had a jet fighter in 1983 when Cobra was still using gliders. Cobra didn't get a jet until 1984. In 1983, GI Joe also got an impressive helicopter, the Dragonfly, and they got an upgrade in 1986 with the Tomahawk. What helicopter did Cobra have at the time? Not counting Dreadnought vehicles, they had only the 1983 Fang. And that is unfair. Only in 1987 did Cobra get a helicopter that was remotely equivalent to what GI Joe had in the air at the time with the introduction of the Cobra Mamba. Like the Tomahawk, it was a two-rotor helicopter, but the rotor blades were in a different configuration. Also, like the Dragonfly, the Cobra Mamba had a mechanism for spinning the blades. We will take a detailed look at the pilot lift ticket later in this video, but let's set him aside for now so we can take a closer look at the Tomahawk. I do have the instruction sheet and the blueprints for the Tomahawk. I will be referring to this when describing some of the features. Let's start by noting the Tomahawk is in desert colors, and it has a painted camouflage pattern. It has a tan base color with a gray pattern painted on it. Paint was unusual for GI Joe vehicles. Most vehicles were not painted, so this is special. I'm very happy with this color scheme. I think it looks great. Let's look at the parts and the features on this monster starting in the front, and let's look at the chin gun. This turret, mounted directly under the cockpit, has a gatling gun on the starboard side of the turret. The blueprints call this a six-barreled XM179 20mm cannon. It can pivot, but not all the way around because it runs into the front landing gear. The gatling gun is on the starboard side of the turret, and on the port side it has a targeting system, and that is actually synced with the gun. The gun can move up and down, and the targeting system will move up and down as well. I think that's a great feature. The Dragonfly helicopter had a similar chin gun, and I love these. I think these are great features on GI Joe helicopters, and I really like this for the Tomahawk. Next let's look at the clear plastic canopy. I did try to clean this up, but with all the handling and moving around I have to do for the review. It gets a bit smudgy, so I'm sorry about that. It has this large canopy covering the cockpit. It also has clear plastic panes on the underside. This would enable the pilot to see what's directly under the helicopter. So a lot of range of vision for the pilot, and a lot of clear plastic here in the front of the Tomahawk. This canopy is hinged at the very front tip of the helicopter. You open the canopy by pulling the top of the canopy down. That hinge is a weak point. The plastic can wear down, and the canopy will come off. That is a frequent break point, so be cautious about that. Inside the cockpit there are two seats. They do not have back pegs. Each seat has a control stick. There is an instrument panel, and as you can see there is a sticker for some additional detail. The cockpit is pretty good. To place a figure in the cockpit you just move the figure into a seated position and place him in the pilot's seat. There is no back peg, and there is no seat belt to hold the figure in place. However the control yoke will move into position over the figure's legs, and that will hold him in pretty well. Also the control stick is small enough that it will fit in the action figure's hand. I tend to put the pilot in the port side seat just because I am American, and that's where the driver of an American car would be. There's plenty of room for two action figures in this cockpit. Each seat has its own control stick, so it could be piloted from either seat. Next we have the stabilizer wings. There is one on each side, and each of those wings has three white bombs. They are all identical, and they peg on with a dumbbell shaped slot that goes all the way through the bomb.  You just drop them and let gravity do its thing, and wherever they land they blow up. In the front section of the tomahawk we have an intricate set of engine covers. We have two on the side, and we have another one in the middle in front of those other two. And you have to remove these in the proper order. To remove the side panels I find it's best to pull up from the bottom, and they should pop out of the tabs, and you can take those off. Those tabs can be a bit delicate, so be careful about breaking those. Once these are removed then we can remove this central engine cover. Having the central engine cover is a bit trickier. It is tabbed at the front on a very thin tab. You kind of have to just pull it up from the back, and then work that tab out carefully. You can see how thin it is. That can break very easily, that's another frequent break point. But once the engine covers are removed you can see all of this wonderful engine detail. This front engine is a separate piece in black. It has some intake turbines, and I think this is a great looking engine. Having it as a separate piece with a separate color of plastic really adds to the color depth of the overall vehicle. On the sides we have dark gray plastic pieces for exhaust pipes, and there are holes in the side engine covers for those pipes, so that's nice. The actual engine detail on the sides is just molded into the body of the helicopter, so it is all that same tan color. Now it's time to look at the twin rotors. This is what makes the Tomahawk really special. It has two rotors, one in the front and another in the back, and each one has five blades. On my example the rotor in the front spins really well, the rotor in the back does not. This configuration is similar to the Boeing CH-47 Chinook, a tandem rotor heavy lift helicopter, and that's definitely the idea they were going for with the Tomahawk. The Chinook takes its name from a Native American tribe, so like the Tomahawk it also has a Native American inspiration. These counter rotating blades eliminate the need for a tail rotor, but the Tomahawk still has one. In this ring it has a knob that allows you to spin the blade, and the rotor housing will also tilt. This tail rotor would be a nice feature if it were needed. Aesthetically it looks great, but as a practical matter it's not really necessary. I have to point out a major problem with these rotor blades. You will find many examples of the Tomahawk with the blades very badly bent. Drooping blades is very common on Tomahawks. Gravity causes the blades to bend and hang at extreme angles, making them useless. You can't spin them because they will run into the body of the vehicle. It is possible to straighten the blades, but removing them from the rotor risks breakage. The blades on my Tomahawk are pretty straight, and I have to thank someone for that. Byron Kellogg, a long time friend of the channel, sent me some straight Tomahawk blades to replace my droopy ones. I suspect the drooping blades are not solely caused by gravity. Gravity is usually blamed, but I think storage is a problem. With the blades, the Tomahawk has a huge footprint. If you are storing the Tomahawk with the blades on, it's difficult to find a box that will fit it. I suspect a lot of Tomahawks got stuffed into boxes that were too small and the blades were bent to fit. If the Tomahawk lives in that box for, oh, say, 20 to 25 years, those blades will be stuck that way when you pull it out. Let's look at more armaments. The Tomahawk has another set of missiles, these large white missiles. There is one on each side. They are both identical, and they peg in with the standard dumbbell-shaped slots. The blueprints call these air-to-ground anti-obstacle missiles. This is what the Tomahawk would use to take out tanks or other Cobra ground vehicles. Here we have another feature that sets the Tomahawk apart from the old Dragonfly helicopter. We have what the blueprints call a six-person capacity staging slash storage area. This compartment can be used to transport troops or small vehicles. It's what allows the Tomahawk to fulfill its air cavalry role. It is an open bay on both sides. You can see all the way through the helicopter. There are no doors that cover these open areas, so this is open all the time. Inside that carrier compartment it has a texture pattern on the floor. The floor is dark gray. It also has five jump seats in light gray. It has four to the rear, and they face back-to-back, and then it has another rear-facing jump seat in the front. Even though the blueprints say this has capacity for six people, it only has seats for five, so I'm not sure where the sixth guy is supposed to go. These jump seats connect to the floor. They are removable. They have a back peg to secure the figure on, and they have a texture pattern. They connect directly to the floor with no leg clearance, so the figures have to sit in their straight legged. With the seats removed, it creates a lot more space in there, so you could transport a vehicle. But there aren't actually very many vehicles, even the small vehicles, that will fit in that space without being partially disassembled. In my review of the LCV recon sled, I did demonstrate how you could fit that vehicle in this compartment. With the seats removed, you can see the cargo area is open all the way to the cockpit, which is cool, but you can't really do much with that space because it is very deep in there, and it's hard to reach. Also in this bay, there are two weapons, one on each side. The blueprints call these laser-enhanced NVS or night vision system 50-caliber machine guns. They will rotate, but they will not elevate. They are molded in this position where they are tilted slightly downward. These would be used to cover troops on the ground or to cover the helicopter as it takes off or lands. I really like these machine guns. It gives the Tomahawk the look of a gunship. You would have to attack the Tomahawk from behind because that's the only side where the Tomahawk doesn't have weapons facing. These machine guns can be operated from the jump seat. They don't have a grip, but they do have this tab on the side that can fit the action figure's hand. But that puts the figure's arm at an awkward angle, so I don't like to use those. But Beechhead can rotate this gun and use it from his seated position. This whole configuration reminds me of the Bell UH-1 Iroquois helicopter, another helicopter with a Native American-inspired name. Colloquially, it was known as the Huey. The Huey also had a cargo slash personnel carrier space amid ships like this, but it also had closing doors. Many closing doors would have helped the Tomahawk, but for a helicopter with this many features, I don't think I can complain about that. There is one more feature of that cargo area that we need to look at, and that is in the very back. It has an opening loading ramp. That loading ramp has a texture pattern on it. It looks really cool. In theory, this loading ramp should allow personnel and equipment to be loaded onto the helicopter. But in practice, it doesn't really work very well because that space is actually very narrow and short. So you can't really fit very many vehicles in there, even small vehicles. I did show in my review of the LCV Recon sled how that vehicle could be driven up that ramp, but you still had to raise the back end of the helicopter to give it a little extra clearance. This is a really nice idea, but not all that useful in practice. Let's flip the Tomahawk upside down because there are more features on the bottom. We have landing gear with rubber tires. We have one in the front and two in the back. Those wheels roll pretty well. The landing gear is not retractable. Of course, the Tomahawk could take off and land vertically. It does not need a runway, but these wheels would allow the Tomahawk to be pushed in and out of hangers or to be moved into position on the helipad. Also on the underside, we have this winch. It is in a dark gray tray that slides into the underside of the Tomahawk. It has a gray hook that looks like it's the same hook as on the Dragonfly helicopter except in color. The hook is tied to a black line and there's a wheel on the bottom of the tray. You can turn that wheel counterclockwise to play out that line so you can pull the line out and hook on to whatever cargo you want to carry. Then by turning the wheel clockwise, you can reel that line back in. That is a feature that was carried over from the Dragonfly helicopter. It also had a working winch. As you can see, that is the same hook except in dark gray. I'm glad they carried that feature over to the Tomahawk as one of the cooler features on the Dragonfly. If they didn't have a working winch on the Tomahawk, it would have been very conspicuous in its absence. This winch works fine for cargo, but I would really like to see a retractable line from the troop carrying compartment so you could lower the joes down to a landing zone. On the tail of the Tomahawk, we have a couple stabilizer wings. They don't really do anything, but they look good. And then here in the very back, we have another set of removable engine covers directly under the rear rotor blade. There is an engine cover on each side. They are removed by pulling up from the bottom. It reveals some additional engine detail. Let's show each side. Each side has additional engine detail. And then in the very back, it has another set of exhaust pipes. And I think that finally rounds out our look at the parts and the features of the Tomahawk. Wow, that was a lot. There are so many great things on the Tomahawk. If I were to complain about anything, I guess it would be the white missiles and bombs. The white doesn't really go with the rest of the vehicle. But it's easy for me to overlook that because there are so many great things on the Tomahawk. Even though it is not based exactly on a real-world vehicle, it does have a very realistic aesthetic and I love that. In 2013, the Tomahawk was reissued as part of the GI Joe Retaliations series. It was renamed the Eagle Hawk and it added some minor improvements to the original. In 2015, that version of the Tomahawk was reissued in Tiger Force colors as a Jocon Convention exclusive. It was renamed the Tiger Hawk. I've decided not to cover those versions in depth. This is a review of the vintage toy, so I don't want to focus too much on the modern era. Other reviewers are better at covering modern toys. Let's take a look at the pilot lift ticket. This is the only version of lift ticket in the vintage line. There were later helicopters in the vintage line, so there were opportunities to give us an updated lift ticket action figure, but we did not get one. The Dragonfly wasn't only an impressive helicopter, it also had an impressive pilot. Wild Bill was a colorful character with an over-the-top personality. Did the Tomahawk have a pilot to match? It depends on how you measure these things. The lift ticket action figure has great sculpting and paint, maybe better than Wild Bill, but Lift Ticket's personality couldn't fill Wild Bill's hat. Let's take a look at Lift Ticket's accessory. He came with only one, and it is a notorious one. He came with a black microphone that was removable. It attached to a hole on the molded-on helmet on the figure's head. The microphone has an angled peg. It fits in that hole, and I've got to say it does not fit very securely. This is a frequently missing piece. Honestly, this microphone adds very little to the action figure. It should either have been simply sculpted onto the head, or if they really needed a separate piece, it should have been glued in. I honestly and truly hate this microphone. There was a moment when I was preparing for this review, when the microphone fell off of the figure and down into the Tomahawk, and I wasn't sure I could get it out. It took a lot of struggling to retrieve the thing. If I had not been able to retrieve it, there's no way I would have been able to replace it in time to do this review, and that would have made me very upset. With Lift Ticket's only accessory out of the way and in a safe place, let's take a look at his articulation. He had the articulation that was standard for GI Joe figures by 1986, so he could turn his head from left to right and look up and down. He could swing his arm up at the shoulder and swivel at the shoulder all the way around. He had a hinge at the elbow that allowed him to bend his arm at the elbow about 90 degrees. He had a swivel at the bicep that allowed him to swivel his arm all the way around. The figure was held together with a rubber O-ring that looped around the inside. That allowed him to move at the torso a bit. He could move his legs apart about so far. He could bend his leg at the hip about 90 degrees and bend at the knee about 90 degrees. Let's take a look at the sculpt design and color of Lift Ticket. The entire body of Lift Ticket minus the head was recolored and reused to make the 1990 Sky Patrol Airborne action figure. Looking at Lift Ticket's head, he has a molded on and non-removable helmet. It is red with a black liner and black chin strap. He has black goggle covers with a silver inverted V shape paint application. That molded on helmet is large and wide. It has the shape of an American football. Given its shape and color and Lift Ticket's birthplace, it really should have an OU stamped on the back of it. The size and the shape of this helmet are realistic. It looks like a sound protective helmet that's worn by real helicopter pilots. He has an expressive face. He has what I believe is supposed to be a snarl, but it comes off looking more like a goofy grin. And with the slightly droopy eyes, Lift Ticket just looks kind of dumb. On his chest, he has a tan vest with silver pilot's wings on the left side of his chest. On his right shoulder, he has a silver device with a cord. This looks like a communications handset, but he already has a microphone on his helmet so I'm not sure why he would need that. He has a black pistol holster on the left side of his chest positioned for a left-handed draw, suggesting that Lift Ticket is left-handed. Then he has three black pouches on his chest. On his arms, he has red shoulder covers with sort of a checker pattern molded into those. He has black pouches on his forearms, on each forearm. Then he has black gloves with some additional molded-in details on the gloves. On his waistpiece, he has a black belt with pouches on each hip and a sculpted-in belt buckle and some detail on it. It's not a bad belt, not the best by any means, but it is adequate. On his legs, he has green trousers, the same green color as on the arms.  On his right leg, he has an unpainted pistol holster with a black pistol in it. This is the second pistol on his left side, so they are heavily implying Lift Ticket is left-handed. Moving down his legs, he has red knee pads, real knee pads. That's very nice, I like those. He has green pouches on the outside of his lower legs and then we finish it off with a pair of black boots. I have to say the color choices and the color balance on this figure are excellent. Lift Ticket is not a ground troop, so I don't mind the red. Red for a pilot is fine. I think this figure just looks really good and really well designed. Let's take a look at Lift Ticket's file card. His file card has his faction as GI Joe, has a portrait of Lift Ticket here. This would have been from the artwork on the front of the box for the Tomahawk. It has his codename as Lift Ticket with a hyphen. He is the Tomahawk pilot. His filename is Victor W. Sikorsky and his name has a couple allusions to the history of the helicopter. Igor Sikorsky, spelled with a Y, was a Russian American aviator and a pioneer in the development of the helicopter. He founded Sikorsky Aircraft Corporation in 1923. His company developed the Sikorsky R-4, the world's first mass-produced helicopter and the first helicopter used by the U.S. Army Air Force in 1942. His primary military specialty is rotary wing aircraft pilot. His secondary military specialty is fixed wing aircraft pilot. So he can fly both helicopters and airplanes. His birthplace is Lawton, Oklahoma, making him the first and as far as I know the only Joe from my home state. His grade is W-02. That should probably be W-02. He is a warrant officer. The file card later explains he went to Flight Warrant Officer School. As a warrant officer, he joins GI Joe's other warrant officers, including 1983 Wild Bill, 1983 Torpedo, 1985 Flint, and 1991 Major Altitude. This paragraph says, Lift Ticket was one of those guys who joined the Army to get out of his hometown. Oh come on, Lawton can't be that bad. I mean I think I've only been there like once in my life. It was years ago, but I think it was okay. Lawton does have a military connection being located near the Fort Sill U.S. Army post. The big difference with Lift Ticket is that he scored so high on his aptitude test that he qualified for West Point Prep, OCS in parentheses officer candidate school, and Flight Warrant Officer School. Nobody in Lawton ever suspected he was that smart. Apparently, neither did Lift Ticket. He opted for Flight Warrant Officer School over the others, thinking it was the only one that offered training applicable to civilian employment. This suggests a very high IQ, but maybe he doesn't make the best life choices. This bottom paragraph has a quote. It says, Getting into a target area is comparatively easy. You wait until dark and get sneaky. Now getting out, after some caps have been popped and a can of firefight's been opened, well that's another story. All you can do is squat on the LZ in parentheses landing zone, and hope that whoever is driving the extraction chopper is skillful, persistent, lucky, and bulletproof. Lift Ticket satisfies the first three requirements, and he's working on the fourth. Looking at how the Tomahawk and Lift Ticket were used in G.I. Joe Media, Lift Ticket and the Tomahawk made their first animated appearance in the miniseries Arise Serpentor Arise Part 1. That miniseries introduced a lot of new characters and vehicles for 1986. Lift Ticket had the most screen time in the episode Million Dollar Medic. That episode isn't even focused on him, that's a lifeline episode. Lift Ticket appeared sporadically in the Sunbow Animated series, he did not carry over to the Deke series. This is one instance when a character was used a lot more in the comic book than he was in the cartoon series. Lift Ticket and the Tomahawk first appeared in the G.I. Joe comic book published by Marvel Comics in issue number 49. Lift Ticket was not colored correctly in that issue, but it was a great issue for a debut. G.I. Joe attacked Cobra's secret base in Springfield. It was a major battle with nearly every Joe participating. Larry Hama, the writer of the comic book, used Lift Ticket a lot in the comic. I don't know that he necessarily liked Lift Ticket, but I think he liked the helicopter. The Tomahawk saw a ton of action in the comic. The Tomahawk was brought in any time G.I. Joe needed a heavy lifter or a troop transport. Lift Ticket even got a chance to shine on his own. In issue number 73, he flew a captured Cobra Mamba to insert Falcon's Recon Team on Cobra Island. That was just as the Cobra Civil War took off. The Tomahawk and Lift Ticket appeared in the comic book long after the toys were discontinued. It's easy to understand why. The Tomahawk is just so useful. It is versatile. It can be an attack helicopter. It can be a rescue helicopter. It can be a transport helicopter. It was used in all those roles in the comic book. The Tomahawk's final appearance was in issue number 125. That was in the Eco Warriors story arc, well into the 1990s. Looking at the Tomahawk overall, it is a top tier vehicle. Top top top. It has the size, it has the features, it has the style to impress anyone. It isn't perfect of course, you'll find a lot of droopy blades on Tomahawks. It has a couple weak points that easily could have been reinforced. It would be nice if the loading ramp and the cargo and transport bay were big enough to accommodate more small vehicles. And I would like a line for repelling troops down to the landing zone. But there's a point at which a vehicle has so many features that asking for more is just being greedy. The Tomahawk is well beyond that point. Lift Ticket is a nice figure, if not very memorable. I'll put it in the middle tier. It's well sculpted, realistic, and the colors work well. The worst part is that damned microphone. I hate the thing, I don't know why they bothered with it. Removable microphones are a plague in vintage GI Joe. If I had a time machine, right after I killed Hitler, I would go back and force Hasbro to glue those things in. Sadly, Lift Ticket doesn't live up to the style and personality of Wild Bill. Lift Ticket is more realistic, but Wild Bill is more fun. So the Texan beats the Oki. Oh well, at least we beat them at football. Sometimes. And that was my review of the Tomahawk and Lift Ticket. I hope you enjoyed it. I wanted to give you another big vehicle early in the year. You know what, so far this year we've looked at a lot of GI Joe, but we haven't looked at Cobra yet. I think next week it's time to do that. And maybe time to have a guest too. Don't forget to like this video on YouTube, subscribe to the YouTube channel, hit the notification bell and share this video, that's what helps this channel grow. I have to say a special thanks to my patrons. You guys keep the fuel in the tank and I am forever grateful. If you like these videos and you'd like to support the channel in that way and maybe get some special perks, make sure you check out my Patreon. I am on social media on Facebook and Twitter and I have a website, HCC788.com. We've got a new t-shirt up in the shop, so make sure you check that out. I'll be back next week with a Cobra toy review. I'll see you then. And always remember, only GI Joe is GI Joe.


Ministers, your Excellencies, the essential delegates, and participants, it is a great honor to participate in this planarization of the ITU planning potential and to have this opportunity to speak on behalf of the Universal Postal Union and the wonderful city of Bucharest. I wish to express my sincere gratitude for the efforts of the ITU Secretary-General, Mr. Foreign Zhao, and the ITU Secretary yet for their preparation as well as to the government of Romania for hosting this wonderful planning potential. The ITU and the UPU have a long history and share strong relationship. Both organizations have played a key role in connecting people and ensuring inclusiveness over the centuries. Both took root in the capital of Berun as an inception around 150 years ago, and we remain through sister organization in this day with many shared policy objectives and joint initiatives. The postal network is crucial to the world, social, economic, and cultural development, especially during times of crisis and in the face of natural disasters, pandemics, and conflicts. Political postal services keep communities connected and functioning. Both also deliver government relief, health service, food and educational supplies, and help business to continue trading, all thanks to ICT. Digital transformation and sustainability are two mega trends that emerged in response to the COVID-19 pandemic and the crisis arising from global conflicts. The UPU is encouraging the postal sector to embrace ICT with a view to achieving sustainable digital inclusion, financial inclusion, the inclusion of small and medium-sized enterprises in e-commerce, and cyber protection of the postal network as a critical national infrastructure as well as ensuring member countries' contribution to the sustainable development goals. However, with almost half the world's post office not yet connected to the Internet, these benefits remain at risk in many member states. A strong partnership between the postal and telecommunications sectors will help countries to achieve full and meaningful Internet connectivity. I firmly believe that by working together, we can help to strengthen not only the ITU and the UPU, but also society as a whole to benefit in particular the millions of disadvantaged people in all communities. In closing, I wish to congratulate Ms. Bob Dhan Marching on her election as a new ITU Secretary-General, Mr. Lamanaska as a new Deputy Secretary-General, and Mr. Manebich, Mr. Onoe, and Mr. Sabasaba on their elections as Bureau Directors. We look forward to working with you to deliver meaningful connectivity and sustainable digital transformation for all member countries. Thank you very much for your kind attention.