So it makes you wonder how many stealth nerfs were a part of the 1.1.0 patch for Diablo 4, while Necromancer's out there, ones that depend on their essence for more damage, bones, skills, bone builds, necrals, guys I have a warning for you. There's a stealth nerf been added into the game, not mentioned in any of the patch notes I have seen so far, it probably will be added later, this could be a bug but this is something you definitely do not want to do because it will affect your build. How's it going guys? My name is DPJ and if you do enjoy the video leaving a like really helps out if you like what you see and want to see more be sure to subscribe. So yes I did this, it's affected me, my build, I've got two spare points and well it's crazy. Okay so if we go to my ability board and we come down to this right here guys we can see this in perfectly balanced. This previously guys as you can see on the screen now I actually come to my Muscle Tree board and I saw this and thought well that should say 3 out of 3. Why doesn't that say 3 out of 3? So I hovered above it as you'll see on the screen now and I decided to refund it. I don't know why I did this but I did. I shouldn't have but I did. People do not do this because you can't reapply the points back to it. So if you don't take them out you get the actual buff of your core skills cost 9% more essence but deal 15% increased damage.  But if you take these points out guys you can only apply one point back into this in perfectly balanced. Yes I announced well I've got two extra points to spend elsewhere not that I needed them but I got them. But yes this was a nerf not mentioned that I saw in any of the patch notes. Again I ran through them well for about an hour heading the hands shocked at what they've done shocked at the nerfs but there's even more nerfs that were not mentioned and this is one of them. Imperfectly balanced has been nerfed under necromancer people you can avoid it do not take the points out of it don't know if it is a bug that's cool hopefully they fix it but I'm not sure it is. I really ain't. Now there's probably other nerfs that were not mentioned too if you've come across any do let me know down below within that comment section but yes again I warn you my fellow necromancers out there who use this imperfectly balanced skill. People do not take the points back out of it do not respect those points because you cannot put them back in I mean I can refund it waste my money here I go to put it in boom that's it no option I'm spamming that button people there's no option to do it wow but you know what after the latest patch I'm not surprised I really am not surprised it's quite a heavy blow to us necromancers quite a sad one too. Guys if you enjoyed the video leaving a like really helps out if you like what you see and want to see more be sure to subscribe and hopefully guys I will see you on that next one


A young woman sits at a table at home. She cuts some cotton cloth. Then she uses her sewing machine to make something special. It is something that will protect both her and other people.  People around the world cover their mouths and noses for health reasons. Doctors wear face masks when they operate. Many people wear masks to protect them from poor air quality. But in 2020 many more people around the world started to wear masks. They did this to protect each other from the COVID-19 virus. Today's spotlight is on wearing masks. We look at the long history of wearing masks for health reasons. Early records show that some individuals wore masks for health reasons hundreds of years ago. Leonardo da Vinci was a famous artist of the 15th century. He used paint that contained poisonous chemicals. He covered his face with a wet cloth to protect his lungs from those poisons. People also wore masks in the 17th century. At that time a deadly sickness or plague came to Europe. People did not understand how disease was spread. But some doctors wore strange masks over their faces. The masks were shaped like the head of a bird. The long pointed beak contained herbs. These sweet smelling plants were designed to protect the doctor from the smell of the disease and dead bodies. In the 19th century doctors and scientists worked to understand how disease spread between people. They began to understand that the human breathing system could carry and spread germs and disease. Based on this new knowledge scientists suggested something new to surgeons or doctors who operated on patients. They suggested surgeons should cover their nose and mouth with thin material called gauze. When a person breathes out he can expel bacteria. But the gauze would stop this bacteria. It would protect any wound from being infected by it. By the 1920s all surgeons wore masks to operate. By then masks were also used as a treatment to prevent disease. In 1910 in Manchuria China a serious plague broke out. Wu Lien Tei from Malaya worked there. He developed a mask made from gauze and cotton that was tied behind the ears. These masks saved the lives of many doctors. The general population also used the masks to avoid getting the disease. A few years later this method of disease prevention had to be used again. That time people in more than one country had to use it. In 1918 World War One ended. In that same year a terrible disease spread around the world. This global disease was a deadly flu virus. Over a period of two years it infected almost one third of the world's population. Experts estimate that over 50 million people died from the virus. Many governments required everyone to wear masks on public transport and at work. Some people did not want to do this.  Health experts said wearing a mask did not just protect the mask wearer it helped protect others around them. In the middle of the 20th century people started to wear masks for another health reason. In some countries industry and high levels of traffic led to poor air quality. In many parts of Asia people wear masks to protect them from polluted air. For example in the Philippines and Vietnam motorcycle riders wear masks in heavy traffic. In many countries in Asia people consider it normal to wear a mask when out in public. In 2017 Kai from Asian Boss spoke to young Japanese people about why they wear masks. It is considered good behavior.  I put it on because the air smells bad. Other Japanese people wear masks for reasons not connected with health. Some people use masks as a social barrier. One young man told Kai. I put my mask on because I feel people will not notice me so much. That makes me feel less worried. So many people in Asia wore masks that designers of clothes started to make masks to match clothes. Famous designers used international fashion events to show their masks. In 2015 Chinese designer Masha Ma included face masks covered with jewels at a fashion show. But in other parts of the world people did not normally wear masks. Some of the young people Kai spoke to were shocked to discover that people in the West did not wear a mask even if sick. In 2020 the attitude of people in the West changed. A deadly new virus called COVID-19 or coronavirus spread around the world. The World Health Organization advised people how to deal with coronavirus. This included information about the need to wear masks. If people could not keep a physical distance from each other they had to wear masks in public places. The organization explained that masks can prevent someone else from being infected. People all over the world started to wear masks to protect each other. Some countries made it the law that people had to wear a mask in public. But not everyone owned a mask and sometimes masks were difficult to buy. Some governments told people to make their own masks. Spotlights Liz Wade is one person who made masks. She lives in the USA where it was not common to wear a mask before coronavirus. As coronavirus spread around the world Liz started to make masks. She made over 500 cloth masks for family friends and local schools and organizations. Every weekend and many nights after work she sat at home and sewed and made masks. Liz explains how she felt about making masks. I know that homemade masks are not a perfect solution to fighting coronavirus. But they can make a difference if everyone wears them. It makes me feel good to know that I am part of the solution. I am helping people in this simple way. Do you wear a face mask? Is wearing a mask common in your culture? Tell us about it. You can leave a comment on our website or email us at contact at spotlightenglish.com. Visit us on youtube at youtube.com slash spotlightenglish one. The writer of this program was Katie Blake. The producer was Liz Wade. The voices you heard were from the United States and the United Kingdom. All quotes were adapted for the program and voiced by Spotlight. You can listen to this program again and read it on the internet at www.spotlightenglish.com. This program is called The History of Masks for Health. Visit our website to download our free official app for Android and Apple devices. We hope you can join us again for the next Spotlight program. Goodbye.


Hello everyone, welcome again to another Knox Vivalife video. I'm out here at the park today. Got a nice view of the city and the background. I came out here for a walk but as you can see it is quite hot and sunny so I'm going to head to the shade over here but yes in this video I am going to be about how there is this one thing that the narcissist does not want you to know. Of course there may be more than one thing but this is the main thing and it's a very important thing that I would like to discuss in this one. Of course this is something that they don't want you to know because of course yes that will trigger that and they may even lash at you very careful when you are watching this but yes the reality is that this narcissist this person that you are dealing with they're actually not even real they don't even exist it is an automation a simulation it's artificial intelligence but of course it can seem real especially in the beginning got a lot of flies on me and just gonna walk over here yes it can seem very real in the beginning when they love bomb you they manipulate you as you're looking at it like I've met the one I've met my soulmate this person who knows me they understand me they see me when in actuality no they are nothing more than just a reflection of your own values and virtues of your own ideas and ideals because this is how they survive emotionally it's by studying their targets and being whatever they think they want to see it has nothing to do with them at all and it will seem very suspicious when you are dealing with them because in the beginning it's like it's almost to be true it's like you get on so well the very agreeable and it just seems like this perfect situation and you're just thinking where is this person being all my life to where I mean many people in the world we do feel like a lot of people don't understand us or they're not the same page they don't really see us and then this person comes along it makes you feel like you are the world to them they make you feel like like there's a reason why it never worked out with anyone else but everything you see is in fact an illusion it's a misinterpreted perception because yes we also have to play a part in it as well we do have our own fantasies and dreams and we want to believe that it's real which makes it very easy for these predators to get in because they study you they know what you want to see and then they just go ahead and play their role and they do it very well in the beginning in the love bomb phase and then also even when you see underneath the mask they become very aggressive and intimidating they coerce you they devalue you even that side of them is not real as well even that side of them is not real that's just because by that point now you are threatening the illusion you're threatening this false character this bought this artificial intelligence and all it really cares about is its own survival that's what is deeply embedded in its programming so if it feels threatened it is going to further manipulate and confuse you it's going to gas like you and make you think that you're losing your mind and it's going to try to keep you down and even try to just wipe you out to erase you because by that point you become this reflection back to them of everything that they were portraying themselves to be in the beginning a steep down they knew they were not they knew that's not who they are and of course they know that because they present different characters to whoever they are around which is why you may see sometimes whether they have other supplies or they're spending time with their friends it may seem like they're a completely different person especially by the devaluation phase it seems like they get in well with them but not you but in fact all you're seeing is just another character that they have tailor-made for someone else that's all that is and I know it may look like sometimes as though maybe this happens with you as though they were fighting before and then they suddenly got mad and began to take it out on you and guess that's exactly what they would love for you to think because they don't want to take accountability and it's really the same thing with any artificial intelligence these chatbots if there's one thing they don't like its accountability they want to blame you instead because otherwise if the artificial intelligence is wrong or incorrect then what is the point in having it in the first place and that's exactly how narcissists think and their entire disorder the whole point of the narcissistic personality disorder it's for their survival this these false characters because they abandoned who they really are a long time ago they didn't just change over night with you although it may have looked like that the reality is that whoever you thought they were in the beginning this character that they presented to you that wasn't even real that was just to lure you in and you can see that because as soon as the the right opportunity or situation is presented to them they will take advantage of it they will exploit it even if it goes against everything that they were meant to stand for this identity this belief system everything that they portrayed themselves to be the reality is that they were like that all along and being around someone like yourself someone who may have been innocent and naive someone who is very trusting compassionate and forgiving an empath being around someone like you just brought out the animal inside of them that was already there it just amplified the traits that they already possessed so they were already like that to begin with they were never with you they were never on your side and once you start to catch on and figure them out they just want to destroy you they want to take you out because by that point you are threatening their reputation you're threatening to expose them just by you being yourself which is why we do find that in a lot of these narcissistic relationships by the end of it people don't even know who they are and yet the narcissist leaves arrogantly as though they know exactly what they think about themselves and about you and they've created this narrative they may have even enforced their fly monkeys and started the smear campaign as well but all of this is fake even when they discard you that is fake too when they ghost you these are all just characters for them to gain power and control and when you're constantly trying to gain power and control you're kind of abandoning yourself in a way as I said with the narcissist they were already like this before the reason why they targeted you in the beginning was for power and control that's all that they were looking for and that is why by the end of it they just begin to despise you they can't stand you they can't even be around you because everything you are your identity your values and beliefs these are all a serious threat to them and of course the reason why it's such a threat is because they never had an identity to begin with they never had anything that they really valued or believed in so that's why it's such a threat to them and to their reputation because of course they don't want people to know but the reality is a long time ago they chose power and control rather than just wanting to be accepted for who they are and that is why they also cannot accept you they would rather you were anyone else than yourself which is why after they target you they see you as an extension of themselves and they try to trap you they try to make you dependent on them even if it's just for some form of invalidation then first they invalidate you and then they validate you try and move you in the direction of where they want you to go because as I said yes this person that you are it's a real threat to the illusion when you have discipline and self-control when you're able to manage yourself and your own perceptions remember narcissists can't do that if the right opportunity or situation is presented to them they will exploit it and I know many of you know exactly what I'm talking about they may have cheated on you lying to you on many occasions maybe stolen from you as well they abused you they manipulated you they gaslighted you they future faked and of course someone who has a strong core and they have empathy someone like that it's very difficult for them to do that I'm not saying that it's impossible but even if they did do it they would feel guilty immediately afterwards and then they would try to rekindle things with you of course as we know narcissists do not do that everything they do is manipulation everything is an illusion which is why if you look back you will see that all they ever did was reflect things back to you you reflect in things that you believed in you were about they never had their own separate identity it was just whatever they thought you wanted to see or whatever they thought would get them what they want from you by tricking you because in fact this illusion it is powered by you this is not something that they've generated from within it's not something where they're just influenced by you this is really all of your power and energy is validating it to produce the effect that they want which means that yes they don't actually have anything of their own you will never hear anything new or different from them and you could tell them something and they will go and repeat it back to you with such confidence and conviction as though they really truly believe in it but if you ask them questions if you ask them to expand they can't do it they can't give a deeper explanation for it and of course the reason why is because it isn't real everything they portray to you from the love bombing to the devaluation to the discards it is all fake and this is the one thing that they do not want you to know so yes they have no identity of their own no innocence of value all they have is just this void which isn't really anything at all and because of that all they can do is take from you and that's how you know exactly what you are dealing with because all they're doing is taking to fill this void inside of them and that's where the revelation comes in these characters this artificial intelligence it's not so that they can help you it's just so that they can feed themselves and the crazy thing is that you may think you know this person you may think that you know who they are but as I said if the right opportunity or situation is presented to them they will revert back to their old ways they do not change or grow they remain exactly the same and there are a number of reasons for this it's um it is of course their disorder they abandon their true identity so now they're just whatever they think people want them to be especially those of the opposite sex they just mold themselves into whatever they think you want them to be and then they present that to you so that they can get what they want but it's nothing new or original it's always just a reflection of your desires or needs but also it can be coincidental as well on some occasions about maybe because of social conditioning and peer pressure or media influences because yes as babu says in the live chat there are most people becoming narcissistic now yes I would say we do live in a narcissistic world I mean we've only got to look around especially those of you if you've been on holiday recently it's like whatever country you go to in the world everyone has a similar style they all dress the same they all have the same interests they all like the same music and a lot of people they all eat American food now everywhere in the world so yes it's definitely having an influence and an impact on the world all of these things and yeah I would say people are being brainwashed by all of these things by television by music and movies they're made to feel insecure as though who they actually are isn't good enough and now sadly especially with the new generations people who who from a young age they have been indoctrinated by the internet by television and movies so they really have no identity of their own at all they are just whoever they think people want them to be they don't spend any time alone you know narcissists they can never be alone they always have to have their sources of supply so they're always being influenced by other people it's peer pressure and social conditioning as well but for myself I was very fortunate I was born in 1989 so the internet didn't come in until later we had television and video games but I was actually the type of person who I spent a lot of time on my own I just enjoyed going to the beach playing with my dog walking in forests riding on my bike so that was typically what I used to do in my childhood and because of that I do believe that I developed quite a unique identity one that is very different to most people in society and of course yes that is what has made me a target for many narcissists that's what made me stand out in the first place but myself I mean of course I have had many opportunities and situations in my life and yes when these opportunities have been presented to me I have maintained my discipline and self-control back in 2017 I gave up playing video games and I stopped drinking alcohol I also gave up coffee and energy drinks so I lowered my intake of caffeine and as well as that I also had a spiritual awakening I became more aware of certain things happening around me and I also became a vegan this was in 2019 so for four years I have avoided eating meat and dairy products and also of course there's my youtube channel I've been making videos every day almost every day for over five years putting out this content so yes sadly unlike a lot of people in this world today I have managed to maintain my identity and that doesn't mean that I'm completely perfect of course not I mean there may be times where I want to enjoy some chocolate or if you've seen me on instagram I like the shisha as well but these are things that I don't do all the time and also it's very different with narcissists because when I'm talking about how they lack discipline and self-control and how they abandon their identities they do this with the intent of going off and harming other people that is the crazy thing about it it's like they look at themselves and they feel like they're not good enough as they are to harm you and also to trick you as well in the beginning so they create this character who is all powerful like the puppet master this evil villain and then that is who they become they take on that role and it's kind of like two different roles that they have there's one where they're trying to lure you in and entice and seduce you and then the other one is when they're like the judge the jury the executioner the punisher when you look at it they really just want to punish people for the very thing that they did to themselves for the fact that they lack discipline and self-control the fact that they chose to abandon their identity when you look at it that's really what they're punishing you for because they take no accountability they don't want to look at themselves and accept that they are weak instead they want to take it out on the people around them and abuse and punish you because they never take accountability they never accept their faults or wrongdoings and of course the reason why is because there's really no one even in there it's like the lights are on but no one is home no one is actually there they're just whatever people want them to be and when they start to lose control and you start to catch on that is when they want to keep you down because at that point you're like this light you're constantly reflecting back to them that they are not real so they just want to stamp that light out so that they can remain in darkness with this world that they've pulled over their own eyes and a lot of times yes they will still steal bits and pieces of your character and identity as well and they will use it to attract their next source of supply or even just to keep you around to make you feel like you're on the same page and they will really want to destroy your identity too everything that is good and unique about you they will start comparing you to other people whether it's in a positive or negative way and then they will try to get you to make adjustments they will try to get you to change because they already know that they're all messed up they know that they gave up on themselves a long time ago and when they see someone with emotional stability you have discipline and self-control you have a plan for your life you have all these things that you've been doing for a very long time when they see all of that it really triggers them because they know that their life is not like that so they just want to take you off course off your path they want to control you because anything that reminds them of who you actually are it really hurts them they become very afraid they feel intimidated because they haven't got anything and you will notice that because they never have anything to give to you they're always negative everything they do is intended to take away from you but they don't want you to know this they don't want you to know that yes in fact they are an automation they have no identity of their own it's just an artificial intelligence there is nothing being generated from within this is just the reality of narcissists and even just narcissism in general and sadly yes as I mentioned we are living in a narcissistic world that is just what the world has become so a lot of people in this world now they don't even have an identity of their own it's all just groupthink a hive mind the effects of media influence and social conditioning so now it's like no matter where you go in the world everyone is the same there's nothing that really separates them anymore and it is sad I don't know if this is a situation that can be reversed because it does seem as though people just don't want to accept themselves as they are and some just won't accept other people as they are as well especially when that's a threat to their false identity so where is the desire or incentive for people to make the necessary changes and that is why I think this is going to continue and I'm sure many of you you may have experienced the effects of being around these types of people and what I would advise for you is to just spend some time alone or at least around people who encourage your own individuality people who you feel safe with people who you can trust because being around narcissists remember they have no identity of their own they have no innocence of value which is why they're so negative all they do is take to fill this void inside of them so all of these great things about you just get lost in this black hole and it just sucks it out of you which is why at some point you do need to take some time to rebuild Priscilla's life page says I felt alone even when he was here he didn't communicate at all he was always quiet yes I have experienced that myself it's like even when they're there it's more lonely than being alone because you're just with this void it's just sucking all of the energy out of you you end up wanting and desiring something and they're portraying something to you but then at the same time you can't get it from them because they don't even have it to give so then you just feel completely stuck but yes this is just how it goes and they don't want you to know about this because it is a threat to their fear of rejection and abandonment their fear of exposure and the longer you're around them you will feel like you're just becoming just like them you will feel drained you will feel lifeless you will have your eyes wide open looking for something to replenish you and then of course that's when they're gonna come around and shame you or act like they're this hero this savior this person who's going to rescue you but even when they do that it's just so they can build you up and break you back down again but yes I will be diving deeper into this topic in the future I have plans to go a bit deeper into it about how narcissists are an automation they are just artificial intelligence and yeah it may seem real on the outside it can seem very convincing but in fact it isn't real at all it is a simulation and the best that you can do if you can't get away from it of course you must limit your contact as much as possible because it will have an effect on you but not only that but you need to kind of release your resistance around it as well because that seems to cause harm too when you're trying to fight it or push it away that's when they gain power over you because remember they want to be in control so that they can feel safe and secure around you so yes when you're around narcissists you must give them something even if it's just a little bit of your time or energy just something to keep them at bay because if you just cut it off completely they will become very hungry and needy they will be all over you like a rash and you just won't be able to get them away they can become very domineering and that energy is suffocating it will pull you in and destroy you unless you at least just give them a little bit and I know it might sound strange it might sound counter-intuitive but just try it practice it let go of that resistance even for a short period of time and then watch how it makes you feel it makes you feel more comfortable because that's why they commit these behaviors in the first place it is of course to take from you so instead of them taking all of the time if you just give then they don't need to come after you so that's my mindset around that because they are going to want something yes they see that you are different you haven't walked the beaten path like everyone else you may prefer to isolate sometimes you spend a lot of time by yourself so they already know that you've got that they know that you generate this energy from within to replenish yourself and they know that that is very rare in today's world it's very difficult for them to get that from anyone else so that's why they come around you and this is why you should recognize that the triangulation after they discard you the new source all of these things are just a fabrication because despite all of that they will still try to come back to you or even just use it to hurt you because they know that yes you are the one who has that energy and anyone else power sources of supply they may have treated them very very differently and of course the reason why is because by hurting them they already know they're not going to get that energy out of them but they know that they can get back from you and yet we look at ourselves and we wonder what makes us so different are we just contemptible when the reality is that yes we are different but it's in a good way we enjoy solitude we enjoy time alone because we do have this value on the inside which is why a lot of us self-love we overthink we overanalyze we're just deep people a narcissist love that they really want to be around people like that even if it's just for a short period of time to get you to to attach and to think about them because that's all energy to them but remember narcissists are superficial they don't self-love they project everything outwards because there is no innocence of value there is nothing coming from within which is why whenever you're around them you always feel drained and that's really the clear difference there and it's how you know exactly what you're dealing with the victim the empath we self-love we feel bad about ourselves we try to be better but narcissists they project everything outwards onto you so that they can take from you because there's nothing that they can generate from within so yes that's really it the one thing they don't want you to know they don't want you to know this about them they don't want you to know that yes they are fake they're just superficial it's just this image you see on the outside but beneath that there is nothing there and that is why you couldn't even have a conversation with them a lot of times instead they just wanted to argue with you and point out all of these things wrong with you because if there is anything new or original that they can bring to the table it's always going to be something that undermines you because they are predators they are manipulators but actually even that as well it's typically likely to be something that they've seen someone else do before it may be something that someone did to them when they were younger or they saw someone do it to someone else and they saw that it was effective so now they just use it on you so yes as pathetic as it sounds this is the reality even the abusive side of them when they're angry when they're fighting you when they're calling names when they're ghosting and discarding you even that isn't them even that is a false character and when you realize that the entire thing just falls apart which is why of course they will often come back to further indoctrinate you to keep you under their spell because as I said this is the one thing they don't want you to know they don't want you to be constantly on them or even just by you being yourself you're reflecting this back to them and you're making them look at themselves and of course when they do that it's just going to come back on you they're going to try to control you they're going to start a smear campaign because the one thing they don't want to do is to look at themselves they just want to look at you and see all of these things wrong with you but they don't ever want to see it in themselves when the reality is that if they would just do that if they would do as we do if they would let go of that resistance and stop fighting it and just accept it and self-love process these emotions and accept that maybe they were taught the wrong things in life maybe they were socially conditioned maybe they were all of these things but now they want to start again spend some time alone and learn to generate it from within then maybe there is a chance that they would not be narcissists anymore but the problem is that for a lot of them it is working for them they're getting the results or the effects that they want so why would they stop there's no incentive for them to do that and of course a lot of them they enjoy it and they're addicted to it so there's just no reason for them to do that they also enjoy turning you inside out as well just the power that it gives them when they come across you in the beginning you're this hard-working motivated person you've got so much discipline you've got your life in order while their life is in shambles it makes them feel better it medicates them when they can tear a person like that that type of person's life apart to just tear it to rubble they love when they can do that so for these reasons there's not really any reason for them to stop unless somehow the world returns back to culture and tradition then these types of people would have a problem if everything was in order again because yes they do thrive in dysfunction that's how they survive if everything was functional and normal they wouldn't know what to do they wouldn't know how to survive because yes they've been doing this a long time they've been surviving by taking from other people draining them stealing so it would be very difficult for them to start again and to learn just how to do things right so in most situations it is highly unlikely that they are ever going to do that but if you feel like you have lost yourself in this relationship with the narcissist it's not too late for you to do that because narcissists it's a shell of a person but with us the victims we are we become almost like a shell of a person ourselves by the end of it but something we don't often realize is that there is something beneath the shell and that is where our true identity lies because they have built up this wall the shield they have contained us in this outer shell and it's like once you break through that that is when you will find yourself and this shell is a fabricated identity it's projective identification that they have used to contain and control you and it's like all you really need sometimes is for someone to come along and to break you out of that shell the problem is if the narcissist sees that they're going to say that the person you're around they're a bad influence they're no good for you when in actuality that was likely what you valued all along that was already the direction that you were going in to break out of this shell and to find yourself so yes that is a very interesting concept that I thought it would share with you a different way of looking at things with the narcissist their outer shell is the false characters and beneath that is just a void but for the victims the game paths I believe that yes this outer shell is the the projected identity that they have given to us and then beneath that is who we actually are and we will find that by and learning everything that we have been taught that is how we will find ourselves but yes that's really it that's really the message for today the one thing the narcissist doesn't want you to know I hope this video was helpful for you if it was you can give it a thumbs up down below and let me know your thoughts in the comment section as well as you may know I do read your comments every morning share the video subscribe one-on-one coaching sessions you can book on my website it's narksurvivor.co.uk and you can check out my Instagram as well I've got new pictures and videos of my travels every day on there and I will be flying out to another country next week so there will be new stuff on there very soon anyway that's it for this one I hope you found it helpful and I hope you enjoy your day


My name is Sam Vaknin and I am the author of Maliglian self-love, Narcissism Revisitives. Over the years, I have corresponded with many men and women who presented themselves as inverted narcissists. To remind you, inverted narcissists, or covert narcissists, or narcissists codependent, is a codependent who depends exclusively on narcissists. So pay attention. If you're living with a narcissist, if you have a relationship with one, you're married to one, you're working with one, it does not mean that you are an inverted narcissist. To qualify as an inverted narcissist, you must crave to be in a relationship with a narcissist regardless of any abuse inflicted on you by him or her. You must actively seek relationships with narcissists and only with narcissists, no matter what your bitter and traumatic past experiences have been. You must feel empty and unhappy in relationships with any other kind of person, non-narcissists. Only then, and if you satisfy the other diagnostic criteria of dependent personality disorder, can you safely be labeled as inverted narcissists. So here's something a woman has written to me about her upbringing and how it brought about what she believes to be her inverted narcissists. In the religious culture I grew up in, women are so suppressed, their roles are so carefully restricted. They are the representations in the flesh of all that is sinful, degrading, all that is wrong with the world.  This is the negative otherness of women as defined by men, and it was fed to me. I was so shy, withdrawn, unable to really relate to people at all, from as early as I can remember. Another woman writes, I grew up in the shadow of my father, who adored me, put me on a pedestal, told me I could do or be anything I wanted because I was incredibly bright, but it ate me alive. I was his property and an extension of him. I also grew up with the mounting hatred of my narcissistic brother, who got none of this attention from our father and got no attention from our mother either. My function was to make my father look wonderful, in the eyes of all outsiders. This wonderful parent with the genius Wunderkind as his last child, the only child of six, that he was physically present to raise from the get-go. The overvaluation, combined with being objectively ignored or raged by him when I stepped out of line even the tiniest bit, these were enough to warp my personality. How do narcissists react to competition, inverted narcissists? How do they react to competition and pathological envy? A man, an inverted narcissist, describes his relationship with a female narcissist, quite a rare combination. He says, I have a dynamic that comes up with every single person I get close to, where I feel extremely competitive toward and envious of the other person. But I don't act competitive because at the very outset I see myself as the loser in the competition. I will never dream of trying to beat the other person because I know deep in my heart that they would win and I would be utterly humiliated. There are fewer things on earth that feel worse to me than losing a contest and having the other person gloat over me, especially if they know how much I care about not losing. This is one thing that I actually feel violent about. I guess I tend to project the grandiosity part of the narcissistic personality he saw in a package onto the other person rather than on a false self of my own. So most of the time I'm stuck in a state of deep resentment and envy toward her, he's bothered. To me, she's always far more intelligent, likable, popular, talented, self-confident, emotionally developed, morally good and attractive than I am. And I really hate her for that. I feel humiliated by it. So it's incredibly hard for me to feel happy for this person when she has a success, because I'm overcome with humiliation about myself. This has ruined many a close relationship. I tend to get this way about one person at a time, usually the person who is playing the role of my better half, best friends, loved ones, partners. It's not like I'm unable to be happy for anyone ever or that I envy every person I meet. For instance, I don't get obsessed with how rich or beautiful movie stars are or anything like that. It only gets projected onto this partner person, the person I'm depending on most in terms of supplies, attention, reassurance, security, binning up my self-esteem and so on. The really destructive thing that happens continues this man, this inverted narcissist. He says, the really destructive thing is that I see her grandiose traits as giving her the power to have anything in anyone she wants.  She obviously is so out of my league. So really what I'm envious of is the power that all that talent, social ability, beauty, etc. gives her to have choices. For instance, the choice to stay with me or to leave me. Whereas I am utterly dependent on her. It's this emotional inequality that I find so humiliating. A woman writes, I agree with the inverted narcissist designation. Sometimes I'll call myself a closet narcissist. That is, I've internalized the value system of grandiosity but have not applied the grandiose identity to myself. I believe I should be these grandiose things but at the same time I know that I'm not and I'm miserable about it. So people don't think of me as having an inflated ego and indeed I don't have one. But scratch the surface and you will find all these inflated expectations. I mean to say that perhaps the parents suppressed every manifestation of grandiosity in me. That's very common in early childhood. Maybe they have suppressed my narcissism. So the defense mechanism that narcissism is was inverted and internalized in this unusual form. A woman inverted narcissist suggests maybe there aren't two discrete states. Narcissistic personality disorder versus regular low self-esteem. Maybe it's more of a continuum. Maybe it's just the degree and depth of the problem that distinguishes one from other. My therapist describes narcissistic personality disorder as the inability to love oneself. As she defines it, the narcissistic wound is a deep wounding of the sense of self, the image of oneself. That doesn't mean that other disorders or for that matter other life stressors can't also cause low self-esteem. But I think narcissistic personality disorder is actually low self-esteem. That's what the disorder is really about. An image of yourself that is profoundly negative. The inability to attain a normal and healthy self-image concludes this inverted narcissist woman. A woman wrote to me to describe a harrowing childhood which brought about what she believes to be a kind of co-dependence. Co-dependence or narcissism.  But remember that not all abuse is alike. There are different kinds of abuse. There are different effects. My XXX style of abuse had to do with trying to annihilate me as a separate person. I also had to do with the need to put all his negative self-image onto me to see in me what he hated in himself.  I was flipped back and forth in those roles. Sometimes I'd be a source of narcissistic supply for him. At other times I was the receptacle of all his pain and rage. Sometimes my successes were used to reflect back on him, to show off to the rest of the family. At other times my successes were threatening to my father, who suddenly feared that I was superior to him and had to be squelched. I experience emotions that most people I know don't feel. Or maybe they do feel them, but to far less extreme intensity. For example, the envy and comparison competition I feel towards others. It's really intense. I experience emotions that most people don't feel to that extent. I guess most of us have experienced rivalry, jealousy, being compared to others. Most of us have felt envy at another success. Yet most people I know seem able to overcome these feelings to some extent, to be able to function normally. In a competition, for example, they may be driven to do their best so they can win. But for me, the fear of losing and being humiliated is so intense that I avoid competition completely. I'm terrified of showing people that I care about doing well because it's so shaming for me if I lose. So I underachieve and I pretend that I don't care. Most people I know may envy another person's good luck or success, but it doesn't prevent them from also being happy for them and supporting them. But for me, when I'm in a competitive dynamic with someone, I can't hear about any of their successes or compliments they've received, etc. I don't even like to see the person doing good things, like bringing Thanksgiving leftovers to the sick old guy next door. Because those things make me feel inferior for not thinking of doing that myself and not having anyone in my life that I do it for. It's just so incredibly painful for me to see evidence of the other person's good qualities because it immediately brings up my feeling of inferiority. I can't even stand to date someone who looks really good because I'm jealous of their good looks. So this deep and obsessive envy has destroyed my joy in other people. All the things about other people that I love and take pleasure in is a double-edged sword because I also hate them for it. For having these good qualities, while presumably I don't. I don't know. Do you think this is a garden variety, low self-esteem, she asks me? I know plenty of people who suffer from lack of confidence, from timidity, social awkwardness, hatred of their body, feeling unlovable, etc. But they don't have this kind of hostile, corrosive resentment of another person for being all the wonderful things that they can't be or aren't allowed to be, etc. One thing I hate is when people are judgmental of me about how I feel, as though I can help it. It's like you shouldn't be so selfish, you should feel happy for her that she's successful, etc. They don't understand that I would love to feel those things, but I can't. I can't stop the incredible pain that explodes in me when these feelings get triggered and I often can't even hide the feeling. It's just so overwhelming I feel so damaged sometimes. There's more, but that's a crux of it for me anyway. She concluded her letter. Be sure to watch the next segment to remind you there are three videos which include correspondence addressed to me written by inverted narcissists. Most of them women, some of them men. This is the end of part one. On to part two.


It's Zidana. So I'm really excited because I have a giveaway for you guys and this giveaway is going to be centered around the PA cat. So some of you may be wondering what is the PA cat? I've never heard about this thing. Like what should I know about this? And that is exactly what we're going to be addressing in today's video. So let's get into it. Hey y'all, it's Zidana. Welcome back to my channel. So if you're new to my channel, take a look around. If you like what you see, go ahead and subscribe. Today's video, we are going to be talking about the PA cat and some of you may know about the PA cat. If you are kind of like really into getting into PA school and you're like in the throngs right now of application season, some of you may not know about the PA cat and that's why I'm here to help you know and understand about the PA cat, okay? So I just recently did an Instagram live with one of my PA colleagues and we're talking about the PA cat. And the PA cat is the physician assistant college assessment test. Sounds familiar? Yeah, you know, it sounds familiar. If you were into healthcare and medicine in general, you've heard of something called the MCAT. The MCAT is specifically for med school, but the PA cat is for PA school. So it should be a better assessment of who you are or who you could potentially be as a PA student. Now with that being said, it is a very brand-new test. It's only been like a few years in the making. More and more schools are requiring the test, but the majority of programs right now are recommending it. The GRE is still king at this moment in time. However, the PA cat is slowly making a run for the title of college like assessment for PA school because it is geared towards physician assistant students or pre-PA students, I guess you could say. So it covers the nine subject areas that you would already be taking into consideration when trying to apply to PA school. So anatomy and physiology, biology, chemistry, all of those sciences. And on top of that, it's a better assessment of who you are at that moment in time, right? So you can study, you've been studying these sciences throughout undergrad if you are a biology major or a chemistry major. Or if you're just interested in being a PA, you've been taking these prerequisites. So it's fresh in your mind as opposed to, you know, something like your other standardized tests that we have to take for PA school where you're you're doing like all these maps that you're not necessarily taking and you have a lot of writing. That's not what this test is about, okay? So with that being said, how much does the PA cat cost? So the PA cat costs $149 plus $79 for a total of $228. The $149 is for the actual exam. The $79 is for the test center. So you have to keep in mind that when you are planning to take this exam, you're gonna have to dish out $228. So it sounds kind of steep, but you're you're it's like any other essentially standardized exam that you're gonna be taking for a higher education, okay? Now that we have all of that out of the way. How do you study for this brand-new exam, right? This is this is new. It's something that's fresh. It's on the market. How are we studying for it? Because you've never heard of it before. So that is where my giveaway comes in. So Roche Review has partnered with Exam Master to create a PA cat cubing. Now, if you've ever heard anything about Roche Review, like I've done a few videos about Roche Review, but specifically for PA school, but Roche Review covers like all across the board. They have stuff for med students as well and you know, they have stuff for PAs as well. So just all of your certification exams and recertification exams, they are a go-to resource for you in terms of helping you study for that. And now they're hitting the market with respect to the PA cat for pre-PA students, so that when you are trying to study for this exam, there's a Cubank for that, okay? So Cubanks are essential when you're trying to just kind of remember make sure that you know exactly what you've been studying that you're not you just haven't memorized this, okay? This is not just a straight memorization thing. You actually know the material and that is why Roche Review is a great tool and asset for you guys to use because it will help you get a better assessment of where you are and what you may need to spend a little bit more time studying. So I'm going to take you through the Roche Review PA Cubank. We're going to do a couple questions and then I'll come back and talk to you about the rest of the giveaway. Okay, so here we are on the home screen. You can see that it says the PA cat Cubank because that's what we want to do.  So let's get into that. So you have here you can create an exam. When you go into create an exam, you can name the exam. You have the opportunity to choose the number of questions. I usually choose anywhere from 10, 30 or 50 questions. You can choose the type of questions that you want to see. So all of the questions, the questions you've gotten wrong, the ones you flagged or the ones that were unused, there are 434 questions available right now on this Cubank. And when I was first approached about this about a month ago, there was only a little bit over 300. So they're adding more questions every day. There is the opportunity for you to choose test mode or tutor mode. Tutor mode will give you the reason why you got the question wrong while test mode just essentially puts you in a testing type environment. And then you can also choose whether or not you want it to be timed or untimed. So there is also the opportunity here for you to go and check out your exams that you've done. I have both access to the didactic Cubank and the PA cat Cubank. So the didactic Cubank, if you guys want to hear more information about that, I can make a video about that. Just leave a comment and comment section below. But that will help you during didactic year of PA school. So here we're going to go to the exams tab. So this is where all of your exams will show up. You see that I already have an exam in progress right now. You can see all the exams that you had in progress and that you would like to resume. You can also go to your performance analysis, which shows you your projected PA cat score and then the probability of passing. So let's resume this exam. What stage of protein synthesis occurs that a ribosome and is responsible for reading the clodon sequences within the messenger ribonucleic acid? So I mean, if you've done biology, then you'd know that you have like translations, transcription, termination is obviously ending of that. But I would say translation and I would be correct. So it goes through explaining, like I said, because this is Tudor Miller talking about all of the various different aspects of the whole messenger RNA system. It tells you why the answers you got were wrong or right. And then there's this option for going further here. So it's really good. And there's a peer comparison. During which phase of the cardiac cycle are all the valves closed. I'm going to probably this, I'm not really like that good at the heart, but I would say like probably iso one, because you know, nothing is happening. There's no exchange. And I would be correct. So here again, if you look at the corner, it says the peer comparison, it shows you that 63% of your peers have gotten the same answer correct. And it's really good. So I really like that. So let's just back back out of the rush review, we can go back to the homepage. So I wanted to show you guys here again, you can name the exam. So I'm just going to name it test. I just choose five questions. You can choose unused, which typically is what I would say you do and then create your exam. Once you create the exam, you have the opportunity when you go off to the side where it talks about all of the questions. So you can see at the top, you can highlight, you can flag questions, you can save them for later. But then when you go off to the corner, you can choose to see all of your questions, only the flag questions or the questions that you haven't attempted. So you were able to skip to the next section, which is really good for people who are like, you know what? I need to see this because I don't want to just look at the one question. Maybe I don't know this. Let me go to something else. So I think it's a really good opportunity for you guys to actually get access to PA cat type questions and learn. So that was it. That was the Cubank and you see it's very user friendly. You can choose how many questions you want. You can decide, yeah, you know, I only have time for 10. So let me just do these quick 10 or maybe you want to do a little bit more of a practice and you want to do 50 questions. It's up to you. And that flexibility is really essential when you're studying because you want to be able to crack down on certain times later on, let's say closer to the test. Maybe you want to do more test questions versus further out where you're still kind of getting your bearings. So hopefully you guys really liked that. And if you did really like that, what I need you to do right now is right now in the comment section, tell me what it is that you liked about that PA cat Cubank. Tell me the things that maybe you feel could be improved. But essentially leave a comment for me because I have two free 365 day access codes to give away for two of my lucky subscribers slash followers via YouTube and Instagram, I will be giving away two free 365 day subscriptions to the Ross review PA cat Cubank. Okay, I will be announcing the winner on Instagram. So you have to follow me on both YouTube and Instagram and you also need to follow Ross review on YouTube and Instagram as well. Okay, I will be having somebody verify exactly if you're doing all of the components of this giveaway. And I mean, the winner is going to be announced very shortly. It's like a 48 hour turnaround. So please be sure to make your comments, write your comments in here, go ahead and follow Ross review, follow myself on Instagram and on YouTube. And we will get you that giveaway. If you don't happen to win the giveaway, fear not. It's okay because I do have a 25% off code for the PA cat Cubank. So what you all you have to do is put in the code, which is adana 25. I will leave that that correct spelling for you because sometimes people don't know how to spell my name and that's okay. But I will leave that for you you at put that in and it will get you 25% off of the PA cat Cubank. Okay, but that is it. So this is a new test guys. It's coming for you guys. If you're interested in PA school, you have to be preparing for this because it is essential for you to ensure that the schools that you're applying to don't require it or if they do require it that you are actually taking the exam. Okay. All right. I can't wait to see who wins. I'm super excited. Thank you guys so much for watching. Please again, leave me a comment in comment section below ask me any question you have or may want I will do my best to answer it in a prompt and timely fashion. Go ahead and follow me on Instagram and on the PA. Follow Ross review on Instagram as well. Follow me on Instagram. I get that's the university and thank you guys so much for watching. I will talk to you guys next time. Bye.


I'm going to lose her sometimes and activate something, trigger something in a, in a, you know, competitor. So we have the fist bump to make it official. This will be a match. Once again, just as a reminder, loser of this is going home. Yes, yes. So a lot on the line, a lot on the line here. Tournament life at stake. So you can't make any mistakes. You can't just walk away from this and say, it's fine. I'll get it in the third bracket because there is no third bracket. This is it. Do or die. Now Tweety, we saw him playing pretty much gear is the whole time. So strange. It's a surprise really to me anyway. It is. I do miss the Baraka that he had a combo breaker. But I actually asked Tweety earlier this weekend. I said, what are the chances that we're going to see Baraka this weekend? And he says zero from anybody because that character is just no good. Oh, that's a bit rough, you know. Poor Baraka getting no love out there. But Hayate is, you know, really taking it to the limit what Aaron Black can do and other character that a lot of people really underrate as we saw Tweety. Speaking of which, we have ourselves a match. Hayate already swinging with those back two twos.  So you have to just kind of adjust, possibly challenge those daggers a little bit more here and there, chucking the interactables and Tweety being very, very patient. Did you see those flawless ones? Yes, sir. Invisible projectile, if you will, flawless one. Yes, not an easy thing to do at all.  Now, Tweety does have access to that interactable there. If he does so, choose to use it. He was looking for something, doesn't find it. Wait a minute. Hayate is knocking on the door, 10% left for Tweety. Oh, good challenge there. Gets to punish as Hayate was not trying to spend any meter.  He's like, why am I going to waste my resources? I want to go into the next round with full bar, big drop kick. Are we going to see the second one? No. I guess the throw escape, not quite gets the reversal throw. All right, in there. Plus, that's so interesting.   I'm just going to wait, maybe make Hayate overextend, over reach somewhere, or wake up, up three from Hayate, the invulnerable, fully invulnerable, wake up attack. Interruption by Hayate. This is the corner. This is a 4-4. A punish, okay, with the high as well. That's a tricky thing to do. Good call out by Tweety, knowing the break it was coming, knowing he had to get as much damage as possible. Pet, speaking of damage, the crushing blow. Free pet boys. The good old days, the good old days. Fight. Hayate utilizing that scut shot amplification, doing it again, so now he's got no bar. Oh, that could have been really dangerous, but Hayate wasn't ready. No punish though. No trip guard, just a bit of chip. Yeah, I'm very, very surprised by that. I guess Tweety just did it a little too late, as you can see there. Drop kick puts himself into the corner. Tweety going with the forward throw through the Santa time. What's going to be the mix up? Backing off again. Now he has the whole screen to work with, that's smart.  The down two, again, perfect call out of the breakaway max. Out that damage, big jump in. Hayate has no choice but to block it. Oh, and I'm not sure what button he was pressing there, but it got perfectly countered. And Tweety taking that first game over Hayate. It was a very timid match almost, both a bit conservative, not really wild with the swings. Yeah, yeah. A lot of throwing too. Yeah, yeah, yeah. I think Hayate has to press the attack a bit more to contest Tweety's nonsense. Yeah, get aggressive here. And again, here we're seeing it again. Back to back throws from Tweety and Hayate, not ready to swing, not ready to duck, but it's so scary to duck in that situation. Good punish by Hayate, Tweety trying to breakaway to get a punishable stage, but doesn't get it. In the corner, lots of damage, blood is spraying. All over the place, cancelling into the high shot, Tweety not blocking the second one, and Hayate coming off those resources. What a sequence from Hayate. Everything's working out. Oh, beautiful techie. I don't know which way he was trying to throw him, but Hayate knew. Plus, oh, I'll confirm this time. Oh, it's gonna hurt, oh, it hurts so bad that leg is just snapped in two. Watch for the vacuum cleaner, this is not death. Watch for it, 3% left for Hayate. What's it gonna be? Wow, gauntlet. He was trying to challenge there somewhere. It's something possibly maybe thinking that Tweety was not gonna go for that gauntlet punch, but there it was, and just like that, Tweety looking really good in this game number two, trying to trip guard Hayate, but not getting the timing quite just right. So what's 1-2 coming through? When is slide gonna come? When is slide gonna come? I think I've seen it slide all day from Hayate.  Here we go. Beautiful second down two there by Hayate. A lot of the easiest thing to do with Aaron Black. Slide, amplifying it for the acid. Do, do, when you're standing on top of it, but he just pushes them off of there. And Tweety with the sand trap right on top, the same situation over and over again. After the throws or after sand traps, that's gonna be big damage Hayate. Gonna amplify it. Yes, he does the acid. This might be it. This might be it. Never mind. Escape failed. Watch for the vacuum cleaner, the succubus. Oh, he's afraid, he's afraid. One more. He's one fatal blow from losing. He's one fatal blow from losing this game. He knows, he knows, he knows. We all know throw escape coming through. Big jump and kick. What attack, the tech of his life.  All this block again there. Look at all, when it comes down to matches like that last round, it really every little bit, you gotta try to avoid as much damage as possible. Even minor chip damage. And not the easiest thing to do is you just saw Tweety possibly looking for the follow spot there. This gut shot hitting as a mid from full screen. Super fast. You can't see it coming. The low sand trap. Tweety is playing free back here. Protect your neck. Oh, back to back. Back to back crushing blows. Tweety coming off those two bars for the breakaway. Gonna amplify, drop the acid, D.O.T. And Hayate ready with that mid back to two. No one was there. 13% left. Standing for a whift. Not sure what he was looking for there. Nothing good. Standing for a slide. What was he buffering? 8%. 8%. Oh, hold on a second. Hold on a second. Once again, the vacuum cleaner. Bait of low is in issue. 8% left. They broke. They both have fatal blows. Uh-oh, uh-oh, uh-oh. Oh, he did it! Tweety, the maniac! That was weird. That was weird. The maniac, are you serious? He did it, that is so punishable with Tweety. He said, I'm fine with betting it all right here. One play, if you guess right, I'm dead.  And he was okay. It's not even that. It is not a mix-up anymore. It's trickier to block, yes. Yes, but it's not true. And that Hayate was not ready for that. I mean, it was just too close. He was not right with the timing. It is 2-0. Tweety over Hayate. I don't know where those bars came from. Down one. Okay, keeping it safe there. Just finishing the string and making Hayate stand for that overhead. 4-4 through, though. Uh-huh. Might have been a trip guard once again. Tweety is really, really good at that, especially offline. As soon as he sees you jump, he's looking to trip guard you with that. It doesn't save punish, but it's definitely unavoidable once you leave the ground. Big choke slam in the corner. What's Hayate going to do? No interactable use, just staying there and blocking. Back to 2-2 to fight his way out. 10% left for Hayate. The grab is left, only a 0-1 punish. Down one. 7-5. Whoa, that's a big knee. And just a nice little poke there at the end. Slamming the sand right on his shoes and just knocking him down. Tweety is on match point right here. Elimination point, Hayate. He needs something big here to stay alive in the tournament. Throw escape coming through. Failed escape that time. Maybe Tweety mixing it up or maybe not mixing it up. There's no mix-up. Mix-up, who knows? Big launcher here from that rifle. No S, it's interesting. I think he might have been, maybe he was anticipating the breakaway, but there's that breakaway now. Oh, that could have been a huge whip.  But Hayate's keeping calm. Whoa, that was dangerous. Almost found the trip guard once again. This is corner city. These are apples. He's definitely looking like apples. Down three. Oh, and that's the counter hit. Wait, no confirmation? There was no breakaway for Tweety? No, it wasn't available. It wasn't available. You have to keep in mind, speaking of no breakaway, Hayate doesn't have two bars yet. This might be it. This might be it. Still alive. 2% left of armor. Not going to matter. Tweety with the Swift 3.0 and possibly a pop-up. Wait a minute, wait a minute. Gentle about pay. CGL boys, you say that's pretty much. Wow, so Tweety over Hayate 3.0, which unfortunately means that Panda Global's Hayate is going home.


Well, I have always been very self-conscious of the appearance of my mouth, and have been bothered by it since about the age of 11 or 12, but was really unaware of what could be done, or if any, until I had to go for other dental care at Fort Belvoir Hospital, and then therefore was referred to Walter Reed. In evaluating a patient for orthodontic surgery at Walter Reed Hospital, we find that a rigid checklist of consultations and accomplishments must be done prior to discussing the patient's problem and evolving a treatment plan. To bring you up to date, previously, sephalometric x-rays, panorax x-rays, and appropriate periapical x-rays were taken. Study models were obtained upon which model operations were done in order to establish the procedure that would best solve the patient's problem. The sephalometric analysis that is drawn from the sephalometric x-ray is thoroughly studied, and the deficiency is then determined. With all this information, a recommendation for surgical correction can then be made to the patient. The procedure we have selected to correct your malocclusion, Mrs. Rose, was developed in the early 1930s in Europe. This particular procedure would entail an incision inside your mouth, won't allow for any scar on the skin, and then a separation of the entire upper jaw from the rest of the skull and a freeing up of all of the teeth with their bone so that they can be placed in the new position in proper alignment with the lower jaw teeth. In these pre-operative views of the patient with their teeth in normal occlusion, a flattening of the middle one-third of her face is evident. There also is a pseudo-prognathic appearance to the mandible. In the profile view of the occlusion, the prognathic relationship of the mandibular teeth to the maxillary teeth can be seen. As the patient bites in centric jaw relation, there is improvement in her facial appearance. The mandible no longer appears so prognathic. There is also an improvement in the position of the anterior teeth of the maxillop to those of the mandible. Occlusal interference by the anterior teeth, however, will not permit posterior closure. A surgical repositioning of the retreated maxillop will correct the occlusion and allow for proper positioning of the maxillop to the mandible. Iliac donor bone required for the graft to the maxillop is taken at a preliminary operation. At surgery, the hip incision is planned transversely to make it invisible under a bikini-type bathing suit. The incision goes through full thickness skin, which is retracted. The crest of the ilium is exposed by dissecting through the overlying external and internal oblique abdominal muscles. Following reflection of the medial periosteum and overlying iliac muscle, the size of the graft is measured and marked with an osteotome. The inner table is selected because it results in the smallest amount of morbidity to the patient. Half the width of the crest is removed along with the inner table and its cancerous bone. The specimen is placed in a receptacle and covered with a saline-saturated sponge. The incision is then closed in layers. Lidocaine 2% with 1 to 100,000 epinephrine is infiltrated for hemostasis, along with a 1 to 5,000 neosinephrine solution. The osteotomy incision is made from the malar buttress to the midline through the mucosa to bone. The lateral wall of the maxilla and antrowalls are exposed by mucoperiosteal reflection. The nasal mucoperiosteum is also reflected. The osteotomy site is then marked on the lateral wall of the maxilla with methylene blue. Osteotomy is accomplished under a constant stream of saline irrigation using the striker rotary handpiece and a fissure burr. The bone incision is extended from the posterior wall of the maxilla to the piriform aperture of the nose. The same procedure is then repeated on the right side, where a mucoperiosteoflap is elevated, exposing the lateral wall of the maxilla. The line of the osteotomy is again marked with methylene blue, and osteotomy is performed with the burr. Retraction of the posterior maxillary wall tissues is readily afforded by a lane retractor resting against the pteragoid plate. The tissues over the nasal spine and the nasal mucosa are reflected. An angled osteotome is inserted to separate the vomer from the maxilla. The assistant surgeon places his finger at the posterior covena to inform the surgeon when this dissection is complete. The lateral nasal wall is then severed by mallet and osteotome. Final detachment of the maxilla can be accomplished by fracturing the pteragoid plates using a special rounded chisel, which fits high in the third molar region of the maxilla. Once the pteragoid plates have been separated, the maxilla moves freely. It can be further disimpacted by the use of the tessier disimpaction instruments demonstrated here. An additional method used to free the maxilla is by downward and forward traction manually on the maxillary incisor teeth. Freeing the maxilla, which is now pedigaled upon the soft palate and pterago-palatine tissues, once freed from its attachment to the cranium, the maxilla moves freely to a more anterior and desirable position. Burr holes are placed in the lateral walls of the maxilla, where interosseous wires are loosely placed. Care must be exercised in tightening these wires to prevent them from pulling through the very thin bone. In areas where the amount of separation between the fragments does not lend itself to placement of wires through a direct approach, an indirect approach can be accomplished using a passing wire. After all wires have been placed, advancement and fixation of the maxilla in its new desired position is accomplished with the aid of an occlusal splint. The bone, which was taken from the hip, is now prepared. You will note that the surgeon is cutting the bone at an angle, so as to create a wedge between the maxillary fragments. Based on the model operation advancement dimension, the pteragoid plate bone graft is measured and prepared. This will be inserted between the pteragoid plate and the posterior wall of the maxilla to prevent relapse of the maxilla posteriorly, following removal of the intermaxillary fixation. The posterior and lateral maxillary walls are grafted under direct vision from a fiber optic light source. The wedge-shaped fragment fills the space created by the osteotomy in such a manner that when the wires are tightened, they will fit snugly against the graft. On the left side, cancelous bone is placed over the osteotomy cut, rather than in between it, as there is a close approximation of the fragments. Additional bone can also be placed in order to fill out an area of flattening in the middle face, or in the lateral nasal region. Fixation now is positive. The incisions are closed with a 3-0 running dexon horizontal mattress suture. In order to achieve further stability, a circumzygomatic wire is passed over each zygomatic arch. The technique utilized on the right side is that of the curved autopsy needle and modified spinal anesthesia needle to place the wire over the zygomatic arch at the appropriate level. The wire is seated by a seesaw motion. It is twisted around the end of the needle holder, and a suspension wire is then placed through it to the mandibular arch bar. On the left side, a special passing awl is used to accomplish the circumzygomatic wire placement. The awl penetrates the skin and has moved downward under the arch until it enters the mouth. The wire is threaded through the awl, and it is withdrawn to the region of the zygomatic arch, then passed laterally over it and inferiorly back into the oral cavity. Here again, the wire will be seated on the zygomatic arch by a seesaw motion. On this side, the wire is tightened over a hemostat, and the suspension wire is again placed through it to the mandibular arch bar. This system of suspension permits the cutting of the distal suspension wires without losing the original wires around the zygomatic arches. The desired occlusion is verified, and final fixation tightening is accomplished at the completion of surgery. Eight weeks post-surgery, the patient has needed fullness in the middle face region. The flatness of the nasal region has been relieved. The occlusion now is no longer pseudo-prognathic, but is normal for the patient. In the post-surgical comparison of the right and left profiles, one notes the improvement in the prognathic appearance, although there remains some fullness of the lower lip. In a close-up of the occlusion, it can be noted that a Class I maxillary mandibular relationship has been achieved, and that there has been excellent healing in the incision over the osteotomy site. In this case, the maxilla was advanced 10 millimeters. The patient is pleased with her post-operative results. Ortho-nathic surgery in the maxilla has resolved this malocclusion problem. It's hard for me to explain how I feel about the results of the surgery. All I can say is that I am very happy with it, and it's made quite a difference. Most of my friends tell me they can tell quite a difference in personality, and my husband says the same thing. My main reason for having the surgery was, of course, my appearance, because I was always very self-conscious of it. But the one thing I didn't even think about during the whole process was the fact that now I could bite and chew my food better. My teeth actually hit together. It's hard to explain how you feel about something that you've wanted all your life.


The once of a nine is up here to do pre-mobilization training for our mobilization to the Horn of Africa this year. We are going through all of our weapons qualifications and gated training to allow us to meet the Army standards to get ready to deploy as a task force. It's good because the training here is, I mean it's rough, it's two weeks, and it's snowy and rainy and muddy, and it's giving you kind of the worst of the layer. If you get the worst of it right now and train in the worst conditions, it's going to be better once you get to a place like Bliss where it's 75 degrees and it's really nice, and so that way you can kind of brace yourself for further training. We're doing tons of different things every day from individual tasks all the way to collective tasks, and we wrap that up here in about another two and a half weeks and then we'll be moving on to Fort Bliss for post-mobilization training. So bringing a different platoon into a different company changes the dynamic in a way that like you bring up morale, gives you a different perspective, and makes us all better people together. I would just say I would want people to know that I, the leadership of the Oklahoma Army National Guard and the task force are very thankful to the citizens of Oklahoma for providing us their very best, and we're going to take good care of them, and they're going to do a great job representing our state and nation.


Bach to Rock is a music school in the Washington, D.C. area. It operates a summer day camp in Bethesda, Maryland. Some campers are playing drums and bass. Others play guitar. And others are busy creating music. This group is recording its song Alcatraz. Brian Gross is the head of Bach to Rock. The majority of the students here have never played an instrument before. And in their one week stay with us, they will have learned, recorded and performed two songs by week's end. Carly Glazier says her son Grant learns about a lot more than music at the camp. The biggest thing is he's learning how to work together as a team. Because when he's taking lessons during the year without a band, he's only learning between his teacher. He's not performing with other counterparts and learning how to put it all together, which I think is a really, really important value that you just can't get in a regular one-on-one lesson. Lisa London is the mother of camper Ben London. It's almost like a team sport. You get all the benefits of a team sport from being in a band. Brian Gross says Bach to Rock is growing. Eventually I actually see this as an international concept. The wonderful thing about music is it's not language restrictive, so we can teach music in China just as easily as we can teach it here in Bethesda. I'm Shirley Griffith.