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Tag: PsA

  • ‘It is the worst product I have ever purchased in my life’: NYC woman buys BÉIS bag as personal item. Now she’s deinfluencing you

    Not every influencer-approved product lives up to the hype. One New York City woman learned this the hard way after purchasing a BÉIS bag she thought would upgrade her travel game—but instead, it’s what she calls “the worst bag on planet earth.”

    Here’s which celebrity-backed brand is to blame.

    NYC Woman Warns Against Viral BÉIS Bag

    In a trending video with more than 17,000 views, content creator Andrea Tamanas (@andreatamanas0) shared her brutally honest review of a BÉIS bag she’d recently purchased as a personal item for flights.

    “Do not order this bag for any reason,” she says. “It is the worst product I have ever purchased in my life. I think it’s also the worst bag on planet Earth.”

    Tamanas had initially been drawn to the bag’s sleek leather design, thinking it would be a cute upgrade from her usual backpack.

    “My mom said this looks like what doctors used to come to your house with back in the day so now I can’t unsee it and now I think it’s ugly,” Tamanas explains.

    Plus, she points out that many airlines might not accept it as a personal item because it’s too big, and even if they do, the bag takes up so much space under the seat that “you’re probably gonna be uncomfortable.”

    And it’s not practical at all when it’s actually filled up; the ergonomics make it too uncomfortable to carry when heavy.  

    “I did the mistake of not having a carry on during this trip and so basically I was lugging this around with me the whole time,” she says. “I dislocated my shoulder and I’m like not even being dramatic.”

    And the hardware is already rusting and making sounds. 

    “Do not buy a BÉIS bag. That’s all I have to say,” she concludes.

    What Counts as a Personal Item?

    If you’re planning to use a bag as your personal item on a flight, size matters, and airline rules can be surprisingly strict.

    According to NerdWallet, personal items should typically fit under the seat in front of you. For most airlines, that means dimensions shouldn’t exceed 18 inches long, 14 inches wide, and 8 inches high. Examples include purses, laptop bags, small backpacks, and briefcases.

    But here’s where it gets tricky: each airline sets its own rules. Delta specifically states that personal items are things like purses, small backpacks, and laptops. American Airlines caps personal items at 18″ x 14″ x 8″. Alaska Airlines doesn’t list specific personal item dimensions but expects passengers to be able to lift anything going in the overhead bin themselves.

    A bag that’s too large for under-seat storage might get you flagged at the gate and you may be forced to pay to check it.

    The Verdict on BÉIS Bags

    BÉIS luggage has become internet famous thanks to celebrity founder Shay Mitchell and countless TikTok endorsements. But buyer reviews paint a more complicated picture.

    On Trustpilot, BÉIS holds a 1.8 out of 5-star rating based on 216 reviews. A whopping 77% of reviewers gave the brand just one star. Common complaints include broken zippers, peeling vegan leather trim, and poor customer service experiences.

    Good Housekeeping put BÉIS luggage through rigorous lab testing and found mixed results. While the bags didn’t dent during drop tests, they scratched and scuffed easily, especially around edges, zippers, and handles. Testers noted the textured matte finish helps hide damage better than shiny suitcases, but recommended using a magic eraser to buff out marks.

    The magazine said BÉIS works best for casual travelers who only fly a few times per year and don’t mind babying their bags. Frequent flyers might want to invest in more durable brands. 

    As one Good Housekeeping editor put it, “What it lacks in durability, Beis makes up for with premium details.”

    @andreatamanas I think the worst travel bag ever invented in the history of life. Also it’s Sunday ignore how I look #travelbag #beis #travelessentials #travel #beisbag ♬ Yacht Club – MusicBox

    What do viewers say?

    “I just got the Luka duffle and love it. Maybe try that one,” a top comment read.

    “Calpak is way better, nothing could make me buy Beis. I’m so sorry!!!” a person said.

    “I bought it. I hate it. It’s so heavy, cumbersome, and non-functional. If you’re standing still – it looks sleek/luxurious. If you’re actually walking through an airport, you’re lopsided and limping,” another wrote.

    The Mary Sue reached out to Tamanas for comment via email and TikTok direct message and to BEIS via email.

    Have a tip we should know? [email protected]

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    Stacy Fernandez

    Stacy Fernández is a freelance writer, project manager, and communications specialist. She’s worked at the Texas Tribune, the Dallas Morning News, and run social for the Education Trust New York.

    Stacy Fernandez

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  • ‘This would kill someone’: Kentucky woman opens Ritz. Then she sees something that could pose a serious allergy risk—and it’s not disclosed anywhere

    One Kentucky woman thought she was getting regular, buttery Ritz Crackers. Then, she opened the package and smelled something suspicious. 

    Raven Brackens (@rae_rnb) expressed her concerns about a fairly peanut-y smelling package of Ritz, a product that does not list peanuts on its ingredients list. Concerned for those with severe nut allergies, she posted a warning video on TikTok that now has over 10,000 views. 

    “ So I just opened a fresh pack of Ritz, right,” Brackens shared while wearing white gloves. “And I was looking at these and I was like, is that peanut butter? And it is. It smells like peanut butter. And nowhere on the box does it say, ‘may contain nuts made in a factory with nuts.’” 

    To her, it seemed very clear that the Ritz may be a contamination hazard. In her video, at least three Ritz crackers had an unknown brown ‘gunk’ that looked suspiciously like peanut butter. 

    “Selling ‘plain’ crackers without clearly stating they’re made in a peanut facility is dangerous. Food allergies aren’t a suggestion,” Brackens stated in her video’s description. 

    Could Ritz Crackers be an allergy risk?

    The possibility of peanut contamination for Ritz crackers is not zero, as Mondelez International does make some of its crackers in factories with peanuts. But Mondelez International has not listed peanuts among the ingredients of Ritz crackers. 

    There are Ritz cracker peanut butter sandwiches available on the market, but only some Ritz cracker facilities make them. Ritz has multiple factories across the U.S., and while some packages have warnings that say the package was made in a facility with peanuts or that they may contain peanuts, others do not. 

    Ritz also hasn’t had many recent Food and Drug Administration (FDA) warnings issued that state that the original Ritz crackers contain peanuts. In 2025, did the FDA issue a warning against Ritz crackers, as their variety pack of cheese and peanut butter crackers contained incorrectly labeled snacks. The cheese-filled crackers had a “peanut butter” label on them. But that is the most recent example of an FDA warning against the company. 

    Are food protections getting worse?

    Many commenters claimed that issues with Ritz might be related to a much bigger issue in the United States: the FDA’s recent financial and structural changes.  

    So, is it true that food protections and general standards are getting worse? 

    The Trump administration proposed an astonishing 11 percent cut to the FDA, but the white House’s proposal was never approved. However, the overall budget did decrease going into 2026. In one of the FDA’s statements, the administration stated it would “continue to consolidate work to core functions and mission-critical activities.” 

    The FY 2026 budget, according to the administration’s summary fact sheet, was reduced by 271 million. Ultimately, though, there hasn’t been any significant reporting that indicates this reduction could lead to complete, critical failures from the FDA. There’s nothing that could indicate that the FDA is specifically “dropping the ball” when it comes to statements on recalls. 

    Viewers generally recommended reaching out to Mondelez International so that it can issue a voluntary recall and potentially pay Brackens for the inconvenience. This advice could inevitably help consumers, as there’s a chance Mondelez International is completely unaware of any contamination issues at facilities. 

    More directly, however, viewers recommended advocating for better food safety standards and more oversight over product expectations. The FDA has been described as having longstanding issues: In a previous article published by The Mary Sue, a consumer found small particles in a Great Value pure granulated sugar bag that looked like microplastics. Some viewers cite recent changes to food safety as an issue directly related to the current FDA and changes happening on an administrative level. 

    The FDA is changing at an incredibly fast rate due to the Make America Healthy Again (MAHA) initiative. There may be benefits from some (but definitely not all) of the public health secretary Robert F. Kennedy’s changes to the FDA. For instance, the elimination of the incredibly criticized GRAS system, which allows chemicals and substances to avoid FDA oversight, could be beneficial. But these changes are coming haphazardly and without technical oversight. That means that they’re often being implemented too quickly, leading to internal issues. 

    Ultimately, though, there isn’t necessarily a direct correlation between this event and FDA changes. It’s just possible that they’re related. It’s more likely that any peanut butter substance found on Ritz crackers is a direct result of a manufacturing defect, requiring an immediate recall. 

    @rae_rnb Selling ‘plain’ crackers without clearly stating they’re made in a peanut facility is dangerous. Food allergies aren’t a suggestion. @Ritzcrackrs @RitzCrackersID #foodallergy #crosscontamination #fypツ ♬ original sound – Raven_N_Brackens

    The Mary Sue reached out to Mondelez International and Brackens for comment.

    Have a tip we should know? [email protected]

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    Rachel Thomas

    Rachel Joy Thomas is a music journalist, freelance writer, and hopeful author who resides in Los Angeles, CA. You can email her at [email protected].

    Rachel Thomas

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  • ‘It is the perfect balance of minerals and electrolytes’: Man drinks Sprite Zero before bed. Then he claims to have discovered a hidden benefit

    Imagine you’re snuggled up under your warmest blankets in the most comfortable position on your bed. As you slowly drift off into the land of dreams, it hits you like a ton of bricks: your bladder screams at you to empty it. Reluctantly, you dragged yourself to the bathroom to take care of it and returned to bed. Depending on the person, the inconvenience can make it difficult to fall back asleep. A full bladder has rudely awakened us during the night.

    This is why a new hack is circulating online to prevent your bladder from disturbing your sleep: drinking Sprite Zero before bed.

    What is the Zero Sprite bedtime trend?

    According to We Got This Covered, former NFL coach Pratik Patel shared in September on X his method for preventing his bladder from disrupting his sleep. By cracking open a can of Sprite Zero before hitting the hay, he claims it prevents him from waking up to use the restroom. Because it contains sodium citrate, potassium citrate, carbonated water, and no caffeine, he calls it the formula for ‘elite hydration.’ Combined with his supplement PreSleep, the soft drink recipe aids him to ‘sleep like a zombie.’

    Regardless, social media users quickly jumped on the bandwagon to participate in what is dubbed the ‘Sprite Zero sleep trails.’ 

    Man questions the viral trick

    TikTok creator Nick Komodina (@nickkomodina_official) discusses this with over 580,000 viewers. “OK, serious conversation,” he says, dragging a 20-oz Sprite Zero bottle. “Apparently, there is a thing that everybody’s squawking about that if you drink a Sprite Zero before bed, you do not get up to go pee.”

    It may sound counterintuitive, since one way to reduce it is to limit fluid intake before bed, according to the Cleveland Clinic. However, the ingredients are allegedly a formula for a melatonin dose. “Because it is the perfect balance of minerals and electrolytes. It’s 60 [milligrams] sodium, 180 [milligrams] potassium,” he explains, mentioning two of the ingredients.

    Skeptical, the content creator wants to run a test. “I’m gonna drink this entire thing before bed tonight, and I’m gonna let you guys know,” Komodina concludes.

    What did viewers think of this sleep hack?

    The comments section quickly weighed in. Ultimately, many were not persuaded and demanded that Komodina post an update.

    “9 [TikToks later,] we still don’t know the results,” one viewer remarked.

    “Wellll any updates?” another asked.

    In addition, others cited firsthand experience to debunk the method.

    “You wake up with acid reflux first and then have to use [the bathroom],” one commenter shared.

    “I’ve been drinking Sprite Zero for a long time. Still wake up to use the bathroom,” a second revealed.

    “[Not ]true. I wake up a million times a night,” a third concurred.

    Did the Sprite Zero hack work?

    After viewers repeatedly demanded it, Komodina delivered the results the following morning. “All right, I just woke up. I drank a little more than half of this before bed last night,” he said in a video update, holding the same Sprite Zero bottle but half empty.

    “I did eat dinner pretty late and I drink a lot of water. So, I think that did play a variable.” His bladder disrupted his sleep. “I did in fact wake up in the middle of the night and go pee,” he shared.

    How does soda affect sleep?

    Whether it has sugar or not, the Sleep Foundation advises against drinking soft drinks before bed. In addition to triggering the bladder, the carbonation in these beverages can cause bloating and acid reflux. So, a stomachache could interrupt your sleep, according to Real Simple.

    @nickkomodina_official ♬ original sound – Nick Komodina

    The Mary Sue reached out to Komodina via TikTok comment and direct message.

    Have a tip we should know? [email protected]

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    Melody Heald

    Melody Heald is a culture writer. Her work can be found in Glitter Magazine, BUST Magazine, The Daily Dot, and more. You can email her at: [email protected]

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  • ‘New fear unlocked’: California woman uses glass straws to drink water. Then she ends up in the ER

    Reusable straws took off as more people started paying attention to waste and sustainability. The classic plastic straw gave way to paper, metal, silicone, bamboo, and glass. The options felt endless, and for many, a glass straw seemed like the cleanest and safest choice. But one California woman says that assumption nearly landed her in surgery.

    TikTok creator @colorful__chaos is now urging viewers to stay away from glass straws altogether after a piece of one broke off while she was drinking water and ended up inside her body. Her warning video, filmed from a hospital bed, has racked up more than 28.7 million views.

    “Don’t use glass straws,” she says at the start of the clip. “It’s not worth it.”

    Woman Has Important PSA About Glass Straws

    In the video, she explains that she had been drinking water like normal when something suddenly felt off. “I was drinking my water with a glass straw and I swallowed something,” she says. “And I was like, what was that?”

    She looks at the straw and immediately sees the problem. A large shard is missing from the tip. “There’s a piece about that big gone,” she says, holding her fingers about two inches apart.

    At first, she tries to stay calm. “I kind of freaked out a little bit,” she says, then explains why she didn’t rush to the hospital right away. “I didn’t feel anything, so I thought maybe it was fine.”

    Two hours later, that feeling changes fast. “I burped really big and my mouth had blood in it,” she says. That’s when she heads straight to the emergency room.

    Once there, she says staff initially doesn’t treat it like an emergency. “At first I really don’t think that they’re taking me seriously,” she says. “They were not trying to get me back quickly.”

    That changes when doctors review her case more closely. “The doctor talked to the gastro, and he said to expedite a CAT scan immediately,” she says. The imaging shows a piece of glass sitting in her stomach.

    Doctors rush her in for an emergency procedure. “They put me to sleep and put the tube down my throat to try to get it,” she says. But by the time they begin the procedure, the shard has already moved.

    “By the time they got me into the room, it had already left my stomach,” she says. “So I’ve got a piece of glass floating around in my intestines.”

    Doctors sent her home with instructions to closely monitor symptoms. “They told me to watch for bleeding over the next two days and to check my poop,” she says. The doctors explain that since the shard already passed through her throat and stomach, they expect it to pass on its own.

    Still shaken, she leaves viewers with an unmistakable warning. “Do not buy these straws,” she says. She also explains that she had previously promoted the product online and is now trying to have that post removed. “I will not promote those. The cups are great, but glass straws will be a no-go forever in my house.”

    She reinforces that message in her caption, writing, “SEND THIS to anyone you know who uses glass straws! If you’re using them TOSS THEM OUT. Not worth it.”

    In follow-up updates, the creator tells viewers she’s doing okay so far, with no pain or bleeding as of her last post. However, she says there is still no clear sign that the shard has passed.

    Are Glass Straws Actually Dangerous?

    Glass straws sit in a strange middle ground. They’re reusable, easy to clean, and don’t retain flavors like plastic or silicone. But they are still made of glass, which means they can break, chip, or crack if dropped, bitten, or exposed to rapid temperature changes.

    There have been previous reports of users swallowing shards when glass straws fracture during use. Dentists have also warned that sipping on hard glass can contribute to chipped teeth, especially for children. Some safety articles also caution against using glass straws with very hot beverages, where heat stress can weaken the glass over time.

    None of those risks is common, but when breakage does happen, the injuries can be serious.

    The video’s comment section quickly fills with alarm and disbelief.

    “Glass straws should be illegal,” one person writes.

    Another shares a photo of herself drinking directly from a cup and adds, “I don’t understand why people can’t just.”

    One parent responds immediately, writing, “Me immediately throwing away my daughter’s glass straws.”

    @_colorful__chaos_ SEND THIS to anyone you know who uses glass straws! If youre using them TOSS THEM OUT. Not worth it. #glassstraws #glassstraw #glass #straw #emergency ♬ original sound – _itsbreezie_

    Others steer people toward safer alternatives. “Guys, buy stainless steel or silicon straws,” one commenter urges. “Those glass straws are not it.”

    And many echo the phrase now attached to the story. “New fear unlocked,” one person writes.

    The Mary Sue has reached out to @colorful__chaos via TikTok messages for additional information and updates.

    Have a tip we should know? [email protected]

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    Ljeonida Mulabazi

    Ljeonida is a reporter and writer with a degree in journalism and communications from the University of Tirana in her native Albania. She has a particular interest in all things digital marketing; she considers herself a copywriter, content producer, SEO specialist, and passionate marketer. Ljeonida is based in Tbilisi, Georgia, and her work can also be found at the Daily Dot.

    Ljeonida Mulabazi

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  • Kotaku’s Essential Guide to Final Fantasy VII Rebirth

    Kotaku’s Essential Guide to Final Fantasy VII Rebirth

    2024’s most anticipated game is finally here, and the further adventures of Cloud Strife and his besties has launched on PS5. Final Fantasy VII Rebirthexpands and enhances the middle section of the 1997 classic, and there’s a big, beautiful world to see. If you’re looking to spend a few dozen hours in Square Enix’s…

    Read more…

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  • Tom Sandoval & Tom Schwartz Have A PSA For All The Dudes Out There Thinking About Cheating! – Perez Hilton

    Tom Sandoval & Tom Schwartz Have A PSA For All The Dudes Out There Thinking About Cheating! – Perez Hilton

    Are Tom Sandoval and Tom Schwartz really the guys to talk about cheating? Well, in a way the Vanderpump Rules stars have the right experience for the job…

    Sandy has of course become synonymous with cheating thanks to Le Scandoval. It was revealed this March he’d carried on a seven-month affair behind longtime girlfriend Ariana Madix‘s back — with her co-star and “friend” Rachel Leviss. And the extent of Schwartz’s cheating on Katie Maloney hasn’t been fully revealed. We do know he “strayed a few times.” And it ended badly for both!

    So while we wouldn’t trust these guys with our sisters, they may actually be the right choice to talk to guys who might cheat. Sort of a Scared Straight thing.

    Related: Rachel Says Ariana Is The Big Reason She Chose Not To Do Vanderpump Rules Season 11!

    On this week’s episode of Sandoval’s podcast Everybody Loves Tom, the pair decided to “give a PSA” to all their listeners, with Schwartz starting off:

    “If you’re unhappy in your relationship, if you feel lost or have experienced feelings for a coworker and it’s starting to escalate, don’t do it. Don’t do it. Just sit down and have that very uncomfortable conversation with your partner. Go to therapy, or just say it’s over. Don’t have a f**king affair.”

    We mean… yes! Exactly right! Sad he had to go through with affairs to learn that, but at least he’s here now, on the other side of it, sending the right message!

    Sandoval got really personal, expressing:

    “One thing that really kept me hanging on was the insecurity I had in myself. I felt like. ‘Oh, my gosh, I can’t lose this other person because I’ll never get this.’ I had such an insecurity with myself that I felt if I let this go, it will never happen again.”

    But even if you don’t think you’ll find the kind of stability or contentment you already have, you’re better off breaking up and taking that risk, Sandy explained — because “banking on that is a much safer bet than staying and doing and living in that.” Because living that double life will destroy the relationship AND you with it. He explained:

    “You become an addict. You cling on to that fling that you had. That euphoria and that feeling you have when you’re with that person… You start to hide from the reality of the rest of your life. And you just become lost in that. Dude, I look back on that now and I’m like, ‘Holy s**t.’ And Schwartz and other people around me, they saw me and I was f**king fixated and barely present.”

    At least he’s holding himself accountable now for his behavior… right?

    What do YOU think, Perezcious readers? Are the Toms doing a good job convincing folks not to cheat??

    [Image via Tom Sandoval/Instagram/MEGA/WENN.]

    Perez Hilton

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  • PSA: You Should Probably Avoid The Train In Warzone For Now

    PSA: You Should Probably Avoid The Train In Warzone For Now

    Glitches are just a part of gaming, but there are different levels. The best are the helpful glitches that give you an unintended edge, but those aren’t great for multiplayer.

    The worst is when a glitch only gives your opponent the edge, and only you suffer. Call of Duty Warzone is currently experiencing the latter in the new Urzikstan map that arrived with Season 1 that everyone should know about.

    A clip is circulating Reddit that shows a player on the train who is somehow invincible despite the gunfight happening in an enclosed space. The player capturing the clip dies without any damage seemingly happening to the enemy player. There are plenty of comments bringing up Warzone’s long history with awful hitboxes on trains as a possible culprit. That would perhaps lend itself to other players speaking up about encountering this same thing.

    With that in mind, it’s hard to call this glitch intentional, as it could just come down to some train-related performance issues. Because of that, we can’t exactly guarantee you’ll run into this every time. However, that doesn’t detract from the main point of avoiding the train for safety. After all, the train can’t get you if you never step foot on board.

    The bad news is that, at this moment, there isn’t anything on the Warzone Trello board that suggests the developers are aware of this glitch/train issue. This means it could be a decent amount of time before the train becomes a legitimate loot spot instead of some sort of unfair playing field.

    We will continue to monitor this situation, and hopefully, things will be fixed before long, so you won’t potentially have to fight the Terminator on board a moving train. In the meantime, I guess we’re only on foot or in a vehicle.

    About the author

    Cameron Waldrop

    Cameron is a freelance writer for Twinfinite and regularly covers battle royales like Fortnite and Apex Legends. He started writing for Twinfinite in late 2019 and has reviewed many great games. While he loves a good shooter, his heart will always belong to JRPGs.

    Cameron Waldrop

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  • PSA: PS5 Alan Wake 2 Players Should Be Using This One Unique Feature/Setting

    PSA: PS5 Alan Wake 2 Players Should Be Using This One Unique Feature/Setting

    Alan Wake 2 on PS5 takes advantage of the Dualsense controller’s haptics, similar to all games. It gets the haptic triggers for shooting and the usual even rumble for effects. However, the game also includes an extra setting I have never encountered before that all players should use.

    This setting can be found in the Audio section called Dialogue Vibration Intensity, and it is set to off by default. What it does is that character dialogue, whether in cutscenes or just surrounding chatter while in towns, will cause the Dualsense to vibrate.

    Image Source: Remedy Entertainment via Twinfinite

    What’s neat is that this makes it like you are feeling the base of a character’s voice. While it allows you to change this on a scale from 0-100, I completely recommend cranking it up to the max; you won’t regret it.

    The serious edge to any voice in the game is heightened to an extra degree, making watching the live-action scenes much more engaging. It’s truly a shame this is only available on PS5, but players should be taking advantage of it. Though I can be love-hate with the adaptive triggers, this is one setting I would never turn off on any game.

    The best way to pair this setting is with a nice headset so you hear the audio right in your ears as it tingles against your fingertips, pulling you into the narrative.

    As things ramp up in the story, there’s nothing better than feeling the (almost) literal weight of the words in your hands. I’m shocked Remedy Entertainment hasn’t been making more noise about this awesome feature. With any luck, it will catch on. Though, I would just as easily settle for enjoying Control 2, or the Max Payne remake with it as an option.

    Considering it’s been a 13-year break between games in the Alan Wake series, it is very nice to see Remedy doing all they can to make this entry feel like a perfect evolution.

    About the author

    Cameron Waldrop

    Cameron is a freelance writer for Twinfinite and regularly covers battle royales like Fortnite and Apex Legends. He started writing for Twinfinite in late 2019 and has reviewed many great games. While he loves a good shooter, his heart will always belong to JRPGs.

    Cameron Waldrop

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  • PSA Stock Price | Public Storage Stock Quote (U.S.: NYSE) | MarketWatch

    PSA Stock Price | Public Storage Stock Quote (U.S.: NYSE) | MarketWatch

    Public Storage

    Public Storage operates as a real estate investment trust, which engages in acquiring, developing, owning and operating self-storage facilities. It operates through the following segments: Self-storage Operations, Ancillary Operations, and Other Items. The Self-storage Operations segment reflects the rental operations from all self-storage facilities. The Ancillary Operations segment deals with the sale of merchandise and reinsurance of policies against losses to goods stored by self-storage tenants, activities which are incidental to the primary self-storage rental activities. The Other Items segment includes general, administrative, and investment costs. The company was founded by Bradley Wayne Hughes, Sr. and Kenneth Q. Volk, Jr. in 1972 and is headquartered in Glendale, CA.

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  • U.S. Announces Nuclear Fusion Energy Breakthrough

    U.S. Announces Nuclear Fusion Energy Breakthrough

    Scientists have successfully produced a nuclear fusion reaction resulting in a net energy gain, a major breakthrough in a decades-long quest to unleash an infinite source of clean energy that could help end dependence on fossil fuels. What do you think?

    “It’ll take some pretty big fundraising dinners to stop this.”

    Debora Emel, Prank Adviser

    “If clean energy is so great, why haven’t we invaded anyone for it yet?”

    Spencer West, Chief Filer

    “I thought we all agreed Earth was more of a run-out-the-clock scenario.”

    Malcolm Gareau, PSA Director

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  • Psoriatic Disease: An Autoimmune Disease Expert’s Point of View

    Psoriatic Disease: An Autoimmune Disease Expert’s Point of View

    By Brett Smith, DO, as told to Rachel Reiff Ellis

    Psoriatic disease is a condition you have your whole life. Skin plaques are the main symptom, but many people also get joint pain. It requires lifelong observation by medical professionals. Although there isn’t a cure for psoriatic disease, there are great medications to help control the symptoms.

    The news that you have it can sometimes come as a surprise. You may see your primary care doctor because you’re having joint pain, but be unaware of plaques because they’re hiding on your backside, scalp, chest, or groin.

    If your psoriasis is mild enough, a primary care doctor should be able to prescribe topical steroids or other topical medications to help, depending on how much of your body is involved.

    But many people with psoriasis require more than just topical therapies, especially if they have joint pain and swelling. If your psoriasis care goes beyond the scope of a primary care doctor, you’ll need to see other specialists to get the treatment you need.

    Your Health Care Team

    After you’re diagnosed, you’ll primarily see a dermatologist. If you have joint pain, you’ll see a rheumatologist. As a rheumatologist myself, I get referrals from primary care doctors, dermatologists, and sometimes pediatricians.

    About 30% of people with psoriasis go on to have joint inflammation. On average, that inflammation comes about 10 years after a psoriasis diagnosis. When people with psoriasis have joint pain, a dermatologist refers them to me. A collaborative approach with a dermatologist gives people the best care.

    You may have to see other specialists along the way, depending on how your psoriatic disease affects you. There are people with joint inflammation who get inflammatory eye problems or intestinal problems later. You’ll need an eye specialist or a gastroenterologist to help you with that.

    Make the Most of Your Appointments

    When you meet with your doctor, especially for your first visit, come with questions and details that cast a wide net. Talk about any symptoms you’re having, even if they don’t seem related to psoriatic disease. Your doctor will want to know if they should look anywhere else for information, like your eyes, gastrointestinal tract, or nails. If you’re having joint or back pain, ask about an evaluation by a rheumatologist.

    Find out about the specific medications you’ll be taking:

    • How often will I take it?
    • How will I take it?
    • What are the possible side effects?
    • What are the goals of treatment?
    • How soon should I expect to see a difference in my symptoms?

    Treatment will vary, depending on your diagnosis and condition. But in general, everyone with joint inflammation from psoriatic disease should be taking medication unless there’s a specific reason that it would be risky for you. Most people are going to feel at least 50% to 75% better within the first 3-6 months of therapy, and even better beyond that.

    Remission — meaning no joint swelling, no pain — isn’t possible for everybody, unfortunately. But we shoot for that goal, because if you’re that person, we want to have you there.

    Stay in Touch

     

    Check in with your doctor every 6 months or so. When psoriatic disease affects the joints, it’s chronic and can be quite aggressive in terms of damage and chronic pain, so you want to make sure your joints are OK.

    Aside from that, you should make a visit to your doctor if your pain gets worse, you notice a swollen joint, you feel stiffer, or your back hurts more.

    Your doctor will also want to know if you have inflammation or pain in one or both of your eyes, or if you have diarrhea or blood in your stool. This could be a sign that your disease is affecting more of your body. In that case, you might need a new therapy that can treat all those things better.

    Don’t underestimate how aggressive the disease can be. You’re more likely to have problems from the disease than you are from the medications you take. Psoriasis can come on at a fairly young age — many people are between 20 and 30 years old when they find out they have it.  So that can be a long time for the disease to be active in your body.

    We can always change therapies and find one that works best for you.

    The goal is to find medication that will help you be comfortable. I know that sometimes the medication can seem intimidating or scary, but we have a lot of experience with them. These medicines can really help.

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  • Should You Stay or Go? When to Change Treatments

    Should You Stay or Go? When to Change Treatments

    Treating psoriatic arthritis (PsA) isn’t like treating strep throat. You don’t just take one medicine for a few days and feel better. PsA is a complex, chronic disease that stays with you and affects many parts of your body — skin, joints, nails, heart, and lungs.

    Many medications slow PsA and relieve symptoms, but the first treatment you try won’t always be the right one for you.

    “There is no one-size-fits-all, and there is no one medication for psoriatic arthritis,” says Saakshi Khattri, MD, assistant professor of dermatology and rheumatology at the Icahn School of Medicine at Mount Sinai in New York. “So often there are patients who do not respond to their medication.”

    There are a couple of reasons you might need to switch to a new treatment, says Ethan Craig, MD, assistant professor of clinical medicine at the University of Pennsylvania and rheumatologist at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia.

    “One is intolerance — the patient has a side effect of some sort. The second is ineffectiveness. Either the medication doesn’t work in the first place, or it works for a period of time and then it stops working,” he says.

    When your medicine doesn’t tame your symptoms, it’s time to regroup with your rheumatologist or dermatologist and talk about other treatment options.

    Signs That It’s Time to Change

    The clearest signs that you need a medication switch is a new flare-up of symptoms.

    Worsening joint pain and stiffness, increased fatigue, and sudden trouble doing activities that were easy for you are some of the most obvious symptoms. More subtle signs like difficulty sleeping and mood changes also suggest the medication you’re on isn’t controlling your PsA well enough.

    If you’ve just started on a treatment, you do need to give it time. 

    Sometimes you can have a partial response — maybe the swelling comes down in some of your joints but not in others. Then your doctor might suggest that you wait it out for 4 to 6 months to give the drug more time to work. During that time, steroids or nonsteroidal anti-inflammatory drugs (NSAIDs) can help bridge the gap until your medication kicks in.

    Once you’ve been on a treatment for several months with no improvement, or if you’re no longer getting relief from a drug you’ve been taking for a while, “that’s often an indication that we need to think about switching things up,” Craig says.

    Advice for Switching Meds

    PsA treatment comes in many forms. Often anti-inflammatories and conventional disease modifying drugs are used (DMARDS). Biologic DMARDS are also often used; they target different pathways in the immune system. There are other options for treatment as well, including targeted synthetic DMARDS and newer oral agents.

    Your doctor will take a few factors into consideration when recommending your next step, including:

    Your symptoms. PsA causes a variety of symptoms. Your choice of medication may hinge on the type of symptoms you have, how much they bother you, and which drug targets them best.

    For example, one of Craig’s patients worked at a ticket window. “Because he had to hand out tickets, he was very self-conscious about the appearance of his nails,” Craig says. “He was willing to be on a drug that helped his nails, even if it didn’t help his arthritis.”

    The drug’s side effects. Each type of medication comes with a set of side effects, which you need to balance against its benefits. For example, methotrexate can irritate your stomach, while biologics increase the risk for infections. It’s important to think about which side effects you can tolerate and which ones you definitely don’t want.

    How you take the drug. Many PsA meds come as an infusion or an injection. If you’re not a fan of needles, you might prefer a pill.

    What other conditions you have. Methotrexate can damage your liver. NSAIDs are linked to heart problems. So if you already have liver or heart disease, these medications may not be safe for you.

    Your insurance coverage. Ultimately, your insurance company could decide which treatment you get next. “The sad fact of the matter is that our choice of medication is often substantially constrained by insurance approval,” Craig says.

    Some insurance companies will expect you to try a certain drug first and prove it doesn’t work before they’ll let you switch to the medication that you and your doctor want to use.

    How to Ask Your Doctor for a New Treatment

    You might already see your doctor every 3 to 4 months if you take medication. During those visits, the doctor can examine your joints, do imaging tests, and check your lab test results to see whether your PsA is under good control.

    But tests don’t always tell the whole story. Your point of view is important, too. Let the doctor know if you’re having any problems with your medications, including side effects or breakthrough symptoms.

    If you’re not due for a visit yet, call the office or send your doctor an email about your concerns through the patient portal.

    Don’t be afraid to speak up. “A lot of patients are hesitant. They don’t want to take up the doctor’s time,” Craig says. “It’s helpful for us if they come in. I hate to see someone suffer for months. And it’s often easier to intervene earlier in the course of the disease, when things are less active.”

    If your doctor isn’t on board with you switching medications, don’t be afraid to push back to get on the right treatment. “Sometimes it’s a matter of miscommunication,” he adds. “We need to be on the same page as to what the expectations are, what we’re treating, and what effect we expect.”

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