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Message: <blockquote data-quote="Holy Bovine" data-source="post: 4908778" data-attributes="member: 203">I took the loss of a healing surge to mean that that surge could not be regained with an extended rest.  Thus, in my experience above, the paladin had 4 different diseases all of which took away a surge (he managed to contract 4 out of the 6 that did this out of 12 different diseases) so he started each day there after down 4 surges.  It was fairly significant for him as he is the only defender and gets damaged a lot so he burns through surges faster than anyone else.In the end disease, imo, is much improved over pervious editions.  It does not, nor was it intended too imo, men death for a PC but is something that must be dealt with successfully.  A little bit of effort on the DMs part can make this into a fun side quest finding cures or (in my case) the right person to do the healing (without a ritual I might add).</blockquote>