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Then try to aim for good synergistic items that can solve the "no hit" starts. A really strong one is fanny pack, which gives you a ton of items after getting hit by the oath, meaning you have a high chance of getting hearts back. Keeping a sun/full health pill on you is also a good alternative
Sacrifice rooms, slot machines, soon enough getting more extra tools to get the run going. Bloody penny, i think mobile slot machine for one floor, fanny pack.
Btw "Spin to win" on Bethany probably is the most OP single item synergy ive seen so far.