Vlad update E rework suggestions
Context~ But wait! I thought his Q was the problem? Yes, sort of. The problem with vlad's Q is that it's free harass and sustain on a targeted ability, but the problem in the big picture is that for a champion that's supposed to use his health as a resource, having a 'refill' skill is good, but right now vlad doesn't really have an incentive to use his health in lane. His W is well balanced, a hefty % health cost and cool down for an escape/dive tool, but because of it's high costs you really don't want to use it in lane.
Now to me, Tides of Blood on paper wants to be vlad's defining skill, as this suits the ap juggernaut playstyle, it wants to be a crescendo of power, rewarding extended fights with more sustain, damage and cost. The only problem is with it's flat HP cost, it's never a crescendo. In lane use it for the occasional poke and cs at the beginning of the game, never putting points into it when a point into Q just gives you more poke damage and sustain anyway, then once you've gotten some spell vamp and start maxing it, it's cost is so extremely minor, that you just repeatedly stab yourself to keep the stacks full. Walking around jabbing yourself every 9 seconds does not feel epic.
Ideas~ Now there's a bunch of things you could do with his E, but I would split it's cost and it's rewards into two separately tracked stacks. The rising cost increases every time you use it, even if it hits nothing, go crazy, no cap on the cost. Then for each champion you hit, gain a stack of the positive stuff. This way you turn it from a mindless spam into a decision, you remove the incentive to stab yourself while walking, and he can still ramp up in power quickly in a team fight if you play offensively enough to be getting 3 or more positive stacks per E.
Now I can't suggest numbers, but as far as balancing vlad goes, I really like the idea of both stacks being either uncapped, or having very high caps. Make it a painful but rewarding choice (is this next E really worth 400 of my health? I HAVE 10 STACKS HELL YES IT IS vs I only have 4, should probably back off). If you want more counter play, you could make his E a cone ability instead of 360 (not terribly a big fan of the thought, because I feel like part of his power fantasy is just running straight through the middle of the enemy team laughing maniacally). If his Q is too problematic as is, move more of its healing to his E, sort of how soraka works right now, so that maxing Q just gives more damaging poke, but if you want more sustain, you have to put points into E.
Also all of the blood puns must stay.