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Saturday, August 26, 2006
Why Biomed Will Always Have Little To Show For Itself
And there are some historical embarrassments in the autism biomed field too. I already discussed Secretin, which Bernard Rimland had claimed to have a 75% improvement rate. This was before double-blind studies showed Secretin to be, at best, as effective as placebo. Don't be surprised if the exact same thing happens to DMSA, MeB12 and the others.
Some readers might be thinking that I'm forgetting Vitamin B6, an old but still popular biomed treatment, which does have some placebo-controlled studies under its belt, many of them showing positive results. But note that Nye & Brice (2005) conducted a detailed literature review and concluded that "due to the small number of studies, the methodological quality of studies, and small sample sizes, no recommendation can be advanced regarding the use of B6-Mg as a treatment for autism."
Multivitamins and supplements could arguably be of benefit to overall health, and thus appear to be effective in treating autism. That is how I interpret the results of Adams & Halloway for example. Readers will note that multivitamins in this study were effective in improving sleep difficulties and gastrointestinal symptoms, but had a non-significant effect (compared to placebo) on autistic features such as language, sociability and behavior. If these results are replicated, it would seem that it is a good idea to use multivitamins with children who have sleeping and gastrointestinal problems. This is probably even the case with non-autistic children.
So why is autism so resistant to biomed treatments? Autism biomed is based on a flawed hypothesis. It assumes that autistic children's brains are just about typical, except for a reversible biochemical imbalance or contamination of some kind. Biomed proponents often compare autism to being drunk or stoned. This, of course, is wishful thinking and fails to acknowledge much of what has been found about autistic neurology and cognition.
Autistic brains are different to neurotypical brains. Of course, some will be closer to neurotypical brains than others, but in general, it is known that autistic brains have a different distribution of grey and white matter, different neuron density, neuron size, different overall volume and so on. Autistic cognition is different to neurotypical cognition, with different strengths and weaknesses apparently. I contend that there is very little biomed treatments can do to compensate for these differences and force an autistic brain to work like a neurotypical brain.
The autism community should do better than engage in wishful thinking and waste all this time and resources with biomed. I suggest that autistic children should (1) be educated by engaging their strengths, (2) allowed to exercise their interests, (3) respected for the unique individuals they are, not defective medical puzzles to be solved, and (4) have their true (proven) medical issues, if any, addressed as medical issues, not as part of their very being, which is what autism is.
25 comments:
- Camille8/27/2006 12:53 AM
It's amazing the wealth of information out there about autistic brains and how that is just cast aside by people like Wakefield. He never talks about the brain except indirectly as it being at the mercy of the gut and whatever it lets into the blood.ReplyDelete
The thing about these unproven "treatments" is that people will push them to the limits and beyond of normal safety levels since they are in the mode of experimenting anyway and willing to risk their children's health in order to make them into typical children, or less autistic, at least. Some kids were hurt by overdoses of B6, it created nerve damage as I recall. There are reports of children beginning to have seizures after starting MeB12 injections. A boy a nearly poisoned to death with massive overdoses of Vitamin A at the hands of Dr. Jang, who is still a DAN! doctor. Abubakar was killed by "biomed." Who knows what the long term consequences will be for the kids getting monthly depot plus daily injections of Lupron? Certainly not the Geiers. Some children were very nearly killed by Dr. Edelson, not the one in Oregon, but the one who was in the Georgia. I expect as more people get toy HBOT baloons in their houses and use them against FDA approval, that is with an oxygen concetrator, that there will be children who are burned and families burned out of their homes. There are potential dangers in using the hard-shell HBOT tanks, too. There may be no harm in ALA, but the parents are trusting total idiots with advice like ALA will cure your child of autism, and that leads them down the path to more idiot quacks with bigger promises charging higher fees and apparently using riskier "treatments." How many went to Buttar and decided to add the urine injections just in case? Never mind his IV chelation.
Just this week the following rigorous study showing efficacy of EFAs came out. Mind you, it is a small sample size, but it seems worth pursuing.
I think you need to remember that one of the altie arguments really does make sense. There is no huge financial incentive for research into these areas. Even though there is money to be made in selling EFA's for example, anyone can sell EFA's and so the company paying for the research cannot be ensured a good payoff.
Biol Psychiatry. 2006 Aug 18;
Omega-3 Fatty Acids Supplementation in Children with Autism: A
Double-blind Randomized, Placebo-controlled Pilot Study.
* Amminger GP,
* Berger GE,
* Schafer MR,
* Klier C,
* Friedrich MH,
* Feucht M.
Department of Child and Adolescent Neuropsychiatry, Medical
University of Vienna; Vienna, Austria; and ORYGEN Research Centre,
University of Melbourne, Melbourne, Australia.
BACKGROUND: There is increasing evidence that fatty acid
deficiencies or imbalances may contribute to childhood
neurodevelopmental disorders. METHODS: We conducted a randomized,
double-blind, placebo-controlled 6-week pilot trial investigating the
effects of 1.5 g/d of omega-3 fatty acids (.84 g/d eicosapentaenoic
acid, .7 g/d docosahexaenoic acid) supplementation in 13 children
(aged 5 to 17 years) with autistic disorders accompanied by severe
tantrums, aggression, or self-injurious behavior. The outcome measure
was the Aberrant Behavior Checklist (ABC) at 6 weeks. RESULTS: We
observed an advantage of omega-3 fatty acids compared with placebo for
hyperactivity and stereotypy, each with a large effect size.
Repeated-measures ANOVA indicated a trend toward superiority of
omega-3 fatty acids over placebo for hyperactivity. No clinically
relevant adverse effects were elicited in either group. CONCLUSIONS:
The results of this study provide preliminary evidence that omega-3
fatty acids may be an effective treatment for children with autism.
Camille: It's very important for people to consider just not effectiveness, but also safety. With something like vitamin B6, people need to weigh the reports of benefit (which are weak anyway) with the real possibility of peripheral neuropathy. And chelation, in particular, can be dangerous in that chelators not only chelate heavy metals but also minerals and nutrients.ReplyDelete
Jennifer: That's an interesting report. Sounds like Omega-3 might help with hyperactivity and "sterotypy"? That's one of those things where it probably helps any child with those characteristics, not just autistic children. In other words, it's not going to do much for autism itself. Maybe Omega-3 is good for everyone?
PubMed entry of the study Jennifer mentioned. The children of the study have autism "accompanied by severe tantrums, aggression, or self-injurious behavior."ReplyDelete
Omega-3 fatty acids have long been touted as being good for everyone (hence all the food you can get with it listed on the package, like yogurt and eggs) but especially for people who have ADHD. That and fish oil.ReplyDelete
I can't speak from personal experience about either, as I haven't tried them (but I may well do so at some point), but one of the kids I worked with in Vancouver did this weird stimmy squinty thing with her eyes until the day her mom gave her cod liver oil. (This kid reacts immediately to anything new introduced into her system; if something is going to 'work' you know it within the hour.)
Which isn't to say that her autism was alleviated, but whatever it was that was making her want to do the weird stimmy thing was definitely helped by the cod liver oil.
From this read-through, it's sounding as though most of the autistic neurological differences are in the physical structure, whereas most treatments are in the (bio)chemical functioning. You're not going to do a lot to change the former with the latter!ReplyDelete
Generally those treatments that have found to be useful for autistics are those which are useful to most anyone, namely good / suitable nutrition. If there's something in the diet that causes problems, it should be removed from the diet. If there's something lacking in the diet, it needs to be added in. Doing these things helps the overall functioning of a person, including their abilities to sleep, work, play and learn. But that still doesn't change the fact that they are autistic, AD/HD et cetera!
Hi Joseph.ReplyDelete
As long as the carrot is out there, and some are convinced that the carrot must be obtained and is attainable, people will reach for it. Biomed may always have a lot to show for itself to the sellers.
Just in case anyone is interested.ReplyDelete
The children in the EFA study were recruited from a specialized day care center for long-term treatment of autistic children. So, I think that it is reasonable that they might have more agression than average. The outcome measure was the Aberrant Behavior Checklist, which is commonly used to assess the efficacy of pharmacutical drugs on autistic people.
There are other studies with Omega-3, for example this one on depression. They are studying it for bipolar disorder as well. It is believed to help neurodevelopment and retinal health. Omega-3 is one of those things which is just good for you. My only concern would be adverse effects after prolonged use. Can you just take a lot of it indefinitely? And what if you stop taking it?ReplyDelete
EFAs are essential to the human body. You need to get them from external sources because you cannot synthesize them yourself. There is an excellent article describing their role in health and disease here.ReplyDelete
The only danger of taking too much appears to be prolonged bleeding times. This is dangerous if you are expecting to undergo surgery, for example. Other than that you are always exposed to EFAs in your diet, so moderate supplementation would appear to be very safe.
Alpha-linolenic acid (ALA), the omega-3 fatty acid, is not the same as alpha-lipoic acid (ALA), an anti-oxidant, which JBJr. reveres as a chelator, right?ReplyDelete
Hi Joseph!ReplyDelete
Thank you so much for my comment over at the blog -- I've been looking over the material at Autism Hub and there's really a wealth of discussion over here. I'm going to add your blog and at least a few others to the blogroll so that my few readers can take advantage of the group resources.
Joseph - you are correct. Alpha-lipoic acid (the supposed chelator) is described here.ReplyDelete
It is an antioxidant. You will note that they describe many attributes of ALA (the supposed chelator), but chelation is not one of them ;)
It's not the same as alpha-linolenic acid, a plant-derived essential fatty acid.
Oops - I just saw the chelation section of the article. In the test tube it has been found to chelate copper and iron - not mercury.ReplyDelete
Thanks for stopping by. Hope you enjoy the Autism Hub. I see one of the topics of your blog is bioethics. Have you been following Kathleen's series on the Geiers over at neurodiversity.com?
Joseph --ReplyDelete
I'm just starting to. I've been over to neurodiversity before but not for a while. More for tomorrow...
Hi Joseph. I've just tagged you for a book meme -- have fun!ReplyDelete
As a parent who started down the biomed road with my son, I can say that in the beginning I saw what I wanted to see. After several months, my husband and I took a serious look at our son and realized we had spent a lot of time, hope, and money on wishful thinking. We won't make that same mistake again. Our son is a fascinating and brilliant human being who reminds us that when it comes to improving his life, we have to think with our brains, not our hearts.ReplyDelete
Thank you for validating our decision to follow the scientific and rational approach to living with autism.
If I had quit chelating after a few months, my son would still be, effectively, a vegetable. After two years of chelating, he's made tremendous progress. You gave up too soon. Chelation doesn't work that fast. The only reason Joseph can claim that there is no scientific proof of chelation working is because it's only been used to treat autism for about 6 years. Everyone's still trying to perfect it.
You can wait 20 or 30 years until some doctor tells you it works or you can help your kid now. You should talk to some parents who are watching their kids improve rather than listening to these folks who are out to prove that the drug companies caused no harm.
If I had quit chelating after a few months, my son would still be, effectively, a vegetable.ReplyDelete
That's, of course, Fore Sam speculating about what might have been.
The only reason Joseph can claim that there is no scientific proof of chelation working is because it's only been used to treat autism for about 6 years.
The only reason I can claim there is no scientific evidence (reserve "proof" for Math please) that chelation works is because there is no scientific evidence that chelation works as an autism treatment. Let's wait for Jim Adams' double-blind study and see. Even though Adams is a DANite, I trust he will report exactly what he sees.
Adams' study will be useless. It's not long enough. I'll expect you to be knocking it when it is released but you might as well start now.
"Adams' study will be useless. It's not long enough. I'll expect you to be knocking it when it is released but you might as well start now."ReplyDelete
Is Fore Sam acutally making a little bit of sense here (albeit for the wrong reason). The real reason it will be useless is that it uses DMSA (known, and repeated by Adams himself NOT to cross the blood brain barrier). Aditionally it looks to be dwindling - like a dozen or so participants left from the orginal 60 or so in the beginning. So what's up with that, 48 or so autisitic kids didn't actually have mercury toxicity? Go figure. Incidentially, according to Adams, the "toxicity" threshold level was 100% of the lab's refernece range for non-provoked levels. See the problems with that? Furthermore, it's doubtful that anything other that spot urine mercury levels will be reported as a ratio to creatinine - can you say "big holes in the methodology?"
12 out of 60? That's pretty bad and unfortunate. What happened there? Sound studies on this are necessary to be able to resolve the controversy once and for all.ReplyDelete
Isn't Adams using ALA? Andy Cutler is the one who should be doing a study.
I seriously doubt Andy Cutler would be in favor of double-blind studies of chelation.ReplyDelete


text:
Oil price sheds gains as supply worries ease
The price of oil edged downward again on Friday, surrendering most of the gains made the previous day, when it rose for the first time in two weeks.
By early afternoon in Europe, benchmark U.S. crude for August delivery was down 38 cents to $102.55 a barrel in electronic trading on the New York Mercantile Exchange. On Thursday, the Nymex contract closed up 64 cents at $102.93.
Brent crude, a benchmark for international oils, was 62 cents to $108.05 on the ICE Futures exchange in London.
Oil prices shot up in the last month to a 10-month high over concerns that strife in Iraq might disrupt supplies. However, they have since been easing back as al-Qaida-inspired militants' gains in Iraq did not affect oil exporters.
Also putting downward pressure on prices is the prospect of a sudden return of Libyan oil to the global market. Libyan exports have been all but cut off over the last several months because of labor and political strife that has shut ports and disrupted production. Agreements with local militias are now expected to open two ports, and a major field restarted production Tuesday.
The International Energy Agency cited only a small increase in oil production by Saudi Arabia, "prompt to respond to upward and downward shifts in global crude demand," as a sign that markets were well supplied.
"Contrary to seasonal patterns, the Kingdom barely hiked production in June, a sign that demand for its crude may not have significantly increased," the Paris-based IEA said in its monthly oil market report.
At the same time, the IEA slightly lowered its 2014 forecast of global oil demand due to weaker-than-expected economic data in the middle of the year while predicting demand would rise 1.5 percent next year, to 94.1 million barrels a day.
In other energy futures trading:
— Wholesale gasoline fell 0.72 cent to $2.9504 a gallon.
— Natural gas added 3.1 cents to $4.151 per 1,000 cubic feet.
— Heating oil was down 0.15 cent at $2.8918 a gallon.
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subset: commoncrawl


text:
Why an 1879 Voyage Is a Time Machine for Climate Change
A doomed Navy expedition kept exacting records that show the rapid weakening of the polar ice cap.
Climate-change researchers have long grappled with a particularly vexing problem: finding a way to figure out what the polar ice cap truly looked like a century ago in order to compare it with today's ice—its extent, its thickness, its overall strength and condition. To understand that, you'd have to take a time machine back into history, build a research station and trap it for years in the dangerously drifting icepack.
As it happens, a group of U.S.Navy explorers did just that in the early 1880s—by sailing a small ship...


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Jonah Travis shot 6-of-8 from the field and finished with 19 points (Gil Talbot).
CAMBRIDGE, Mass. – Jonah Travis tallied a career-high 19 points and grabbed a career-best 10 rebounds for a double-double, and Laurent Rivard added 14 points as the Harvard men's basketball team topped Seattle, 80-70, before 1,896 fans Sunday afternoon at Lavietes Pavilion.
Travis shot 6-of-8 from the floor and made 7-of-9 foul shots, while Rivard drained 6-of-7 chances from the line. With the victory, Harvard head coach Tommy Amaker earns the 250th of his head coaching career. The Crimson is off to its best start (8-0) since the 1984-85 campaign. Harvard also extends its home win streak to a program-best 19 straight games.
Up next, the Crimson will visit No. 8 Connecticut, the defending national champion, Thursday, Dec. 8 at 7 p.m. The game will be broadcast nationally on ESPN2.
Brandyn Curry netted eight points and dished out four assists and Kyle Casey netted eight points for the Crimson in the win over Seattle (2-4), while Clarence Trent (14 points) and Aaron Broussard (12 points) led the Redhawks. The Crimson shot 41.1 percent for the game (23-of-56), and went 29-of-36 from the foul line (.806). Seattle made 53.8 percent of its shots (28-of-52) in a losing effort.
Casey scored Harvard's first four points, as the Crimson lead, 6-4, early on. Casey added another bucket with just under 17 minutes to go in the half, as Harvard opened a 10-6 advantage. Seattle got back within one, 11-10, until Travis buried both from the line to get Harvard back up by three. With the shot clock winding down, Rivard converted on a difficult floater in the lane, making it 15-10 in favor of the Crimson.
With 11:33 left in the frame, Casey dished a pass to Corbin Miller, who nailed a trey from the left corner, as Harvard opened a 20-12 lead. The Redhawks scored the next two baskets to get back within four, 20-16, but Brandyn Curry answered with a jumper with just over nine minutes remaining.
Travis hit a fall away jumper and made the foul shot after being fouled with 8:17 to go, as the Crimson started to take control, 25-16. Seattle got back into the game with consecutive 3-pointers, cutting the deficit to five, 27-22, with 7:05 remaining. Travis converted another conventional 3-point play, as Harvard pushed the lead back to eight, 30-22. With just over five minutes late, Rivard nailed a trey from the corner, making it a 10-point game, 35-25. With 40 seconds left in the half, Travis followed a missed Harvard shot with a two-handed slam, bringing the crowd at Lavietes to its feet and making the score 42-30, entering halftime.
At the break, Travis led Harvard with 10 points in only eight minutes, while Rivard netted eight points in period one. Harvard made 12-of-14 foul shots in the first half (.857).
Opening the second, Casey hit a layup and Christian Webster buried a trey as Harvard grabbed its largest lead to that point, 47-32. After Oliver McNally made a conventional 3-point play after drawing harm, Rivard stepped to the line and drained two, making it 52-38. Rivard nailed another trey with just under 15 minutes left, as the Crimson opened a 17-point edge, 55-38.
With 13 minutes to go, Travis made another layup after being fouled and hit the ensuing free throw to make it 58-42 in favor of the Crimson. After Curry made three foul shots within 34 seconds, Steve Moundou-Missi made a basket on a tip-in, giving Harvard a 63-49 lead.
With 8:01 left, Curry buried a trey after receiving a pass from McNally, as the Crimson maintained a 15-point lead, 66-51. Travis continued to score in the paint and hit a left-handed shot, making it 70-54, with just over five minutes left. Travis capped off his double-double with an offensive board and a bucket with 2:56 to play, as Harvard led, 74-58.


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Special Projects
Hap Holly, KC9RP, founder, guiding light and moderator of the weekly amateur radio audio feature magazine known as RAIN - the Radio Amateur Information Network. From his home studio/ham shack in suburban Chicago, Hap produces his 12 to 17 minute weekly amateur radio program service, featuring timely interviews, thought-provoking commentaries from other hams, excerpts from Dayton Hamvention Forums and other items ofgeneral interest to the amateur community at large. Ham radio istraditionally an aural - as opposed to a visual - medium; we meet and recognize fellow hams primarily by voice, seldom seeing them in person. RAIN programming is also an aural medium, distributed to hundreds of repeaters across the country via the RAIN dial-up line, commercial satellite,(discontinued) Hap's subscription service on audio tape and on WA0RCR's weekly 160 meter informational broadcasts. Those repeater groups and others then replay the weekly RAIN tapes over their local repeater systems on their regular "net night" gatherings, permitting thousands of hams to hear Hap's offerings for that particular week. It's all done with volunteer help and - in the best of amateur traditions - without profit to anyone involved. Hap Holly makes it happen; he's an uncommonly intelligent and outgoing individual. Hap is also very aurally oriented and insists on quality in every way in his RAIN programming. He conducts most of the interviews, edits and engineers all of the program material, writes the scripts, duplicates and mails out the RAIN cassettes and archives and catalogs the RAIN library. It's all accomplished by touch and by ear...Hap is one of a number of non-sighted amateurs within our ranks, but you'd never know it. For Hap, blindness happened literally overnight...when he was only 7. Problems with his vision began when he was 4, but then he awoke one morning totally blind. The condition is untreatable, at least within current medical terms, but to Hap, it hasn't been a handicap. In fact, in talking to him over the years, most of his friends tend to forget his unusual challenges, because he does so much of what we all do, without mention of his visual impairment. Both of Hap's parents were blind, his father's resulting from a football accident in college and his mother's when she was around the age of 12. His father, nonetheless, was a successful building contractor and architect, formulating the plans he devised within his "mind's eye", then describing the details precisely to his secretary, who constructed balsa wood models. Then only by touch, Hap's dad would go over the "3-dimensional plans", incorporating additions or changes as needed. Hap's father was also a long time columnist for the Christian Science Monitor and was known world-wide for his "Ask a Builder" column, which he wrote from 1965 until his passing in 1984. He was a touch typist - as is Hap - and was able to generate his column by that method alone (before the days of computers, word processors and voice synthesizers). In 1988, a 420-page book was written about Hap's mother, depicting her struggle for independence from her New England industrialist father, her marriage to Hap's dad and the eventual challenges that two sightless parents encountered raising four sighted children - then Hap too became blind. That book, entitled "What Love Sees" and is being made into a made-for-TV movie this year, which will be shown on the CBS television network when completed.It will star Richard Thomas of the original "Walton's" series and Anna Beth Gish who played Pat Nixon in the widely acclaimed motion picture "Nixon" which also starred Anthony Hopkins. The TV movie, which is also entitled "What Love Sees", primarily takes place in the small southern California ranching town of Ramona (where much of it will be filmed) and reportedly will follow the Holly household up until shortly after the time that Hap's sight was lost, and the family was forced to move to a larger city - Escondido - to seek specialized educational opportunities for their youngest son. Be sure to watch for it this fall on television.( The movie aired in Sept., 1996 and again in June, 1999 on CBS; Lifetime aired it in Sept., 1999.) Hap's ham career began when he earned his Novice ticket in 1965, at the age of 14, receiving the call sign WN6UJH, while living in Escondido. He became a General - dropping the "N" in his call - a year later in 1966 and served as a phone-patch station and net control for the Westcars traffic net until 1970. Hap then headed off to Principia College in Elsah, Illinois and from 1970 to graduation in 1974, ran phone patches and kept radio schedules for his fellow students. He graduated with a Bachelor of Arts degree in Sociology, and soon found himself in the Chicago area, where he sought out world-class jazz accordionist Leon Sash, to pursue his other love, music. A year later, another love, Stephanie, became the center of Hap's attention and the two were married in August of 1976 after meeting the previous summer at the Roundup Ranch in Buena Vista, Colorado, where Hap was a counselor. Hap taught a class in non-visual perception to the high school campers at the ranch, all of whom were sighted, but who learned to "see" in yet another way ...with Hap's patient guidance. Hap's wife, Stephanie - who is also sighted - received her ham ticket in 1986 and the call KA9WKD, after realizing how much ham radio, and the good it was able to accomplish, meant to Hap. In 1977, Hap picked up the "9-land" call of WD9GJQ and he and Stephanie moved into their comfortable home in Des Plaines, Illinois where he resumed his phone-patching and DXing activities with his now permanent antenna and station set-up. In 1981, Hap passed his Advanced class license exam and changed calls once more, this time to his current KC9RP call sign. Hap served as ham radio informational programming guru for the BEAR, the Broadcast Employees Amateur Repeater in suburban Chicago, from 1984 to 1989. Hap's weekly "net nights" became something of a legend in the Chicago area, sometimes attracting in excess of 100 check-ins, via simulcasts on five area repeaters. This stint led to Hap's forming RAIN - the Radio Amateur Information Network - and the weekly RAINReport dial-up, and the bi-monthly RAIN Journal tape (produced especially for the blind amateur). According to Hap, "My inspiration for producing weekly ham radio programming resulted from my 'need to know' . I faithfully listened to the weekly Newsline (formerly WestLink Radio) reports in the early 1980's on my local repeater. I owe a great deal of gratitude to Newsline's founder and producer, Bill Pasternak, WA6ITF for his encouragement and direction. RAIN is truly an offspring of Newsline. In recent years, Hap has written for Spec-Com Journal, Radio Scan Magazine and occasionally reports for Newsline but with a human interest focus, as opposed to a news-only approach As mentioned before, Hap's RAIN programming can now be heard on hundreds of ham repeaters across the nation,by telephone, (847) 827-RAIN. (and here on www.rainreport.com)Vern Jackson, WA0RCR continues to carry the RAIN Report on his 160 meter Gateway Radio News letter AM bulletin service from Wentzville, Missouri on 1.860Mhz, Saturday afternoon/evening. Hap is a common sight at the yearly Dayton Hamvention, taping a number of the forums with the help and cooperation of the Hamvention organizers. these forums are then incorporated throughout the year in Hap's RAINReports,making Dayton come alive for those of us who may not be able to attend personally. Hap is active on HF, VHF and The Internet, using both a Pc equipted with the JAWS speech screen reader program. He will be retiring his Versa-Braille II Plus terminal, which allows an accomplished Braille reader like Hap to access his Internet E-Mail with nearly the speed of a sighted user. He hopes to be mastering all RAIN audio digitally by summer. As a professional keyboardist, Hap's diverse repertoire of American music from the past 60 years has made him a popular choice in the Chicago area.Since 1975 Hap has been an active and honored member of theDes Plaines Lions Club and received the prestigious international Melvin Jones Fellowship plaque for his service to humanity. As a member of the Des Plaines Toastmasters since 1976, Hap has served as its president a number of times, and has twice served as an area governor. He and Stephanie are currently active with Des Plaines EMA. For Hap Holly, blindness has never been a disability, only a challenge that has served to "fine-tune" his other senses. If you have a friend or relative with a serious handicap or disability, and you've felt that amateur radio would be a worthwhile hobby for them to pursue, perhaps Hap's extra-ordinary story might be just the inspiration they would need to take the plunge. Hap would disagree with my choice of terms (extra-ordinary) since he considers his accomplishments no more than the expected effort required to achieve anything worthwhile...but then that's the sign of extra-ordinary people isn't it? Hap's RAIN Dialup can be accessedby calling: 1-847-827-RAIN (7246).


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The Villages At Lakeshore
Market Snapshot of Real Estate Listings in The Villages At Lakeshore Neighborhood, Columbia , SC 29229
The current prices for all Real Estate Listings in The Villages At Lakeshore Neighborhood, Columbia , SC are reflected in the table below.
|Total Number
The Villages At Lakeshore Neighborhood, Columbia SC Real EstateModify Search Criteria
304 Calhoun
Winnsboro, SC 29180
LOOK AGAIN! PRICE REDUCED!! Neighborhood Church property located on corner lot in Winnsboro. 3,300 SF block construction with large sanctuary, balc...
100 S Congress
Winnsboro, SC 29180-1104
Retail furniture store in heart of Winnsboro, next to Town Clock! Over 8,000 square feet to meet your business needs. Freight elevator on premise...
235 Satterwhite
Whitmire, SC 29718-9999
Old Carver Middle School property. The building at the back has been remodeled and was used as a church. Great for daycare, church or community c...
150 Main
Whitmire, SC 29145
Look no further for a a place to start your business, in the town of Whitmire. Ideal for office space or boutique and various other business.
23636 Us Highway
Whitmire, SC 29178
Previous Successful Restaurant that's currently used as a Community center. Great Opportunity. Previously Used as a Restaurant with Additional Grea...
822 Williams
West Columbia, SC 29169
Prime location in the heart of West Columbia! Almost 10,000 square feet of usable space. Massive upfit is 95% complete, with 3300 sf newly finished...
1215 Augusta
West Columbia, SC 29169
GREAT LOCATION!! This commercial property is currently used as a Pawn Shop, moped repair business, and rental property upstairs. This is the perfec...
3019 Charleston
West Columbia, SC 29172
Great multi-use property in booming Lexington County. Currently set up as a warehouse with loading docks and lots of paved space in the back. Fin...
1323 Platt Springs
West Columbia, SC 29169
BRING OFFERS on this 2 story Triangle City office building built as 10 units with separate exterior doors, bathrooms, meters and thermostats. Recen...
409 Barron
West Columbia, SC 29169
REDUCED!!! You can't find a better LOCATION for your business in West Columbia. Close to downtown Columbia. Just a block off of Hwy 378. Turn of...
Reduced -$7,000
130 McSwain
West Columbia, SC 29169
Two Multi-Purpose Commercial Buildings. Suitable for child care, adult day care, medical offices, dentist, retail/business offices, service/supply,...
2001 Sunset
West Columbia, SC 29169
Corner lot located on Hwy 378 & Arehart St. near Lexington Medical Center. Inbound side to Columbia. Great location for new business. Adjacent prop...
352 Garners Terrace
West Columbia, SC 29171
Great open large metal building of 23,000 sq. ft. has many possibilities sits on 9 acres and has up to 63 acres that can be purchased that is attac...
Reduced -$25,000
180 Ballington
West Columbia, SC 29171
Almost 9 acres with (1) building 1960 sq.ft , (1) building 5000 sq.ft. , (1) building 1200sq.ft., (2) open sheds 2000sq.ft. this property has all t...
3460 Charleston
West Columbia, SC 29171
Great location on Charleston Hwy. in front of the entrance to the State Farmers Market'. The corner lot with traffic lights for easy access in and ...
Increase +$125,000
3032 Sunset
West Columbia, SC 29169
Call listing agent to see or show. Value is in land, not structure
2120 Old Dunbar Rd
West Columbia, SC 29172-3920
The property consists of 3 buildings, (1)building 14x50 fully insulated with car lift, A/C and water (2) building 20x60 front open with water, (3)b...
935 Sunset
West Columbia, SC 29169
Business location in the path of development. One acre corner lot including 12,300 sf of warehouse/industrial space and 1200 sf of flex/office spac...
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3920 Platt Springs Rd
West Columbia, SC 29170
620 Sunset
West Columbia, SC 29169
Hwy 378 frontage and extremely visible from Jarvis Klapman. This property is continuous to one of the entrance points to the riverwalk. From the eq...
1420 Charleston
West Columbia, SC 29169
Awesome opportunity to own this Turn Key bar/ restaurant/ nightclub fully equipped with furniture, fixtures, and all you need to start your new bus...


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A generation ago, defiant residents of Allegany County blocked the state from establishing a dump licensed to handle the state's radioactive waste in their community. Today, a handful of the same people object to a private company's plan to boost imports of radioactive wastes from Pennsylvania gas drilling to its Allegany landfill.
The state Department of Environmental Conservation is weighing whether to let Casella Waste Systems expand its Hyland Landfill in Angelica by 49 percent.
State officials have not responded to requests for a full environmental review or even a public hearing on the plan. They have reason to tread lightly. The last time Alleghany residents mobilized on this issue, in 1990, they mounted horses to resist state troopers and built barricades with old tractors and manure spreaders.
The state then canceled its planned licensed radioactive waste dump, sending shock waves across the country. Since then virtually every state has scrambled to find any community willing to accept a licensed dump for its "low-level" radioactive waste. Almost all, including New York, have failed.
That has left the oil and gas industry without enough licensed facilities to handle its substantial radioactive waste. In response, the federal government and the states have eased rules for disposal, backtracking on accepted scientific conclusions about the gravity of the risk.
At the federal level, the so-called Halliburton Loophole in the Energy Policy Act of 2005 exempted oil and gas waste from key provisions of the 1972 Clean Water Act and the 1974 Safe Drinking Water Act.
At the state level, the DEC has if anything been even more complicit in denying the risk of radioactive waste so private companies can sidestep the cost of addressing it. The agency now allows Hyland and four other Southern Tier landfills -- none with a license to handle radioactive waste -- to import drill cuttings and other wastes from hydraulic fracturing, or fracking, of Marcellus shale wells in Pennsylvania.
Currently, New York restricts fracking in its Marcellus shale. But if industry wins its long-running bid to frack here, the facilities for the resulting radioactive waste will be waiting.
Shale formations are known to have high levels of naturally occurring radioactive material, or NORM, and the Marcellus is suspected to be the most contaminated of all the nation's shales.
So, to help out, DEC officials adopted an aggressive if not radical legal interpretation. They declared that they had no authority to regulate NORM that had not been "processed and concentrated," and then they interpreted "processed and concentrated" so narrowly that it never applied.
This loophole means the level of radioactivity in fracking waste is legally irrelevant to the DEC. High or low, it doesn't matter, the agency argued in support of a 2010 plan by Casella to import Marcellus wastes to the Chemung County Landfill, which it operates.
An administrative law judge at the DEC agreed, brushing aside arguments by Dr. Earl Robinson, a pulmonologist who lives a mile from the Chemung landfill. Robinson predicted that radon would escape into the air and lethal Radium 226 would leach into groundwater and the nearby Chemung River, raising risks for lung and bladder cancers.
Many Marcellus gas wells are highly contaminated with radium isotopes, particularly Radium 226, a carcinogen that remains radioactive for 1600 years. It decays into Radon, the nation's second-leading cause of lung cancer (after smoking). Both are most dangerous when swallowed or inhaled, and roughly 20 percent of ingested radium reaches the bloodstream. From there, it tends to accumulate in the bones, where it raises risks for bone cancers and leukemia.
When the DEC conducted tests of brine from all 12 of New York State's conventional Marcellus wells in 2008 and 2009, it found alarmingly high levels of Radium 226 in more than half. Readings were up to 260 times the legal limit for release into the environment.
Those readings -- inadequately labeled and buried in an appendix to a lengthy DEC analysis of gas drilling -- alarmed the New York State Department of Health and the New York City Department of Environmental Protection.
"These data raise serious issues for public health, particularly with disposal of both solid waste (i.e. drill cuttings and equipment) and wastewater," the NYCDEP wrote. One high-ranking city environmental official said further analysis "must be completed before any activity that is likely to generate radioactive waste can move forward."
The DEC disagreed. But it sidestepped a legal confrontation with the city over radiological regulation when it ruled that any gas well within the city's watershed would not qualify for the state's planned fast-track Marcellus drilling permit system. The city, effectively shielded from drilling risk, no longer needed to contest the issue.
The DEC's loophole on NORM has been a gift to Pennsylvania frackers, who are beginning to run out of options. Even that frack-friendly state has announced plans for a comprehensive study of radioactivity in fracking waste.
New York has made no similar move to educate itself, choosing instead to continue to hide its head in the sand like an ostrich.
• Peter Mantius is a freelance journalist from Schuyler County who follows shale gas drilling issues. He is a former reporter at the Atlanta Journal-Constitution and former editor of two business weeklies in the Northeast.
Marcellus Watch: The DEC plays ostrich on radioactive waste
A generation ago, defiant residents of Allegany County blocked the state from establishing a dump licensed to handle the state's radioactive waste in their community. Today, a handful of the same people object to a private company's plan to boost imports of radioactive wastes from Pennsylvania gas drilling to its Allegany landfill.


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Okay, that's a misleading title. This is a somewhat subtler problem than undergraduate linear algebra, although I suspect there's still an easy answer. But I couldn't resist :D.
Here's the actual problem: We're given a black-box linear transformation from $V \rightarrow W$, where $V, W$ are vector spaces of dimensions m, n respectively (say m < n), and we want to know if it has full rank. (Numerical considerations aren't an issue; if you want, say it's over a finite field.) This is easy to do in time $O(m^2n)$ and with m calls to the black-box function, just by computing the image of a basis in m and using Gaussian elimination. It's also immediately obvious that we can't do better than m calls to the function in a deterministic algorithm, and I'm pretty sure but haven't quite managed to prove that you can't beat Gaussian elimination asymptotically either.
But can we do better if we just want a probabilistic algorithm? If we're allowed to make as many function calls as we want? What's the best lower bound we can get, probabilistically? These are probably pretty trivial questions (since everything's linear-algebraic and nice), but I just don't know how to approach them.


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Report: Hasek, 47, interested in NHL comebackby Michael Langr
It's been almost 13 years since goalie Dominik Hasek announced his retirement for the first time. Since then, his career his continued in fits and starts.
Instead of contemplated retirement, Hasek was eventually traded to the Detroit Red Wings and won the Stanley Cup with them in 2002. He officially retired after that, but after just a one-year break, he came back to join the Wings again. He continued playing after the lockout for the Ottawa Senators and came back to Detroit one more time to win the Cup and announce another retirement in 2008.
But after another one-year break he returned to the crease, this time to win the Czech Extraliga title with HC Pardubice, where he had started his career. In 2010, Hasek signed a one-year deal with the Spartak Moscow in the Kontinental Hockey League. He retired once more last year.
"I am working hard almost every day. I am in great shape. And the other side knows that. If the deal is done, I would start with even more intense workout from the end of June or so. I am not skating yet, I usually do that just before the season. But it does not mean I am not getting ready. Now we have to wait what happens and start right from there."
-- Dominik Hasek, as told to Denik Sport
Now, at the age of 47, the Dominator wants to come back once again.
And, surprisingly, it seems that the NHL is the only option for him.
According to Czech newspaper Denik Sport, Detroit or Tampa Bay are among teams that might come into play.
Hasek travelled to the United States earlier this month to visit his son, Michal, at Michigan State University, but he reportedly also met with the managers of a few NHL clubs.
"We are working on [a new deal] but I don't know the answer yet," Hasek told Denik Sport.
Despite his most recent retirement, Hasek spent a busy year full of other sports: cycling, skiing, spinning, soccer and volleyball. His various activities drove him to cross Albania by bike, to ski on a glacier in the Alps with Czech Olympic downhill skiing medalist Sarka Zahrobska, and to compete with professional drivers while racing at the Lamborghini Super Trofeo Race in Barcelona.
"I wanted to do some sport at least five times a week. I wanted to stay in a good shape to be ready to step into the hockey training again," Hasek told NHL.com in March.
At the time, he said he had a plan when he returned to hockey training, but refused to discuss it. Now, it appears Hasek had his eye on the NHL all along.
"Of course, my agent Rich Winter knows about what I want. But I don't want to comment on that any further. Nothing changed in my plans. But right now, I don't have anything in front of me. So I'm waiting. I think in June the decision will be made," Hasek told Denik Sport. "I know where I would like to play, but I don't want to talk about it. I think it's better to keep it between the two sides involved. It wouldn't be appropriate to publish anything right now."
Hasek's trip to North America is not the only indication that the Dominator is aiming toward the NHL.
He turned down the offer from the Czech club KLH Chomutov and he admitted that Russia was not interesting for him anymore.
"I don't know about [the offers from the Russian clubs]. And, to be honest, I don't even care," he said. "I've had many offers from European clubs, but my answer was just: 'No, thank you.' That was not what I wanted."
Apparently, what he wants is the NHL.
It is a pretty daring plan, but as he has proven many times, nothing is impossible for the Dominator.
Hasek has won the Stanley Cup twice (2002 and 2008), Olympic gold (1998) and three domestic league titles (1987, 1989 and 2010). He has six Vezina and two Hart Trophies on his mantle.
But spending evenings on the sofa showing off his silverware and telling kids stories about "how it once was when I was playing hockey" is not an attractive outlook for this restless character.
Instead of sitting and looking forward to becoming a grandpa one day, Hasek has talked with his personal coach Josef Bruk about setting plans for the summer training.
"I am working hard almost every day. I am in great shape. And the other side knows that," he told Denik Sport. "If the deal is done, I would start with even more intense workout from the end of June or so. I am not skating yet, I usually do that just before the season. But it does not mean I am not getting ready.
"Now we have to wait what happens and start right from there."


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Thursday, June 30, 2011
Change Is Good
Posted by Sarah at 7:39 AM 0 comments
Labels: Kids
Tuesday, June 28, 2011
Sock Bun Curls
Thanks to Pintrest I have recently been inspired to try new hair styles. I have found a bunch of cute styles that are fast and look like I made a bit of effort to be presentable.
Last night I attempted the sock curl. Basically you put your dry/damp hair in a high pony tail (kinda loose) and then using a sock you roll your hair up into one big curl. I tied the two ends of the sock together and went to bed. When I woke up I just undid the whole thing and used a little shine spray to cut done on the frizz and we were done. Mine doesn't look as amazing as that chick but I am pleased with the results.
Posted by Sarah at 9:14 AM 0 comments
Labels: Life
Monday, June 27, 2011
Simple Skirt
I attempted to make a modified circle skirt this morning using a wide piece of elastic and let's just say I had to move to Plan B. I have made this simple skirt for my daughter about three times now and each time I get faster and faster.
Posted by Sarah at 2:47 PM 1 comments
Labels: Sewing Projects
Friday, June 24, 2011
Butterfly Garden Excitement
Insect Lore's Butterfly Garden has been my go-to birthday gift for the past year. I love that the gift teaches and the excitement lasts longer than one day. I finally bought one for my kiddos and its arrival was pretty exciting!
Posted by Sarah at 10:40 AM 2 comments
Thursday, June 23, 2011
Items May Appear Smaller At The Store
Posted by Sarah at 7:32 AM 0 comments
Labels: Cocktails and Crafts
Tuesday, June 21, 2011
The Superhero Federation Wants You!
I recently made all my nephews and niece superhero capes. I am not going to go into detail on how to make them but if you Google "Superhero Cape Tutorial" you will come up with about 1,020,000 results. What I will share with you is how I made the arrival of the capes in the mail a little more exciting.
Rather than sending them from Aunt Sarah, I sent them from the Superhero Federation. Here is how I did it.
I whipped up a logo on Photoshop and then I wrote the following letter:
Now you can send out your own Superhero Federation letter using the following links:
Superhero Letter (Word Format)
Superhero Federation Logo
Hope your little Superheros enjoy it as much as mine did!
Posted by Sarah at 12:40 PM 3 comments
Thursday, June 16, 2011
My Crafting Space
If you read or follow craft blogs you might have noticed the trend to post about your awesome craft room and show how neat and tidy you keep it all the time. If that is the kind of inspiration you are looking for, I suggest you stop reading the rest of this post. If you are looking for ways to store all your craft/yarn/fabric stuff without your house being taken over by storage totes then you should continue to read.
While I didn't have the
guts foresight to take a before picture, you will just have to take my word that it wasn't pretty.
So without further ado... my craft space.
So that brings us to the storage part. Like I mentioned before, imagine a small walk-in closet filled with storage totes (and some clothes). I could never find anything and if I did find what I was looking for, getting it out was hard physical labor.
Enter the storage piece...
I still have some random supplies around, like patterns, random craft tools I picked up for Cocktails and Crafts and stuff I have no idea what to do with but feels like a waste to throw it away. Right now that is all under my bed.
I am learning more and more that in a small space organization in key to keeping your sanity. While I do love my new blue beauty I can still dream about my ideal craft room (and third bedroom, playroom and basement).
Posted by Sarah at 1:32 PM 0 comments
Labels: Cocktails and Crafts
Sunday, June 12, 2011
Must Make These!
Source: coolmomtech.com via Sarah on Pinterest
Posted by Sarah at 7:10 PM 1 comments
Wednesday, June 8, 2011
Crochet Sausage Links Pattern
You made have heard (or read) that my family loves sausage! My kids wanted to help but clearly couldn't with raw pork involved so I came up with this solution. Now they can help make and cook sausage.
Crochet Sausage Links Pattern
Hook: US F5/3.75mm
Yarn: Worsted weight. I used Red Heart Eco-Ways in Cinnabar.
Step 2: 6 Single Crochet (SC) in second stitch from the hook, join with slip stitch to create circle (6 stitches)
Step 3: 2 SC in each stitch (12 stitches)
Step 4: 1 SC in next stitch, 2 SC in next stitch - repeat around (18 stitches)
Step 5: SC each round until you get the desired length of sausage (18 stitches)
Step 6: To start decrease: 1 SC in next stitch, Single Crochet 2 stitches together (SC2tog), repeat around (12 stitches)
Step 7: SC2tog around (6 stitches)
Step 8: SC2tog around (3 stitches)
Step 9: Chain 5
Repeat Steps 2 - 9 until you have the desired number of sausage links.
I took some stash yarn and tied little bows since in my mind that is how sausages look, even though we personally don't make sausage like that.
Sausage Links by Sarah Boccolucci is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
Posted by Sarah at 12:29 PM 1 comments
Labels: Crochet Projects
Tuesday, June 7, 2011
Puff Daddy's Baby
I think I will make another that is fatter and shorter so I can make sure all newborns will fit on the cushion. The pattern calls for it to be knitted flat and then seamed but I wasn't up for that so I cast-on with smaller needles and more stitches (US 17 - 12.75 mm and somewhere around 40 stitches).
To make this size took three skeins of Jiffy held together. I could even gotten away with using two since I created a gray pillow case to hold the polyfil - I hate seeing the white polyfil peak through. I also seamed one end using elastic so I could pull the pillowcase out for easy cleaning, newborns can be unpredictable like that.
Posted by Sarah at 1:13 PM 0 comments
Labels: Knitting Projects
Monday, June 6, 2011
Grandpa's Smoked Sausage
Over the weekend we made homemade elk sausage from a recipe my husband got from his Grandfather. Homemade smoked sausage is better than anything you can find in the store. We load it up with enough garlic to make our house stink for a couple days and we loooove it.
We are lucky enough to also have his old Stimpson meat grinder that has the sausage attachment. This thing weighs a ton but gets the job done.
We made about 45 pounds of sausage! Apparently, my husband and I don't believe in cooking small batches of things we love. A batch of homemade raviolis has been known to number in the 400s.
The Recipe:
75% Pork
25% Elk
Casings (local butcher shop can get you how much you need)
For every 15 lbs of meat:
1 tablespoon black pepper
3 tablespoons salt
3 cloves of garlic (or 5-6 if you really like garlic)
2/3 cup warm water
Hickory chips
Posted by Sarah at 2:11 PM 2 comments
Labels: Food
Friday, June 3, 2011
Cake Wreck
I made this super yummy white cake today and had visions of what the photograph would look like. Nicely frosted with chocolate frosting and fresh raspberries, placed outside on our patio set. That isn't what it looks like at all. It looks like my golden retriever tried her hand at cake decorating. I am pretty sure my three year old could have done a better job than this.
Don't be fooled by the picture, the cake tastes amazing. I failed to grease the pan enough or let them sit too long before getting them out of the pan. I tried some surgery with frosting but frosting couldn't save this disaster.
If you can get past the photo and take my word that it really does taste good then check out the recipe after the picture. It is my take on a white cake recipe from AllRecipe.com.
2 cup white sugar
1/2 cup butter
1/2 cup shortening
4 eggs
4 teaspoons vanilla extract
3 cups all-purpose flour
3.5 teaspoons baking powder
1 1/2 cup milk
Posted by Sarah at 4:29 PM 3 comments
Labels: Food
Wednesday, June 1, 2011
Project Intervention
Do you ever feel like you project list is just getting longer and nothing is ever crossed off? I was taking stock of all the projects I have either started or bought the materials for but haven't started and it is slightly embarrassing.
1. Cathedral window quilt
2. Knitting photo prop
3. Two Tunisian crochet patterns I need to commit to paper
4. Refashioned t-shirt dress
. Anchor t-shirts for pirate themed birthday (wow, one I can actually cross off)
6. Zig zag quilt
7. Refinished dresser to house all my craft supplies (in progress)
8. Bird fascinator - oh yeah.
I feel like every time I start a project it inspires another project, especially those involving yarn. Maybe I need a craft intervention?
Posted by Sarah at 12:09 PM 1 comments
Labels: Cocktails and Crafts


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13 years and four billion devices later
DLNA Certification remains in demand for consumer electronics manufacturers, middleware vendors and software developers. Whether you need interoperability with other DLNA Certified devices or interoperability of your own branded devices, DLNA Certification ensures that your certified products have implemented the features necessary to comply with the DLNA Guidelines, and that they will interoperate with other DLNA Certified products.
To aid in DLNA Certification, DLNA Test Tools were developed to streamline the process. The tools lower the cost to develop new products and free up engineers' precious time. More information about the DLNA Test Tools.
Join over four billion certified devices. Learn more about DLNA Certification.


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The facts about Multiple Myeloma.
Multiple myeloma starts in plasma cells, a type of white blood cell. It's also called plasma cell myeloma. In 2012, about 22,000 Americans will be diagnosed with this disease.
This booklet is only about multiple myeloma. It is not about bone cancer. Although multiple myeloma affects the bones, it begins in plasma cells. Bone cancer begins in bone cells. It's diagnosed and treated differently from multiple myeloma.
Also, this booklet is not about plasmacytoma (a collection of abnormal plasma cells that forms a single tumor) and other types of plasma cell tumors.
This booklet tells about diagnosis, treatment options, and tests the doctor may give you during follow-up visits. It also tells about supportive care before, during, or after treatment. Learning about the medical care for multiple myeloma can help you take an active part in making choices about your care.
This booklet has lists of questions that you may want to ask your doctor. Many people find it helpful to take a list of questions to a doctor visit. To help remember what your doctor says, you can take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend go with you when you talk with the doctor – to take part in the discussion, to take notes, or just to listen.
What is Multiple Myeloma?
Multiple myeloma is a type of cancer. Cancer is a group of many related diseases. Myeloma is a cancer that starts in plasma cells, a type of white blood cell. It's the most common type of plasma cell cancer.
Normal Blood Cells
Most blood cells develop from cells in the bone marrow called stem cells. Bone marrow is the soft material in the center of most bones.
Stem cells mature into different types of blood cells. Each type has a special job:
- White blood cells help fight infection. There are several types of white blood cells.
- Red blood cells carry oxygen to tissues throughout the body.
- Platelets help form blood clots that control bleeding.
Plasma cells are white blood cells that make
. Antibodies are part of the
immune system
. They work with other parts of the immune system to help protect the body from germs and other harmful substances. Each type of plasma cell makes a different antibody.
Normal plasma cells help protect the body from germs and other harmful substances.
Myeloma Cells
Myeloma, like other cancers, begins in cells. In cancer, new cells form when the body doesn't need them, and old or damaged cells don't die when they should. These extra cells can form a mass of tissue called a growth or tumor.
Myeloma begins when a plasma cell becomes abnormal. The abnormal cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. These abnormal plasma cells are called myeloma cells.
In time, myeloma cells collect in the bone marrow. They may damage the solid part of the bone. When myeloma cells collect in several of your bones, the disease is called "multiple myeloma." This disease may also harm other tissues and organs, such as the kidneys.
Myeloma cells make antibodies called M proteins and other proteins. These proteins can collect in the blood, urine, and organs.
Myeloma cell (abnormal plasma cell) making M proteins.
Risk Factors for Multiple Myeloma
No one knows the exact causes of multiple myeloma. Doctors seldom know why one person
develops this disease and another doesn't. However, we do know that multiple myeloma isn't contagious. You cannot catch it from another person.
Research has shown that certain risk factors increase the chance that a person will develop this disease. Studies have found the following risk factors for multiple myeloma:
- Age over 65: Growing older increases the chance of developing multiple myeloma. Most people with myeloma are diagnosed after age 65. This disease is rare in people younger than 35.
- Race: The risk of multiple myeloma is highest among African Americans and lowest among Asian Americans. The reason for the difference between racial groups is not known.
- Being a man: In 2011, about 11,400 men and 9,100 women will be diagnosed with multiple myeloma in the United States. It is not known why more men are diagnosed with the disease.
- Personal history of monoclonal gammopathy of undetermined significance (MGUS): MGUS is a benign condition in which abnormal plasma cells make M proteins. Usually, there are no symptoms, and the abnormal level of M protein is found with a blood test. Sometimes, people with MGUS develop certain cancers, such as multiple myeloma. There is no treatment, but people with MGUS get regular lab tests (every 1 or 2 years) to check for a further increase in the level of M protein. They also get regular exams to check for the development of symptoms.
- Family history of multiple myeloma: Studies have found that a person's risk of multiple myeloma may be higher if a close relative had the disease.
Many other suspected risk factors are under study. Researchers have studied whether being exposed to certain chemicals or germs (especially viruses), having alterations in certain genes, eating certain foods, or being obese increases the risk of developing multiple myeloma. Researchers continue to study these and other possible risk factors.
Having one or more risk factors does not mean that a person will develop myeloma. Most people who have risk factors never develop cancer.
Symptoms of Multiple Myeloma
Common symptoms of multiple myeloma include:
- Bone pain, usually in the back and ribs
- Broken bones, usually in the spine
- Feeling weak and very tired
- Feeling very thirsty
- Frequent infections and fevers
- Weight loss
- Nausea or constipation
- Frequent urination
Most often, these symptoms are not due to cancer. Other health problems may also cause these symptoms. Only a doctor can tell for sure. Anyone with these symptoms should tell the doctor so that problems can be diagnosed and treated as early as possible.
How is Multiple Myeloma Diagnosed?
Doctors sometimes find multiple myeloma after a routine blood test. More often, doctors suspect multiple myeloma after an x-ray for a broken bone. Usually though, patients go to the doctor because they are having other symptoms.
To find out whether such problems are from multiple myeloma or some other condition, your doctor may ask about your personal and family medical history and do a physical exam. Your doctor also may order some of the following tests:
- Blood tests: The lab does several blood tests:
- Multiple myeloma causes high levels of proteins in the blood. The lab checks the levels of many different proteins, including M protein and other immunoglobulins (antibodies), albumin, and beta-2-microglobulin.
- Myeloma may also cause anemia and low levels of white blood cells and platelets. The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets.
- The lab also checks for high levels of calcium.
- To see how well the kidneys are working, the lab tests for creatinine.
- Urine tests: The lab checks for Bence Jones protein, a type of M protein, in urine. The lab measures the amount of Bence Jones protein in urine collected over a 24-hour period. If the lab finds a high level of Bence Jones protein in your urine sample, doctors will monitor your kidneys. Bence Jones protein can clog the kidneys and damage them.
- X-rays: You may have x-rays to check for broken or thinning bones.An x-ray of your whole body can be done to see how many bones could be damaged by the myeloma.
- Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether myeloma cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Your doctor removes some bone marrow from your hip bone or another large bone. A pathologist uses a microscope to check the tissue for myeloma cells. There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit:
- Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
- Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.
You may want to ask your doctor these questions before having a bone marrow aspiration or biopsy:
- Will you remove the sample of bone marrow from the hip or from another bone?
- Where will I go for this procedure?
- Will I have to do anything to prepare for it?
- How long will it take? Will I be awake?
- Will it hurt? What will you do to prevent or control the pain?
- Are there any risks? What are the chances of infection or bleeding after the procedure?
- How long will it take me to recover?
- How soon will I know the results? Who will explain them to me?
- If I do have multiple myeloma, who will talk to me about next steps? When?
Staging of Multiple Myeloma
If the biopsy shows that you have multiple myeloma, your doctor needs to learn the extent (stage) of the disease to plan the best treatment. Staging may involve having more tests:
- Blood tests: For staging, the doctor considers the results of blood tests, including albumin and beta-2-microglobulin.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your bones.
- MRI: A powerful magnet linked to a computer is used to make detailed pictures of your bones.
Doctors may describe multiple myeloma as smoldering, Stage I, Stage II, or Stage III. The stage takes into account whether the cancer is causing problems with your bones or kidneys. Smoldering multiple myeloma is early disease without any symptoms. For example, there is no bone damage. Early disease with symptoms (such as bone damage) is Stage I. Stage II or III is more advanced, and more myeloma cells are found in the body.
How to Treat Multiple Myeloma?
People with multiple myeloma have many treatment options. The options are watchful waiting, induction therapy, and stem cell transplant. Sometimes a combination of methods is used.
Radiation therapy is used sometimes to treat painful bone disease. It may be used alone or along with other therapies.
The choice of treatment depends mainly on how advanced the disease is and whether you have symptoms. If you have multiple myeloma without symptoms (smoldering myeloma), you may not need cancer treatment right away. The doctor monitors your health closely (watchful waiting) so that treatment can start when you begin to have symptoms.
If you have symptoms, you will likely get induction therapy. Sometimes a stem cell transplant is part of the treatment plan.
When treatment for myeloma is needed, it can often control the disease and its symptoms. People may receive therapy to help keep the cancer in remission, but myeloma can seldom be cured. Because standard treatment may not control myeloma, you may want to talk to your doctor about taking part in a clinical trial. Clinical trials are research studies of new treatment methods.
Your doctor can describe your treatment choices, the expected results, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your needs.
Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat multiple myeloma include hematologists and medical oncologists. Your health care team may also include an oncology nurse and a registered dietitian.
Before treatment starts, ask your health care team to explain possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.
You may want to ask your doctor these questions before you begin treatment:
- What stage of myeloma do I have?
- Is the disease affecting my kidneys?
- How do I get a copy of the report from the pathologist?
- What are my treatment choices? Which do you recommend for me? Why?
- Will I have more than one kind of treatment? How will my treatment change over time?
- What are the expected benefits of each kind of treatment?
- What are the risks and possible side effects of each treatment? What can we do to control the side effects?
- What can I do to prepare for treatment?
- Will I need to stay in the hospital? If so, for how long?
- What is the treatment likely to cost? Will my insurance cover the cost?
- How will treatment affect my normal activities?
- Would a clinical trial be right for me? Can you help me find one?
- How often should I have checkups?
Watchful Waiting
People with smoldering myeloma or Stage I myeloma may be able to put off having cancer treatment. By delaying treatment, you can avoid the side effects of treatment until you have symptoms.
If you and your doctor agree that watchful waiting is a good idea, you will have regular checkups (such as every 3 months). You will receive treatment if symptoms occur.
Although watchful waiting avoids or delays the side effects of cancer treatment, this choice has risks. In some cases, it may reduce the chance to control myeloma before it gets worse.
You may decide against watchful waiting if you don't want to live with untreated myeloma. If you choose watchful waiting but grow concerned later, you should discuss your feelings with your doctor. Another approach is an option in most cases.
You may want to ask your doctor these questions before choosing watchful waiting:
- If I choose watchful waiting, can I change my mind later on?
- Will the cancer be harder to treat later?
- How often will I have checkups?
- Between checkups, what problems should I tell you about?
Induction Therapy
Many different types of drugs are used to treat myeloma. People often receive a combination of drugs, and many different combinations are used to treat myeloma.
Each type of drug kills cancer cells in a different way:
- Chemotherapy: Chemotherapy kills fast-growing myeloma cells, but the drug can also harm normal cells that divide rapidly
- Targeted therapy: Targeted therapies use drugs that block the growth of myeloma cells. The targeted therapy blocks the action of an abnormal protein that stimulates the growth of myeloma cells.
- Steroids: Some steroids have antitumor effects. It is thought that steroids can trigger the death of myeloma cells. A steroid may be used alone or with other drugs to treat myeloma.
You may receive the drugs by mouth or through a vein (IV). The treatment usually takes place in an outpatient part of the hospital, at your doctor's office, or at home. Some people may need to stay in the hospital for treatment.
The side effects depend mainly on which drugs are given and how much:
- Blood cells: When a drug used for myeloma treatment lowers the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop therapy for a while or reduce the dose of drug. There are also medicines that can help your body make new blood cells.
- Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may be somewhat different in color and texture.
- Cells that line the digestive tract: Chemotherapy and targeted therapy can cause poor appetite, nausea and vomiting, diarrhea, constipation, or mouth and lip sores. Ask your health care team about medicines and other ways to help you cope with these problems.
The drugs used for myeloma may also cause dizziness, drowsiness, numbness or tingling in hands or feet, and low blood pressure. Most of these problems go away when treatment ends.
You may want to ask your doctor these questions before having induction therapy:
- Which drugs will I get? What will the treatment do?
- When will treatment start? When will it end? How often will I have treatments?
- Where will I go for treatment? Will I have to stay in the hospital?
- Will I have side effects during treatment? What side effects should I tell you about? Can I prevent or treat any of these side effects?
- Will there be lasting side effects? How long will they last? What can I do about them?
- How often will I need checkups?
Stem Cell Transplant
Many people with multiple myeloma may get a stem cell transplant. A stem cell transplant allows you to be treated with high doses of drugs. The high doses destroy both myeloma cells and normal blood cells in the bone marrow. After you receive high-dose treatment, you receive healthy stem cells through a vein. (It's like getting a blood
.) New blood cells develop from the transplanted stem cells. The new blood cells replace the ones that were destroyed by treatment.
Stem cell transplants take place in the hospital. Some people with myeloma have two or more transplants.
Stem cells may come from you or from someone who donates their stem cells to you:
- From you: An autologous stem cell transplant uses your own stem cells. Before you get the high-dose chemotherapy, your stem cells are removed. The cells may be treated to kill any myeloma cells present. Your stem cells are frozen and stored. After you receive high-dose chemotherapy, the stored stem cells are thawed and returned to you.
- From a family member or other donor: An allogeneic stem cell transplant uses healthy stem cells from a donor. Your brother, sister, or parent may be the donor. Sometimes the stem cells come from a donor who isn't related. Doctors use blood tests to be sure the donor's cells match your cells. Allogeneic stem cell transplants are under study for the treatment of multiple myeloma.
- From your identical twin: If you have an identical twin, a syngeneic stem cell transplant uses stem cells from your healthy twin.
There are two ways to get stem cells for people with myeloma. They usually come from the blood (peripheral blood stem cell transplant). Or they can come from the bone marrow (bone marrow transplant).
After a stem cell transplant, you may stay in the hospital for several weeks or months. You'll be at risk for infections because of the large doses of chemotherapy you received. In time, the transplanted stem cells will begin to produce healthy blood cells.
You may want to ask your doctor these questions before having a stem cell transplant:
- What kind of stem cell transplant will I have? If I need a donor, how will we find one?
- How long will I be in the hospital? Will I need special care? How will I be protected from germs? Will my visitors have to wear a mask? Will I?
- What care will I need when I leave the hospital?
- How will we know if the treatment is working?
- What are the risks and the side effects? What can we do about them?
- What changes in normal activities will be necessary?
- What is my chance of a full recovery? How long will that take?
- How often will I need checkups?
Second Opinion
Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it.
If you get a second opinion, the doctor may agree with your first doctor's diagnosis and treatment plan. Or the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at your options.
It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually won't make treatment less effective. To make sure, you should discuss this delay with your doctor. Some people with multiple myeloma need treatment right away.
There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists.
Nonprofit groups with an interest in multiple myeloma may be of help.
Supportive Care for Multiple Myeloma
Multiple myeloma and its treatment can lead to other health problems. At any stage of the disease, you can have supportive care.
Supportive care is treatment to prevent or fight infections, to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with the feelings that a diagnosis of cancer can bring. You may receive supportive care to prevent or control these problems and to improve your comfort and quality of life during treatment.
Because people with multiple myeloma get infections very easily, you may receive
and other drugs.
Some people receive vaccines against the flu and pneumonia. You may want to talk with your health care team about when to get certain vaccines.
The health care team may advise you to stay away from crowds and from people with colds and other contagious diseases. If an infection develops, it can be serious and should be treated promptly. You may need to stay in the hospital for treatment.
Myeloma and its treatment can lead to anemia, which may make you feel very tired. Drugs or a blood transfusion can help with this problem.
Multiple myeloma often causes bone pain. Your health care provider can suggest ways to relieve or reduce pain:
- A brace that relieves pain in the neck or back
- Drugs that fight pain anywhere in the body
- Radiation therapy from a large machine aimed at the bone
- Surgery to fix a compressed (squeezed) spinal cord
Some people get pain relief from massage or
when used along with other approaches. Also, you may learn relaxation techniques such as listening to slow music or breathing slowly and comfortably.
Thinning Bones
Myeloma cells keep new bone cells from forming, and bones become thin wherever there are myeloma cells. Your doctor may give you drugs to prevent bone thinning and help reduce the risk of fractures. Physical activity, such as walking, also helps keep bones strong.
Too Much Calcium in the Blood
Multiple myeloma may cause calcium to leave the bones and enter the bloodstream. If you have a very high level of calcium in your blood, you may lose your appetite. You also may feel nauseated, restless, or confused. A high calcium level can also make you very tired, weak,
, and thirsty. Drinking a lot of fluids and taking drugs that lower the calcium in the blood can be helpful.
Kidney Problems
Some people with multiple myeloma have kidney problems. If the problems are severe, a person may need
. Dialysis removes wastes from the blood. A person with serious kidney problems may need a kidney transplant.
Some people with myeloma develop
. This problem is caused by abnormal proteins collecting in tissues of the body. The buildup of proteins can cause many problems, some of them severe. For example, proteins can build up in the heart, causing chest pain and swollen feet. There are drugs to treat amyloidosis.
Nutrition and Physical Activity
It's important for you to take care of yourself by eating well, drinking plenty of fluids, and staying as active as you can.
You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.
However, you may not feel like eating during treatment or soon after. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to deal with these problems.
Research shows that people with cancer feel better when they are active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know about it.
Follow-up Care for Multiple Myeloma
You'll need regular checkups after treatment for multiple myeloma. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, you should contact your doctor.
Your doctor will check for return of cancer. Even when the cancer seems to have been completely destroyed, the disease sometimes returns because undetected myeloma cells remained somewhere in the body after treatment. Also, checkups help detect health problems that can result from cancer treatment.
Checkups may include a careful physical exam, blood tests, x-rays, or bone marrow biopsy.
You may want to ask your doctor these questions after you have finished treatment:
- How often will I need checkups?
- Which follow-up tests do you suggest for me?
- Between checkups, what health problems or symptoms should I tell you about?
Sources of Support
Learning you have myeloma can change your life and the lives of those close to you. These changes can be hard to handle. It's normal for you, your family, and your friends to have new and confusing feelings to work through.
Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities.
Here's where you can go for support:
- Doctors, nurses, and other members of your health care team can answer many of your questions about treatment, working, or other activities.
- Social workers, counselors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. Often, social workers can suggest resources for financial aid, transportation, home care, or emotional support.
- Support groups can also help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.


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As two of the most popular Hollywood stars of the 80s and 90s, Billy Crystal and Bette Midler are no slouches when it comes to making mass-appeal comedy. But for their first teaming in "Parental Guidance," they also relied on the steady hand of director Andy Fickman.
Fickman, who's helmed a string of well-performing screen comedies ("She's the Man," "The Game Plan" and "You Again)" reveals the strategies behind bringing two beloved icons back to the screen for a family comedy fit for the holidays.
I'm assuming that, like most of us, in your formative years you saw your share of Billy Crystal and Bette Midler films.
Yeah. the truth is both of them were really big influences on me, comedically: Billy, I think from "Soap" on; everything Billy did, I watched and couldn't get enough and loved everything he did on "Saturday Night Live." He's truly been one of my heroes. And for Bette, years earlier before I really started directing and producing and writing, I was a development executive for Bette at the company, All Girls Production –apparently, I was the All Boy at All Girls Productions. I was there for a couple of movies, and so I really had the benefit of working firsthand with her. But both of them, their style of comedy and the heart that they bring to it had definitely big influences on me as a director.
How did you bring in his Billy Crystal-ness and her Bette Midler-ness into the story that you were telling?
They're great actors, to start with, and I think that's always a plus. Neither of them had really been forefront on the big screen anytime recently. They'd done some smaller cameos – they've both been working: Bette was on stage in Vegas, and Billy was on stage with his one-man show. But I think there was something magical about the two of them having never worked together, so on top of them stepping back into this world, putting two legends together and letting them find that rhythm really was exciting.
So those personas that are what we hope to get out of a Bette Midler movie, what we hope to get out of a Billy Crystal movie, became very natural. And I think just the two of them were helping feed the other one, and it was fresh to them because they have never worked with each other and have such similar sensibilities. The very first time I had a meeting with them, we had a dinner, and five minutes into the meeting, they were finishing each other's sentences. They were cutting each other off. They were like an old married couple.
Billy's comedic voice comes through in his dialogue. How much did you let him spin something or tweak it a little bit so it's Billy Crystal-esque?
I'm a big believer as a director that we write dialogue in a little bit of a vacuum, and then you ask the actor to try to make it their own, so that always helps. This story originally had come from an actual event that had happened with Billy, so Billy is not only is the producer, but kind of created the original story. But really, when you get on set, you start rehearsing that scene, and you've got all your actors. You have Marisa Tomei and Billy and Bette, and they start talking. They all have a good ear in which they can say "I don't know if I'd say it that way. I think I'd say it this way." As a director, you're connecting these actors for a reason, and – unless it's not appropriate to the character – you don't really want to put shackles on them. You really want to allow that creative freedom to come out.
There's a scene where Bette and Billy get their little song-and-dance number. How did that come about?
Early on we were joking around, like "You're going to have Bette Midler – wonder if they'll ever do a song?" What we didn't want to do was make people feel an unnatural reason to do it, and as we were developing the script and starting to work on the movie and really getting into production, what we realized was there wasn't enough of a moment for them to connect, and this felt like a really sweet moment. And funny enough, you go to someone like Bette – Grammy Award-winning artist – and certainly she's going to have her thoughts about singing. But then you go to Billy, who's got so much life in him, but then there's that paralyzed moment of, like, "Really? I'm singing with the Grammy Award-winning Bette Midler? Is there anybody else on the crew I could be singing a duet with so I look maybe slightly better?"
Bette, while we were shooting, would always be singing songs from the 50s, mainly with the kids, teaching them songs. Then we realized that was partially what she and Billy's characters probably would have connected with, the 50s and 60s, and that was the song that was one of the songs that they had really liked and thought it was fun to sing. Next thing you knew, we made a makeshift recording studio the night before in the house, and we just started working through it the next day. And everybody enjoyed seeing it.
Tell me about putting Maria Tomei into that mix. She, too, also knows big-style comedy (and won an Oscar for it), but isn't playing big comedy in this one.
The crazy chemistry of casting this when you're trying to find a child of two famous people – who IS that? And we kept doing the DNA of, if Billy Crystal and Bette Midler had a child, who would that child be? And for the sake of our movie, can they be strong enough to stand up against them? And you start going through a certain age group. You start going through their ability for comedy, their ability for drama. It's not so much that her character drives the comedy in this one, while there's certainly comedic elements, but there's a lot of other things happening.
And Marisa was truly kind of at the top of our list, and we were going through casting and did that typical let's have a meeting with her. Billy and I had a meeting with Marisa, and they knew each other a little bit and had talked in the past. She started talking about the character, and before we knew it, we were having a two-hour conversation, all of us, about relationships with our own parents and she came aboard. And she was great because she could hold her own against Billy and Bette from the very beginning. We got very lucky, having Marisa.
Is there an untapped audience for fans of these superstars of a fairly recent era that isn't getting served in the big franchise, big blockbuster mentality of studio films right now?
Yeah, I really hope so. When I started telling people that this was the cast, I can't tell you how many people would say to me how much they love Billy and how much they loved Bette, and then start telling me their favorite movies. And that list: you think about Bette and you think about 'Down and Out in Beverly Hills' and 'Ruthless People' and 'Big Business,' and 'Outrageous Fortune,' and 'Beaches' and 'Hocus Pocus' and 'The Rose.' All of a sudden, like that list is deep – and the same with Billy. I feel like whether it's nostalgic or not, talent is talent. I'm hoping that audiences who don't know them, from a younger standpoint, discover them, and for audiences more nostalgic who grew up loving those movies, I hope it's a nice holiday treat for them.


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Customize your home
Add your favorite games and best Xbox friends to your home screen and keep track of the latest info and activities associated with them.
Game "blocks" can show things like achievements you're chasing, clubs you might like, and activity feed posts from the game. In friend blocks, you'll find items such as gamerscore updates, recent game clips and screenshots, and quick actions like inviting to a party.
To add a game block to your home, go to any game tile currently on your home, in the guide, or in your games and apps, press the Menu button , and select Add to home. You can also add game blocks from any game hub.
To add a friend block to your home, go to a friend's profile or their profile card in the guide and select Add to home.
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