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So you're ready for your family to grow? Getting a new pet is always an exciting time – whether you're adopting a middle-aged, abandoned dog or starting anew with a kitten. In every case, we're here for you and your new pet today, next month, and in 10+ years.
Getting a New Pet?
Are you or are you about to become a new pet parent? Visit our New Clients portal to discover and learn all about what to expect, download essential new pet forms, and more!
There are many things for you to take into consideration when adding another furry friend to your family. Do you already have pets? What "tricks" will you (or should you) teach your pet? What kind of food should I buy? How do I make this affordable?
The first step is to make an appointment with your veterinarian so they can examine the pet and administer the appropriate vaccinations and do a few tests to make sure Fluffy is happy and healthy. While at this visit, it is important to talk to your vet about many things, including: 1. Microchipping. Approximately 20% of lost dogs and less than 2% of lost cats who were not microchipped were reunited with their families. When microchipped, 52% of dogs and almost 40% of cats were returned home. 2. Pet Nutrition. Feeding your new pet a healthy and nutritious diet is one of the most important things to do. 3. Spaying and neutering
If you're adopting or buying a baby animal, you should also start thinking about training. There is a plethora of helpful information out there on what you should teach your pet and the best way to go about doing this. Vetstreet, the ASPCA, and PetMD all offer themselves as informative and valuable resources.
Here are some more valuable links to help you along you and your pet's journey:
If you ever have any questions, please don't hesitate to call our office at 215-379-2747. We hope you and your new pet create rich and fun memories together!


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Yesod needed a new coded website design and created a contest on 99designs.
A winner was selected from 19 designs submitted by 5 freelance designers.
I want to redesign my site http://www.massagegeraete.com with a very professional design. I need 3 search-engine optimated html-templates (index-site, category-sites and product-site) made with css. The site needs to look very confidence-arousing that people buy my expensive products. And the site must be a wellness-paradise ;).
Desired Style:
It needs to be a wellness-paradise where everyone wants to buy!
Accepted File Formats:
html, css, jpg
Hi, i want to make a redesign of my Site http://www.massagegeraete.com.
Sorry for my bad english btw ;-).
Here is what i want:
- I want a very professional and confidence-arousing look!
- Resolution 1024x768
- I want a unique design
- Full graphic rights need to be included.
- I need 3 html-templates with css. One for the index-site, one for category-sites
(click for example on "Komfort-Massagesessel" to see one) and a product-site (click for example on the "Massagesessel Wellance Pro" on the index-site to see one).
- It needs to be search-engine-optimated - Navigation no graphics but text (background-images), h1 and h2 used headertext should be text with background-image, navigation-texts should be the first what search-engines see,...
- On every site i want a new area (box or so) i dont have right now with links for example to call-back-service, related products, user-comments, related infos,...
- It should be for german market.
- Clear and easy navigation
- Compatible with firefox and IE 6 and 7!
- My Site ranks good now and it should in future!

subset: commoncrawl


text:
You are here
Kitchen Designed for Comfort
Interior designer Denyse Rinfret prefers to create kitchens where people will linger
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The lure of a kitchen is undeniable. No matter the occasion or time of day--from tempting aromas of coffee in the morning to fresh-baked bruschetta before a dinner party--it's the room that seems to have a magnetic pull. And while attracting people may be no problem, interior designer Denyse Rinfret prefers to create kitchens where people will linger. That motivation drove her interior design for the Hampton Designer Showhouse in Bridgehampton, New York. "I wanted a kitchen where people would gather and stay, not just a place to grab a bite and leave," says the Manhasset, New York, designer. "I like the kitchen to be a communal room where people sit with family and friends to eat, converse, read, or just relax."
Photography: Bruce Buck
Produced by: Bonnie Maharam
Interior design: Denyse Rinfret, Rinfret Interiors LLC, 99 Bourndale Rd. N., Manhasset, NY 11030; 516/365-7234, rinfretinteriors.com.
Builder; kitchen design: George Gavalas, Gavalas Builders, P.O. Box 1821, 9 West Pond Drive, Bridgehampton, NY 11932; 631/537-8955, gavalasbuilders.com.
Bridgehampton builder George Gavalas laid the groundwork, constructing a new house with a spacious rectangular kitchen rich in architectural details. His white wood cabinets with recessed panel doors are accented by pilasters, carved corbels, a plate rack, and a glass-fronted china cabinet. Carrara marble perimeter countertops and a marble mosaic backsplash are sophisticated, while bin-style pulls and a beadboard ceiling keep the mood informal. The white cabinets and marble are warmed by the toast-colored Australian cypress floor and a dark mahogany countertop on the large center island.
Gavalas designed the kitchen so traffic flows easily around the island, and a dining area at one end of the room makes it ideal for entertaining. Two sinks and ample work surfaces accommodate multiple cooks and others who just like to hang out.
Cabinetry and china cabinet (custom design by George Gavalas): Gavalas Builders, 631/537-8955.
Floors: Australian cypress.
Countertops: Carrara marble.
Island countertop: mahogany.
Farm sink: Kohler, 800/456-4537, kohler.com.
Refrigerator: Sub-Zero Inc., 800/222-7820, subzero.com.
Stove; wall oven: Thermador, 800/656-9226, thermador.com.
Dishwasher: Miele Inc., 800/843-7231, miele.com.
Cabinetry hardware (brushed nickel); faucets (brushed nickel): Waterworks, 800/899-6757, waterworks.com.
Backsplash: marble mosaic.
Bar stool: English Country Antiques, 631/537-0606, ecantiques.com.
Hanging lanterns over island: Ann-Morris Antiques, 212/755-3308.
Giving the island focal-point status are a pair of 17th-century antique English lanterns. Not just pretty faces, the lanterns were electrified and provide task and mood lighting. In addition, recessed ceiling fixtures can be dialed up or down. "I always use versatile lighting in a kitchen. That way you can change the mood from industrial lighting for cooking to romantic light in the evening," Denyse says.
To create an inviting eating area, Denyse brought in a large wood table--inspired by an English antique--that can extend to seat 12 people. The table also works as a serving area for buffets or as a place for children to do homework, she says.
Comfort was the mantra for seating, with a pair of upholstered wing chairs bookending the table. "The armchairs give the kitchen more of a family-room feeling," Denyse says. A Swedish country settee backing up to a large window is softened with colorful blue and pink pillows ("colors the vibrant skies of the Hamptons are known for"). Antique wicker chairs across from the bench are casually slipcovered in a cozy plaid fabric.
A reproduction of an antique chandelier hangs above the table, and a striped cotton area rug provides warmth and softness underfoot while helping to define the dining area.
Settee: Laurin Copen Antiques, 631/537-2802.
Wing chair; rattan dining chairs; dining table (antique library table): English Country Antiques, 631/537-0606, ecantiques.com.
Settee fabric; wing-chair fabric: Ralph Lauren Home, 888/475-7674, ralphlaurenhome.com.
Plaid fabric on chair backs: Zimmer + Rohde, 866/627-6899, zimmer-rohde.com, trade only.
Chandelier: antique.
Rug: Elizabeth Eakins Inc., 212/628-1950, elizabetheakins.com.
Drapery (white linen): Westgate Fabrics, 800/527-6666, westgatefabrics.com.
Drapery trim: Fabric Mill, 516/465-6400.
Paint (custom color): Benjamin Moore, 888/236-6667.
Decorative painter: Eileen Blanchard, 631/ 467-7542.
Art (by Mark Humphrey): Mark Humphrey Gallery, 631/283-3113, markhumphreygallery.com.
White linen curtain panels edged with a band of blue-and-white plaid soften the window behind the dining bench. The designer hung the panels with clip-on rings that fit over decorative nail heads made for hanging pictures.
A decorative plate rack, pilasters flanking the farmhouse sink, brushed nickel fixtures, and marble tops and mosaic backsplash give the new kitchen vintage character.
Seeded glass is accented by diamond-shaped moldings in a furniture-style china hutch.
Interior designer Denyse Rinfret. "People want a nucleus in their homes," she. "Most people gravitate to the kitchen. It should be inviting--functional and a beautiful, friendly place."


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As the ink dries on the Supreme Court's health care ruling, advisors are figuring out how the law will add to their clients' as well as their own costs. Considering the Patient Protection and Affordable Care Act's broad reach, one simple thing is true of the PPACA's potential tax and investment consequences: it's complicated.
Doctors, for example, can expect individually to be socked with at least 20 new taxes over the next 10 years, according to Jeffery Van Wart, manager for the Houston branch of national broker-dealer and RIA Cantella & Co., which manages nearly $1 billion and serves both physicians and medical groups.
From an investment standpoint, Van Wart said, both doctors and medical groups are staying liquid and in securities such as safer tax-free municipal bonds while they wait to see how the PPACA shakes out over the next few years.
"They're not willing to take on a lot of risk because so much is so uncertain about how this is going to affect their income both individually and in the industry as a whole," Van Wart said in a phone interview with AdvisorOne on Thursday. "We're living in a world of negative uncertainty. The bill is so cumbersome that you have to be a political scientist and legal scholar to understand it all. What we do know is that there are a lot of new taxes because the law has to be paid for, and that's never a positive for a business."
Health Law's Costs May Strike as Bush Tax Cuts Disappear
Van Wart said he has been experiencing a sense of disbelief that the PPACA's requirements may hit him in the wallet at the same time that the Bush tax cuts fall off the fiscal cliff on Jan. 1. Already, he said, as an independent contractor he pays $1,400 per month in health insurance premiums for his family policy.
People will quickly find ways to undercut the law, Van Wart predicted. As a hypothetical example, he said, if he made $500,000 a year and paid the 1% penalty tax instead of buying insurance, that $5,000 cost would be substantially less than what he pays now for his health policy. "And if something bad happened to me, they couldn't refuse me, so I'd just go get some insurance then and get coverage," he said. "So it would be cheaper for me not to have insurance, pay the tax, and then go get insurance [after getting sick] because they've got to take me. It's absurd."
Van Wart still hopes that the PPACA will be overturned – and he is not alone. Republicans in both houses of Congress have sworn that they will take up a vote to put an end to the health care law, and presidential candidate Mitt Romney has promised to put a repeal into motion if he wins.
At issue for many advisors is the Supreme Court's 5-4 ruling that the health care law is a tax. Indeed, the historic ruling written by Chief Justice John Roberts says that the PPACA's mandate for individuals to buy insurance falls under lawmakers' power to levy taxes. Republicans are now accusing Obama administration officials of forcing the bill through Congress in 2010 while lying that the mandate wasn't a tax.
"Look, reconciliation is available because the Supreme Court has now declared it a tax," Republican Senate Minority Leader Mitch McConnell told "Fox News Sunday" on July 1. "They have unearthed the massive deception that was practiced by the president and the Democrats, constantly denying it was a tax." (Romney, meanwhile, has faced charges that his Massachusetts health care plan also amounts to a tax.)
Democrats, for their part, have declared the June 28 Supreme Court decision a victory. The Democratic Senatorial Campaign Committee raised $2.5 million in the three days following the ruling, according to a Huffington Post report, and the Democratic Congressional Campaign Committee said it had raised another $2.3 million. However, the report also said that the National Republican Senatorial Committee has witnessed a significant uptick in donations because the ruling confirms that the PPACA constitutes a massive tax on small business.
Preparing Clients for Income Taxes as High as 43.4%
Politics aside, one thing is certain: the PPACA gets the majority of its funding through tax increases on the highest earners. Individuals must pay a 3.8% tax on investment income if they earn more than $200,000 annually, and couples likewise must pay the investment income tax if they make more than $250,000. In addition, the act imposes a 0.9% tax increase on wages for people who earn that much.
According to Tim Steffen, director of financial planning at Robert W. Baird & Co., the most obvious repercussion of the court ruling is that some investors may trigger capital gains they were thinking about taking in 2013.
"High earners may accelerate income from stock options or bonuses into this year to avoid the additional 0.9% tax on their wages above the thresholds scheduled for 2013," said Steffen in a statement, but he cautioned investors not to overreact as months remain before year-end to consider market performance and make investment decisions. The results of the presidential election in November also may change tax policy, he noted.
Gavin Morrissey, director of advanced planning at Commonwealth Financial Network, said in a blog post for AdvisorOne that the PPACA 3.8% surtax coupled with the expiration of current tax rates "could lead to a federal marginal income tax rate of as much as 43.4%" for advisors' highest-earning clients.
"A few safe havens from the new surtax are available," Morrissey added. "For example, distributions from IRAs and qualified plans are not subject to it. But investment income is, including interest, dividends, capital gains, nonqualified annuity distributions, rents (if passive income) and royalties."
What can advisors do to prepare their clients? For those who already contribute the maximum amount to their qualified plans, Morrissey recommends a Roth conversion of IRA balances. "Your clients could pay tax on the converted amount at today's lower marginal rate while building an account from which future distributions would not be included in MAGI," he said.
Investments in Belly of the Health Care Beast
Or, investors can head straight into the belly of the beast and invest in health care stocks and bonds.
Frank Fantozzi, CEO of Cleveland-based Planned Financial Services, which offers securities through LPL Financial, said on the day of the court ruling that he expected to see market movement in subsectors such as hospitals, medical devices and pharmaceuticals. The overall health care sector is expected to benefit from about 32 million additional insured customers phased in from 2014 to 2019.
"From a business standpoint, when you understand how insurance companies work, theoretically, if you can insure the entire population, then you can get a truer measure of your costs and risks and a lower cost of insurance," Fantozzi said. "Long term, this all gets baked into the economy, just as past legislations have come to fruition."
And S&P Capital IQ ETF Analyst Todd Rosenbluth wrote on May 21 that in light of the pending court ruling on health care reform, he believes that the Health Care Select Sector SPDR Fund (XLV) is worthy of scrutiny. XLV is the largest health care ETF in the United States, with more than $4.5 billion in assets.
"Year to date through May 18, XLV was up 4.6%. This was near the 4.3% increase in the Health Care sector of the S&P 500 Index and ahead of 3.0% gain for the S&P 500 Index," Rosenbluth wrote in "A Bottom-Up Look at a Key Health Care ETF."
On the day before the Supreme Court ruling, the ETF was up 9% year to date, driven by an improvement in Pharmaceuticals, and as of Friday, it was up 11.02% versus 10.47% for the S&P 500 Index.
Jeff Loo, head of S&P Capital IQ's health care equity research, said in a phone interview the day before the ruling that the sector was outperforming the broader markets by about 40 basis points year to date.
"Depending on how the Supreme Court decides, I think if they overturn the mandate and keep the rest of the law intact, I would expect some downward pressure on the health care sector," Loo said. "If the entire law is kept intact, I would expect some appreciation in the health care sector, although modest, because I think some of that is already priced into the marketplace."
For more about the PPACA and taxes, read William H. Byrnes and Robert Bloink's Unintended Consequences of the HIT: Eliminating Health Coverage in Small Businesses at AdvisorOne and Alson Martin's blog at Tax Facts Online.


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Phil Kelsall - My Special Collection
The World famous Blackpool Tower Ballroom Wurlitzer Organ. The mighty Worthing Wurlitzer and its fascinating history. A re-acquaintance after 25 years with Rossall School chapel organ. The remarkable Technics SX-FA1 Electronic organ in the lavish surroundings of the Spanish Hall of Blackpool's Winter Gardens. TITANIC archive sequence.


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|Killingly, CT
|High School:
#25 Shane Gibson - Career Stats
Career Game-by-Game Stats: 2011-12 | 2010-11 | 2008-09
2010-11: Returned to the Pioneer line-up starting all 29 games..Averaged 32.9 minutes per game, second on the team...Led the team in scoring and was ranked second in the NEC at 17.2 ppg...Named to the All-Northeast Conference second team and the NABC All-District second team...He averaged 4.0 rebounds, 1.6 assists and 1.4 steals per game...Shot 44.0% (173-393) from the field, ranking 15th among NEC leaders...A 38.9% (75-193) shooter from behind the three-point arc...Was the 8th best three-point threat in the NEC and ranked third in 3pt FG makes per game (2.59 pg)...He ranked ninth in the NEC in steals, with 40, tops on the team...Scored in double figures in 23 of 29 games...Notched 12 games with 20 plus points...Set a new career-high with a 34 point performance at Wagner...Shot 12-of-15 from the field with four three's and also had five rebounds against the Seahawks...He earned the Choice Hotels NEC Player of the Week award on back to back weeks...Scored 19 points at Stony Brook followed by a 23 point afternoon at Yale to notch his first weekly award on Dec. 20th...Had 26 at Providence followed by 21 at home vs. Holy Cross helping Coach Bike to his 500th career win to earn his second NEC award on Jan. 3rd...Scorched CCSU for 27 points on 10-of-18 shooting...Finished the season with games of 24 points at Bryant, 22 vs. FDU and 24 vs. Monmouth in the finale...Finished the year with 498 points.
2009-10: Used his red-shirt season
2008-09: As a rookie, played in all 31 games earning 14 starts...Averaged 23.5 minutes per game..Scored at an 8.1 per game clip...Shot 45.5% (90-188) from the field and 42.0% (37-88) from three...An 80.5% (33-41) shooter at the charity stripe...Averaged 2.2 rebounds, 1.5 assists and 1.1 steals per game...had 35 steals defensively...Started the first 13 games of the season...Hit a three-pointer with :07 left against Columbia to send the game into overtime...Had 11 double digit scoring games including five in his first eight games of his career...Set a season high with 20 points hitting four three's against FDU...Had 12 points and four assists in the game before vs. the Mount...For his efforts he was named the Choice Hotels NEC Rookie of the Week...Scored 19 points including a three just before the buzzer to send the game to overtime at Columbia...Tallied 16 against Long Island and 15 points and three assists vs. Albany.
High School: Attended Killingly High School where he played basketball for four years for coach Scott Derosier. Was team captain his senior year. Was team MVP three times. He is Killingly's all-time leading scorer and set the school's single-game scoring mark with 51 points. Was named All-State twice.
Personal: Son of Al and Stephanie Gibson. Has three siblings - Jarrel, Ciara and Bianca. Business Management major. Favorite sports teams are the Tennessee Titans and Dallas Mavericks. Favorite athlete is Kobe Bryant. Favorite movie is Wedding Crashers and favorite TV show is Burn Notice. Favorite food is pepperoni pizza. Considers Kobe Bryant his role model.


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Didn't this city suffer enough?
Last year's frightening flooding of the Mississippi River didn't do any direct damage to the site of one of the pivotal battles of the Civil War. It did bring in some undesirable new neighbors.
Park officials say a pack of wild hogs seeking higher ground moved in and are rooting up the landscape at Vicksburg National Military Park, an 1,800-acre park where thousands of Union and Confederate troops fought and died in 1863.
They fear the hogs could undermine some of the park's 1,370 monuments, its national cemetery and trenches and earthworks on the bluffs above the river. The hogs could also startle or injure more than 1 million annual visitors.
"It looks like the world's biggest Rototiller has gone through some areas," park Superintendent Mike Madell said. "People think we plowed some of the areas they've been in."
Maybe they're just trying to throw up earthworks:
"It's an all-out war on them," he [Jim Walker of the Mississippi Department of Wildlife Fisheries and Parks] said. "But hunting will never get rid of them. They can breed three times a year and a sow can have eight to 10 pigs each time. You do the math."
Fondly do we hope, fervently do we pray, that this mighty scourge of war may speedily pass away. Yet, if God wills that it continue…as was said three thousand years ago, so still it must be said "the judgments of the Lord are true and righteous altogether."


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In a huge oversight on my part, I neglected to mention...
The pictures below happened practically ages ago. And by ages, I mean only weeks. I'm still trying to catch up. Mostly. It seems I'm stacking up writerly functions. And then forgetting to blog about them. Makes me feel like a chump (especially since I will not get to all of them). In fact, since this event (pictured below), I've gone to even more events, which makes me feel like a bigger chump for being so behind.
Okay, so to catch you up (kind of). Ages ago (weeks), the fabulous Erica Chapman and I decided we'd make the trek back to Anderson's in Naperville (the indie bookstore I mentioned like a bazillion times now) a week after Veronica Roth's Divergent book launch at the same book store to attend another YA authors' book signing (3 1/2 hour drive). There was a special title for the event, but I'm not much good at remembering titles or names or dates or people's faces or my birthday. It had to do with luck, the title. But that's all I got.
Suffice it to say that there were some amazing authors there: Lisa and Laura Rocker (The Liar Society), Julia Karr (XVI), Leah Clifford (A Touch Mortal), Courtney Moulton (Angelfire), Sara Bennett Wealer (Rival), Sarah Rees Brennan (The Demon's Surrender), Saundra Mitchell (The Vespertine), and Christine Johnson (Claire de Lune) were all signing. Like us, Scott Tracey (Witch Eyes), Erica O'Rourke (Torn), and Loretta Nyhan were also there to support their author friends, and we all connected at some point in the evening. Every last one of them is a freaking superstar, by the way. I was wowed to even be in the same room. Talk about a special event to share with my sweetie peetie gal pal Erica C. Had so much fun with her, as always.
But, yeah, so Erica and I arrived a little late. Again. Don't be a hater, it happens to the best of us. It's not like I TRY to be late to these things. It's called arriving fashionably. Or something. I really need a personal assistant, FYI.
All the signing authors talked a bit before signing. They were all very funny and fun and awesome.
From left, Christine Johnson, Julia Karr, Sarah Rees Brennan, and Saundra Mitchell
From left: Saundra Mitchell, Lisa Roecker, and Laura Roecker.
They're all looking to the side because I said, "Okay, everybody look to the right now." Not really.
From the left: Lisa, Laura, Leah Clifford in the cute yellow sweater, Courtney Moulton, and Sara Bennett-Wealer. There is also some woman's head up really close. Lovely shade of chestnut.
And here is Scott Tracey, first with Erica, then with me. He gave us some fabulous bookmarks for his YA novel, WITCH EYES.
Here's a group photo. I won't label them all. I did that already, k?
And here we are with my favorite authorly sister duo, Lisa and Laura Roecker. So kind, these two. Beautiful inside and out.
I'm not sure why we were laughing. But I think Scott Tracey was involved.
Here I am with Julia. We've met up loads of times now. I forgot to tell her I was coming. So when I walked in, she was like, DUUUUUUDE you are EVERYWHERE. Except she didn't say dude, but now I'm going to beg her to say it. That would be awesome. P.S. She's my all time favorite Julia. A truly amazing person.
There was a gathering after the signing at a local pub. Bar? I don't know. I've been to this place twice, and I can't remember the name. Anyway, here we are with Loretta Nyhan. Such a sweetheart. One of those people that you wish you could miniaturize so you can carry them everywhere with you to take out when you need a hug except that would be creepy so you should probably just have them Facebook friend you.
Finally, here I am with Leah. Who by the way, wins the award for superest cutest dress of the night. Also? You can totally tell how sweet she is just by looking at her. A dearheart, I tell you. A beautiful person.
I wish I had a picture with Erica O'Rourke. She was freaking funny and so so kind. She has a book coming out in July called TORN, which I'm really excited about.
Okay, that's it for pictures. I didn't use my camera nearly enough, and a few of these I stole from Erica (namely pictures 5, 8, 9, 11, and 12). I think this was the last signing I went to. But I'm headed to ALA's annual conference next week, at which there will be a boatload of signings. I'll try to make as many as I can (and then blog about it). I'm excited about everything except the New Orleans humidity. Yeah.
Try not to alarmed if my pictures look like this:


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Jim Fletcher was a comic book artist and animator, who drew many comics with Disney characters during the 1960s. Born in Illinois, James Lawrence Fletcher attended the Chicago Art Institute in 1954. He became an inbetweener with the Disney Studios in that same year, working on films like 'Sleeping Beauty'. He was an animator with Warner Bros from 1958 to 1964, and then a lay-out artist for Hanna-Barbera from 1968 to 1974.
Morty & Ferdie - High Flying Melody (S 65029)
He was active as a comic book artist for Western Publishing in the first half of the 1960s. He drew stories with Disney's 'Donald Duck' and Hanna-Barbera's 'The Jetsons'. Between 1963 and 1968 he drew a great many stories with 'Donald Duck' for the Disney Studios, but also 'Mickey Mouse', 'Chip 'n' Dale', 'Br'er Rabbit' and many 'Mad Madam Mim & Magica the Spell' stories.
Madam Mim - Mim's Prize Painting (S 65158)
His Disney comics can be identified by the way he drew Uncle Scrooge's whiskers: they seem to come from a single point on the cheek. In the 1980s, he drew for Eternity Comics and worked as an animator on such cartoon series as 'Transformers' and 'GI Joe'. In the early 1990s, he did artwork for 'Zen' at Archie Comics and storyboards and layouts for Warner Bros series like 'Tiny Toons' and 'Animaniacs'. He passed away in Sherman Oaks, California, in 2004.
Brer Rabbit - The Weather Wizard (S 66004)


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Time Misuse
Chesscube "accommodates" the internet speed difference by making seconds go faster when i play with people with lower pings. it steals seconds at the beginning of each of my moves. i took a watch to check and each time i play with someone with a lower ping, there is a difference in the length of seconds between the chesscube timer and my watch timer
fix this issue please
fix this issue please


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Your vehicle inspection doesn't have to be a hassle. At Powell's Service Center, we make it easy to complete your state-mandated vehicle inspection. Offering convenient hours and efficient service, Powell's Service Center in New Kensington, PA takes the headache out of state vehicle inspections.
Convenience and Quality
State-mandated inspections are a necessary but inconvenient part of life for any vehicle owner. But your vehicle inspection doesn't have to ruin your day, and at Powell's Service Center, it won't. You can trust us to thoroughly and efficiently inspect your vehicle according to state requirements while providing you with the friendly, professional service you deserve. We understand that your time is valuable. That's why we do everything we can to get you back on the road quickly–with no stress and no hassle.
If it's time for your state-mandated vehicle inspection, Powell's Service Center has got you covered. Contact us today for information about our hours, documentation requirements and inspection services.
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Great service, my go to guys👍thank you!!
The guy got me right in. Got my car inspected and was on my way. Fast and friendly service. Will definitely go back.
Great place to have your vehicle fixed and I have known Bill for many years excellent mechanic
I like this place
Great as usual
Fast, reliable service. Will go back anytime needed.
Bill is an HONEST mechanic who was available at the last minute for an inspection. I will definitely do future business with him over my dealership. He is close to home and efficient with repairs.
I've been taking ALL my vehicles here for years. They are always honest and reasonable. They get the work done in a timely manner. Love Billy Powell he's a great guy!! The last of the honest mechanics.
He does a great job
Excellent service! Got me in quickly for emissions and inspection. We hung out at the shop while it was done and had a nice chat with the owner. This is where we'll be going for our car maintance needs from now on!
My wife and I brought our car in for emissions/inspection and found the service to be phenomenal. Bill was wonderful to deal with and got us in and out right away. We felt very comfortable and will absolutely be going back there again if we need anything!
I wish that I had learned about Bill's auto service shop 20 years ago! Bill and Dan are both skilled mechanics and capable of working on all vehicle makes and model years.
Got my car inspected here and it couldn't have been easier. Nice guy and good service, will definitely come back here! Also got a free t-shirt, definitely can't complain about that. :)
Great place dont judge a book by its cover been there longer then dirt... Ha ha nice people
In my opinion MR Powell's mechanic is one to be desired
Good local shop for all mechanical needs.
Very knowledgeable and extremely honest people
They were very friendly and quick with the job. They answered any questions I had and were very professional. I would recommend them to anyone needing anything for their cars! Excellent service all around!
I've taken my car twice to Powell's, and I'm extremely satisfied with the work, and most importantly, honesty from Bill. I'll definitely continue to come here.
Always a great experience at Powell's, he is very fair in terms of looking out for your interests prior to doing work and is very upfront with pricing. I continue to go back and refer friends to him as well.
Currently I am a college student, with a small budget, and a crazy schedule. I had heard about Powell's Service Center, and had received excellent service. The guys were nice and were professional. They were a huge help in recommending/advising repairs that would help my car run more smoothly. I definitely plan on continuing to come to Powell's for automotive service. Thank you again guys!
I have been taking my vehicles to Powell's since I moved to the area. It is very difficult to find a garage that will not try to upsell you services. Not the case at Powell's. Bill will only repair what is necessary, and if he thinks it can be done better or cheaper elsewhere, he will inform you of that right away. He is easy to schedule with, which is great considering my hectic work schedule. My last visit, I stopped by to schedule an appointment. I dropped the car off on a Tuesday night for service on a Wednesday. When I handed Bill the keys, he informed me that he may not be able to get the car done as agreed due to a personal matter with his staff. This was not a problem for me and I told him to take the time he needed as I had a spare vehicle (I know, not many of us do). My point is, Bill was upfront about it and you just don't see that kind of integrity very often now a days. My recommendation is to have your auto repairs done at Powell's. His prices are very reasonable. Why support out of the area expensive dealerships when you have a compotent mechanic right here in New Ken? Thanks Bill.
Powell's Service Center is very professional and Bill takes care of you in a timely fashion. I highly recommend you going to his place for all your auto needs. Reliable, smart, hardworking, and above all trustworthy. I WILL RECOMMEND TO ALL MY FAMILY AND FRIENDS!
We've taken our car there for the past 2 years for inspection and emissions. The service is great! Their work is reliable. We needed a lot of work done last year and he worked with us on getting it done little by little. This year we didn't need anything extra done. It was quick and easy. Super friendly and excellent service! I would definitely recommend them to anyone.
I visited Powell's Auto Service Center a few weeks ago to have my car inspected. What I found was a diamond in the ruff. They are friendly, affordable, and provide quality service. My car has never been happier:) I will use them for all my car needs in the future.
I was a first time customer and I just had my car inspected. I didn't have any problems with the car, but the service was fast and friendly. There's not really a waiting area so it's more of a drop off and pick up. I always brought my car to performance auto, but they seem mainly interested in convenient hours for themselves and charging top dollar. I was a long time customer and spend thousands there. I asked for a one-time break on a diagnostic fee and they said no way and I said goodbye :-)
After years of searching for a good mechanic I have finally found one! Bill is fair, honest and does an awesome job. He takes his time to talk with you, to diagnose your car's problem and to come up with a solution on how to fix your vehicle. He doesn't try to up-charge or sell unnecessary parts or service! I am so happy we found him and he will be our mechanic for years to come!
These guys do awesome work. We have had work done on all of our vehicle by Powell's and they get the job done right the first time with reasonable labor rates. They don't try and sell you stuff you don't need and simply throw parts at a problem; instead, they correctly diagnose it and only fix what is broken. They also give you an accurate time-frame of how long the repair will take which is usually very fast. I have been to other places that will store your car in their lot for days before even looking at it. I rarely write reviews, but this place deserves a good one!
Powell's Service Center is, without a doubt, the most trustworthy and reliable place to have your vehicle taken care of. The rates are always fair and reasonable, and the service is top quality. We have been loyal customers for years and have had Mercedes, Infiniti, Lexus, and Toyota cars all serviced without any issues. Highly recommend!
I have been using powells for the past 3 years for inspection/emmissions he always is professional and puts the stickers on straight And is Fairley priced
I've been dealing with Bill for more years than I care to admit. Always fair with his work estimates and pricing. The repair work that he recommends is what is needed - no unnecessary work.
38 years, 14 different vehicles and raised two children. Best place if your concern is safety. Never had to worry if the job was done correct - it was or Bill would not work on your vehicle. Affordable and Friendly.
I've been having my vehicle serviced through Powell's since I began driving. Bill is an outstanding mechanic and I've never had an issue. His prices are fair and the service is top notch. He's even been kind of enough to drop me off at my house and pick me up after service was complete. I'd highly recommend the good people at Powell's to anyone in and around the area.
Bill has been my mechanic for more than thirty years. He always does the job right, he does it in a timely fashion, and his prices are always reasonable. What more could I want?
Best service around!
I recommend everyone I care about to go to Powell's service center if they need any assistance with their vehicles at all. Whether it just be questions or serious mechanical work. Bill Powell is both honest and very kind hearted. He will help you in any way he can. And if he can't help, he will send you to a reliable alternative. Trust is everything with your mechanic and I have nothing but trust for Powell's. Today I got all of my tires changed, an oil change, wipers and filters changed, and it was both timely and affordable per usual. Do yourself a favor and go check it out for yourself next time you need any help. You'll never go anywhere else after that.
The staff was very friendly and answered any questions that I had. I'm new around the area and I googled where to take my car and Powell's was the correct choice. I will recommend them to anyone I know in need of anything with their car. They were fast, friendly and very professional.
Very professional and honest with excellent customer service.
I've taken my car twice to Powell's, and I'm extremely satisfied with the work, and most importantly, honesty from Bill. I'll definitely continue to come here.
Quality Service
Currently I am a college student, with a small budget, and a crazy schedule. I had heard about Powell's Service Center, and had received excellent service. The guys were nice and were professional. They were a huge help in recommending/advising repairs that would help my car run more smoothly. I definitely plan on continuing to come to Powell's for automotive service. Thank you again guys!
Great mechanic
I have been taking my vehicles to Billfor the last seven or so years. From inspection and emissions, to engine, suspension, and exhaust work. He does a great job and is reasonably priced. Why pay dealership rates, when you can get quality service for less?
Quality Service affordable price
I am a single woman on a budget..car repairs happen to everyone. Powell's service station is who I trust for these needs..Mr. Powell is honest and trustworthy.. I never have to wonder if the repairs he recommends are necessary. He explains the repairs well.. provides options for the repair..and I have never had to question anything he ever did. I would trust him implicitly with all my car repair needs.. I highly recommend his service for your needs as well.
My experiences at Powells
My family has been using Bill Powell for about 20 years. He is an excellent mechanic and I have never had a complaint. I am not a new car enthusiast so I keep my cars until no longer road worthy. Bill does an excellent job in helping me with this goal. (I want my Jeep to go to 200,000 miles) When I was a single woman I depended on Bill to keep my auto safe. And he did! Obviously, I high recommend Bill as THE mechanic to us.
Professional and Very approachable to talk about car issues
Bill gets your vehicle serviced in a timely fashion and is very affordable. I felt that Bill was approachable, from his demeanor, to talk about extra issues with my truck and how they could be dealt with. He was very insightful on what needs done and what issues are unnecessary. I just went to get my truck inspection and emission stickers, THE STICKERS WERE PUT ON STRAIGHT!!!! WHAT!? that was just an extra boost to his reputation being the best. Thanks a ton Bill. Ill see ya soon for my oil change and new tires. I will recommend to all my friends and family. YOU DA MAN! (DAN IS ALSO VERY INTUITIVE, GOOD MAN)
Highly recommend them
We've taken our car there for the past 2 years for inspection and emissions. The service is great! Their work is reliable. We needed a lot of work done last year and he worked with us on getting it done little by little. This year we didn't need anything extra done. It was quick and easy. Super friendly and excellent service! I would definitely recommend them to anyone.
This was my first time ever going to Powell's service center and I must say I am 100% pleased with my experience. I went to get my car inspected and emissions done the process was fast the service was amazing and pricing was reasonable. I would definitely recommend to any and everyone looking for a garage with great mechanics and reasonable pricing.
AWESOME Mechanic!
After years of searching for a good mechanic I have finally found one! Bill is fair, honest and does an awesome job. He takes his time to talk with you, to diagnose your car's problem and to come up with a solution on how to fix your vehicle. He doesn't try to up-charge or sell unnecessary parts or service! I am so happy we found him and he will be our mechanic for years to come!
excellent service!
Been taking my cars to Mr Powell for 10 years and will not go anywhere else. He only fixes what needs to be fixed and never rips you off.
great garage
Ive been using powells for the past few years for my vehicle inspection he is fast and easy to get along with he also puts the stickers on straight
Honest repair service.
I've had my vehicles inspected and repaired at Powell's for over ten years. The work is always done right and at a fair price. Repairs are completed promptly.
Great work
Bill has been doing my auto repairs for years now. Nothing but good things to say. Only the necessary work will be recommended and no extras.
Great Job!
Powell's did a great job at a great price! I definitely will go back for future service and recommend anyone else to take your automobile as well.
I have had my cars serviced there for the last 30 years and Bill has always been honest and never did anything that didn't need to be done. Would recommend them to everyone I know.
My go-to shop
Powell's Service Center has been my first stop for automotive service since I moved to the area. I take both of my vehicles there for inspections, oil changes and service. I really appreciate Bill's honesty. He doesn't try to up-charge or sell unnecessary parts or service. He is also straight with his customers when another shop would be able to do it better or cheaper, and so I always trust his advice.
Always thorough and fair.
Bill Powell has been my mechanic for over 10 years now. He has never charged me an outrageous price for any work I've had done to multiple vehicles. He does a great job explaining the problem and going over options with me and I will continue to use him in the future.
Great service
Got an appointment quick. Problem was found and fixed in a timely fashion. Have been here a few times, I don't feel like I'm being over charged. I will go to powells again.
Great Service
I have taken my vehicles to Powell's Service Center many times. Each experience has been positive. They accurately diagnose mechanical problems and make the needed repairs in a timely manner. I have taken my vehicles to other garages in the area, and they mis diagnosed my problem. Powell's was able to determine the correct problem the first time. Great price for service as well.
I just went in for an inspection this time But like always it was great,affordable and fast service. You just don't find places like this anymore you can tell they love what they do.
What more could I want?
Bill has been my mechanic for more than 30 years. He always does the job right, he does it in a timely fashion, and his prices are always reasonable. What more could I want?
always a pleasure
always a pleasure to have my automobiles serviced at PSC! Bill is a very friendly fellow and knows what he is doing. been going to PSC for 20+ years!
The best car repair secret in town!
Powell"s Service Center has been my choice for my car service for approximately 20 years, Bill Powell is the reason for the success of his business. He is a man of integrity and humility. I called him about needing my car inspected (late inspection as usual) He told me to bring my car in the next day. Upon inspection Bill discovered some noise in my brakes. He fixed it. Bill could have told me that I needed new brakes and I would not have known the difference. He also checked my tires and put air in them where needed. Bill Powell is a man of faith who doesn't necessarily talk about it, he lives it. His work is of the highest quality and I highly recommend his service to everyone.
Car inspection
Almost forgot about car inspection and called Bill at the last minute. He got the work done quickly and at a fair price.
years of great service
I have been dealing with Bill Power for many years. He has taken care of me as only a privately own business person can. When I have car trouble, I pull into his station and the problem is taken care of immediately. His recommendations when it comes to oil changes and tires has save me considerable money. Bill is the only man I go to for my inspections. I am very grateful he is around to service my vehicle.
Great Service, Honest Guy
My whole family has used Powell's for a number of years. Would recommend to anyone looking for a local trustworthy shop.
I've always appreciated the service I received at Powell's Service Center. I have been returning to Bill with auto inspections and repairs for a little over 10 years and have never been disappointed with the service and advice from Bill. It's convenient to drop the car off the evening before; and Bill would usually have the work completed the next day. I trust Bill's work and will probably stay with him.
Great Service at Powell Service Center
I've been taking cars to Powell Service Center for over 20 years and my experiences have always been positive. I am able to get an appointment quickly and I am always confident the work will be done precisely with an emphasis on safety. I always have Powell Service Center take care of the yearly car inspections, oil changes, tire rotation and air checks, and anytime I have a problem . I am always confident that Bill will take of it. I like taking my car to someone I can trust, someone who knows my car , and a place that is independently owned . Thanks, Bill for your years of service in maintaining my cars. I would recommend Powell Service Center!
Excellent Service! Fast & Knowledgeable
We always take our vehicles to Bill Powell's!
We have taken our cars to Bill for over10 years. He is honest and always does a good job in a timely manner. Anytime we have a problem he finds the time to fit us into his busy schedule.
The work is guaranteed, reliable and the owner is trustworthy!
Recently had a problem with defective parts (a bad caliper ruined my brakes.) BillP had our history (ie., when those brakes were installed) and went back to the supplier. New parts were reinstalled, the problem corrected at no cost to us ... since we had nothing to do with the problem. Powell's always does the right thing. That's why we trust him with our cars!
Always appreciate the thorough and personal care!
Powell's is the most thorough and trustworthy auto service center that we have found in the Alle-Kiski Valley. Honesty and careful work is the trademark of this business and we won't go anywhere else.
The only place I trust to take my vehicles to.
I've been taking my vehicles to Powell's Service Center for the past 15+ years. He has always been reasonable in cost and knowledgeable with the service of the vehicle. I won't go anywhere else.
Great service!
Been going there for over 10 years, great service, dependable, fair, knowledgeable.
reasonably priced, honest. our #1 place to take our vehicles!
It was a good experience
We always like to use a local establishment. We have always have had a good experience with Powells service center. We get an appointment , as we need it. Bill is fair and the work on our car is always a good job. Always to our liking. That is why , we always go back to Powells. The Shanks
Great Service!!
I have been going for years, good people and service was excellent. I would recommend to everyone.
Always a great experience
I have gone to Bill for all of my auto repairs for many years and he is always great. Very dependable and the prices are always reasonable. I would recommend him to anyone!
Windshield Wiper Pump
I contacted Powell's Service Center on Thursday and spoke briefly about my windshield wiper fluid not dispensing, we concluded it may be the pump and that to further diagnose this to bring in my car the following day. It was confirmed that it indeed was the pump that was bad. Bill contacted a number of suppliers for my make and model for my car. The part was delivered and replaced within an hour and a half. Super service! I couldn't be happier. Very professional. I will call Powell's in the future if I ever have any other work that needs done. Thank you!
Small garage Big service
Having been a customer for over ten years, Powell's has always provided the best service at a reasonable price. Powell's only does repairs for what is needed and has even sent me back one time to the dealer for covered repair work on a used vehicle I had purchased. Powell's also offers Saturday hours as well, which makes it convenient for a simple repair or oil change without the need to find a ride to work. U
Friendly Neighborhood Service Center
Powell's Service Center has always been a trusted place to take my vehicle for repairs. Bill is one of the nicest people I know and he's only ever done the absolute necessary service for my vehicle. It is always completed in a short amount of time and competitively priced. If you are looking for a trusted place, go see Bill!
Wouldn't go anywhere else
I have been going to Powell's for over 5 years and simply wouldn't go anywhere else. The service is dependable. I can take my vehicles anytime and know that I will get honest affordable service and the job is done right.
Best service center in the Valley
Bill is always ready to explain what needs to be done and never adds on unnecessary repairs. He is honest and reliable. I get all 3 of my vehicles inspected there every year. Also, you can get great deals on tires (I have bought 3 sets so far). I rate the customer service as great! Thank you Bill.
Quick and thorough service
Powell's Service Center had our car ready within hours. They inspected our car and installed tires at a reasonable price. Would recommend to friends!
It was a pleasant experience getting my car inspected. He was thorough, quick and polite.
Can always count of Bill Powell's Service
This has not been my first experience, yet each time was a good experience. Bill helped make sure that my car was safe, knowing I am a single woman. Bill provided an inspection and emission, an oil change, purchase of two new tires, purchase of a tire sensor and driver's license bulb. With this said, everything was discussed with me prior to. In my book, Bill has integrity. He does not charge outrageous labor fees, and at times, Bill charges me the price at his own cost for parts sometimes. Whenever, I have needed immediate attention, Bill has always been there for me. I would recommend Powell's Service to anyone. In fact, I already have {and still do} tell others about my experiences. A friend of mine referred me to Powell's Service, and I am very thankful that she did.
Great Customer Service
I got an inspection and an oil change. I felt like more than a customer, I felt more like a friend that was being helped out. Bill went went above and beyond to make sure that the work was done timely and right. Thank you Bill for taking care of me.
Another Great Experience!!
My car was up for state inspection and emission. Mr Powell gave me some great advise on how to clean my engine exhaust to press emissions. My car has a direct injection engine, and doesn't always burn off the excess carbon. Anyways, dropped car off the night before, picked up the next afternoon. All with no fuss. Highly recommend!
Cannot say enough about the service I received recenly at Powell's. Excellent service given in such a short time frame. Bill is very knowledgable along with his staff. Problem was diagnosed and corrected, at a very reasonable cost, in a few hours to get me back on the road. Would highly recommend Powell's to all my friends.
Very courteous and friendly. Bill took car of my car quickly and had easy hours to pick up my car after work was done. I will go back for any other issues I have.
Excellent Service
Powell's Service Center continuously provides honest and quality service. Every time my family experiences an issue with one of our cars, Powell identifies the best and most economical way to afford it. I have never had a bad experience and will only take my car to Powell's based on the stellar service.
I have used Powell's for a number of years. I have also used other places due to warrantees etc. There is no comparison. Powell's is straight forward about what is wrong with your car. If it does not need fixed he will tell you. Service is also prompt. There are times I have called to have my car fixed or an inspection done and I was able to bring it in that day.
Best repair facility in the area.
I have been going to Powell's Service Center for 35 years and I would only trust my car to his facility. He is meticulous on safety and I never had to worry if it was safe for my wife and children as they traveled to their destinations. With Bill's work it was done right and done with a high safety intrest for my family.
I've known Bill for many yrs. and just recently started taking my vehicles to him for repair. He's honest, upfront and a good mechanic. Not to mention reasonable priced. He saved me a considerable amount on my most recent visit that I thought would cost a small fortune. He didn't do work on thing that weren't mentioned but let me know what I might need in the future. I'll be back for sure!
I Understand
Bill talks to me in a lanquage I can understand. I have recommended Powell's Service Center to friends and relatives.
I've been going to Powells Service Center for several years. Great, honest service and easy of appointments. Wouldn't think of going anywhere else.
As always, Powell Service Center provides outstanding, personalized auto service. Very comfortable bring any of my vehicles to his shop for friendly, quality service.
- English


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Cafeteria Design
With fork in hand, this Spartan is making his way to lunch! Nutrition and wellness sayings on attractive LineSigns... guide the students... while they march along the lunch line... to good health! All good Spartans start their day with breakfast here at Spartan Cafe!
Lima Senior High School
1 Spartan Way
Lima, OH 45801
Carrie Woodruff - Food Service Director
Learn more about the custom design process & how it works.
See amazing before & after photos from our portfolio.
Contact us to arrange an on-site visit or phone consultation.


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|'Her Mistress's Voice' art by Grace Slick
Was the 60's phenomenon of the 'hippies' really a CIA and other assets manipulation of the mind through supplied LSD and created cultural memes? An experiment to see just how well these techniques would work? One that was decades in the making?
Those of us who were around during those times and had a very good time may not want to see ourselves as social lab animals in a grand game but I think we would also want to know some of the hidden details of our past. We're still learning and maybe that's what matters.
Dave McGowan went fairly deep into some aspects of the psyops of psychedelia in his Laural Canyon series.
n 2012 Jan Irvin made an important discovery.
Joe Atwill and Jan Irvin have continued in that tradition with their Manufacturing the Deadhead: A product of social engineering…
excerpts from their conclusion:
The authors are in disagreement about the use of mind-altering drugs. One believes that we do should not dismiss the potential of these substances as biological tools to open doorways of the mind, and possibly spiritual dimensions; but those who consider these substances as only spiritual tools often ignore their dark side and never consider that they can be easily used as much for control. He recommends they not be used without a prior thorough study in something such as the trivium method, and suggests that, like a knife which may be used to cut your food, and also used to kill; psychedelics can be used to empower or control. It is important for people who use these substances to consider what others think of them who don't use them for spiritual purposes. The other believes that given their provenance, they should not be taken under any circumstances.
We must consider: Does the predator think that these substances are tools for spiritual awakening, or for the control of others? What the reader may believe is not necessarily the whole truth.
Though it seems incredible, Esalen, and Huxley, McKenna, Bernays, Wasson and Dulles appear to have been part of a secret agenda within the U.S. government that intends to usher in a post-modernist, neo-feudalism Dark Age and slavery in America. What makes this particularly difficult to believe is the unanswered question of the organization's motivation. What would motivate such a group? Racism? Classism? Religious fervor? Power? All of the above? And how would it be able to maintain such secrecy, involving certainly hundreds, if not thousands of individuals over such a long time?
One thing is clear. Whatever is the basis for this organization, it resides within identifiable secret societies. The number of individuals that can be demonstrated to have taken part in creating the Deadhead who are also members of Skull and Bones, the Century Club and the Bohemian Club is simply too large to have been circumstantial. Moreover, Dr. Colin Ross has shown that high level Freemasonry was responsible for funding the original LSD research (waiting for citation from Ross) and this group should also be inspected closely.
We appeal to scholars and to the public to help us find the truth behind MK-ULTRA and the creation of the Deadhead and the post-modernist, neo-feudalism movement.
The authors are not looking to bring anyone out of one cave and into yet another, but to free humanity from this insanity. And only the truth is capable of that. Esalen, Aldous Huxley, Gordon Wasson, Timothy Leary, Terence McKenna, and the peddlers of this agenda: The spell is now undone and the true secrets of Eleusis, of the CIA and the psychedelic revolution, are now revealed for the entire world to see. more
Joe Atwill and Jan Irvin interview with Vinny Eastwood: CIA, MK Ultra & Origins of Acid Counter Culture
Deanna Spingola interview with Joe Atwill on Manufacturing the Deadhead
Deanna Spingola interviews Jan Irvin on Manufacturing the Deadhead - See more at: http://www.gnosticmedia.com/deanna-spingola-interviews-jan-irvin-on-manufacturing-the-deadhead/#sthash.NfsrMRvv.dpuf
It's an interesting subject. That rabbit hole has not been fully explored. Control through social engineering seems to have around throughout human history and it is reaching a peak today through technology.
I'll leave it to others who experienced the 'acid days' to decide what's what. All I know is that during that period we began to question pretty much everything and some of us are still doing that up to this day.
and Grace Slick was hot in 1969.....
e At
e At
d Jan Irvin
Joe Atwill and Jan Irvin
hat tip to JJ Cale
J.J. Cale, Musician and Songwriter, Dies at 74


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Monday - Friday
All visits are scheduled by appointment only.
The effects of stress on your health can be far-reaching. Some of the conditions often associated with stress include
high blood pressure,
tension headaches,
decreased mental function, and drug or
alcohol abuse. Stress is known to cause changes in the body's chemistry, altering the balance of hormones in our systems in ways that can lower our resistance to disease. As a result, we can become more susceptible to
flus, and other types of illness. Too much stress sometimes brings on outbreaks of
cold sores
or genital
for people who carry these viruses in their systems. Other chronic diseases such as
irritable bowel syndrome,
inflammatory bowel disease, and
rheumatoid arthritis
may also flare up during times of stress.
If it's possible to avoid situations that cause you to feel tense, unhappy, or worn down, that's obviously to your benefit. However, it isn't always possible to live a stress-free existence. Work deadlines, family demands, relationship problems, traffic jams, missed appointments, forgotten birthdays, personality conflicts, college exams—all of these things, and many more, can be sources of stress. Furthermore, though most of us associate stress with unpleasant events, even wonderful events in our lives, like weddings, vacations, and holidays, can be genuinely stressful.
Not everyone responds to these situations by getting "stressed out." There are those apparently unflappable folks whose pulse rate wouldn't even go up during an earthquake, and then there are those for whom being five minutes late constitutes reason for a state of total panic. How you manage the stress in your life can determine the impact it will have on you.
There are many different methods of dealing with stress. The basics for good health that we all know (but often forget) help in coping with stress: Eating a balanced diet and getting adequate rest help your body adapt and respond to the events in your life. Ironically, stress can interfere with your ability to take care of yourself in this way. When you're worrying so much you can't sleep, getting adequate rest becomes impossible. Stress can affect your eating habits too. So what else can you do? Exercise, meditation, and biofeedback are all widely accepted stress management tools that might help you break out of a stress-induced downward spiral.
For some people, stressful circumstances can trigger symptoms severe enough to warrant seeking medical attention. Conditions associated with stress, such as
depression, and
panic attacks, may become severe enough to require medications.
One proposed natural approach to treating the physical consequences of stress involves the use of so-called
adaptogens. The term "adaptogen" refers to a hypothetical treatment described as follows: An adaptogen helps the body adapt to stresses of various kinds, whether heat, cold, exertion, trauma, sleep deprivation, toxic exposure, radiation, infection, or psychological stress. Furthermore, an adaptogen should cause no side effects, be effective in treating a wide variety of illnesses, and help return an organism toward balance no matter what may have gone wrong.
However, physical exercise is the only indubitable example of an adaptogen. There is no solid evidence that any substance functions in this way. However there is a bit of suggestive evidence for the herb
Panax ginseng, which is discussed in the next section.
Most of the evidence cited to indicate that
Panax ginseng
has adaptogenic effects comes from animal studies involving ginseng extracts injected into the abdomen. Such studies are of questionable relevance to the oral use of ginseng by people; furthermore, the majority of these studies were performed in the former Soviet Union and failed to reach acceptable scientific standards. However, a few potentially meaningful studies in humans have found effects that are at least consistent with the possibility of benefits in stressful situations.
According to a number of animal studies, most of which were poorly designed and reported,
Panax ginseng injections into the blood stream or abdomen can increase stamina, improve mental function, protect against radiation, infections, toxins, exhaustion, and stress, and activate white blood cells.1
However, when ginseng is injected into the abdomen or bloodstream, it enters the body directly without going through the digestive tract. This mode of administration is strikingly different from taking ginseng by mouth.
A smaller number of animal studies (again, most of them poorly designed) have looked at the potential benefits of ginseng administered orally, and often reported benefit.2-8 In addition, studies in mice found that consuming ginseng before exposure to a virus significantly increased the survival rate and number of antibodies produced.9,10
Human studies of
Panax ginseng
have only indirectly examined its potential benefits as an adaptogen. For example, a
double-blind, placebo-controlled
study found evidence that
Panax ginseng may improve immune system response.11
This trial enrolled 227 participants at three medical offices in Milan, Italy. Half were given ginseng at a dosage of 100 mg daily, and the other half received
placebo. Four weeks into the study, all participants received influenza vaccine.
The results showed a significant decline in the frequency of colds and flus in the treated group compared to the placebo group (15 versus 42 cases). Also, antibody levels in response to the vaccination rose higher in the treated group than in the placebo group.
These findings have been taken by some researchers to support their belief that ginseng has an adaptogenic effect. However, the study might instead simply indicate a general form of
immune support
unrelated to stress.
Other studies have looked at
Panax ginseng's
effects on
overall mental function,15-17general well-being,18-21,54
sports performance.22-28,52
While it is true that positive results in such studies might tend to hint at an adaptogenic effect, the results were, in general, too mixed to provide conclusive evidence for benefit.
The bottom line: It is not clear that
Panax ginseng
offers general benefits for stress.
For more information, including dosage and safety issues, see the full
Surprisingly, a treatment as simple as
tablets may be helpful for stress.
In a double-blind, placebo-controlled study, 300 men and women were given either a multivitamin-mineral tablet or placebo for 30 days.38
The results showed that people taking the nutritional supplement experienced less anxiety overall and an enhanced ability to cope with stressful circumstances. The supplement used in this study supplied the following nutrients and dosages:
vitamin B1
(10 mg),
vitamin B2
(15 mg),
vitamin B6
(10 mg),
vitamin B12
(10 mcg),
vitamin C
(1,000 mg),
(100 mg), and
(100 mg).
Benefits were seen in another double-blind, placebo-controlled trial that enrolled 80 healthy male volunteers.39
The supplement used in this trial was similar but not identical.
It's not clear how these nutrients help stress. But, considering that many of us would benefit from general nutritional supplementation in any case, it might be worth trying.
In the 1940s, Dr. Brekhman, the same scientist who first dubbed
Panax ginseng
an adaptogen, decided that a much less expensive herb,
Eleutherococcus senticosus, is also an adaptogen. A thorny bush that grows much more rapidly than true ginseng, this plant later received the misleading name of "Siberian" or "Russian ginseng." Its chemical makeup, however, is completely unrelated to that of Panax ginseng.
As with
Panax ginseng, many animal studies finding adaptogenic benefits with eleutherococcus have been reported, but most were relatively poorly designed and used injections rather than oral administration of the herb, making the results not particularly relevant to the normal human usage of the herb.
Numerous human trials of eleutherococcus have been reported as well, some involving enormous numbers of participants. However, most of these were not double-blind and many were not even
controlled, making the results nearly meaningless. (For information on why double-blind, placebo-controlled studies are essential to establish the effectiveness of a treatment, see
Why Does This Database Rely on Double-blind Studies?)
Again, as with
Panax ginseng, a few reasonably well-designed studies in humans have been reported that may have indirect bearing on the herb's potential adaptogenic properties. For example, in one double-blind trial, participants took either 10 ml of extract of eleutherococcus or placebo 3 times daily for a 4-week period. Blood samples were analyzed to determine changes in immune cells. A statistically significant increase in numbers of cells important to immune functions was observed in the treatment group as compared to the placebo group.
This study has been widely advertised as proving the eleutherococcus strengthens immunity. However, mere changes in immune cell profile do not at all automatically translate into enhanced immunity. (See the
Immune Support
article for more information on why this is so.) More meaningful data was obtained in a double-blind, placebo-controlled study involving 93 people who experience recurrent flare-ups of
Use of eleutherococcus significantly reduced the severity, frequency, and duration of herpes outbreaks relative to placebo during the 6-month trial. This study does suggest a possible immune strengthening effect.
Panax ginseng, eleutherococcus has also been studied for potential
sports performance enhancement benefits, but published studies have not been encouraging.42,55 One small double-blind, placebo-controlled trial of endurance athletes actually found that use of eleutherococcus may increase physiologic signs of stress during intensive training.52
For more information, including dosage and safety issues, see the full
Three small double-blind trials suggest that the herb
Rhodiola rosea) may improve mental alertness in people undergoing sleep deprivation or other stressful circumstances.44,45,56
Numerous other herbs are said to be adaptogens as well. These include
reishi, shiitake,
suma, and
schisandra. However, there is little to no real evidence as yet that they have adaptogenic effects.
One study failed to find greater adaptogenic effects with fish oil as compared to placebo.59
Many people report that they experience stress relief through the use of alternative therapies, such as
guided imagery,
relaxation therapy,
Tai chi,
massage, and
yoga. Regarding the use of massage therapy, one study failed to find regular massage more effective for controlling stress than use of a relaxation tape.60 Whereas, a large 2012 review of 35 studies involving 1,794 people found evidence to support the use of yoga to decrease stress and anxiety, although the overall quality of these studies was poor.75
A study failed to find either cognitive behavioral therapy or increased physical activity helpful for stress-related illnesses.68
Preliminary evidence, including small, double blind trials suggest that the amino acid
improve memory and mental function under conditions of sleep deprivation or other forms of stress.50,51,69
One double-blind study found that use of
vitamin C at doses of 3,000 mg daily (slow release) reduced both physical and emotional responses to stress.53
In small double-blind studies, theanine, a constituent of
black tea, appeared to reduce the body's reaction to acute physical or psychological stress.61,65
Benefits have also been seen with a combination of
(2.64 g per day) and
arginine (2.64 g per day).67
One double-blind study found evidence that a processed form of casein (a protein found in milk) may reduce a variety of stress-related symptoms.66
According to another small, double-blind trial, a mixture of soy
lecithin may decrease the physiological response to mental stress.62
Another study evaluated use of phosphatidylserine for reducing stress in golfers, but the benefits seen failed to reach
statistical significance.74
A proprietary
herbal formula containing
Bacopa monniera and almost 30 other ingredients has shown some promise for treating symptoms of stress. In a 3-month, double-blind, placebo-controlled trial of 42 people in high-stress jobs who complained of fatigue, participants using the herbal formula reported fewer stress-related problems.57 Also, in a 3-month, double-blind, placebo-controlled study of 50 adult students, this formula appeared to improve memory and attention and reduce other signs of stress.58
In naturopathic medicine,
adrenal extract
are often recommended for treatment of stress, but there is no evidence that this treatment is effective.
Equivocal evidence hints that
valerian, alone or in combination with lemon balm, might reduce anxiety symptoms during stressful situations.46,63-64
Three studies failed to find
Bach flower remedies helpful for situational anxiety (anxiety caused by stressful situations).70-72
For other natural treatments relevant to stress, see the discussion in the articles on
Schulz V, Hansel R, Tyler VE.
Rational Phytotherapy: A Physicians' Guide to Herbal Medicine.
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Dua PR, Shanker G, Srimal RC, et al. Adaptogenic activity of Indian
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C.A. Meyer.
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C.A. Meyer (G115) on alveolar macrophages from patients suffering with chronic bronchitis.
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Sorenson H, Sonne J. A double-masked study of the effects of ginseng on cognitive functions.
Curr Ther Res.
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Hallstrom C, Fulder S, Carruthers M. Effects of ginseng on the performance of nurses on night duty.
Comp Med East West.
Caso Marasco A, Vargas Ruiz R, Salas Villagomez A, et al. Double-blind study of a multivitamin complex supplemented with ginseng extract.
Drugs Exp Clin Res.
Sotaniemi EA, Haapakoski E, Rautio A. Ginseng therapy in non-insulin-dependent diabetic patients.
Diabetes Care.
Forgo I, Kayasseh L, Staub JJ. Effect of a standardized ginseng extract on general well-being, reaction time, lung function and gonadal hormones [translated from German].
Med Welt.
Cardinal BJ, Engels HJ. Ginseng does not enhance psychological well-being in healthy, young adults: results of a double-blind, placebo-controlled, randomized clinical trial.
J Am Diet Assoc.
Cherdrungsi P, Rungroeng K. Effects of standardized ginseng extract and exercise training on aerobic and anaerobic capacities in humans.
Korean J Ginseng Sci.
Forgo I. Effect of drugs on physical exertion and the hormonal system of athlete [translated from German].
MMW Munch Med Wochenschr.
McNaughton LG, Egan G, Caelli G. A comparison of Chinese and Russian ginseng as ergogenic aids to improve various facets of physical fitness.
Int J Clin Nutr Rev.
Engles HJ, Wirth JC. No ergogenic effects of ginseng (
Panax ginseng) during graded maximal aerobic exercise.
J Am Diet Assoc.
Engels HJ, Said JM, Wirth JC, et al. Failure of chronic ginseng supplementation to affect work performance and energy metabolism in healthy adult females.
Nutr Res.
Morris AC, Jacobs I, McLellan TM, et al. No ergogenic effect of ginseng ingestion.
Int J Sport Nutr.
Teves MA, Wright JE, Welch MJ, et. al. Effects of ginseng on repeated bouts of exhaustive exercise [abstract].
Med Sci Sports Exerc.
Schlebusch L, Bosch BA, Polglase G, et al. A double-blind, placebo-controlled, double-centre study of the effects of an oral multivitamin-mineral combination on stress.
S Afr Med J.
Carroll D, Ring C, Suter M, et al. The effects of an oral multivitamin combination with calcium, magnesium, and zinc on psychological well-being in healthy young male volunteers: a double-blind, placebo-controlled trial.
Psychopharmacology (Berl).
Bohn B, Nebe CT, Birr C. Flow-cytometric studies with eleutherococcus senticosus extract as an immunomodulatory agent.
Williams M. Immuno-protection against herpes simplex type II infection by eleutherococcus root extract.
Int J Alt Complement Med.
Dowling EA, Redondo DR, Branch JD, et al. Effect of
Eleutherococcus senticosus
on submaximal and maximal exercise performance.
Med Sci Sports Exerc.
Darbinyan V, Kteyan A, Panossian A, et al. Rhodiola rosea in stress induced fatigue—a double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty.
Spasov AA, Wikman GK, Mandrikov VB, et al. A double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with a repeated low-dose regimen.
Cropley M, Cave Z. Effect of kava and valerian on physiological responses to psychological stress assessed under laboratory conditions [abstract].
Fahey TD, et al. Hormonal effects of phosphatidylserine during 2 weeks of intense training [abstract].
Med Sci Sports Exerc.
1998;30(5 suppl).
Monteleone P, Maj M, Beinat L, et al. Blunting by chronic phosphatidylserine administration of the stress-induced activation of the hypothalamo-pituitary-adrenal axis in healthy men.
Eur J Clin Pharm.
Fahey TD, Pearl MS. The hormonal and perceptive effects of phosphatidylserine administration during two weeks of resistive exercise-induced overtraining.
Biol Sport.
Deijen JB, Wientjes CJ, Vullinghs HF, et al. Tyrosine improves cognitive performance and reduces blood pressure in cadets after one week of a combat training course.
Brain Res Bull.
Neri DF, Wiegmann D, Stanny RR, et al. The effects of tyrosine on cognitive performance during extended wakefulness.
Avit Space Environ Med.
Gaffney BT, Hugel HM, Rich PA. The effects of
Eleutherococcus senticosus
Panax ginseng
on steroidal hormone indices of stress and lymphocyte subset numbers in endurance athletes.
Life Sci.
Brody S, Preut R, Schommer K, et al. A randomized controlled trial of high dose ascorbic acid for reduction of blood pressure, cortisol, and subjective responses to psychological stress.
Psychopharmacology (Berl).
Ellis JM, Reddy P. Effects of Panax ginseng on quality of life.
Ann Pharmacother.
Eschbach LF, Webster MJ, Boyd JC, et al. The effect of Siberian ginseng (Eleutherococcus senticosus) on substrate utilization and performance.
Int J Sport Nutr Exerc Metab.
Shevtsov VA, Zholus BI, Shervarly VI, et al. A randomized trial of two different doses of a SHR-5 rhodiola rosea extract versus placebo and control of capacity for mental work.
Dixit S, Agrawal U, Dubey G. Executive fatigue and its management with Mentat.
Agrawal A, Dubey M, Dubey G. Effects of Mentat on memory span, attention, galvanic skin resistance (GSR) and muscle action potential (EMG) among normal adults.
Bradbury J, Myers SP, Oliver C, et al. An adaptogenic role for omega-3 fatty acids in stress; a randomised placebo controlled double blind intervention study (pilot).
Nutr J.
2004 Nov 28. [Epub ahead of print]
Hanley J, Stirling P, Brown C. Randomised controlled trial of therapeutic massage in the management of stress.
Br J Gen Pract.
Kraemer WJ, French DN, Spiering BA, et al. Cortitrol supplementation reduces serum cortisol responses to physical stress.
Hellhammer J, Fries E, Buss C, et al. Effects of soy lecithin phosphatidic acid and phosphatidylserine complex (PAS) on the endocrine and psychological responses to mental stress.
Kohnen R, Oswald WD. The effects of valerian, propranolol, and their combination on activation, performance and mood of healthy volunteers under social stress conditions.
Kennedy DO, Little W, Haskell CF, et al. Anxiolytic effects of a combination of Melissa officinalis and Valeriana officinalis during laboratory induced stress.
Phytother Res.
Kimura K, Ozeki M, Juneja LR, et al. l-Theanine reduces psychological and physiological stress responses.
Biol Psychol.
2006 Aug 21. [Epub ahead of print]
Kim JH, Desor D, Kim YT, et al. Efficacy of alpha-s1-casein hydrolysate on stress-related symptoms in women.
Eur J Clin Nutr.
Smriga M, Ando T, Akutsu M, et al. Oral treatment with L-lysine and L-arginine reduces anxiety and basal cortisol levels in healthy humans.
Biomed Res.
Heiden M, Lyskov E, Nakata M, et al. Evaluation of cognitive behavioural training and physical activity for patients with stress-related illnesses: A randomized controlled study.
J Rehabil Med.
Mahoney CR, Castellani J, Kramer FM, et al. Tyrosine supplementation mitigates working memory decrements during cold exposure.
Physiol Behav.
2007 May 22. [Epub ahead of print]
Halberstein R, DeSantis L, Sirkin A, et al. Healing with Bach® Flower Essences: testing a complementary therapy.
Complement Health Pract Rev.
Walach H, Rilling C, Engelke U. Efficacy of Bach-flower remedies in test anxiety: a double-blind, placebo-controlled, randomized trial with partial crossover.
J Anxiety Disord.
Armstrong NC, Ernst E. A randomized, double-blind placebo-controlled trial of a Bach flower remedy.
Complement Ther Nurs Midwifery.
Inoue K, Shirai T, Ochiai H, et al. Blood-pressure-lowering effect of a novel fermented milk containing gamma-aminobutyric acid (GABA) in mild hypertensives.
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Last reviewed December 2015 by EBSCO CAM Review Board
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OAKLEY 2011 Helmet Bowl SUPERLIGHT 2.0 Purple Size L / XL
In 2010, Oakley has been working with the manufacturer of safety equipment TSG to develop his first helmet. This collaboration has been very successful, and a second project helmet quickly emerged: the Oakley Superlight 2.0. The solid outer shell is fused with the internal padding expanded polystyrene foam to reduce weight drastically, making it one of the lightest helmets in the world bowls with a weight of 300 grams only. The system aerodynamic ventilation holes 14 and the air channels in the upholstery guarantee optimal breathing while both washable interior pads, ensure a perfect fit and optimum comfort. The models agree perfectly with the Oakley Bike Collection. Other features: - Complies with safety standard EN1078/CPSC - Washable pads
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Blog Article
When providing DNS nameserver services a degree of redundancy is needed. In most cases the DNS records for a particular domain will be hosted by at least two nameservers, but is that enough by itself?
When building a resilient system the risks involved with the failure modes of the system need to be considered and weighed up against the associated costs and overheads. As a common example - does having both DNS servers on the same local network segment provide you with protection against network failure? Probably not.
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Lauren Socha Gossip
Lauren Socha gossip, latest news, photos, and video.
Nathan and his mother
Here's Robert Sheehan aka ex-Nathan on Misfits with his mother in Dublin the other day which is my excuse to talk about Misfits now that it's been confirmed that Lauren Socha will not be returning (because she assaulted a cab driver and yelled racist insults at him - click here Full Story
Just...don't paint your face!
Ashton Kutcher's ad for Popchips has been pulled. Kutcher plays several characters in the commercial, one of whom is a character called Raj - Ashton in "brown face" with a thick accent. I'm surprised they didn't go balls out and put him in a turban. Obviously he's a moron. But what's more alarming is how this was approved. Full Story
The new Misfit
Misfits season 3 is now shooting. Yes, yes, without Robert Sheehan. Like I've been saying, I don't think I'll miss him. I don't miss him already. And besides, again as I've been saying, Nathan was becoming less and less interesting to me. You would have tired of him scratching his balls and the high pitched voice. Full Story
Misfits: Lauren wins, Robert talks
HAVE YOU STARTED WATCHING THIS SHOW YET? It's easy online. Try it. The BAFTAs happened on Sunday honouring the best of British television. Misfits won in the drama category last year. There was no repeat but Lauren Socha, aka Kelly, took home Supporting Actress. Yay! All five original actors were on hand for the event. Full Story
Down one orange jumpsuit
If you are just getting into Misfits, please note there is a MAJOR spoiler below. Might want to avoid. If you are not yet into Misfits, I will keep yelling at you to get into it because, well, frankly, the longer you put it off, the longer you're depriving yourself of amazing, irreverent, no dancing sh-t tv. Full Story
Misfits minus one
I'm not done nagging you to watch Misfits. The dvds are available. The episodes are on YouTube. You have no excuse to deprive yourself of one of the most kick ass tv experiences in recent memory. Trust me. The converted have been emailing me consistently about it. There's euphoria. And then there's distress. Full Story


text:
The Incredible Shrinking Doctor's Appointment
In case you haven't noticed, your time is limited. Here's how to use it wisely.
The Incredible Shrinking Doctor's Appointment
After waiting two months to get on the physician's calendar, 15 minutes looking for parking and what feels like forever flipping through old magazines in the reception area, you'll likely get just 11 minutes of face time with your doctor, according to research from Case Western Reserve University in Cleveland. With double-booked office schedules, fewer physicians and insurance companies demanding shorter appointments, "Doctors are stretched thin," says Jim King, M.D., president of the American Academy of Family Physicians. "So the time you get with yours needs to be quality." Read on to learn how to make the most of those minutes.
Before Your Visit
When scheduling your appointment, be sure to tell the office assistant why you're coming in, whether it's for an annual checkup or a specific health problem. This could actually affect how much time they block out for you, says Patricia Agnew, author of How to Talk to Your Doctor: Getting the Answers and Care You Need (Quill Driver Books). Then do a little prep work: A lot of precious time during appointments is spent taking or updating your health history. Ask the receptionist if she can send you forms to fill out ahead of time or if you can download them from the Web. Or create your own document by writing down the medications and supplements you take (include name, strength and dosage), any drug allergies, past surgeries, basic family history and current diagnoses. Your doctor can scan it quickly and move on to your immediate concerns.
Next, organize your thoughts by making a list of your health questions or complaints. Consider this your "agenda" during the appointment, says Barbara M. Korsch, M.D., coauthor of The Intelligent Patient's Guide to the Doctor-Patient Relationship: Learning How to Talk So Your Doctor Will Listen (Oxford University Press). "You wouldn't go into any other important meeting without a plan, so be prepared," she says. If you have a chronic issue, keep a detailed record (at least three days) of your symptoms and when they occur. For example, if you have indigestion, write down when it happens, how long it lasts and what foods and drinks you had that day. Have chronic pain or discomfort? Jot down when it happens, what makes it better or worse, and what it feels like (such as throbbing, burning or aching), says Kim Alumbaugh, M.D., an ob-gyn in private practice in Louisville, Kentucky. The morning of your appointment take an eyebrow pencil and literally draw a circle around where the pain is—so your doctor doesn't have to spend time poking around. Finally, do some research ahead of time on your symptoms or condition. You'll be informed and won't have to ask basic questions.
During Your Appointment
Your doctor is busy—and unfortunately, you're bound to feel a little rushed once he enters the room. "Doctors are pressed for time, so they're focused on getting to an endpoint," says Dr. King. In fact, research has found that physicians interrupt their patients within the first 18 to 23 seconds of speaking, so it's crucial for you to be concise and avoid rambling. "Have your opening statement ready," says Agnew. For instance: "I'm having pelvic pain and am worried I might have fibroids" or "I fell and hurt my knee, and I think I may have torn a ligament." In your statement (make it one or two sentences tops), explain not only what the problem is but also why you're worried about it. If you have multiple issues to discuss, mention that in your opening statement as well by saying, "There are three things I want to talk about today," so your doctor doesn't spend the whole time on the first problem.
If you are interrupted while explaining your problem, quickly redirect your doctor. "It might help if I told you the rest of the story first" is assertive—but still polite. You also shouldn't shy away from stopping your doctor if he's speaking a language you can't understand. "Doctors live in the world of medical jargon," says Dr. King. "You should always feel comfortable interrupting and asking what something means."
Another option to consider, especially for appointments that involve a lot of new information: Take along to your appointment a family member or friend who can help interpret the doctor's advice, brainstorm questions or take notes. "A lot of patients get very nervous and anxious in the exam room, so having someone there can help," says Dr. Alumbaugh.
Before You Leave
To save yourself a follow-up call later, ask for clarification on anything that still seems unclear and be sure you fully understand the doctor's advice, including whether you should be looking out for any symptoms and whether you need to call the office for test results. If the information you've been given seems confusing, ask if the office has a handout you can read at home or if your doctor can point you to a reputable Internet resource. If you're still fuzzy on anything—but your doctor has moved on to the next patient—ask to speak with a nurse or medical assistant.
And most important, avoid asking what doctors call the dreaded "doorknob question" at the end of your appointment. "People often wait until the doctor is halfway out the door before they bring up the most pressing thing on their minds," says Dr. Korsch. Usually, it's something patients are embarrassed to bring up at the start (incontinence and sexual dysfunction top the list). Trouble is, you're not likely to get much quality time to discuss it. Instead, put this question at the top of your agenda. "These are things doctors treat day in and day out," says Dr. King. "So there's no reason to be embarrassed."
Top Five Time Wasters
Stay away from these common exam room time traps:
Small talk: A quick exchange about the weather is okay, but going on and on about topics unrelated to your health isn't.
Miscellaneous gripes: The lack of parking, chilliness of the waiting room or meager magazine selection is probably not in your doctor's control, so don't bring them up. The same goes for complaints about doctors you've seen in the past.
Billing/insurance questions: When checking in for your appointment, ask who in the office can address those concerns. It's not your doctor.
Irrelevant medical info: Though your family's medical history is important, stories about your friend's health problems won't help the doc treat you.
Little white lies: No one likes to admit they forget to take their medicine, don't exercise or drink too much, but not answering your doctor's questions truthfully will make it harder for her to effectively treat you.
Always Worth a Mention
Chronicling every little ache and pain you experience will eat up the clock, but some symptoms should always be brought to your doctor's attention. "Any significant change to your well-being warrants mention," says Jim King, M.D., president of the American Academy of Family Physicians. The following are some examples:
- Chest pain
- Unintended weight loss
- Big drops in your energy level
- Blood in your stool or urine
- Recurring nausea, vomiting, constipation or diarrhea
- Chronic headaches
- Heavy or prolonged menstrual bleeding
- Frequent feelings of sadness or hopelessness
- An unexplained lump or bruise
- Any change to a mole, a new growth on the skin or a blemish that does not heal
Copyright © 2008 Meredith Corporation. Originally published in the September 2008 issue of Family Circle magazine.