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Internal Medicine Blog
Irritable Bowel Disease: Diagnosis and Treatment
- 26 August 2014
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- Internal Medicine Blog
One of most frequent reasons that women come to see their primary care physician is to discuss abdominal pain and bloating. I don't think a day in the office goes by that I do not hear those words. Most frequently these patients have what is known as Irritable Bowel Syndrome (IBS). Not surprisingly, it is the most commonly diagnosed gastrointestinal condition, affecting 10-15% of the population.
The true definition of IBS is: a gastrointestinal syndrome of chronic abdominal pain and altered bowel habits (without other organic cause) at least 3 days per month in the last 3 months. Commonly, the abdominal pain is intermittent and described as "crampy". Exacerbations can occur frequently and are associated with eating and times of increased stress. The abdominal pain associated with IBS can vary in intensity and location, but is often relieved with bowel movements. Other common symptoms include: bloating, gas, nausea, diarrhea and/or constipation, and feeling full quickly. "Red flag" symptoms such as anorexia, weight loss, persistent rectal bleeding, pain awakening a patient from sleep or certain lab findings (i.e. anemia) are rarely associated with IBS and should prompt a further workup for an alternative diagnosis.
Unfortunately there are no tests specific to the diagnosis of IBS. Frequently, a physician will run blood or stool tests and maybe order additional procedures such as a colonoscopy to rule out other potential causes of symptoms. If no other source is found and no "red flag" symptoms are present, a diagnosis of Irritable Bowel Syndrome is made.
There are 4 different subtypes of IBS:
1) Diarrhea predominant
2) Constipation predominant
3) Mixed type
4) Unsubtyped
Treatment options vary between the different types.
As any patient who suffers from IBS knows, making the diagnosis is only half of the battle. Treatment for this ailment takes time, patience and diligence to improve symptoms. IBS is a chronic disease, which means most patients will likely have it for life. That being said, the majority of patients will be able to control their symptoms with one or more of the treatment modalities available.
Upon diagnosis, a patient should take time to keep a log of symptoms and what the circumstances were at that time (what she ate, what she did, etc). This will help to elucidate any specific pattern or specific food that may be contributing to a patient's pain. It has long been thought that certain foods in certain individuals can be a source of IBS symptoms. If a patient has been diagnosed with Irritable Bowel Syndrome, her first step should be to eliminate foods known for high gas production such as: beans, onions, celery, carrots, raisins, bananas, apricots, prunes, Brussels sprouts, pretzels, bagels, alcohol and caffeine. In many patients, reduction in these foods can bring around a significant improvement in abdominal pain and bloating.
If still with significant symptoms despite reduction of high gas forming foods, a patient may decide to follow a stricter approach with the low FODMAP (fermentable, oligo-, di-, and monosaccharides and polyols) diet. High FODMAP foods are poorly absorbed and are rapidly fermented in the gut causing gas and bloating. Such foods are listed below.
Oligosachharides: wheat, barley, rye, onion, leek, garlic, shallots, artichokes, beets, fennel, peas, pistachio, cashews, legumes, lentil and chick peas..
Disaccharides: lactose (milk, ice cream, yogurt)
Monosaccharides: apples, pears, mangoes, cherries, watermelon, asparagus, sugar snap peas, honey and high fructose corn syrup.
Polyols: nectarines, peaches, plums, mushrooms, cauliflower, artificially sweetened chewing gum and other sweets
Obviously this can be a very restrictive diet. If taking on a low FODMAP diet it is recommended that you do this under the guidance of a trained dietician in order to avoid over- restriction and malnutrition. Ideally a patient would be on a low FODMAP diet for 6-8 weeks at which time she would gradually re-introduce the above foods one at a time to determine which specific foods are tolerated and which are not.
Though it is thought that food allergy could possibly play a role in Irritable Bowel Syndrome, at this time there is insufficient evidence to recommend food allergy testing in patients with IBS. This is largely due to the fact that current modes of allergy testing have not been reliable in identifying affected patients.
In addition to dietary management, 20-60 minutes of moderate to vigorous exercise 5 days a week has been shown to significantly decrease symptoms of IBS. It is also important to address daily stressors through counseling and stress-reduction techniques (meditation, yoga, etc) as increased stress often leads to increased IBS symptoms.
If lifestyle interventions still fail to control symptoms, your doctor can prescribe medications specific to the patient's symptoms. For example, anti-diarrheals in diarrhea predominant IBS, laxatives in constipation predominant IBS, antispasmodic agents, and antidepressants.
In summary, Irritable Bowel Syndrome is a very common disease affecting a large number of women. Symptoms generally consist of abdominal pain, bloating, and a change in bowel habits. In order to diagnose IBS, doctors must rule out other organic causes of gastrointestinal disease. Though it is not curable, most patients are able to control their symptoms with lifestyle changes or medications.
Screening for Breast Cancer
- 01 July 2014
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- Internal Medicine Blog
Breast cancer, we are taught, is an illness that all women need to be aware of, and be screened for. But how do we most effectively screen for it? This question is not as straightforward as one would think, as the recommendations for different screening modalities are always evolving, based on new assessments of available evidence. Traditionally, women were advised to do monthly self-examinations in the shower as a front-line defense against breast cancer. But in recent years, these exams have not been shown to consistently prevent breast cancer deaths (which is, after all, the goal of any screening program). Therefore, most expert groups now either recommend against self-exams entirely, or they recommend encouraging "breast awareness", which means each woman should be aware of her own body, so that she can recognize potentially alarming changes--this could include a traditional breast exam, but not necessarily.
Another mainstay of breast cancer detection has been the clinical breast exam, performed annually by a physician at the time of the gynecological examination. While the American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG) recommend these exams every 1-3 years for women ages 20-39 and annually for women thereafter, the US Preventive services task force (USPSTF), an independent government-sponsored organization, notes that there is insufficient evidence for these exams, as well.
Mammography is recognized by most women as the most important tool we have for breast cancer screening, and most medical societies agree, recommending annual mammograms for all women beginning at age 40. A few influential groups, though--notably the American College of Physicians (ACP), the American Academy of Family Physicians (AAFP), and the USPSTF--feel that the evidence for mammography in women between the ages of 40 and 49 is not as strong as for women 50 and older, and they have therefore departed slightly from this recommendation. They advise instead that for these women, mammograms may be performed every 1-2 or every 2 years, and that the decision can be individualized for each woman in this age group. Annual mammography is recommended by many societies to continue throughout the later years of life, but again there is some variability--the AAFP advises screening only until age 74, the USPSTF recommends stopping at age 75, and ACOG recommends individualizing the decision to screen after age 75.
So where does all of this conflicting evidence leave doctors and patients? There is not an absolute correct answer for how to screen--but it is important that patients do what makes them feel most comfortable, that doctor assess the evidence various expert groups use in making their recommendations, and that both groups communicate their preferences and concerns about screening to one another.
Obesity and Weight Loss
- 29 April 2014
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- Internal Medicine Blog
The number of Americans who are overweight and obese has reached epidemic proportions. This year the CDC estimates that 2/3rds of US adults are overweight (BMI >25) and 1/3 of the population meets the classification of obese (BMI >30). Rates have risen dramatically from 1990 through the current time period. Many factors play a role in this increase which includes an overall decrease in daily activity with increased access to and consumption of high calorie low nutrient foods, fast foods, and processed foods. Being overweight and obese is associated with many negative health consequences including (but not limited to) elevated blood pressure, high cholesterol, diabetes and pre-diabetes, metabolic syndrome, arthritis, back pain, PCOS, infertility, irregular menstrual cycles, vitamin D deficiency, depression, skin tags, colon, breast , and endometrial cancers (among others), sleep apnea, worsening asthma, and fatigue. There is good news, however! Health effects from obesity are dramatically diminished with even moderate weight losses.
While I would encourage everyone to aim for a BMI in the "normal" range, a maintained loss of 10-20% of maximum body weight produces significant health benefits and risk reduction. The National Weight Registry is a research database that has tracked successful "loosers" for over 20 years. These individuals shed at least 30 pounds and kept it off over 1 year. The most common habits of successful maintainers are eating breakfast, exercising daily (average 1 hour per day), keeping a daily food log, and weighing themselves weekly. Most of these successful individuals also lost their weight gradually at an average of 1-2 pounds per week. Making sustainable lifestyle changes is the key to success! There are many tools from food logs, support groups, individual counseling, pre-packaged meals, medications, and surgery that can help achieve goals. I would encourage anyone who could benefit from weight loss to take action! Not sure where to start? Consider making an appointment with your doctor to assess your risks and start you on a healthier path.
Spring Cleaning: A Few Recommendations
- 01 April 2014
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- Internal Medicine Blog
By: Maria Mazzotti, D.O.
As the weather starts to give us a break, I would like to give you a few reminders to help you stay healthy and enjoy the rest of your year.
1. If you have not started your allergy medications, I would high recommend doing that immediately. Getting started early may make a big difference in controlling you allergies. That goes for Singular as well, since it take about for this particular medication to start working effectively. Also keep in mind that Ventolin, commonly used for asthma, has a short half life. So once you open the foil package, you need to discard it after 6 months, even if you have not finished all of the inhalations. If you have severe allergies, you want to make sure your Epipen has not expired. This is also a good time of the year to have your carpets cleaned of all of the debris that accumulated over the winter and you can keep the windows open to make sure the carpets dry well.
2. Make sure you are up to date with your Tdap vaccine. You may know this vaccine as the Tetanus shot, Pertussis vaccine or whooping cough vaccine. This vaccine protects against 3 different infections. This time of the year, when we start gardening and hiking, this vaccine is important because it protects you against "Lockjaw" if you get a bad cut, burn or step on something rusty. Also Whooping Cough season is from June to September. It takes a few weeks to kick in, so you still have time.
3. This is also a good time of the year to clean out your medicine closet. Do not keep any medications that you are actively using. It is better to write down any medications that you are allergic to or have side effects from, then to keep the medication bottle hand for reference.
4. Now is also a good time to schedule those tests that you were forced to cancel due to the bad weather (mammogram, colonoscopy, blood work, PAP, physical, DEXA Scan, etc) before the steamy weather hits.
5. Make sure your sunscreen is not expired. Remember to apply it at least 30 min before stepping out for it to be more effective.
6. If you have not already, make sure you sign up for Obamacare. This is the first time in our nation's history that everyone can have healthcare. Having insurance saves us all money, and more importantly keeps us healthy.
7. Also you should change your heating filters when you start using your AC. It may also be a good time to get you system cleaned/inspected if you did not do so in the fall.
8. As you get ready to be more active outside, make sure your sneakers are not worn out.
9. This is also a good time to start juicing, since a lot of your favorite fruits are coming in season.
10. Most importantly, this is a good time to focus on getting heart healthy. Whether you need to loose weight or not, you should be doing at least 30 min of a cardiovascular workout five times per week. Keep it fun, have friends join in, but do not work through pain. Exercise is also an effective way to help with anxiety/stress/depression and difficulty sleeping. And if you loose weight along the way, it is a plus.
What is Osteopathic Manipulative Medicine?
- 28 January 2014
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- Internal Medicine Blog
By: Catherine Liebman, D.O.
Since joining the Rittenhouse Women's Wellness Center in July, Dr. Catherine Liebman is often asked to explain "What is Osteopathic Manipulation?" and who may benefit from it. Osteopathic Manipulative Medicine (OMM) is a medical specialty that is specific to Doctors of Osteopathy (DOs). While all DOs get some training in OMM in medical school, others choose it as their specialty. For an OMM specialist the main focus is the musculoskeletal system. OMM is the application of manipulation to the body to address problems in the joints, muscles, nerves, connective tissues, and organs. Dr. Liebman incorporates OMM into conventional musculoskeletal medicine including orthopedic examinations, interpretation of x-rays and MRIs, managing physical therapy, injections, medications, and medical acupuncture, to create a unique and integrated approach to patient care.
OMM is based on the principle that the structure and function of the body depend on one another. During a visit Dr. Liebman assesses the patient for joints that are out of alignment, muscles imbalances, and connective tissues that are restricted. The dysfunctions that are identified are corrected with Osteopathic techniques. Many Osteopathic techniques are well known in other areas of musculoskeletal medicine, including myofascial release, soft tissue techniques, strain-counterstrain, muscle energy, and craniosacral therapy. The goal is to treat a patient with the most current clinical medical practices and to identify and correct the cause of pain, not just mask the symptoms.
As an example, a patient with low back pain may be evaluated for any organ or neurologic cause, receive a prescription for a medication and/or x-ray, and receive an OMM treatment to improve the symptoms immediately – all in one visit. It is truly integrated and holistic healthcare. Initial visits typically take one hour for evaluation and treatment and follow-up visits take 30 minutes. Depending on the situation, patients may need to return for more treatment. The treatment and management of the patient is tailored to her unique situation, and may include other modalities as well. However, the goal is to give patients the tools to feel and perform their best on their own and prevent further injuries.
Conditions commonly treated with OMM include:
- Chronic pain
- Acute pain
- Sports injuries
- Tendonitis
- Fibromyalgia
- Migraine/Headaches
- Neck pain
- Low back pain
- Joint injuries
Ask the Doctor
- 06 January 2014
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- Internal Medicine Blog
Ask the Doctor: January 6th, 2014
Answered by: Dr. Linda Bullock
Question: How important is it, if you have a family history of heart disease, but are not exhibiting symptoms yourself, to have blood tests for C-reactive protein and lipoprotein A? I believe these might be better assess your risk of arterial plaque.
Answer: The U.S. Preventive Services Task Force deems these tests lacking enough evidence to use them for clinical decision making. Traditional tests (total cholesterol, HDL, triglycerides) still guide treatment.
C-reactive protein is produced by the liver and is a general marker for increased inflammation in the body. It may be associated with an increased risk for heart disease but it is not specific. Lipoprotein(a) is a circulating lipoprotein and it has been associated with an increased risk of coronary artery disease, but the added value of this test beyond measuring a lipid panel is not known at this time.
Measuring these and other tests such as the homocysteine level and the ankle brachial index may be used to guide treatment decisions in the future. Reducing risk factors is imperative, especially if you have a family history. If you smoke, please stop. If you have diabetes or hypertension, these should be treated. If you are overweight, try to reach your optimal weight. Diet and exercise are the cornerstones for risk reduction and if your cholesterol is elevated after you have maximized your healthy behaviors, you may need a cholesterol medication.
Questin: December 1, 2013
Answered By: Dr. Linda Bullock
Question: "I've been told to get my calcium from food only, and the allergist wants me to limit my dairy. There are many "calcium fortified" food items like cereals and almond milk, but is seems to me getting calcium from these products are no different then taking a pill. Should these be avoided as well?"
Answer: Taking calcium pills may be counterproductive so current recommendations suggest food sources of calcium. while dairy products are very high in calcium, there are other foods high in calcium. dark green leafy vegetables such as broccoli, kale and collard greens, oysters, salmon, sardines, molasses, tofu, parsley, dried figs and almonds, to name a few. When it comes to fortified foods, there are several stipulations to consider (according to fitday.com). 1) calcium absorption is better at higher acidity levels in the stomach 2) products with calcium carbonate are absorbed equally as well as dairy. 3) precipitation can cause the nutrients to settle on the bottom of the container, shaking the container can improve this. 4) plant estrogen is soy can increase calcium absorption. Hope this helps.
Calcium Levels in Milk vs. Almond, Rice and Soy Milk / Nutrition / Healthy Eating
Question About Menopause: Answered by: Dr. Linda Bullock
Information About Cervical Cancer
- 02 January 2014
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- Internal Medicine Blog
What is cervical cancer?
"Cervical cancer" is a disease which causes the cells of the cervix to grow in an out of control way. The abnormal cells develop the ability to spread and invade other organs. When this occurs, cervical cancer can spread and ultimately lead to death. This can even occur in young, healthy woman.
What are the risk factors?
Most cervical cancer is caused by a sexually transmitted virus. This virus is called HPV. The virus is spread by skin to skin contact, which means that condoms may not protect you. Some strains of the virus cause genital warts, however most strains cause no symptoms at all. Most of the time, your immune system clears the virus. However, some woman remain infected, this constant infection with HPV can lead to cervical cancer. Having the virus does not mean you will develop cancer, although it does mean that you should be vigilant!
Other factors which can increase your risk of cervical cancer are:
*long-term oral contraception
*multiple sexual partners
*cigarette smoking
What can I do?
Make sure to schedule your annual gynecological exam! The American College of Obstetricians and Gynecologists recommends annual pap smears for all women starting from 21 years of age.
The best way to detect cervical cancer is by having your pap smear. There are different recommendations for when to have your pap smear (from every 6 months-every 3 years), which depend on your previous results. However, even if you do not get your pap smear once a year you should schedule an annual exam to regularly reassess your risk factors, as well as to get an internal and breast exam and std testing when necessary. If you are under the age of 26, your doctor may also recommend the HPV vaccine series. The HPV vaccine is used to prevent infection with HPV types 6, 11, 16 and 18 and is covered by most insurances (please contact your carrier for additional coverage information)
Lastly, please make sure to follow through with any additional appointments that your physician recommends. Scheduling a colposcopy with a gynecologist may not sound like fun, but timely follow-up can make the difference between a small treatment procedure and extensive cancer therapy. In summary – don't delay! If you have not had your pap smear for several years or if you have any further questions about cervical cancer, schedule an appointment with one of our physicians right away and take control of your health!
What's Keeping You Up at Night?
- 29 November 2013
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- Internal Medicine Blog
Insomnia is the most common sleep complaint in the U.S. population, affecting as many of 10% of adults at one time or another. Insomnia is defined as trouble falling or staying asleep, or feeling that one's sleep is nonrestorative. Chronic insomnia can result in a number of problems--daytime fatigue, anxiety, feeling cranky or irritated, forgetfulness, or making mistakes, to name a few--and because of this, it can affect the relationships and work of those who experience it.
Insomnia has many causes, and determining what is causing one's sleep problems is often the first step toward finding a solution. For example, certain medical conditions that cause pain or breathing difficulty can keep one awake. Having to get up to go to the bathroom frequently can interfere with sleep. Some medications may have side effects that make sleep difficult. And stress or anxiety--due to work issues, the death of a loved one, etc.--can make a good night's sleep a chronically unattainable goal.
So how do we handle the inability to sleep well through the night? For starters, if you do have an uncontrolled physical symptom or medical issue causing your insomnia, talk to your doctor about it! The next step is to promote a restful sleep environment. This is referred to as "Sleep Hygiene". First, make sure you have a set bedtime and wakeup time, and stick to them. Do not nap or doze during the day. Make sure your bedroom is dark and quiet, and kept at a comfortable temperature. Use an eye mask or earplugs, or a white noise machine, if needed. Exercise daily, but not right before bedtime. Do not have any alcohol, caffeine, or nicotine in the late afternoon or evening. And be sure to resolve any stressful issues from your day long before bedtime.
If you are still unable to sleep, then further steps may be taken. One option is to retrain your body to sleep through the night using the following method. If you cannot fall asleep after 15-20 minutes, get out of bed and do something relaxing, like reading. Do not engage in any activities that are goal-oriented or will make you more alert. When you start to feel tired, then return to your bed. If you are unable to fall asleep after another 15-20 minutes, repeat this cycle until you are able to fall asleep. Remember that even if you do not get a full night's sleep at first, you should stick to your regular wakeup time. This may take a couple of weeks to result in a full night's sleep, but eventually your body will adjust to the sleep cycle you are enforcing.
For those who do not respond to any of the above measures, other options--like cognitive or relaxation therapy--may be helpful. A formal sleep study, or even referral to a sleep medicine doctor, may be indicated. And as with any health concern, if your insomnia persists, you should follow up with your doctor to get to the bottom of it.
Pink Eye: Viral vs. Bacterial
- 29 October 2013
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- Internal Medicine Blog
By: Jillan Rowbotham, D.O.
It's an experience almost everyone has had: you wake up to find one eye seemingly glued shut. You carefully pry your lashes from the crust that has them stuck to your cheek revealing an eye that is red and watery – the dreaded pink eye.
Pink eye is the common name for conjunctivitis, inflammation of the thin membrane that covers the eyeball and inner surfaces of the eyelids. Acute conjunctivitis can be caused by an infection, allergies, or an unknown irritant. Infectious pink eye can be viral or bacterial and both are quite contagious.
Though many people think pink eye is always caused by a bacteria and needs an antibiotic eyedrop, the most common cause of infectious conjunctivitis in adults is the adenovirus, the same virus that can cause the common cold. Sometimes viral pink eye comes as part of a general cold syndrome with swollen lymph nodes (glands), fever, sore throat, and a runny nose. The eye can have a burning, sandy, or gritty feeling, is often crusted shut in the morning, and will have a watery or mucus discharge throughout the day. The other eye usually becomes infected in the next day or two. Just like a cold, viral pink eye symptoms often get worse for the first three to five days then gradually improve over one to two weeks. There is no cure for viral conjunctivitis and antibiotic eye drops will not reduce the duration or intensity of symptoms. Over the counter antihistamine eye drops or artificial tears can help with the eye discomfort. A warm or cool wet washcloth (whichever feels better) can also be soothing.
Bacterial conjunctivitis can involve one or both eyes. Whereas the discharge with viral conjunctivitis is watery with perhaps some mucus, bacterial conjunctivitis causes a thick white, yellow, or green discharge. The affected eye will continuously ooze throughout the day, with more pus-like discharge accumulating just a few minutes after the eye is wiped. An antibiotic drop or ointment can improve symptoms and reduce the likelihood of spreading the infection to others.
Both viral and bacterial conjunctivitis are spread by contact, usually with objects which have come into contact with the infected person's eye secretions. For an example, an infected person touches her eye then touches her phone or a door handle. Some organisms can live for many hours on a surface so it is easy to see how it can spread. Infected individuals should consider themselves contagious as long as they have eye discharge and should not share tissues, towels, cosmetics, or bed linens. They need to discard any cosmetics that may have become contaminated. They should avoid touching the infected eye and wash their hands frequently to help reduce spread to others. Antibiotic eye drops can reduce the spread of bacterial conjunctivitis but do nothing to reduce the spread of viral conjunctivitis. Viral conjunctivitis is like a cold and the decision to return to work or go to a social gathering should be similar to how one would behave with the common cold.
Contact lens wearers need to wear glasses until their eye is no longer red. Their lens case should be discarded and the contact lenses disinfected overnight or replaced if disposable.
If you are not sure if you have viral or bacterial pink eye or you think you need an antibiotic please make an appointment to be seen in the office. Calling first thing in the morning (as soon as you unstick your eye, of course) can help us be sure to see you that day.
A red eye that is associated with moderate to severe pain, loss of vision, or intense sensitivity to light (cannot keep the eye open for more than a few seconds) indicates a more serious condition that could potentially lead to blindness if left untreated. Contact lens wearers are at higher risk of more serious infections, particularly with extended-wear lenses. Evaluation should be sought immediately at an Opthalmologic ER such as Wills Eye or Scheie Eye Institute.
Acupuncture for Pain
- 27 September 2013
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- Internal Medicine Blog
By: Catherine Liebman, D.O.
With the change in seasons come changes in the rest of our lives, including how our bodies feel. While some of us may feel fatigued or run down in this busy time, others may develop new aches and pains or exacerbations of old injuries. Pain can arise for a variety of reasons: whether it's a new job requiring you to sit all day long, or a new hobby or sport that's placing different demands on your body. The good news is that there are a lot of options that can help. Medications, exercise, yoga, meditation and acupuncture can all help to relieve pain and get you moving again.
Acupuncture is one of the best researched modalities in Complementary and Alternative Medicine. In 2012 a large review of studies on acupuncture for pain was published in the Annals of Internal Medicine. This review looked at nearly 18,000 patients with chronic pain syndromes such as back pain, neck pain, headaches, and shoulder pain. The results showed that acupuncture was superior to both sham (fake) acupuncture, and traditional treatment alone.
The even better news is that the side effects are minimal. The most common side effects are small amounts of bleeding after the needles are removed, and temporary itching at the location of the needles. While many people cringe at the thought of voluntarily being poked with needles, the reality is that most patients enjoy the treatments. The placement of the needles is relatively painless and it leaves people feeling calm, relaxed, and pain-free.
So how does acupuncture work to relieve pain? There are several answers to that question. Firstly, acupuncture treats the underlying conditions that predispose people to having pain in the first place. By accessing points of the affected meridian, the flow of qi, or energy, is optimized. Secondly, needles may be placed in tight or painful muscles to reduce spasm and muscle tension. Oftentimes, gentle electric stimulation or heat is used to increase the pain-relieving effects. Electroacupuncture, or acupuncture with electric stimulation, has been shown to increase the body's production of natural pain-relieving chemicals. The overall effect is proper balance in the flow of energy, decreased tension in the muscles, and decreased pain.
Acupuncture is becoming more and more widely accepted as an effective modality for relieving pain. In fact, the United States military is a big supporter. Military medics are trained in acupuncture so they can quickly reduce an injured soldier's pain on the battlefield until they can be transported to a medical center. But you don't have to be a wounded veteran to benefit from acupuncture. At the Rittenhouse Women's Wellness Center we provide acupuncture services to our patients at both locations.
Rittenhouse Internal Medicine™ has received the highest recognition (Level 3) from the National Center for Quality Assurance (NCQA). What this means for our patients – learn more
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text:
♥Name: Frances Bean Cobain
♥Age: 18
♥Species: Unknown
♥Talent: Unknown
♥Relationship Status: Taken by Damen, The Narnia Guy XD
♥Looking: No longer...
♥Imprint: Impossible!
♥Imprintee: No one that I know of…
♥Crush: --
♥Virgin: Yes, and quite content with it...
♥Drink/Smoke/Drugs : I'm staying away from these substances after seeing what they did to my father…
♥Likes: Music
♥Dislikes: My Mom
♥Children: Lucy
♥Parents: Kurt Cobain & Courtney Love
♥Food: Pizza
♥Drink: Soda, I guess
♥Place: Home
♥Song: 'Polly' by Nirvana
♥Color: Yellow
♥Movie: Forrest Gump
♥Book: The Hitchhiker's Guide to the Galaxy
♥TV Show: Meh... I don't like TV
♥Besties: Aria
♥Thinking: No matter how old I get I'll still be looking for my daddy
♥Doing: NOTHING!!!
♥Mood: Bored
♥Eating: --
♥Drinking: --
♥Person on Mind: No one really
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Posts Tagged 'senza lock'
Senza Bike Lock Calls for the Handle Bars to be the Lock
Toting around the good old bike lock is a pain in the ass, and literally if you resolve to the hipster methodology (they stick it in their back pocket). So it only makes sense to integrate the lock into the bike's components. ...


text:
Dr. David C. Fisher, MD
Family Medicine, Woodhill Family Medicine
- 813 Leesburg Rd
Columbia, SC 29209
- Within miles of
- 1 Office Location
- Email a Friend
- (803) 783-4433
Dr. David C. Fisher has been practicing medicine for 13 years. Dr. Fisher graduated from the Rush Medical College in 2001. He practices medicine in Columbia, SC and specializes in Family Medicine. Dr. Fisher speaks English and Spanish.
Gender: Male
Years in Practice: 13 Years
Languages Spoken: English, Spanish
Medical School: Rush Medical College
Graduation Date: 2001
Hospital Affiliations: Not Available
Specialties: Family Medicine
©2005-2014 WebMD, LLC. All rights reserved.
WebMD does not provide medical advice, diagnosis or treatment. See additional information.


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Post with 70 notes
"I refuse to conform to any narrative conventions that say, 'Well, if you begin a film with voice-over you at least have to bookend it, have it at the end. You can't just have it at the beginning and let it taper off.' I'm thinking, I'm 50 and I'm going to use whatever cinematic device I want to." -Alexander Payne
Alexander Payne, you're the worst. That's one of the reasons I disliked The Descendants.
Alexander Payne does what he wants!
Advice from the screenwriters of two of my favourite films this year.


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text:
- Narrator
- Nicky Campbell
- Series Producer
- Rachel Bazeley
- Director
- Ailsa Bannerman
Duration: 15 minutes
Preschool history series. Children discover their own and their family's history through fun, adventure and play.
PaBa John shares his memories with his grandson, Harry. Together, they find out all about PaBa's life as a farmer in Australia, and Harry gets to feed a hungry lamb. They visit a very old farming show.
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Anybody who follows me in Boston, the Police Department also confirmed that they are looking into a possible threat at the JFK Library, if you're in the area then you should clear out.
Do NOT drive through Boston or take the subway right now. The emergency radio is buzzing with more possible bombs. Please spread this everywhere you can to let your friends and family members know. It could save a life.
(Source: strangestdanger)


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Chinese wild card Ze Zhang stuns world No. 5 Richard Gasquet
Beijing, China (4E Sports) – Wild card Ze Zhang, China's highest-ranked male player in the ATP Tour at No. 165, produced the day's biggest upset when he stunned 14th-ranked Richard Gasquet, 6-4, 3-6, 6-4, Thursday to reach the quarterfinal round of the China Open.
The 22-year-old Zhang claimed his first win over a Top 20 player by rallying from a 0-2 deficit in the third set, grabbing three of his break points and hitting six aces, for his sixth ATP match victory.
"Today I had no fear," said Zhang. "I was very much relaxed. I wasn't that nervous, so I tried my best to play with the utmost performance."
"I had chances to win this match and I made bad mistakes," admitted Gasquet, who won the Thailand Open last week. "He's talented. He plays aggressive and fast, and at the end he played better than me. I didn't play my best match, but it happens and it's because he's talented. He deserves this victory."
Zhang will next play Florian Mayer of Germany, who defeated Marius Copil, 3-6, 6-3, 6-2.
Feliciano Lopez defeated Yen-Hsun Lu of Chinese Taipei 6-3, 7-6(7) in one hour and 32 minutes to advance against American Sam Querrey, who dismissed Italy's Andreas Seppi, 6-1, 6-4 in 66 minutes.
World No. 28 Mikhail Youzhny advanced to the Beijing quarterfinal for the fourth time afte beating South Africa's Kevin Anderson 6-3, 6-3. Next in line for him is third-seeded Frenchman Jo-Wilfried Tsonga.
In the women's side, world No. 1 Victoria Azarenka and second-ranked Maria Sharapova scored straight-set wins over qualifiers to reach the quarterfinal round.
The second-seed Sharapova was first to advance, winning the first eight games en route to an easy 6-0, 6-2 victory over Polona Hercog of Slovenia.
Unlike Sharapova, the top seed Azarenka had a tough opponent in Russian qualifier Elene Vesnina but still came through with a 6-3, 6-3 triumph after one hour and 32 minutes.
This was the first time that both Azarenka and Sharapova reached the quarterfinals in Beijing since it became a Premier Mandatory event in 2009. Azarenka went out in the early rounds in 2009, 2010 and 2011 while Sharapova fell early in 2009 and 2010 and missed the event in 2011 due to injury.
Fifth seed Angelique Kerber of Germay also made it to the quarterfinal after beating 10th ranked Caroline Wozniacki, 6-1, 2-6, 6-4, together with hometown favorite and seventh seed Li Na, who beat compatriot Peng Shuai, 4-6, 6-2, 7-6 (3).
At the Japan Open, second seed Tomas Berdych claimed his 50th match win of the season by beating Alejandro Falla, 6-3, 7-5, Thursday in the second round of the Rakuten Japan Open Tennis Championships.
In the quarterfinal, the sixth-ranked Berdych will play No. 8 seed Kei Nishikori, who beat Tommy Robredo, 5-7, 6-1, 6-0.
World No. 9 Janko Tipsarevic also reached the quarterfinal after beating qualifier Marco Chiudinelli 6-4, 6-2. The third-seeded Tipsarevic will square off against sixth seed Milos Raonic, who was leading 3-0 when Viktor Troicki retired.
Marcos Baghdatis upset No. 4 seed Juan Monaco 7-5, 1-6, 6-3 to advance against qualifier Dmitry Tursunov, who beat wild card Tatsuma Ito 7-5, 6-3.
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5 Crunch-Free Moves for Bikini-Ready Abs
Written on June 20, 2012 at 8:29 am , by Karla Walsh
Today is officially the first day of the most belly-baring season: summer! While we may be tempted to chill out by the pool with a tasty drink, it's not the time to slack off on staying fit and strong (but when is?). We asked Jill Miller, trainer and creator of the new Coregeous workout DVD, to share five of her favorite, unique moves that tone the midsection.
Add them to your routine this week and hit the beach with confidence all summer long!
Magician's Assistant on a Ledge
- Place your right hip on a brick and right elbow on the ground.
- Engage your side-waist muscles to raise your legs to hover four to six inches above the ground. (Make sure that your shoulders, pelvis and ankles line up with each other, and that the two legs remain glued together.)
- Sustain the position while breathing deeply for one full minute, then switch sides and repeat.
WHY? "This exercise targets the internal and external oblique layers and a deep low back muscle," Miller explains. "You will feel this one tomorrow!"
Coreso Leg Lifts
- Lie on a yoga mat with a block or phone book under your pelvis.
- Reach the arms overhead and externally rotate them so that the hands hold on to the sides of the yoga mat and attempt to pull the mat edges apart.
- Stretch the right leg towards the ceiling (if hamstrings are tight, bend the knee), and lower the left leg towards the ground without touching the floor. Do not allow the spine to lose it's stability or natural curves.
- Breathe for one full minute on each side while remaining stable.
WHY? "This pose targets the critical relationship between our breath and our posture while toning the innermost abdominal muscles. You will feel a tremendous stretch while lengthening and strengthening," Miller says.
Forward Ocho
- Prep your body for a plank pose, then twist the plank so that the right and switch the placement of your feet (both pointing towards the right).
- Bend the left knee and lace it around the right leg so that the whole body pivots and the feet land pointing to the left.
- Then the right knee bends towards the chest and twirls around the left. The movement resembles a tango dancer's "figure 8-like" dance steps.
WHY? "This pose leaves no abdominal muscle unserviced! Your core is challenged from all angles, and as a bonus, the inner thighs and outer butt muscles are strengthened due to the fresh positioning of the feet," Miller claims.
Rotated Plank on Stability Ball
- Get in plank position with shins on top of a stability ball. Point toes to the left with ankles stacked. Engage core muscles from the shoulders to the outside of the rich hip to prevent slouching or dropping.
- Hold for up to one full minute, then pivot the legs and point the feet towards the right.
WHY? "This pose integrates all core and back muscles within a 'twist' while attempting to stabilize on the stability ball while also building balance and power," Miller says.
Rib Rock Massage
- Place two grippy Yoga Tune Up® Therapy Balls (can sub tennis balls) along the side of the spine in the upper back region.
- Breathe slowly into the ribs and rock from side-to side and allow the balls to massage in towards the rib joints. Roll for one to two minutes on left side of spine, then switch sides and repeat. Then move the balls into the lower back and ribs and repeat.
WHY? "The rolling motion uncorks tension along the upper back and spine so that the spinal bones regain fluidity and mobility," Miller says.
Categories: Fitness, The Fit Stop, Workouts | Tags: abs workout, at home, bikini, Coregeous, Jill Miller
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Across the Page (March 2007)
This month's round-up includes first-time novelist Lu Vickers on a young girl's coming-out in the Deep South during the early 1970s, a breakdown of why the book version of Notes on a Scandal is far more successful than the controversial film, and the new anthology of Michelle Tea's top picks.
Breathing Underwater, by Lu Vickers (Alyson Books)
Lily Edwards, the narrator of Lu Vickers' Breathing Underwater, has a whole host of troubles: Her town, Chattahoochee, Fla., revolves around a mental institution — "a trap, like one of those man-eating plants" — where everyone is either a patient or an employee; her father is detached and unreliable; her brother, James, is favored because he's a boy; her sister, Maisey, because she's the youngest; and her mother, the pivot of Lily's existence, relies on pills and alcohol to treat her depression and psychosis. Being "a lezzie," a term she learns at her Baptist church camp, is the least of her problems.
But, of course, being gay is rarely the least of any adolescent's problems, especially in the Deep South during the early '70s. Lily does her best to disguise her emerging identity and sexuality. When she plays "the kissing game" with her friend Rae, they always insist that someone plays "the boy." She keeps her hair long. She carries her books by her side rather than against her chest. If she needs to look at her nails, she holds her fingers out flat rather than turning her hand around. Still, Lily knows she'll be "in deep trouble if anyone ever found out that I hated wearing dresses, that I'd kissed Rae, or that I'd stood in a souvenir store looking at a doll's titties."
Breathing Underwater begins when Lily is 12 years old. She is fishing at the lake with James, Maisey and her mother when she accidentally falls in to the water. Unable to swim, she frantically kicks her legs and tries to call out for help. As her head bobs up and down, she spots her mother standing on the dock: "Mama didn't move. She was going to let me drown and was weighing her gains against her losses. Watching me, eyes flat as pennies. I was Not the Right Kind of Girl. Never had been."
Finally, Lily's mother jumps in and saves her from drowning. But the hesitation and the understanding that she was "Not the Right Kind of Girl" continues to haunt Lily as she grows up. Lily decides that the only solution to her problem is to fall in love with a boy named Ronnie. "I needed to be normal," she thinks, though the relationship comes to an end when Lily meets Cat Reeves, a new girl at school who, with her "fluffy Afro and dark glasses," looks like a " Jackson 5."
When Lily's mother discovers the relationship with Cat, she finally has the opportunity to unleash her venom, and the two get into an all-out brawl: "I held her tighter," Lily says, "and she screamed even louder, 'Let me go, you goddamn queer, you goddamn queer,' and it was strange, hearing my own mama call me a name I hadn't thought of calling myself."
Later, when Lily's mother sobers up, they're in the bathroom tasting baby powder. "I don't remember the first time I saw Mama eat baby powder; it was just something she always did, as if it were ordinary," Lily says, and then tastes it herself. "The powder felt like chalk in my mouth, tasted faintly of perfume. Not ordinary, but something I could get used to, like the way it left the palm of my hands feeling like silk, soft and slippery. Like being queer."
Toward the end, as Lily begins to confront her sexuality and family, she remarks, "I felt tired, like I'd been awake for a million years." Her exhaustion is well-earned, and the overall narrative pace of the book is exhilarating. Breathing Underwater is a coming-of-age and coming-out story. But it's also more than that. It is a story about accepting circumstances and people you cannot change. It is about understanding how to grow up, to move forward and away.


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Mike Truman
Born 12 October 1974.
We currently have no biography for this artist. You can contribute biographical information for Mike Truman to Wikipedia, the user-contributed encyclopedia. If you know that a biography for Mike Truman already exists in Wikipedia, you can add a link to Mike Truman's entry in MusicBrainz.
Links & Information
- Last.fm page on Mike Truman
- Discogs at discogs.com/artist/5992
- MusicBrainz entry on Mike Truman
Member Of
Collaborated on
Links & information come from MusicBrainz. You can add or edit information about Mike Truman at musicbrainz.org. Find out more about our use of this data. The BBC is not responsible for the content of external sites.


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SLEIGH BELLS @ OGDEN THEATRE | 4.13.12 Ever heard of the loudness wars? Doesn't matter. War's over. Sleigh Bells wins. Decisively. Right now, there's a roomful of people banging their heads in unison, in the kind of scene that makes dollar signs appear in the eyes of chiropractors. It's so loud you ... More >>
It's really hard to be a successful corporate retailer. Not only do you have to sell truckloads of stuff to make money, but you have to keep track of whose stuff it is you're even selling. Sigh. It's even harder when you appropriate a design by a band that's really popular thinking, "that'll sell," ... More >>
Brief sketches of what's happening in the Denver art scene.
Sixty-year-old rolling stone Bob Dylan still gathers no moss.


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|Saturday, May 2, 2015
Please check back for more information about the 2015 race.
|Age Requirements:
|14 and over may run on their own
|5-13 must be accompanied by a parent/guardian
|(child and parent/guardian must both be registered)
Participants will receive a shirt and a medal. Click here to view the 2014 course map.
Course Rules
- Bikes, strollers, roller blades and animals are NOT permitted on the course.
- Participants must meet at least a 14:00 minute/mile pace.
Registration Rules
- No refunds or deferments of entry fees
Award Rules
All finishing participants will receive a finishers medal.
Prizes will be awarded for the top three finishers for the 5K in the following age categories for men and women: 9 & Under, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70+
- Age category awards are based on chip time not gun time.
- Age category awards will be mailed once official race results have been submitted. Please allow 3-4 weeks post-race for awards to be mailed out.
- Overall and Master category winners are not eligible for age group awards.
- U.S. and PA are bonus categories and are eligible for overall prize money and age group awards.


text: Past Christmas Classics: 2008 CHRISTMAS CARD (back) "OLD FAITHFUL" We did WAY too many takes of this as having the can explode right when the timer went off proved to be quite challenging. I was literally covered in soaking wet Miller High Life and deeply regret not bringing a change of clothes, much less a towel, to this shoot. The three hour drive back to our apartment was extremely damp, sticky, and smelly. Had I been pulled over things could have been pretty interesting. christmas card desert happy new year miller high life beer explosion salton sea christmas pregnant pregnancy trailer home


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Liberty Kicker Flies over Limitations
- Friday, November 28, 2008
Said Smith, who kicked and punted at his Florida high school: "You use your arms a lot with momentum, to swing your body through the zone. You use them for balance to square up your shoulders to where you want to kick it. A big thing with accuracy is where you shoulders are pointing at the point of the kick."
Accuracy hasn't been a problem for Shipps, who has converted 15 of 16 extra-point attempts and 5 of 6 field goals this season. What's more impressive is the improvement he's shown on kickoffs, a weakness coming into the season. Bevins has battled injuries all season, as has punter Mike Larsson.
That's left Shipps as the best option on kickoffs. When he first took over the duty, his kicks rarely went deeper than the opponent's 15-yard line. In recent weeks, he's booted balls consistently inside the 10, even inside the 5. Those extra yards provide valuable field position for the Flames' defense.
"With kickers, a lot of it is confidence," Liberty special teams coach Chad Wilt said. "Knowing that the coaches believe in you can give you great confidence, that they're willing to put trust in you. I think Shipps is really gaining confidence in himself right now."
Shipps made a decision early in life that he wasn't going to allow his limitations to dictate his life.
"I'm comfortable in my own skin," he said.
He began playing soccer at age 5, dabbled in basketball and picked up golf. The one finger on his left hand allows him to grip a club, and though he can't take a full backswing, he can still hit the ball just fine.His grandparents both flew planes and his father Steven has a pilot's license, so Shipps was drawn to aviation. Shipps now has his pilot's license and has about 90 flight hours under his belt. He's part of Liberty's aviation program and is also studying business management.
"I've always been around it," Shipps said. "My uncle has a plane. I've always had a foot in the door, and I just decided to try it for myself."
His career can wait, though. Shipps still has plenty of business to take care of on the football field. He'll be an integral part of Liberty's efforts Saturday against Elon in what might be the most important game in the school's Division I history. With a victory, the Flames will still have a chance at earning their first-ever Football Championship Subdivision playoff berth.
Shipps isn't just happy to be a part of the team. He's a key contributor now, one who has earned the respect of his coaches and teammates.
Said Wilt: "How can you not root for that guy?"
Chris Lang is a sports writer for the Lynchburg News & Advance. Story reprinted with permission. A video about Shipps is also available from the News & Advance.
Copyright (c) 2001 - 2008 Southern Baptist Convention. Used with permission.
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Michael BamiroFree Agent
Offensive Tackle
Ht: | Wt:
News | Stats | Stat vs. Team | Targets | Injury | Depth Chart | Roster
|Bills | Try out several players
Fri, 12 Sep 2014 00:05:17 -0700
The Buffalo Bills had several free-agent players in for workouts, including QB Tajh Boyd, RBs Maurice Hagens and Franklyn Quiteh, WR Jeremy Kelley, TE Kyle Auffray, OT Michael Bamiro, LBs James Davidson and Jerrell Harris, DBs Ross Weaver and Junior Mertile, and DTs Jeremy Towns, Derek Landri, and Abe Koroma.
|Comment (0)
|| Share:
|| Source: The Baltimore Sun - Aaron Wilson
|Packers | Host several free agents
Sun, 31 Aug 2014 15:31:56 -0700
The Green Bay Packers worked out free-agents OT Michael Bamiro, OT Manase Foketi, OG Adam Gettis, CB Robert Steeples, QB Pat Devlin, QB Jon Jennings and QB Jeff Mathews Sunday, Aug. 31.
|Comment (0)
|| Share:
|| Source: ESPN.com - Rob Demovsky
|Eagles | More cuts announced
Sat, 23 Aug 2014 09:39:13 -0700
The Philadelphia Eagles have waived TE Blake Annen, OT Michael Bamiro, OG Karim Barton, WR Kadron Boone, OG Donald Hawkins, TE Emil Igwenagu, LB Jake Knott, DE Joe Kruger and SS Daytawion Lowe.
|Comment (0)
|| Share:
|| Source: ESPN - Adam Caplan
|Eagles | Michael Bamiro works at OG
Thu, 29 May 2014 17:16:51 -0700
Philadelphia Eagles OT Michael Bamiro worked exclusively at right guard during organized team activities Thursday, May 29.
|Comment (0)
|| Share:
|| Source: CSNPhilly.com - Geoff Mosher
|Eagles | Seven signed to futures contract
Mon, 06 Jan 2014 15:18:17 -0800
The Philadelphia Eagles have signed QB G.J. Kinne, WR B.J. Cunningham, TE Emil Igwenagu, OT Michael Bamiro, DE Brandon Bair, LB Emmanuel Acho and LB Travis Long to futures contracts. Terms of the contracts were not disclosed.
|Comment (0)
|| Share:
|| Source: PhiladelphiaEagles.com - Chris McPherson
|Eagles | Several added to PS
Tue, 03 Sep 2013 20:26:14 -0700
The Philadelphia Eagles signed RB Michael Bamiro, LB Travis Long, WR Greg Salas and RB Matthew Tucker to the practice squad. The team also signed free-agent FS Trenton Robinson (49ers) to the practice squad.
|Comment (0)
|| Share:
|| Source: ProFootballTalk.com - Mike Wilkening
|Eagles | Five players cut
Sat, 31 Aug 2013 11:27:40 -0700
The Philadelphia Eagles have released OG Danny Watkins, TE/WR Clay Harbor, WR Russell Shepard, SS David Sims and OT Michael Bamiro.
|Comment (0)
|| Share:
|| Source: The Philadelphia Inquirer - Jeff McLane
|Eagles | Part of Michael Bamiro's salary guaranteed
Thu, 18 Jul 2013 13:54:13 -0700
The Philadelphia Eagles have guaranteed $140,000 of OT Michael Bamiro's 405,000 base salary this season and $107,100 of his 2014 base salary.
|Comment (0)
|| Share:
|| Source: CSNPhilly.com - Reuben Frank
|Eagles | Contract details for Michael Bamiro
Thu, 18 Jul 2013 10:08:19 -0700
Philadelphia Eagles OT Michael Bamiro's three-year contract is worth $1.486 million, with $248,270 in guaranteed money.
|Comment (0)
|| Share:
|| Source: The Baltimore Sun - Aaron Wilson
|Eagles | More on Michael Bamiro signing
Tue, 16 Jul 2013 16:46:46 -0700
Philadelphia Eagles OT Michael Bamiro has been guaranteed a portion of his base salaries for his first two seasons in part to offset the fact that he received a low signing bonus, according to a source. He was reportedly rated a fourth- to sixth-round pick in the 2014 NFL Draft, but he learned that he had exhausted his eligibility at Stony Brook last season because he began attending the University of Pittsburgh in 2008 as a student only. Stony Brook appealed on his behalf for an additional season of eligibility but was denied. He was also declared ineligible for the supplemental draft, which took place last week. Former Eagles OT Tra Thomas had been training Bamiro and oversaw his workout last week in front of 22 NFL teams, several of which made strong attempts to sign him. He was a right tackle at Stony Brook and could eventually be a threat to OT Jason Peters' playing time.
|Comment (0)
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|| Source: FOXSports.com - Mike Garafolo
Also see
07/19 - Fantasy football players in the news
07/17 - Fantasy football players in the news


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2 months ago with ♥131
13/04/2014 - West Coast Blues n Roots Festival
13/04/2014 - West Coast Blues n Roots Festival
If you missed Wolf Watch last night, then you missed Dylan doing this. Therefore, you should go watch it!
"You're a weird dude, but people like that."
Behind the Scenes: John Mayer on 'Letterman'
"I do a lot of weird things. I do a lot of weird movements."
September 21st, Brazil. (Rock in Rio 2013)
Happy 22nd Birthday Dylan O'brien! (August 26th, 1991)


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UK Consumers have rights over you
The UK is considering a set of laws that give consumers rights over the providers of digital stuff. These new consumer rights will blow a hole through EULAs and side step a whole mess of intellectual property law. All UK consumers of 'digital content' would have these rights irrespective of where it's provided from, the rights cannot be contracted out of, and the remedies apply to content providers where ever they are.
In short, if you are a game company based anywhere selling to the UK - you need to pay attention.
This is a consultation so none of it might happen. Actually that's not true. The first option will happen as an EU law has been passed that gives consumers greater rights and this includes the digital domain.
This is a consultation so most of it might not happen. But if it does, this is what's being proposed:
Define stuff
- Digital content – everything from games to MP3s
- Related services – a service you must have to run some content and have no option which service to use e.g. a streaming service
- Enabling services – a service that you need to consume some content but you do have a choice e.g. an ISP
Ensure that stuff is of reasonable quality
This is the big change. The proposal suggest that when a consumer gets a digital thing they should have a reasonable expectation of what that thing is. Just like any other good or service they would buy in the UK.
Seller has go to have the rights to sell it to you – so when Amazon removed Orwell's 1984 from people's kindles, that was their bad and the consumes should have got compensation
Is what it says it is – so if I buy something and THEN find out I need some specific player for it, that's your bad not mine as you should have told me.
Uninterrupted use – so you know when Sony patched the PS/3 so you could not longer run Linux on it. Yeh, they can't do that any more, as they sold a device that ran Linux and that's what consumers paid for. The consultation does note that things change, and that's fine, you just can't suddenly remove valued features.
It's basically gotta work – here things get tricky, but basically UK Gov are saying that there's a reasonable expectation that, allowing for the usual bugs, digitial stuff has gotta be a certain quality
Paid for version is the same as the trial – ok, the trial might be limited but you can't have a demo that's substantially different from what people pay for.
And just in case you thought that some things might not full under this, the documents give all kinds of examples:
- A game that needs an online service for authentication but that service is down because of demand – that's covered
- Open Source – if you sell it, that's covered too
- Stuff we are just giving away – if the consumer gave you anything of value in return, even information about themselves, that's covered
- Ahhh, but you did not buy it, you used a virtual currency and that has no value – nope, UK gov covered that one too.
- Ah ha ha, we put in the EULA that you agree to wave you rights as a condition of playing our game – don't bother, it's not worth the paper it's not printed on, these rights are not subject to contract.
The rights against providers that customers may have are:
- Replace or repair
- Reduced purchase price or refund
In conculsion
So, wow, the UK government are treating digital stuff just like other stuff. No EULA or IP trump cards. I'm sure there are a lot of happy consumers out there, but industry, how happy are you? Unreasonable burden on business? Have Koster's rights of the Avatar finally come to pass?
Note the full document is over 250 pages long, so for a very detailed analysis see the summary over at the Virtual Policy Network: http://www.virtualpolicy.net/ukcontentrights.html
tVPN is also putting together a civil society / academic response on Google Docs.
Your local trade association might be doing on too – see UKIE in the UK and ESA in the US.
The full consulation can be found here: http://www.bis.gov.uk/consultations/consultation-rationalising-modernising-consumer-law
Comments on UK Consumers have rights over you:
Caveat: I do not live in the UK. However, I can't say I have much sympathy for companies/associations that will likely protest these laws. No doubt it will be more expensive for them, but as I see it digital product companies have had their way with consumers for too long. Physical product companies have found ways to deal with similar laws (some well, others badly), so there is no reason to believe that digital product companies cannot. At very least the proposed laws may reduce BOHICA moments for the consumer.
Posted Jul 19, 2012 8:54:30 PM | link
> Stuff we are just giving away – if the consumer gave you anything of
> value in return, even information about themselves, that's covered
What rights do customers get in this case? Can a company choose to just "refund" the customer's $0, or is the company required to relinquish the information?
Posted Jul 19, 2012 11:29:50 PM | link
"This is a consolation so most of it might not happen."
While accurate, this is perhaps a typo. After all, it's not much consolation.
Posted Jul 19, 2012 11:32:39 PM | link
Ha. I corrected the typo now. Point taken though.
Posted Jul 20, 2012 3:27:06 AM | link
Gabriel says:
>> Stuff we are just giving away – if the consumer gave you anything of value in return, even information about themselves, that's covered
>What rights do customers get in this case?
It's not that precise. I presume 'all the other ones'. So if there is a trial of something and you have to sign up giving personal info for the full version, then the trial must have been representative. Possibly the fact that this may be by law will provided a basis for other claims against the company. Or maybe data would have to be give up (actually EU level recommendations might handle some of that: http://www.virtualpolicy.net/policy-bites-eu-commissions-proposed-data-protections.html)
Posted Jul 20, 2012 3:52:26 AM | link
Given that recently Steam/Valve, in effect, just waved two fingers at me and and told me to feck off when I was (in my view) mis-sold a broken product (your point "It's basically gotta work".. well not Cities 2012 XL it seems...) when I wanted to exercise my rights under the UK "Consumer Protection (Distance Selling) Regulations 2000", I have very little, indeed, none at all, sympathy for the industry in this instance.
Indeed, I'd go as far as to say that I view the current attitude of US companies (Valve in particular) selling to European customers and ignoring the country specific consumer legislation as atrocious bad business practices (and if you think UK country specific consumer legislation is harsh, you should read some of the German consumer protection laws).
I hope this legislation hits them hard in the only thing they obviously care about; their bottom line, and ensures better, and more ethical, business practices with consumers.
Posted Jul 20, 2012 1:13:10 PM | link


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FAIRBANKS-On Saturday the Alaska Nanook volleyball team got their first game experience in the Alumni game. The Nanooks took the first set 25-16 but the Alumni come back in the second to win 25-16 as well. The Nanooks regrouped to win the final set 25-15 after jumping out to an 8-0 lead.
6'1" freshman setter Katelyn Camp had 29 assists. Sam Harthun posted a double double with 15 kills and 12 digs.
Tina Ferringer, one of the volleyball alums from 2002, likes what she sees from this new team.
"Very strong hitters, they're very quick on their attacks and I think that's definitely what caused a lot of their success tonight were the quick attacks." Ferringer added," It means a lot to come back and support the Nanooks and be here for the girls so it was exciting."
Camp was pleased with her teams outing but given that it was the first one she saw areas where the team can get better.
"Our communication could be like a little but higher but I think overall we still did really well for our very first game." Camp also said, "we all click really well as a team and we all get along so playing on a court is like a bunch of sisters together, it's like one big happy family; I love it."


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Alan Watt - Predictive Programming in Movies
- Jordee
- uploaded: Dec 19, 2012
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Alan Watt
Alan Watt
This audio is from 2006, and still relevant today-
*What is predictive programming? Alan Watt explains:
"Hollywood is the magician's wand (holly-holy) which has been used to cast a spell on the unsuspecting public. Things or ideas which would otherwise be seen as bizarre, vulgar, undesirable or impossible are inserted into films in the realm of fantasy. When the viewer watches these films, his/her mind is left open to suggestion and the conditioning process begins. These same movies which are designed to program the average person, can give the discerning viewer a better understanding of the workings and the plan of the world agenda. "Be-aware".
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Views from the Hawke's Nest: Daniel Bryan: Superstar Collection
Posted by
TJ Hawke
on 08.19.2013
Best in the world.
February 23, 2010
Daniel Bryan (w/ the Miz) vs. Chris Jericho (w/ Wade Barrett)
This was the first main event in NXT history. Jericho was the World Heavyweight Champion at the time of this match.
Bryan looks like a GEEK with this haircut. Bryan tried to follow the Code of Honor, but Jericho wasn't having any of it. Jericho bullied him, but Bryan slapped him and hit a dropkick. Jericho quickly managed to cut him off, and he worked Bryan over for a bit. Bryan came back, and they fucked up a dragon screw. Cole started burying Bryan, the internet and THE DIRTSHEETS. Bryan got a nearfall with a running lariat. Bryan sent Jericho to the floor (sloppily), and he then hit a tope suicida. Bryan crashed hard into the commentation station (shaped like a table!). Bryan then went for a springboard, but Jericho caught him. He went for the Walls, but Bryan reversed it into a heel hook. Jericho made the ropes and then hit a Codebreaker. Jericho then locked in the Liontamer, and Bryan immediately tapped out.
The Miz attacked Bryan after the match.
This ten minutes of video perfectly shows why the first season of NXT was such a failure (at least in my eyes). Instead of trying to make a bunch of "rookies" look like future superstars, the show was about making them play "tackle football on concrete." The match itself was okay, but there were a couple of real sloppy moments that bothered me when it originally happened and still take away from the match for me now.
Match Rating: **3/4
Night of Champions
September 19, 2010
The Miz© (w/ Alex Riley) vs. Daniel Bryan [US Championship]
This match happened a month after Bryan made the surprise return to the WWE. This match had been building since the first NXT episode in February of the same year.
The Miz started going after Bryan's left arm, while Cole buried Bryan on commentary. Bryan eventually came back with a tope suicida and a missile dropkick. Bryan got a nearfall with a buzzsaw kick. Miz managed to crotch Bryan on the ropes and then gave him a Nigel diving lariat: 1…2…NO! Miz got an armbar, but Bryan made the ropes. Bryan almost got the LeBell Lock, but Riley jumped on the apron. Miz accidentally knocked him down, and Bryan got a roll-up: 1…2…NO! Great nearfall. Riley failed again. Miz got a nearfall with a small package. Bryan locked in the LeBell Lock…and Miz tapped out!!!
The Miz would go on to win the WWE Championship in a few months, while Bryan would languish in the midcard for the next sixteen months.
This was an excellent US Title match. They told a logical story, and they got the crowd into a frenzy. This has to be the best Miz match that I have ever seen.
Match Rating: ***1/2
Money in the Bank
July 17, 2011
Daniel Bryan vs. Sin Cara vs. Wade Barrett vs. Justin Gabriel vs. Sheamus vs. Cody Rhodes vs. Heath Slater vs. Kane [Money in the Bank Match]
I hate recapping these matches. There's rarely a story to get over. I'll let you know what spots stand out. There was an everyone dive to the floor sequence early on. Sin Cara didn't even botch his contribution to the proceedings. Cara gave Bryan the One Man Spanish Fly. A ladder got bridged between the apron and the commentation station. Sheamus gave Cara a diving powerbomb through the ladder. Awesome. Cara got stretchered out. The climbing spots started. Best spot of the match: Kane and Sheamus gave Bryan the Doomsday Device. LOL. Kane gave everyone a chokeslam. There was this really awkward that ended with Slater almost dying. Sheamus gave everyone a Brogue Kick. Kane chokeslammed Sheamus off a ladder onto a bridged ladder. Ouch. Gabriel did a 450 off a bridged ladder onto Bryan. Barrett cleared house. Bryan and Barrett were on the ladder. Bryan delivered some elbows and a big kick. Bryan got the briefcase!!!
Bryan's eyes welled up after the match.
This was an excellent match. WWE has a fantastic track record with longish ladder matches, and they put together some brilliant stuff in this one. I remember being shocked at the time that Bryan won. Retrospectively, this is a very significant match in his WWE career.
Match Rating: ****1/4
November 4, 2011
Daniel Bryan (w/ The Big Show) vs. Mark Henry
The Hall of Pain was a great time.
This is the fourth different entrance theme that Bryan has had on this DVD. Henry overpowered Bryan early on. Bryan was eventually able to get Henry on his knees, and he then hit a buzzsaw kick for a nearfall. Bryan went for the guillotine, but Henry powered out of it. Henry dominated him again after that. The story was that Henry could win the match at any time, but he wanted to do more damage. Show had enough and knocked Henry out with one punch. The referee disqualified him.
Show revived Bryan, and he tried to get him to cash in his Money in the Bank briefcase. Bryan jumped in the ring, but Henry gave him a World's Strongest Slam. I think the story going on under the surface was that Show was trying to make Bryan champ, because Show couldn't beat Henry. It's a fine storyline for a midcard title, which is pretty much what the World Heavyweight Championship is at this point.
This was television match designed to get over a storyline. With that in mind, it was fine. It does not belong on any DVD releases.
Match Rating: **
Royal Rumble
January 28, 2012
Daniel Bryan© vs. The Big Show vs. Mark Henry [Cage Match for the World Heavyweight Championship]
Bryan was doing the "Yes!" gimmick. Bryan, once again, had a new entrance theme. This DVD had five different matches, and Bryan entered to five different songs.
Bryan was trying to escape the cage. Show and Henry were taking a more physical approach to winning this match. Bryan almost got out through the door, but Henry stopped him. Show dominated both men for a bit. Henry was then in control. Show got back in control. Bryan hit Show with a tornado DDT for a nearfall. Bryan then got the LeBell Lock, but Henry escaped. Show knocked Henry out with a punch. Bryan and Show climbed, and they were on the top. Show was holding onto Bryan, as he was falling off the cage. Eventually, Show's grip loosened, and Bryan fell down. Bryan wins.
This was all story and very little fun action. It came across as a television main event instead of a PPV world title match.
Match Rating: **3/4
Watch Daniel Bryan in some free matches:
Daniel Bryan vs. Dolph Ziggler
Daniel Bryan vs. Seth Rollins
Daniel Bryan vs. Nigel McGuiness
Daniel Bryan vs. Randy Orton
Daniel Bryan vs. Drake Younger
Daniel Bryan vs. Zack Salvation
The 411
: While this collection doesn't convey how Daniel Bryan is one of (if not) the best wrestlers of the last thirty years, it does provide an entertaining two hours of content and a representative look of his first 20 months on the WWE roster. Bryan started as a "rookie geek" that apparently need to job as much as possible. His return to the company in the fall of 2010 lead to his first real push in the company. After cooling off in the first half of 2011, his Money in the Bank win lead to his initial run in the main event scene. One day, Daniel Bryan is going to have an amazing multi-disc set with loads of great matches. This is obviously not it, but if this DVD ends up on Netflix, I recommend that you watch it.
Final Score: 7.0
[ Good ]
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