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EndometriosisHysterectomy and endometriosis
An in-depth report on the causes, diagnosis, treatment, and prevention of endometriosis.
Endometriosis Symptoms
Endometriosis symptoms vary widely, and some women with the condition have no symptoms. Symptoms can include:
- Pelvic pain, especially around the time of menstruation
- Pain during sexual intercourse
- Heavy menstrual bleeding
- Sleep problems
- Cyclical abdominal pain
- Intermittent diarrhea and constipation
- Painful or difficult urination
- Blood in the urine
Infertility and Endometriosis
Endometriosis rarely causes a complete inability to conceive, but it can contribute to reduced fertility.
Treatment options for endometriosis include:
- Watchful Waiting. Delaying treatment may be most appropriate for women with mild endometriosis or those who are approaching the age of menopause.
- Drugs. First-line drug therapies are estrogen-progestin oral contraceptives, which are usually used along with nonsteroidal anti-inflammatory drugs (NSAIDs). Progestin-only pills, injections, or intrauterine device (IUD) may also be used. Gonadotropin-releasing hormone (GnRH) agonist drugs are another option.
- Surgery. Conservative surgical approaches, such as laparoscopic ablation, remove endometrial implants and cysts without removing reproductive organs. Conservative surgery can help improve fertility. Hysterectomy, the surgical removal of the uterus, may be recommended in severe cases of endometriosis, but it does not necessarily cure the condition.
Endometriosis is a condition in which the cells that line the uterus grow outside of the uterus in other areas, such as the ovaries. The condition can interfere with a woman's ability to become pregnant. Endometriosis can also cause severe pelvic pain, especially during menstruation.
Endometriosis is a common gynecological condition. It is chronic, and may be a painful and progressive disease. However, the causes of endometriosis are unknown, it is widely variable in symptoms and severity, and it is difficult to diagnose.
Endometrial Implants
Endometriosis occurs when cells from the tissue layer lining the uterus (endometrium) form implants that attach, grow, and function outside the uterus,usually in the pelvic region.
Endometrial cells contain receptors that bind to the female hormones estrogen and progesterone, which promote uterine growth and thickening. When these cells become implanted in organs and structures outside the uterus, these hormonal activities continue to occur, causing bleeding and scarring.
Endometrial implants vary widely in size, shape, and color. Over the years, they may diminish in size or disappear, or they may grow.
- Early implants are usually very small and look like clear pimples.
- If they continue to grow they may form flat injured areas (lesions), small nodules, or cysts called endometriomas, which can range from sizes smaller than a pea to larger than a grapefruit.
- Implants also vary in color; they may be colorless, red, or very dark brown. These so-called chocolate cysts are endometriomas filled with thick, old, dark brown blood. They usually appear on the ovaries.
Location of Implants
Implants can form in many areas, most commonly in the following locations in the pelvis:
- Ovaries
- Fallopian tubes
- Uterine surface
- Cul-de-sac, an area between the uterus and rectum
- Bowel
- Bladder
- Rectum
- The peritoneum. This is the smooth surface lining that covers the inner wall of the abdomen and folds over the organs in the pelvic area.
Rarely, remote sites of endometriosis may include the spinal column, nose, lungs, pelvic lymph nodes, the forearm, and the thigh.
Process of Endometriosis
The process of endometriosis mimics the stages of the menstrual cycle:
- Each month, the exiled endometrial implants respond to the monthly cycle just as they would in the uterus. They fill with blood, thicken, break down, and bleed.
- Products of the endometrial process cannot be shed through the vagina as are menstrual blood and debris. Instead, the implants develop into collections of blood that form cysts, spots, or patches.
- Lesions may grow or reseed as the cycle continues.
The lesions are not cancerous, but they can develop to the point that they cause obstruction or adhesions (web-like scar tissue) that attach to and bind together nearby pelvic organs, causing pain, inflammation, and sometimes infertility.
Doctors don't know the exact cause of endometriosis. A combination of genetic, biologic, and environmental factors may work together to trigger the initial process, produce implantation, and cause subsequent reseeding and spreading of the implants.
Theories of the cause of endometriosis include:
- Retrograde Menstruation. Retrograde menstruation occurs during a woman's period, when menstrual tissue flows backward through the fallopian tubes rather than out through the vagina. In some cases, the redistributed endometrial tissue may attach and grow in areas outside the uterus, forming endometriosis implants. This theory does not fully explain endometriosis, however. Many women have some retrograde menstruation, but not all of them develop endometrial cysts. Consequently, other factors must explain why uterine tissue becomes implanted and grows in areas outside the uterus.
- Exposure to Estrogen. Prolonged exposure to estrogen may play a role in the development of endometriosis. Causes of prolonged exposure to the body's own estrogen include early-age menstruation, short menstrual cycles, and obesity. Sources of external estrogen exposure include endocrine-disrupting chemicals.
- Impaired Immune System. Another theory is that women who develop endometriosis have an impaired immune system that fails to identify and destroy endometrial tissue that grows outside of the uterus. Some researchers think that endometriosis is a type of autoimmune condition, in which the immune system launches an attack on its own cells and tissue. There appears to be a relatively high incidence of other inflammatory autoimmune disorders (such as multiple sclerosis, rheumatoid arthritis, and lupus) among women with endometriosis. It is unclear, however, how this response relates to endometriosis itself and whether endometriosis should be treated as an autoimmune condition.
- Inflammatory Response. The damage, infertility, and pain produced by endometriosis may be due to an overactive response by the immune system to the early presence of endometrial implants. The body, perceiving the implants as hostile, launches an attack. Levels of large white blood cells called macrophages are elevated in endometriosis. Macrophages produce very potent factors, which include cytokines (particularly those known as interleukins) and prostaglandins. Such factors are known to produce inflammation and damage in tissues and cells.
Risk Factors
Endometriosis can occur in teenagers and adult women of all ages, but most typically it occurs in women ages 25 - 40.
Family History
A family history of endometriosis, especially in a mother or sister, increases a woman's likelihood of developing it herself.
Not Having Had Children
Pregnancy appears to protect against endometriosis, while never having had children is associated with increased risk. However, endometriosis can still occur in women who have had children.
Dietary Factors
Some studies suggest that consumption of red meat and trans fats may increase the risk of developing endometriosis, while consumption of fruits, green leafy vegetables, and omega-3 fatty acids (found in fish) may be protective.
Menstrual History
Women atincreased risk for endometriosis tend to have more problems with menstruation. They usually have a shorter than normal cycle, heavier periods, and longer periods. They may also have begun menstruating at a younger than average age.
Adhesions can cause significant pain. They are dense, web-like structures of scar tissue that can attach to nearby organs. Pelvic pain is the most common complaint for women with endometriosis, and it can significantly impair the quality of life, including work and social activities. The pelvic pain associated with endometriosis is usually chronic (lasting more than 6 months). Pain may also occur in the abdomen and back.
Infertility is another main complication of endometriosis. Endometriosis is responsible for about a third of cases of female infertility. Endometriosis rarely causes an absolute inability to conceive, but it can reduce fertility both directly and indirectly:
- If implants occur in the fallopian tubes, they may block the egg's passage.
- Implants that occur in the ovaries prevent the release of the egg.
- Adhesions that form among the uterus, ovaries, and fallopian tubes can prevent the transfer of the egg to the tube.
Effects on Other Parts of the Pelvic Region
Implants can also occur in the bladder (although less commonly) and cause pain and even bleeding during urination. Implants also sometimes form in the intestine and cause painful bowel movements, constipation, or diarrhea.
Not all women with endometriosis have symptoms. When symptoms occur, pain is the main one.
Many women with endometriosis have chronic pain in the pelvic area (the lower part of the trunk of the body). The pain is often a severe cramping that occurs on both sides of the pelvis, radiating to the lower back and rectal area and even down the legs. The pain may be continuous or it may come and go. Pain tends to worsen over time.
The severity of the pain varies widely and does not appear to be related to the extent of the endometriosis itself. In other words, a woman can have very small or few implants and have severe pain, while those with extensive endometriosis may have very few signs of the disorder except for infertility. Large cysts can rupture and cause very severe pain at any time.
Pain caused by endometriosis is associated with:
- Menstruation. Women with endometriosis typically have heavy or prolonged menstrual bleeding, and very painful menstrual cramps (dysmenorrheal). Women may also experience pelvic pain at other times during their menstrual cycle and they may have spotting or bleeding between periods. Menstrual pain may worsen over time.
- Sexual Intercourse. Endometriosis can cause pain during or after sexual intercourse (dyspareunia).
- Urination and Bowel Movements. Pain during defecation or urination may be especially severe during menstrual periods. Women may also experience other gastrointestinal problems, such as diarrhea, constipation, or bloating.
Because endometriosis symptoms do not always appear, or may be caused by other conditions, a diagnosis cannot be based on symptoms alone. Laparoscopy, an invasive diagnostic procedure, is the only definitive method for diagnosing endometriosis. However, a trial using a hormonal drug may be used to confirm or rule out endometriosis.
Pelvic Exam
After collecting your symptom report and medical history, the doctor will perform a physical and pelvic exam. During the pelvic exam, the doctor will evaluate the size and position of the ovaries and check for tender masses or nodules behind the cervix.
Diagnostic laparoscopy is used to confirm a suspected diagnosis of endometriosis and to evaluate the severity of the condition. It may also be used to treat endometriosis. During laparoscopy, the surgeon determines the number, size, and location of endometrial implants and adhesions. This information can help in staging endometriosis and in making treatment decisions.
The procedure involves the doctor making a small incision in the abdomen, and inserting a thin flexible fiber-optic tube (the laparoscope). The laparoscope is equipped with a small telescopic lens, which enables the doctor view the uterus, ovaries, tubes, and peritoneum (lining of the pelvis) on a video monitor. Laparoscopy normally requires a general anesthetic, although the patient can go home the same day. [For more information on laparoscopy, see the "Conservative Surgery" section of this report.]
Imaging Tests
An ultrasound is performed in cases where other conditions are suspected, such as uterine fibroids, ovarian cysts, or ectopic pregnancy. This non-invasive imaging technique can detect endometriomas, cysts that are usually located on the ovaries and filled with thick dark blood. Ultrasound can also pick up cysts larger than 1 cm (about 1/3 inch), but it will miss smaller cysts, or small and shallow endometrial implants on the surface of ovaries or on the peritoneum (lining of the pelvis). Other imaging techniques, such as computed tomography (CT) scanning or magnetic resonance imaging (MRI), may occasionally be used.
Ruling out Conditions with Similar Symptoms
Many conditions cause pelvic pain. In many cases, the cause is unknown, and the condition often resolves on its own. However, some causes of pelvic pain can be serious and should be ruled out during a work-up for endometriosis.
Primary Dysmenorrhea. Primary dysmenorrhea is recurrent pelvic pain associated with menstruation. Dysmenorrhea is common in many women.
Adenomyosis. A condition called adenomyosis occurs when nodules (knots) of endometrial tissue develop within the deep muscle layers of the uterus. This disorder is often classified with endometriosis, but adenomyosis is a different disease. (Endometriosis occurs when endometrial tissue grows and functions outside the uterus.) Adenomyosis is a significant cause of severe pelvic pain and menstrual irregularities. It typically occurs in women who have uterine fibroids, women age 40 - 50, and women who have had children. Women who have had surgery for endometriosis, yet continue to suffer from menstrual and pelvic pain, may actually have adenomyosis.
Other Causes of Pelvic Pain. Many conditions cause pelvic pain that may or may not be related to menstruation. Some causes of pelvic pain that can be serious and should be ruled out include:
- Uterine fibroids
- Pelvic inflammatory disease (which is a result of infections in the pelvic area)
- Miscarriage
- Ectopic pregnancy (when the fertilized egg implants in an area outside of the uterus, usually the fallopian tube)
- Pelvic cancer (rare)
- Uterine polyps
- The use of an intrauterine device (IUD) for contraception
Conditions that may mimic symptoms of endometriosis but which are unrelated to problems in the reproductive organs include:
- Severe kidney or urinary tract infections
- Celiac disease
- Appendicitis
- Interstitial cystitis
- Inflammatory bowel disease
- Diverticulitis
- Irritable bowel syndrome
There is no perfect way of managing endometriosis. The three basic treatment approaches are:
- Watchful waiting (conservative therapy to relieve symptoms)
- Hormonal therapy (to reduce the size of endometrial implants)
- Surgery (to reduce endometrial implants, restore fertility, or possibly cure the condition)
The choice depends on a number of factors, including the woman's symptoms, her age, whether fertility is a factor, and the severity of the disease.
Watchful Waiting
Delaying treatment may be most appropriate for women with mild endometriosis or those who are approaching the age of menopause.
Women may also use lifestyle modifications, such as exercise and relaxation, to cope with their pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) -- such as ibuprofen (Advil, Motrin, generic) and naproxen (Aleve, generic), or acetaminophen (Tylenol, generic) --can help provide some pain relief.
Hormonal Therapy
Hormonal therapies are used to mimic states in which ovulation does not occur (such as pregnancy or menopause) or to directly block ovulation. Hormonal drugs include oral contraceptives (a first-line treatment), progestins, GnRH agonists, and (rarely) danazol. They can be very effective in relieving endometriosis symptoms, especially pain. Some of these drugs may also be used after surgery to help prevent recurrence of endometriosis. Downsides of these drugs include:
- None of these drugs can cure the problem. Symptoms recur in about half of patients within 5 years of treatment.
- They do not improve fertility rates and may delay conception.
- Side effects of some of these drugs can be distressing.
- Women who take GnRH agonists, danazol, or similar drugs should use non-hormonal barrier birth control methods (such as the diaphragm, cervical cap, or condoms) because these drugs can increase the risk for birth defects.
Surgery is an option for women who:
- Have severe pain that does not respond to watchful waiting and medical treatment.
- Want to become pregnant and endometriosis is most likely the major contributor to infertility.
There are two basic surgical approaches for endometriosis:
- Conservative Surgery (Laparoscopy or Laparotomy). Conservative surgery uses minimally invasive laparoscopy, or sometimes laparotomy (conventional "open" surgery through normal incision), to remove the endometrial implants without removing any normal tissue or reproductive organs. It is a good option for women who wish to become pregnant or who cannot tolerate hormone therapy. Endometriosis often recurs after conservative surgery, however. The risk for recurrence or residual pain after any procedure increases with the severity of the condition, particularly if endometriosis has affected areas outside the uterus.
- Radical Surgery (Hysterectomy). Hysterectomy offers the best option for either a cure or more significant control of the problem. Younger patients can often have only a hysterectomy while leaving one or both of their ovaries intact. However, if endometriosis has developed outside the uterus then even this procedure is not curative. Removing only the uterus with hysterectomy has the same risk for recurrence as conservative surgery. Removing both ovaries (bilateral oophorectomy) along with the uterus is the only potential cure for endometriosis.
In choosing between hysterectomy (with or without removal of the ovaries) and conservative surgeries, age and the desire for children are important factors.
Nerve Surgery for Pelvic Pain. Laparoscopic uterine nerve ablation (LUNA) and laparoscopic presacral neurectomy (LPSN) are procedures that aim to reduce chronic pelvic pain by destroying or interrupting the nerves that attach the uterus to the pelvic bone. Some small studies have shown more benefit for LPSN than for LUNA. LPSN appears to work best when combined with laparoscopic ablation of endometrial implants (conservative surgery). Stronger evidence is needed before these procedure scan be recommended for women with chronic pelvic pain associated with endometriosis. Many insurance companies consider these procedures experimental and will not pay for them.
Treating Infertility in Patients with Endometriosis
For women with severe endometriosis who want to become pregnant, conservative surgery (typically laparoscopy) is the appropriate approach for restoring fertility. Hormonal therapies that treat endometriosis itself, such as GnRH agonist or progestins, generally do not help fertility. If surgery fails, fertility drugs and assisted reproductive technologies, such as in vitro fertilization, are options. Women with endometriosis who are trying to conceive should discuss all treatment options with a fertility specialist.
Herbs and Supplements
Some studies suggest that the omega 3 fatty acids found in fish and fish oil supplements may be helpful for endometriosis. Others have indicated possible benefits from Chinese herbal medicine. There are few well-conducted studies on these treatments and more research is needed.
Generally, manufacturers of herbal remedies and dietary supplements do not need approval from the Food and Drug Administration (FDA) to sell their products. Just like with drugs, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from herbal products. Patients should check with their doctor before using any herbal remedies or dietary supplements.
The basic approach in hormonal treatments for endometriosis is to block production of female hormones (estrogen and progesterone) or to prevent ovulation. Hormonal drugs are used for pain relief only. They do not improve fertility rates and in some cases may delay conception. Specific hormonal drugs may have different effects for women with endometriosis.
- Inducing Pseudopregnancy. Oral contraceptives that contain estrogen and a progestin mimic a pregnant state and block ovulation. (Progestins are synthetic forms of progesterone). Progestin may also be used alone, since it has specific effects that can cause the endometrial tissue to atrophy (shrink).
- Inducing Pseudomenopause. Gonadotropin-releasing hormone (GnRH) agonists reduce estrogen and progesterone to their lowest levels.
- Inducing On-going Blockage of Ovulation. Danazol, a derivative of male hormones, is a powerful ovulation blocker but has very unpleasant side effects. It is rarely used nowadays.
Most women achieve pain relief after taking these drugs. To date, comparison studies have found few differences in effectiveness among the major hormonal treatments. Differences occur mostly in their side effects. Women should discuss the effects of particular medications with their doctors to determine the best choice.
Oral Contraceptives
Oral contraceptives (OCs), commonly called birth control pills or "the Pill," contain combinations of an estrogen and a progestin. Combined oral contraceptives are a first-line treatment for endometriosis pain. They are generally used along with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
When used throughout a menstrual cycle, OCs suppress the actions of other reproductive hormones (luteinizing hormone [LH] and follicle stimulating hormone [FSH]) and prevent ovulation. There are many brands available. The estrogen compound used in most oral contraceptives is estradiol. Many different progestins are used, and there are many brands. None to date have proven to be better than others. Women should discuss the best options for their individual situations with their doctor.
Standard OCs are the first-line treatment. They come in a 28-pill pack that contains 21 active pills and 7 inactive pills. Women with severe pain who have not been helped by standard combination OCs may benefit from switching to newer continuous-dosing combination OCs. Continuous-dosing oral contraceptives aim to reduce -- or even eliminate -- monthly periods and thereby prevent the pain and discomfort that often accompanies menstruation. These OCs contain a combination of estradiol and the progestin levonorgestrel but use extending dosing of active pills.
OCs with continuous dosing include:
- Seasonale, contains 81 days of active pills followed by 7 days of inactive pills. Women have on average a period every 3 months.
- Seasonique produces about 4 periods a year. A woman takes 84 days of levonorgestrol-estradiol pills followed by 7 days of pills that contain only low-dose estradiol.
- Lybrel, supplies a daily low dose of levonorgestrel and estradiol with no inactive pills. Because it contains only active pills, which are taken 365 days a year, it completely eliminates monthly menstrual periods, although some women may continue to have occasional bleeding or spotting during the first few months.
Estrogen and progestin each cause different side effects. The most serious side effects are due to the estrogen in the combined pill. Uncommon but more dangerous complications of OCs include high blood pressure and deep-vein blood clots (thrombosis), which may contribute to heart attack or stroke.
Progestin alone may be helpful for women whose pain has not been relieved with combination estrogen-progestin oral contraceptives. Progestins can prevent ovulation and reduce the risk for endometriosis in the following ways:
- They block luteinizing hormone (LH), one of the reproductive hormones important in ovulation.
- They change the lining of the uterus and eventually cause it to atrophy.
- They may provide pain relief equivalent to the more powerful hormone drugs. Some doctors recommend them as the first choice for women with endometriosis who do not want to become pregnant.
Specific Progestins. Progestins are available in various forms. They include:
- Intrauterine Device. The levonorgestrel-releasing intrauterine system, or LNG-IUS (Mirena) is very effective for treating heavy menstrual bleeding (menorrhagia), and studies indicate that it helps control the symptoms of minimal-to-moderate endometriosis pain. Progestin released by the IUD mainly affects the uterus and cervix and causes fewer widespread side effects than other forms of progestins. Research suggests that the LNG-IUS works as well as GnRH agonists in managing endometriosis pain, and causes less loss of estrogen.
- Injection. Medroxyprogesterone (Depo-Provera, also known as DMPA) is administered by injection every 3 months. (A low-dose formulation is called Depo-subQ Provera 104.) Depo-Provera can cause loss of bone mineral density, a condition associated with osteoporosis, but GnRH agonists may cause even more bone thinning. Because of the risk for reduced bone density, Depo-Provera should not be used for longer than 2 years. Depo-Provera can cause persistent infertility for up to 22 months after the last injection.
- Pill. Oral progestins include medroxyprogesterone (Provera, generic) and norethindrone (Micronor, generic). Norethindrone is also known as norethisterone.
Side Effects of Progestins. Side effects of progestin occur in both the combination oral contraceptives and any contraceptive that uses only progestin, although they may be less or more severe depending on the form and dosage of the contraceptive. The most common side effects include:
- Changes in uterine bleeding, such as higher amounts during periods, spotting and bleeding between periods (called break-through bleeding), or absence of periods
- Weight gain
- Water retention and swelling in the face, ankles, or feet
- Breast tenderness
- Headaches
- Nausea
- Mood changes
GnRH Agonists
Gonadotropin releasing hormone (GnRH) agonists are effective hormone treatments for endometriosis. They block the release of the reproductive hormones LH (luteinizing hormone) and FSH (follicular-stimulating hormone). As a result, the ovaries stop ovulating and no longer produce estrogen. Ovulation and menstruation resume around 4 - 10 weeks after stopping the drug. The specific length of time depends on the type of GnRH agonist used.
Specific GnRH Agonists. GnRH agonists include the implant goserelin (Zoladex), a monthly injection of leuprolide (Lupron, Depot, generic), and the nasal spray nafarelin (Synarel).
Side Effects and Complications. Common side effects (which can be severe in some women) include menopause-like symptoms, including hot flashes, night sweats, vaginal dryness, weight change, and depression. The side effects vary in intensity depending on the GnRH agonist. They may be more intense with leuprolide and persist after the drug has been stopped.
The most important concern is possible osteoporosis from estrogen loss. To help protect the bones, doctors prescribe "add-back therapy," with a supplement of combination estrogen-progestin. Because of estrogen loss side effects, doctors generally recommend that women not take GnRH agonists for more than 6 months.
GnRH treatments can increase the risk for birth defects. Women who are taking GnRH agonists should use non-hormonal birth control methods, such as the diaphragm, cervical cap, or condoms while on the treatments.
Other Drug Treatments
Danazol. Danazol (Danocrine, generic) is a synthetic drug that resembles a male hormone (androgen). It suppresses the pathway leading to ovulation. Many women stop taking this drug because of its adverse side effects, which include bloating, acne, irregular vaginal bleeding, and muscle cramps. Danazol can also cause male characteristics, such as growth of facial hair, reduced breasts, and deepening of the voice. Because GnRh agonists cause far fewer side effects, danazol is rarely used these days for endometriosis treatment.
Conservative Surgery
The goal of conservative surgery is to remove as many endometrial implants and cysts as possible without causing surgical scarringor subsequent adhesions that could cause fertility problems. Surgery can help improve fertility in women with severe endometriosis. Whether it offers any advantage in pregnancy rates in women with mild-to-moderate endometriosis is unclear. Conservative surgery can also help relieve pain caused by implants. It may, however, miss microscopic implants that could continue to cause pain and other symptoms after the procedure.
The two conservative surgical procedures are:
- Laparascopy is the gold standard and most commonly performed surgical treatment for endometriosis. It involves several small abdominal incisions through which a thin telescopic tube (laparoscope) is inserted. The doctor removes implants and scar tissue and destroys them with heat. Laparoscopy requires general anesthesia, but it is an outpatient procedure and the patient can go home the same day. Recovery usually takes a few weeks.
- Laparotomy uses a wide abdominal incision and conventional surgical instruments. It is much more invasive and requires a longer recovery time (typically several months). Laparotomy is rarely performed except in cases of severe endometriosis.
Laparoscopy Procedure
A laparoscopy is performed, usually under general anesthesia, as follows:
- Carbon dioxide gas is injected into the abdomen, distending it and pushing the bowel away so that the doctor has a wider view.
- The procedure requires making small incisions at the navel and above the pubic bone.
- The laparoscope (a narrow tube equipped with camera lenses and a fiber-optic light source) is inserted through the incision at the navel (the umbilical incision).
- A probe is then inserted through the second incision, allowing the doctor to directly view the outside surface of the uterus, fallopian tubes, and ovaries.
- One or two additional small incisions can be made on either side of the lower abdomen through these incisions. Surgical instruments or other devices are passed through these accessory incisions to destroy or remove abnormal tissue. Implants can be removed by excision (surgical removal) using a laser or scissors or by destroying the area with lasers or with electricity (or electrocautery).
Complications. Patients may experience temporary but severe discomfort in the shoulders after laparoscopy due to residual carbon dioxide gas that puts pressure on the diaphragm. The incisions, even with laparoscopy, may cause pain afterward, which can usually be treated effectively with mild pain relievers. There are small risks for bleeding, infection, and reaction to anesthesia.
Recurrence. Even with very successful surgery, endometriosis may recur within several months to several years.
Hysterectomy is the surgical removal of the uterus. Endometriosis accounts for a significant percentage of these procedures. Hysterectomy does not, however, necessarily cure endometriosis.
A woman cannot become pregnant after having a hysterectomy. Women should realize that hysterectomy causes immediate menopause if the ovaries are removed.
Types of Hysterectomies
Once a decision for a hysterectomy has been made, the patient should discuss with her doctor what will be removed. The common choices are:
- Total Hysterectomy (Removal of uterus and cervix). Removing only the uterus with hysterectomy has the same risk for recurrence as conservative surgery. Subtotal hysterectomy involves removing the uterus but keeping the cervix intact.
- Bilateral Oophorectomy (Removal of both ovaries) or Bilateral Salpingo-Oophorectomy (Removal of the fallopian tubes and ovaries). For endometriosis treatment, removal of the ovaries is often performed in combination with hysterectomy. This is the only potential cure for endometriosis. If endometriosis has developed outside the uterus then even ovary removal procedures are not curative.
Removal of the ovaries (oophorectomy) along with hysterectomy significantly reduces the likelihood that endometriosis will recur. However, there is still a small chance that recurrence can happen.
Types of Hysterectomy Procedures
Hysterectomies may be performed abdominally (through an incision in the abdomen) or vaginally (through a vaginal incision). A variation of the vaginal approach is called laparoscopic-assisted vaginal hysterectomy (LAVH). There are other laparoscopic approaches as well. Recovery times for vaginal hysterectomy and laparoscopic procedures are shorter than those for abdominal hysterectomy.
After Hysterectomy
The ovaries are the main source of production of estrogen. In premenopausal woman, the removal of both ovaries causesimmediate menopause. After hysterectomy with bilateral oophorectomy, women may have hot flashes and other symptoms of menopause, including vaginal dryness, insomnia, and weight gain. Women who have surgical removal of both ovaries, and who do not receive hormone replacement therapy, tend to have more severe hot flashes than women who enter menopause naturally..
If hormone replacement therapy is recommended after hysterectomy, it is given as estrogen-only therapy (ET). (Women whodo nothave a uterus do not need to take combination estrogen-progesterone therapy.)
After a total hysterectomy, in which the cervix has been removed, a woman does not need annual Pap smears of the cervix. However, she still should get regular pelvic and breast exams.
- www.asrm.com -- American Society for Reproductive Medicine
- www.acog.org -- American College of Obstetricians and Gynecologists
- www.womenshealth.gov -- National Women's Health Information Center
- www.endometriosis.org -- Endometriosis.org
- www.resolve.org -- National Infertility Association
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Peterson CM, Johnstone EB, Hammoud AO, Stanford JB, Varner MW, Kennedy A, Chen Z,et al. Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study. Am J Obstet Gynecol. 2013 Jun;208(6):451.e1-11Epub 2013 Feb 27.
Schrager S, Falleroni J, Edgoose J. Evaluation and treatment of endometriosis. Am Fam Physician. 2013 Jan 15;87(2):107-13.
Shakiba K, Bena JF, McGill KM, Minger J, Falcone T. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol. 2008 Jun;111(6):1285-92.
Advanced Studyec
Related Informationec
Review Date: 9/23/2013�
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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Kidney removal - dischargeNephrectomy - discharge; Simple nephrectomy - discharge; Radical nephrectomy - discharge; Open nephrectomy - discharge; Laparoscopic nephrectomy - discharge; Partial nephrectomy - discharge
You had surgery to remove part of one kidney or the entire kidney, the lymph nodes near it, and maybe your adrenal gland.
You may have an 8- to 12-inch surgical cut over your belly or along your side. If you had laparoscopic surgery, you may have three or four small cuts.
What to Expect at Home
Recovering from kidney removal usually takes around 3 to 6 weeks. You may have some of these symptoms:
- Pain in your belly or on the side where you had the kidney removed. The pain should get better over several days to a week.
- Bruising around your wounds. This will go away on its own.
- Redness around your wounds. This is normal.
Plan to have someone drive you home from the hospital. Do not drive yourself home. You may also need help with everyday activities for the first 1 to 2 weeks. Set up your home so it is easier to use.
You should be able to do most of your regular activities within 4 to 6 weeks. Before then:
- Do not lift anything heavier than 10 pounds until you see your doctor.
- Avoid all strenuous activity, including heavy exercises, weightlifting, and other activities that make you breathe hard or strain.
- Taking short walks and using the stairs is OK.
- Light housework is OK.
- Do not push yourself too hard. Slowly increase the amount of time and the intensity of your exercise.
To manage your pain:
- Your doctor will prescribe pain medicines for you to use at home.
- If you are taking pain pills 3 or 4 times a day, try taking them at the same times each day for 3 to 4 days. They may work better this way. Be aware that the pain medicine can cause constipation. Try to maintain normal bowel habits.
- Try getting up and moving around if you are having some pain. This may ease your pain.
- You may put some ice over the wound. But keep the wound dry.
Press a pillow over your incision when you cough or sneeze to ease discomfort and protect your incision.
Make sure your home is safe as you are recovering.
Wound Care
You will need to keep your incision area clean, dry, and protected. Change your dressings the way your doctor or nurse taught you.
- If stitches, staples, or glue was used to close your skin, you may take a shower.
- If tape strips were used to close your skin, cover the wounds with plastic wrap before showering for the first week. Do not try to wash the tape strips off. Let them fall off on their own.
Do not soak in a bathtub or hot tub, or go swimming, until your doctor tells you it is OK.
Eat a normal diet. Drink 4 to 8 glasses of water or liquids a day, unless your doctor tells you not to.
If you have hard stools:
- Try to walk and be more active. But do not overdo it.
- If you can, take less of some of the pain medicines your doctor gave you. Some can cause constipation.
- Try a stool softener. You can get these at any pharmacy without a prescription.
- Ask your doctor or nurse what laxatives you can take.
- Ask your doctor about foods that are high in fiber, or try psyllium (Metamucil).
When to Call the Doctor
Call your doctor or nurse if:
- You have a temperature above 100.5°F.
- Your surgical wounds are bleeding, are red or warm to the touch, or have a thick, yellow, green, or milky drainage.
- Your belly swells or hurts.
- You have nausea or vomiting for more than 24 hours.
- You have pain that does not get better when you take your pain medicines.
- It is hard to breathe.
- You have a cough that does not go away.
- You cannot drink or eat.
- You cannot pee (urinate).
Kenny PA, Wotkowicz C, Libertino JA. Contemporary open surgery of the kidney. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 54.
Review Date: 5/22/2013
Reviewed By: Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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GPS III Prototype Proves Compatibility with Existing Constellation
The Lockheed Martin prototype of the next-generation GPS satellite, the GPS III, has proven that it is backwardly compatible with the existing GPS satellite constellation in orbit. During tests that concluded on October 17, Lockheed Martin's GPS III testbed successfully communicated via cross-links to Air Force simulators of the current GPS constellation in orbit. The current GPS constellation includes GPS... read more


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Italian Peninsula, 1000–1400 A.D.
European Paintings in The Metropolitan Museum of Art by Artists Born before 1865: A Summary Catalogue "Fourteenth-Century Italian Altarpieces": The Metropolitan Museum of Art Bulletin, v. 40, no. 1 (Summer, 1982) The Robert Lehman Collection. Vol. 1, Italian Paintings
The Metropolitan Museum of Art Guide provides a comprehensive view of art history spanning five millennia and the entire globe.
Experience the best of human creativity from every corner of the globe at The Met.
Explore highlights of the collection through a variety of tours.
The easiest way to see what's happening at The Met every day—wherever you are.


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To study the connection between chocolate and stroke risk, researchers collected information on lifestyle habits from 37,103 Swedish men, tracking them for approximately 10 years. From the 1,995 cases of stroke that occurred during the study period, the researchers found that after adjusting for other factors that can affect stroke risk—including smoking, height and weight, physical activity, high blood pressure, aspirin use, atrial fibrillation (a type of irregular heart rhythm), family history of heart attack, and dietary habits—men who ate 63 grams of chocolate per week had 17% lower risk of stroke compared with men who never ate chocolate.
The amount of chocolate associated with lower stroke risk averages out to just a square or two per day (63 grams of chocolate is about 2.2 ounces). The protective effects of chocolate were similar for both types of stroke—ischemic and hemorrhagic. Ischemic stroke occurs when a blood vessel supplying blood to the brain becomes blocked, while hemorrhagic stroke occurs when there is bleeding in or around the brain.
This study is observational, so it cannot prove cause and effect. It only tells us eating chocolate is associated with lower stroke risk, not that chocolate caused lower stroke risk. Still, chocolate contains nutrients, including magnesium and polyphenols, which may protect against vascular disease.
So long as you stick with high quality, pure chocolate—not chocolate baked goods—and you don't gain weight from eating it, indulging may provide health benefits. Our tips will help you adopt a stroke risk reduction lifestyle, with or without the chocolate:
(Neurology 2012;79:1223–9)
Copyright © 2017 Healthnotes, Inc. All rights reserved. www.healthnotes.com


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A winter storm fulfilled some white Christmas wishes across Utah on Monday, ushering in colder temperatures and a soft place for Santa to land his sleigh.
More than a foot of snow fell in some mountain locations and between 2 and 5 inches dusted valley floors, National Weather Service data shows.
And there's more on the way.
"It looks like we'll cloud up and see snow again Wednesday over much of the state, continuing into Thursday," NWS meteorologist Pete Wilensky said.
Utah could get a break from the stormy weather Friday or Saturday, he said.
On Christmas Eve, snow fell steadily across Salt Lake County and across northern Utah mountain passes from mid-day and into the evening.
Utah resorts got the biggest boosts, with Alta and Snowbird adding 13 inches The Canyons in Park City also got 13 inches. In Northern Utah, the Powder Mountain resort recorded 11 inches of new snow and Snowbasin, 10 inches.
American Fork recorded the most snowfall of any Utah city, with 8 inches. Central Utah's Fillmore was a close second with 7 inches. Snow totals in most Wasatch Front cities ranged from 1 to 5 inches, including 5 inches in Draper, 4 inches in Sandy and Provo. Bountiful got 3 inches of snow and 2 inches fell in Salt Lake City.
By about 6 p.m. Monday, slick and slushy roads had drivers slipping and sliding from Ogden to Provo. By 9 p.m., police had responded to 119 crashes in Salt Lake County, 27 in Utah County and nine in Davis County, UHP spokesman Lt. Todd Johnson said.
No fatalities were reported and 22 accidents resulted in injuries. Skiers may be rejoicing over the new fallen snow, but the Utah Avalanche Center on Monday had advised backcountry travelers to exercise extreme caution. The risk for dangerous snow slides was rated at "Considerable" for the Logan and Salt Lake area mountains as well as northeastern Utah's Uinta Mountains. The Provo and Ogden area slopes rated "moderate" for avalanche risk.
Air quality for Christmas Day rated "Green," or healthy grades, statewide, according to the Utah Division of Air Quality.
Salt Lake City expected a yuletide high of 32 degrees after an overnight low of 19; Ogden looked for 29 and 17 degrees, respectively; Provo 31 and 18; Logan 25 and 14; Wendover 31 and 18; Duchesne 22 and 12; Cedar City 33 and 10; St. George 45 and 31; and Moab 29 and 12 degrees.


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TheatreWorks has done it again, bringing to fruition a budding musical spotlighted at its 2012 New Works Festival and staging the newly developed work superbly well. Composer-lyricist Paul Gordon (known to local audiences for previous hits "Emma" and "Daddy Long Legs") and Grammy- and Emmy-nominated composer Jay Gruska have concocted an update of the venerable comic masterpiece "The Importance of Being Earnest," by Oscar Wilde. Setting the story in 1965 London, with the backdrop of mod fashion, rock music and shifting morality, Gordon and Gruska wisely keep a significant percentage of Wilde's original dialogue, yet manage to augment and enhance it with delightful songs.
The wacky Wildean plot has two young men, Jack Worthing (Hayden Tee) and Algernon Moncrieff (Euan Morton), posing as other than themselves and using the name "Earnest" in order to woo lovely young women, Gwendolen Fairfax (Mindy Lym) and Cecily Cardew (Riley Krull). Gwen's mum, Lady Bracknell (Maureen McVerry), negates Jack's proposal of marriage when he appears to have less than stellar parentage. In turn, Jack will make his ward, Cecily, into an old maid and Algy a professional bachelor if he can't have Gwendolen.
When all meet at Jack's country estate, including slightly odd governess Miss Prism (Diana Torres Koss) and slightly randy Reverend Chasuble (Brian Herndon), various truths come spilling out — of the handbag, so to speak. Whether you're unfamiliar with the play or you've seen it dozens of times, you're in for a treat with the staging of the final reveal.
It's hard to imagine songs complementing Wilde's urbane wit, but these provide musical interludes sure to please the master comedian himself, with a light sentiment and sweet romantic touches.
Gwendolen's ode to the name Earnest, "Age of Ideals," appeals with wit and with Lym's saucily flawless delivery. Algernon's adoring ballad of "Cecily" reveals his new heart in a dreamy endorsement of love. "Absolutely Perfect" unites Morton and Krull in a charmingly funny duet, later reprised to great comic effect by McVerry. The musical motif first introduced in "No Romance" by the two young men becomes familiar and catchy by the end; you'll find yourself humming it after.
"Absolutely Perfect" might also be sung about this cast — not a weak link among them. They're all so well-matched to their roles, with terrific vocals in addition to obvious comedic skills. Morton's velvety voice particularly stands out, and he has numerous opportunities to shine. Lym's smooth, liquid delivery at first hides the lovely surprise of her humorous abilities, and she and Krull do great justice to the famous Cecily-Gwendolen garden scene. Krull's youthful brashness as Cecily comes across in her vivacious vocals and endearing demeanor.
Tee, playing the more conservative of the men, is no less attractive with solid voice and droll expressions. Torres Koss and Herndon add delicious color and comedy in their roles as well as strong ensemble vocals.
Joe Ragey's gorgeous set morphs into various locales rather effortlessly, establishing a familiar mid-century British context. Fumiko Bielefeldt's mod costumes are another character unto themselves; they're fun and memorable. Musical direction by William Liberatore and sound design by Jeff Mockus achieve a near-perfect balance of instrumentation and voices — no easy feat with amplified instruments. Kudos to director Robert Kelley for bringing it all together in such smart staging.
You may want to see this one more than once before it takes Broadway by storm. It's great fun, and great humor, and adds up to a terrific evening. In Act Two, the authors pay homage to Wilde himself with insertions of his famous witticisms, and projections of Wilde seem somehow appropriate. He would no doubt approve of the ending projections; don't rush too quickly for the exit.
What: "Being Earnest," a new musical based on the play by Oscar Wilde; book & lyrics by Paul Gordon, music by Paul Gordon & Jay Gruska; presented by TheatreWorks
Where: Mountain View Center for Performing Arts, 500 Castro St.
When: Through April 28, with shows at 7:30 pm Tuesdays & Wednesdays; 8 p.m. Thursday through Saturdays; 2 p.m. Saturday & Sunday; and 7 p.m. Sundays
Cost: Tickets are $23-$73.
Info: Go to theatreworks.org or call 650-463-1960.


text: Watch video Liam Lacey revisits Daybreakers Add to ... The Globe and Mail Published Thursday, Jan. 07, 2010 10:21AM EST Last updated Thursday, Jan. 07, 2010 4:31PM EST Liam Lacey got an advance look at Daybreakers when it premiered last fall at TIFF. Now that it's in wide release, he's back for another bite. Watch More Video: Video: TomKat's split, Emma Stone's outfits, and other gossip Video: Afghan rock 'n' roll scene thriving after Taliban prohibition Russell Brand's MTV Movie Awards monologue Best actress nominees Viola Davis and Michelle Williams On the red carpet with Nick Nolte Raw Video: The White House turns blue(s) Fans travel to say goodbye to Whitney Houston Whitney Houston's casket arrives at funeral Fans pay respect on eve of Houston's funeral Billy Bob Thornton's father issues Meryl Streep jokes about her pants The Muppets are Oscar-bound Oscar buzz abounds at TIFF Hear what the stars are buzzing about at TIFF The stars come out at TIFF 2011 Jennifer Garner feels lucky in Toronto Madonna's publicist denies TIFF 'Diva' allegations Ethan Hawke on how films have changed Madonna the filmmaker wants respect Madonna walks the red carpet Comments Share via email Share on facebook Share on twitter Share on LinkedIn Print More Related to this Story Liam Lacey on Youth in Revolt Liam Lacey on Nine Liam Lacey on Guy Ritchie's Sherlock Holmes


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Lacrosse news straight to your inbox.
Tuesday August 6th, 2013 1:12am
HOBOKEN, N.J. — The nationally ranked No. 7 Stevens Institute of Technology men's lacrosse team dominated Endicott College in the 2013 home opener, 21-9. Stevens scored at least five goals in each of the first three quarters to cruise to its second victory of the season. Eight different Ducks scored in the contest.
Senior Nicolas Philippi (Mullica Hill, N.J.), junior Charlie Cronin (Northampton, Mass.) and sophomore Andrew Scrutchfield (Lewes, Del.) each tallied seven points for Stevens. Cronin led the way with five goals and two assists, while Philippi and Scrutchfield each registered four scores and three helpers.
Fellow senior Rich Dupras (Hillsborough, N.J.) posted a hat trick and three assists for six points, while sophomore Michael Maroon (Virginia Beach, Va.) handed out three assists and scored one more. Stevens' goals were capped off by two from senior Harrison Dorne (Morristown, N.J.) and one a piece from junior Sean Scrudato (Westfield, N.J.) and freshman Connor O'Shea (Ridgewood, N.J.).
Despite only winning 12-of-33 faceoffs in the game, Stevens maintained possession for a majority of the game due to 33 Endicott turnovers. The Ducks caused 14 turnovers, led by six from sophomore Brian Fahy (Eastchester, N.Y.). Fahy also scooped up six of the team's 46 groundballs. Senior Tim Culloty (Mahwah, N.J.) paced Stevens with seven groundballs.
Sophomore Matthew Deiner (Millstone Twp., N.J.) earned the victory in goal for the Ducks in just over 48 minutes of action. Deiner made nine saves and picked up two groundballs before being replaced by freshman Alex Malecki (Hillsborough, N.J.). Malecki stopped two shots in the final 11:48 of game time.
Endicott netted the first goal of the game just 1:38 into the opening quarter, but the Ducks responded with five-straight from over the next nine minutes of play to take a 5-1 lead. After two scores by the Gulls to chip into Stevens' edge, 5-3, Philippi assisted on tallies by Cronin and Scrutchfield to bring the contest back to a four-goal advantage, 7-3, and closed out the first 15 minutes.
Philippi kicked off the scoring in the second period with a man-up goal at the 10:05 mark before Endicott tried to mount a rally with two more goals in a 2:19 span. After Stevens' lead got cut to 8-5, the Ducks ran off four scores in the final 2:53 of the half and went into intermission with a 12-5 cushion.
In the third quarter, Stevens outscored Endicott, 6-2, and pushed its lead out to 18-7 with 15 minutes left to play in the contest. The Ducks increased the difference by one more goal in the fourth quarter to account for the final outcome of the showdown.
The Ducks were successful on 17-of-19 clears, while holding Endicott to just 9-of-16. Stevens also scored on five of its 15 man-up opportunities and shutout the Gulls on all 14 of their chances. In all, 29 penalties were called in the game.
Stevens will play two-straight road games before returning home on March 6 against Muhlenberg College at 4 p.m. The Ducks travel to Eastern Connecticut State University on February 27 for a 4 p.m. showdown, and remain on the road on March 2 against Springfield College for a 1 p.m. start.
Remember to "like" Stevens Athletics on Facebook and follow @StevensDucks on Twitter for the latest news and updates.


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About Miri Airport
Miri Airport is the second busiest airport in Sarawak. Located close to the border of Brunei Darussalam, it serves the city of Miri and the northern region of Sarawak.
It is also a hub for domestic flights and serves Malaysia Airlines and Air Asia.
In 2011, it was announced the Miri Airport will be expanded to cater for the growing number of passengers. The new terminal has a capacity of 2 million passengers per year.
Latest News
10 April 2017
We are pleased to inform that runway recovery works at Sibu Airport is now complete and the airport had resumed normal operations at 0000 hours, 10 April 2017, with the first flight commencing operations 0928 hours this morning.
The runway had earlier been damaged on 8 April 2017 when a Malaysia Airlines aircraft,...
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Everything you need to know about Miri Airport
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text: Webexclusive Ribbon & Lace Love Wall Plaque, Set of 4 Item #: 125275 $39.99 $19.97 Qty: Sorry, this item is currently unavailable online. Ship to Home If you're looking to add some homespun charm to your wall décor, look no further than the Ribbon & Lace Love Wall Plaque Set! Each plaque features a letter made of ribbon, lace, and cute jewel accents in a natural wood frame. Plaques measure 6.5L x 10.5H in. Crafted of wood composite Set of four (4) plaques Features the letters L-O-V-E Letters decorated in ribbon, lace, jewel accents on fabric backgrounds Natural wood frames Vertical display Comes ready for wall mount; no hanging hardware required This item is available at Kirklands.com only, not available in stores. Sorry, this item is currently unavailable online.


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Tony Danza
Screening at SXSW this weekend, Joseph Gordon-Levitt's directorial debut has been renamed from "Don Jon's Addiction" to "Don Jon."
Also written by the "Looper" star, the movie will hit theaters in Russia on September 19th, with a U.S. release date still unannounced.
Having some fun with his co-star, Joseph Gordon-Levitt posed for pictures at the Sundance Film Festival on Saturday (January 19) in Park City, Utah.
Handsome in jeans, a maroon shirt, and tie, the "Don Jon's Addiction" hottie shared the spotlight with his on-screen father, Tony Danza.
New York City's Madison Square Garden was swarming with stars on Wednesday night (December 12) for the 12-12-12 Sandy Relief Concert.
Kristen Stewart was on hand to introduce the legendary Bon Jovi, who gave a rockin' performance for a great cause.
After 24 years of marriage, Tony Danza and his wife Tracy are calling it quits.
According to TMZ, the "Who's the Boss" star cited irreconcilable differences as the reason for the split in recently filed legal paperwork.
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I've had the most devastating day. It was just an ordinary Tuesday until I found Kris lying in my driveway. I'd been out running errands this morning, doing a little local shopping, avoiding the chains and helping out the local business owners. So I was totally unprepared to find a murder victim in my driveway. [Read More…]
The murder victim in my driveway
December 14, 2011 by 6 Comments


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Results 1 to 4 of 4
Thread: Vaccinations and peanut allergy
8th November 2013 01:14 AM #1
- Join Date
- Nov 2013
- Posts
- 10
Vaccinations and peanut allergy
I was told by some other mums in our playgroup that some vaccinations contain a trace amount of peanut oil and could cause an allergic reaction in babies/children. I've tried to look online but not really found any concrete sources. Has anyone every heard of a connection between vaccinations and peanut allergy? Is this just a rumour? I can't imagine why companies would put peanut product in vaccines, seems like that's just asking for trouble.
Last edited by Callie; 8th November 2013 at 01:16 AM. Reason: grammar
8th November 2013 12:43 PM #2
- Join Date
- Feb 2012
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- Marrickville, Sydney, Australia
- Posts
- 170
Hi Callie
My two children have anaphylaxis - one to peanuts and one to eggs. Consequently I have done a lot of research on allergen-free foods as well as exploring possible allergens in vaccines.
In Australia at least I have been assured by medical professionals that there are no traces of either peanuts or egg in vaccines. There certainly were traces of egg albumen in vaccines of old but vaccines have been refined over the years, in part as a result of the need to ensure they can be administered safely to the vast majority of children.
However, that said you should always check with the administering doctor if you have any concerns in regards to any medications or vaccinations your child receives. Personally I had my doctor call the manufacturer and confirm... while I was sitting there listening!
8th November 2013 11:52 PM #3
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- Nov 2013
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What a good idea to have them call the manufacturer, I hadn't thought of that. Of course at this point I don't have any reason to believe my daughter would have an allergy, but I imagine it must be very difficult to monitor everything your children contact for risk of having a reaction. Thanks for your response!
12th November 2013 06:56 AM #4
My understanding of vaccines has also been that they contain no traces of peanuts. My son was believed to have had a peanut allergy when he was younger and it has been safe for him to have all his vaccines.
Best wishes,


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We heard rumours of this app being in development as far back as early last year but it is now available to download for Windows Phone. RSA securID tokens should be familiar to many who work remotely, they allow business to secure access to their systems.
The app is an important addition to the business credentials Windows Phone now exhibits as a platform for work and play. Having the token on a users smartphone allows IT departments to stop giving out expensive hardware fobs to its mobile workers. The app is compatible with devices running Windows Phone 7.5 and Windows Phone 8. Read on to find out more.


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Jeff's MCAD Blogging
Jeff Rowe
Jeffrey Rowe has more than 40 years of experience in all aspects of industrial design, mechanical engineering, and manufacturing. On the publishing side, he has written well over 1,000 articles for CAD, CAM, CAE, and other technical publications, as well as consulting in many capacities in the … More »
Getting Started With IoT In A Box
June 25th, 2015 by Jeff Rowe
With all of the buzz that the Internet of Things (IoT) has generated, a number of our readers have asked if there was anything available for experimenters who may have interest, but not a lot of money to spend on exploring the technology. Until recently, the answer would have been, "No." However, that all changed this month with the availability of the ARM® mbed™ IoT Starter Kit-Ethernet Edition from ARM Ltd.
In the 1980s British computer manufacturer Acorn Computers first developed the Acorn RISC Machine (ARM) architecture for its personal computers.
A reduced instruction set computing (RISC)-based computer design approach with ARM processors require significantly fewer transistors than typical complex instruction set computing (CISC) x86 processors in most personal computers. This approach reduces costs, heat and power use. Such reductions are desirable traits for light, portable, battery-powered devices and other embedded systems. A simpler design facilitates more efficient multi-core CPUs and higher core counts at lower cost, providing improved energy efficiency for servers.
ARM Holdings develops the instruction set and architecture for ARM-based products, but does not actually manufacture products itself.
ARM core processors are used in a wide range of products including the Microsoft Surface tablet, Apple's iPad, iPhone, and iPod, ASUS tablets, Canon PowerShot digital cameras, and Nintendo DS handheld game consoles. In a word, ARM cores are everywhere.
ARM Processor – Sowing the Seeds of Success
Hexagon and HxGN Measure Up and Beyond
June 18th, 2015 by Jeff Rowe
A couple of weeks ago I attended the Hexagon Global Network (HxGN) 2015 Live conference. Although not held in my favorite destination, Las Vegas, this was an opportunity for my first direct exposure to Hexagon. In a word, I was not disappointed. In fact, the experience went far beyond my modest expectations that I had before attending the event.
I went to HxGN specifically for the metrology (science of measurement) portion of the conference with regard to sensing, inspection, QA, and reverse engineering applications – in other words what Hexagon Metrology is all about. However, metrology was not the only area represented, as the company known as Hexagon AB also has a huge presence with its hardware, software, and services in other industry segments, such as geospatial (GPS and surveying); process, power, and marine (PP&M); and security, government, and infrastructure (SG&I). It was a lot to take in and I focused on industrial metrology and related technologies – sensors and software used for optimizing manufacturing processes and throughput.
Founded in 1992 and headquartered in Stockholm, Sweden, Hexagon AB has offices in 46 countries, 15,000+ total employees, and is R&D focused with 11% of net sales and more than 3,400 employees invested in R&D. The industrial side of Hexagon AB, known as Industrial Enterprise Solutions (IES), that includes manufacturing and industrial plant facilities accounts for about half of the company's sales. Roughly one third of Hexagon's business is derived from metrology.
HxGN LIVE 2015 Conference
The Invisible Labor Shortage of Technicians Who Keep Things Running
June 11th, 2015 by Jeff Rowe
The pressing need for engineers of virtually all disciplines has become increasingly urgent as relatively few students view and pursue engineering as a career. Business seems more attractive to many, and yeah, there's always psychology (the "new" liberal arts degree) that has a lot of sellers, but relatively few buyers, at least at the BA/BS level.
Yes, engineering education and engineers are vital for keeping our technological world moving ahead, but who keeps the underlying machinery, tools, and software moving at all? Technicians.
Whether you recognize them, or not, there are technicians in just about every field and industry. For example, automotive mechanics, machinists, cosmetologists, electricians, emergency medical technicians (EMTs) — the list is about endless. If it's "technical," the odds are extremely good that there is a technician involved somewhere in the chain, and that may include many links in the chain.
So, what exactly is a technician?
Technicians can be classified as either highly skilled or semi-skilled workers, and are usually an integral part of a larger process. They work in a variety of fields, and they usually have a job title with the designation "technician" following the particular category of work. For example, an engineering technician is a highly skilled, highly educated occupation requiring several years of post high school training in a formal apprenticeship and probably college (usually two year) for further education.
Experienced technicians in a specific domain typically have at least an intermediate understanding of theory and expert proficiency in technique. Because of this practical knowledge, technicians are generally better versed in technique compared to average laymen and even general professionals in that field of technology, namely engineers, for whom theory often trumps practice.
What is the Future of (Automotive) Technicians?
Read the rest of The Invisible Labor Shortage of Technicians Who Keep Things Running
IoT and PTC's Brave New World
June 4th, 2015 by Jeff Rowe
About a month ago I spent a few days in Boston at PTC's LiveWorx 2015 event. It was an eye opener for me and a brief look into the future of PTC with its growing emphasis and dependence on the Internet of Things (IoT).
Recaps of the event, entitled LiveWorx 2015: PTC Drives Home Its IoT Future – Part 1 and PTC ThingWorx Converges On IoT were published shortly after the event last month.
Beyond the technologies and business strategies presented, what struck me was the relatively young crowd attending with relatively young PTC PR people pushing the IoT platform. Sold out with over 2,300 attendees (up from ~350 in 2014), the draw was similar or maybe more than this year's PTC Live Global user event. Although Creo and Windchill were certainly present at LiveWorx, they took a back seat to IoT offerings, such as ThingWorx, Axeda, and others.
So what does IoT really mean? I don't know either because it's evolving so rapidly and all participating vendors define it so that it accommodates what they offer best. In other words, until standards are established, the definition continues to evolve. I will admit, however, that PTC currently has a leg up on virtually all of the competition for IoT in its traditional design, engineering, and manufacturing space.
A standard definition is in the works, however, and IoT generally refers to uniquely identifiable objects and their virtual representations in an Internet-like structure. The term Internet of Things was proposed by Kevin Ashton in 1999, although the concept has been discussed since 1991, so it's not exactly brand new.
According to PTC, the Internet of Things has the potential to create trillions of dollars of new economic value in the coming decade. To capture this value, manufacturers will rely on new applications that enable the creation of smart, connected products, thus PTC's interest and commitment, as shown in the brief video below.
PTC's Vision for Smart, Connected Products
Read the rest of IoT and PTC's Brave New World
Wohlers Report 2015 and the State of the 3D Printing Industry
May 28th, 2015 by Jeff Rowe
An independent consulting firm and industry source that we know quite well, Wohlers Associates, Inc., recently released the Wohlers Report 2015, the company's annual detailed analysis of additive manufacturing (AM) and 3D printing worldwide. According to the Report, in 2014, interest in 3D printing reached an unprecedented level and exceeded the $4 billion milestone. The phenomenal attention to AM began in 2012, was sudden, and has continued to proliferate since then.
Wohlers Associates is widely recognized as the leading consulting firm and foremost authority on additive manufacturing and 3D printing. This annual publication has served as the undisputed industry-leading report on the subject for two decades. Over the 20 years of its publication, many have referred to the report as the "bible" of additive manufacturing (AM) and 3D printing—terms that are used interchangeably by the company (and industry).
Wohlers Report 2015
The market for additive manufacturing, consisting of all AM products and services worldwide, grew at a compound annual growth rate (CAGR) of 35.2% to $4.1 billion in 2014, according to Wohlers Report 2015. The industry expanded by more than $1 billion in 2014, with 49 manufacturers producing and selling industrial-grade AM machines. The CAGR over the past three years (2012–2014) was 33.8%.
Read the rest of Wohlers Report 2015 and the State of the 3D Printing Industry
RAPID 2015: 3D Printing In Vivo, In Vitro, In Situ, and In Space
May 21st, 2015 by Jeff Rowe
We've been in Long Beach, California all week at SME's RAPID 2015 conference and exhibition. If you want to learn what's new exciting in things 3D, this is the place to be. Hardware and software vendors, service providers, distributors and resellers, and educational institutions all showcase new offerings in 3D printing, scanning, and additive and subtractive manufacturing.
RAPID is an interesting mix of industry experts, pundits, users, and people just curious about this fascinating 3D world that continues to grow at an exponential rate. This year about 4,000 attended RAPID with almost 200 exhibitors
RAPID is about the most recent developments in the field, as well as what may be coming in the future. A number of technologies, techniques, and innovations are discussed during technical sessions, but this year, we found among the most interesting topics to be 3D bioprinting and 3D printing in space.
The first morning's keynote was made by Jason Dunn, CTO of Made In Space, who talked on the topic of "Bringing Additive Manufacturing to Space." The company was founded in 2010 with the goal of enabling humanity's future in space. It has developed additive manufacturing (AM) technology specifically for use in the space environment (no easy task). By manufacturing space assets in space, as opposed to launching them from Earth, the company is attempting to accelerate and broaden space development while also providing unprecedented access for people on Earth to use in-space capabilities (the ultimate goal of a business model to monetize its cash outlay in space on earth).
Made In Space Launches First 3D Printer to Space
Read the rest of RAPID 2015: 3D Printing In Vivo, In Vitro, In Situ, and In Space
Meet Us at RAPID 2015
May 15th, 2015 by Jeff Rowe
We're heading to Long Beach, California next week to participate in one of SME's marquee events — RAPID 2015.
I'll be at the conference all week taking in the keynotes, new hardware and software products and service announcements, as well as sitting in on a few technical sessions.
This is an especially pivotal year in the evolution of 3D printing as it strives to get to the next level with higher quality parts, lower cost materials, and greater presence in manufacturing direct part production.
I'll be hitting the floor running early Tuesday morning and will be Tweeting throughout the event, as well as posting blogs at the end of each day.
If you're going to RAPID 2015 in Long Beach, feel free to contact me at 719.221.1867 or email@example.com and let's meet up for discussing the latest technologies, trends, rumors, etc.
Hope to see you there!
PTC ThingWorx Converges On IoT
May 14th, 2015 by Jeff Rowe
Last week at LiveWorx 2015, PTC made several major product and strategic announcements around the Internet of Things (IoT) and their implications for the future of PTC. A couple of the most prominent of these product announcements were ThingWorx 6.0 and ThingWorx Converge.
Before being acquired by PTC about 18 months ago, ThingWorx realized that making IoT a reality required an ecosystem of complementary technologies that enable "things" to be created, connected, operated, and serviced. With the ecosystem established, applications that capitalize on the data these "things" generate can be developed.
According to Russ Fadal, President & General Manager, ThingWorx, a PTC business, it's estimated that in 2010 there were approximately 7 billion connected smart devices in the world. That number is expected to be in the neighborhood of 1 trillion by 2035. That's explosive growth, to say the least!
He said that today IoT is challenged because 80% of resources are dedicated to infrastructure and 20% for applications, and he would like to see those percentages reversed. Other issues that he, PTC, and the IoT industry as a whole are trying to resolve include security, predictable performance, 10X+ faster production and implementation, and what to do with the mountains of data generated by IoT devices. Security is especially important because it is not an event, but an ongoing process that will never go away. No small concerns here, therefore the evolution of the platform ecosystem — ThingWorx.
Stratasys Reports Disappointing Q1 Financials
May 11th, 2015 by Jeff Rowe
As exciting as the 3D printing/additive manufacturing (AM) space has been the past several, especially the last couple, its unbridled enthusiasm and expectations couldn't be expected to go on forever, and they're not. Stratasys reported less than anticipated financials for Q1 2015.
All was not doom and gloom for Stratasys, however, as the financials also include the following:
Stratasys Presents a 3D Printed Aircraft Interior at EuroMold 2014
Fred Fischer, Director of PolyJet and FDM Applications at Stratasys, presents an aircraft interior 3D printed using a unique combination additive manufacturing technologies. The presentation was filmed at Stratasys' aerospace-themed booth at EuroMold 2014 in Frankfurt.
Read the rest of Stratasys Reports Disappointing Q1 Financials
LiveWorx 2015: PTC Drives Home Its IoT Future – Part 1
May 7th, 2015 by Jeff Rowe
So, you think that the Internet of Things (IoT) is a fad? Based on my experience at PTC's LiveWorx 2015 in Boston this week, IoT is a big part of the future, not only for PTC, but for all of us.
Still not convinced? Just the attendance figures alone from this year over last might help convince you – LiveWorx 2014 (~350 attendees); LiveWorx 2015 (>2,300 attendees). Numbers don't lie and that shows the growing interest in IoT.
Because of the amount of material covered in just a couple of days, and the major implications surrounding IoT and PTC, I'll be writing about some the major (and some minor) technology and business announcements, as well as how this all fits together and might shape PTC's strategy going forward, including:
LiveWorx 2015 Highlight Reel
Read the rest of LiveWorx 2015: PTC Drives Home Its IoT Future – Part 1


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WATCH: Justin Bieber dances seductively with Selena Gomez
Listen to Justin Bieber on iHeartRadio | Listen to Selena Gomez on iHeartRadio
Justin Bieber has made it clear he wants Selena Gomez back - and recently, Selena seems to be reciprocating the feelings after the Bieb's most recent efforts.
After his "most elegant princess" Oscar post, their secret rendezvous for breakfast, and Justin serenading her at SXSW this week, the pair spent some more time together at a dance studio.
Biebs posted two videos to Instagram of him and Selena seductively dancing to John Legend's "Ordinary People." The pop star later deleted them, but they live on through YouTube.
Is Jelena really back together? Check it out below!


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Chan Resignation Letter Sets Last Day on Council as October 18th
As expected, north side Councilwoman Elisa Chan has submitted her letter of resignation so she can seek the Republican nomination for State Senate, 1200 WOAI news reports.
In a letter 'to Mayor and Council' distributed by her staff, Chan says her final council meeting will be October 17, and her resignation will be effective the following day.
"I am very proud of our city and what we have accomplished," Chan wrote. "Texas is in the middle of an economic miracle and San Antonio is doing its part to bring jobs and economic prosperity to this state. When I travel, I am so proud to say where I am from and inform them of the things we have accomplished."
Chan, is a native of Taiwan and she became a U.S. citizen in 1999. She is the co-owner of Unitech Consulting Engineers, a structural and civil engineering firm. She is the first Asian American woman to serve on San Antonio City Council, and she took the lead in opening up San Antonio to Chinese commerce, leading the city's very successful trade mission to Shanghai.
Chan became a conservative superstar last month when she led the unsuccessful opposition to San Antonio's gay and lesbian non discrimination ordinance.
In her resignation letter, Chan quoted Abraham Lincoln, "I like to see a man proud of the place in which he lives. I like to see a man live so that his place will be proud of him."
Chan says she will 'remember those words as I move on to my next challenge.'
Chan, who once was rumored to be considering a run for Mayor, will have a challenge ahead of her. She plans to take on popular first time State Senator Donna Campbell in next spring's primary.
Campbell is popular with conservative activists and the Tea Party movement and is a social conservative. She unseated State Sen. Jeff Wentworth in the primary in 2010 to win the seat in the overwhelmingly Republican district, which stretches from north San Antonio to New Braunfels and into the Hill Country.-


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Tribe Loses
The Indians struck out 10 times, hit into 3 double-plays, and left 10 runners on and lost to the Diamondbacks in the 2nd game of Wednesday's double header 1-0 in 12 innings.
CC Lee walked the lead off hitter in the 12th and Tuffy Gosewisch drove in the winning run while Jason Kipnis struck out to end the game with Lonnie Chisenhal on 2nd.
Josh Tomlin started and pitched 5 innings, but was pulled after only 50 pitches. He had not surrendered any runs and had only given up 4 hits.
Arnie Hamilton
WTAMS Sports


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Melbourne Rebels winger Cooper Vuna will only miss one Super Rugby game for his role in the post-match fight between teammates while Wallabies star Kurtley Beale may find out his fate on Thursday.
Vuna and Beale were sent home in disgrace from South Africa, missing their clash with the Cheetahs on the weekend.
Following their 64-7 loss to the Sharks in Durban and a team outing to a nightclub, Beale punched captain Gareth Delve and when Vuna intervened they traded blows.
Vuna then tweeted about the incident, calling Beale a "grub" in another breach of team protocol.
The Rebels announced on Wednesday night after a hearing that Vuna would be available for their game against the Western Force in 10 days time, taking into account his previous good behaviour and community work.
Vuna has been banned from using social media.
The club and Australian Rugby Union inquiry into Beale's actions is continuing with a resolution likely on Thursday.
He may face a lengthy suspension or even have his contract terminated.
After the hearing, Vuna apologised for the embarrassment he caused the club.
"During my time with the Melbourne Rebels I have turned my life around," he said in a statement.
"The outcome of this incident in Durban is not consistent with the values of my family, my church and my football club."
Vuna, a father of two, has been on a self-imposed alcohol ban for the last six months and dropped 10kg in the process.
The rugby league convert is trying to add to his two Test caps earned last year.
Meanwhile, Delve says he would have no trouble playing alongside wayward Wallaby star Beale despite the punch.
"I'm a professional rugby player - for the most part my relationship with Kurtley has been excellent," Delve said.
"It's not something I can't get past."
The Rebels are attempting to put the crisis behind them as they prepare to face the in-form Cheetahs in Bloemfontein this weekend.
The Cheetahs are returning from their most successful Australasian tour after victories over NSW Waratahs, Highlanders and the Force.
Delve said the players would be out to try to repair some of the damage from both the crashing defeat and the brawl.
He said they needed to make it up to the coaching staff and Melbourne fans.
"We've got a great opportunity to come out this week to turn things around and to put things right," Delve said.
"We owe everyone a big performance this week."
Coach Damien Hill is set to ring the changes following the Durban game, where the Rebels finished with the sorry tally of 19 turnovers and 31 missed tackles.
Richard Kingi is set to start on the wing in place of Vuna while prop Paul Alo-Emile will start ahead of Laurie Weeks.
Rookie Jordy Reid will also get his first start, replacing Scott Fuglistaller.
Wallabies backrower Scott Higginbotham has been cleared of any shoulder damage while centre Mitch Inman is on the mend after a stomach bug.


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Ok, time to dip from the proverbial knowledge pool. Im trying to focus on learning bluetooth cracking (yeah im a dee-de-dee but i think i want to try to develop something along the lines of kismet for bluetooth sniffers). However, in an effort to be at least semi-cutting edge from 2006, i'm trying to get into FPGAs. I would hop on the whole Pico E12 or E16 bandwagon, but i think i left my $1000 bucks (899 for the e12) in my other pants.
I've been looking at Spartan E3 starter kit (retails at the low low price of $149.99) www .xilinx.com/products/silicon_solutions/fpgas/spartan_series/spartan3e_fpgas/index.htm
But due to lack of true knowledge of the hardware out there i'm left with a few questions:
All the fpga tools on bt3 (winzipcrack, wepcrack, cowpatty,etc) that harness fpgas, do they need just the e12, or e16? OR can a guy get any FPGA and go to work?
If all fpgas are not created equal, is there a term that will help me in my searches for the proper (read CHEAP) fpga? I'm not even 100% sure the E3 is in the same realm as the e12 and e16s from PICO.
If anyone has any experience with the E3 let me know as im frothing at the mouth to order it. If an E12 gets 9,000,000/s key attempts and a p4 gets 150,000 if i could even get 3 or 4,000,000/s from the cheapo E3 i'd be happy.
Thanks in advance. God i love this forum.


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Discussion in 'Fan Zone' started by GiveDezdaBall88, Oct 10, 2012.
How the heck is this guy in the NFL let alone starting on our team?
From Marty B to Macky B now. I like your style.
I would rather a revolving door than Macky B.
So.......what do you suggest?
yea, sometimes those CAN be tricky to get through!!:laugh2:
Anyone on god's green earth but him...
In fairness to "Macky B," he has not had a lot of prep time. The guy is built like a tank but he has not had the time to work on his explosion and power since he was injured most of the offseason. Not only that, he has not had the opportunity to work with his line mates.
I think the guy has played poorly to date but I do see an upside. If he can regain his lower body strength and power he should be a solid contributor by November. If he's JAG, he will keep playing the way he is and will be cut at the end of the season.
You do realize you're talking about the same guy who couldn't even start on the Carolina Panthers?
How about Alex Barron?
I'd never thought i would ever miss Montrae Holland but MAcky B made that possible. Macky B FAIL when your best just isn't good enough.
When did he become an OG?
Yes, it has indeed occured to me. Considering how bad they are doing, it is telling that there has been no rueage on the local airwaves about letting him go.
Hopefully he visited Miracle Max during the bye week.
The Panthers prefer agile interior linemen; he was expendable.
Anyway, lots of guards go on to play well on other teams after they are deemed expendable by another. Nate Newton and Ron Stone immediately come to mind. And lets not forgot the memorable Brian Waters.
He did stop Orakpo that game, granted he held and it cost us the game but still, he stopped him.
I can draft and sign better O-lineman drunk than Double J and his son!
Macky B? :laugh2:
He said anybody, scroll up
Every D-lineman that goes up against Macky B sends him a limo to the game, can't afford any accidents.


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The Indiana State Department of Health is not recommending any specific bioterrorism-related precautions for the public. However, everyone should have a family disaster plan in place. This would include having the following emergency supplies on hand:
Should a bioterrorism event occur, it is important that people listen to the instructions of emergency and public health workers. They will need the public's cooperation to perform their duties as rapidly and successfully as possible.
Having a plan in place is necessary for anyone to respond to an emergency, be it a natural disaster or a terrorist attack. For more information please visit the Indiana Department of Homeland Security.
An attack with bacteria or virus spread in the air would be extremely unlikely because it is difficult to make a bacteria or virus that will survive being spread through the air. Terrorists have tried unsuccessfully to attack with biologic agents in the past.
When it is determined that a biologic event has occurred, notification will promptly follow. Public health authorities have been working to educate physicians and other health care providers to recognize and report the diseases that would most likely be used in a terrorist attack. An event would most likely be recognized by local health care providers who would then notify state and federal health authorities. Not only will the public be notified, there will be frequent updates of important public health messages. Communication in any disaster, including a bioterrorism event, is of the greatest importance.
There are no vaccines being recommended for the public. Please see below for more specific information on anthrax and smallpox vaccines.
Smallpox was wiped out in 1979 after a vaccination program, but existed still in two labs - one at the Centers for Disease Control and Prevention (CDC) and one in the former Soviet Union. The CDC currently has enough doses of smallpox vaccine on hand to vaccinate all Americans, which would be used if needed for a bioterrorism event. The vaccine would be effective if given within three days after exposure. The federal government, including the CDC, is concerned about the threat of bioterrorism. Plans for a response to such an event are being developed at many levels of the government. These plans do not include widespread use of smallpox vaccine at this point. The benefits and risks of reintroduction of smallpox vaccine are continuing to be examined. For more information on smallpox, click here.
Anthrax is a disease found in animals in many places around the world, including the United States. The anthrax vaccine is not available commercially except to the military. For more information on anthrax, click here.
Because biological or chemical attacks are unlikely to be announced, military gas masks would have to be worn continuously to be protective. For a mask to be effective, it must fit properly and be worn correctly. A mask cannot be worn with facial hair as an effective seal between the mask and skin cannot be maintained, making the mask ineffective. Additionally, the mask does not protect against skin contact with biological or chemical agents providing no protection against skin absorption. A gas mask makes breathing more difficult, increasing the stress on individuals with pre-existing heart or lung problems. The design of gas masks reduces the field of vision and makes working more difficult. It is, for example, very dangerous to drive while wearing a gas mask. Furthermore, since the filters and activated carbon discs need changing after use, it is hard to know how effective a gas mask will be.
We do not recommend that the public keep antibiotics on hand for use in a terrorist attack. There would be time after such an attack to treat large numbers of exposed persons, if necessary. The Strategic National Stockpile consists of medical supplies and antibiotics placed strategically around the country. These supplies can reach Indiana within hours of a request from the Governor.
The Strategic National Stockpile is a large reserve of antibiotics, chemical antidotes, and other medical supplies set aside for emergencies. The Strategic National Stockpile consists of two parts: a 12-hour "push package" and the Vendor Managed Inventory (VMI). There are 12 identical 12-hour push packages, strategically located around the United States. The CDC reports that it has the capacity to move these to affected areas in the United States within 12 hours of notification. The Vendor Managed Inventory is a federally owned, vendor-managed cache of drugs and medical supplies that will follow a 12-hour push package, if needed. For more information about the Strategic National Stockpile, click here.
Public drinking water supplies are safe. It would be VERY difficult for a bioterrorist to contaminate our drinking water supplies to cause widespread illness because huge amounts of water are pumped daily from our reservoirs, most used for industrial and other purposes. Anything deliberately put into the water supply would be greatly diluted. Also, water treatment facilities routinely filter the water supply and add chlorine to kill germs.


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Prosecutor to ask for lesser sentence
(Akron) — A prosecutor says she'll seek a lesser sentence for a Massillon man convicted of fatally shooting his ailing wife in her hospital bed.
Summit County Prosecutor Sherri Bevan Walsh said she'll file a motion asking that 68-year-old John Wise be sentenced for the lesser crime of manslaughter, which would greatly reduce his prison time.
If accepted by the judge, Wise would be sentenced to six years.
He was convicted Friday of aggravated murder, murder and felonious assault, which carries a mandatory punishment of life in prison. He had pleaded insanity, claiming he couldn't stand to see his wife in pain in the hospital.
In a statement, Walsh said that because of the "unique" circumstances of the case, "a shorter prison sentence is just."
He will be sentenced Monday.
Get breaking news sent to your mobile phone. Text "news" to 21095.
(Copyright 2013 The Associated Press, all rights reserved.)


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