text:
Tyler was born on September 14, 2000. He weighed 6 lbs 1 oz. and was a healthy baby boy. The first 5 months of Tyler's life were so special. My heart soared watching him grow and learn. My little boy: saying Mama, Dada, playing peek-a-boo with his mommy, and exploring his brand new world. Then Tyler's world changed forever: our son was diagnosed with Lennox Gastaut Syndrome (LGS) in 2007. LGS is a rare and often debilitating form of childhood-onset epilepsy. The syndrome is characterized by frequent seizures and multiple seizure types, a resistance to medications and/or therapies, cognitive dysfunction, regression, and an abnormal EEG with generalized slow spike-and-wave discharges. LGS constitutes between 1 and 4 percent of pediatric epilepsies and typically appears between the second and sixth year of life. Some of the known causes of Lennox Gastaut Syndrome include brain injury associated with pregnancy or birth (including asphyxia, low birth weight, and prematurity), severe brain infections (including encephalitis, meningitis and rubella), developmental malformations of the brain, or a history of infantile spasms. In 30-35 percent of cases, no cause can be found.
At around 6 to 6 1/2 months, I quickly noticed something in Tyler was changing. While changing his diaper one evening I noticed what looked to be a seizure, words can't describe how scared I really was. I brought him to the doctor and he ordered an MRI & EEG. The MRI came back normal and a neurologist had to read the EEG. The radiologist told us that the EEG showed spikes in Tyler's brain waves, which indicated seizures. This process took almost 6 months, and we didn't know the results of his tests definitively until after Tyler reached his 1st birthday. The doctors then started Tyler on clozapine, saying that if he went without a seizure for a full year we could take him off the medications. The clozapine made him very tired and made it very difficult for him to drink liquids, but he was not having seizures and could eat baby food.
After getting used to the medication, Tyler seemed happy but he was not reaching normal mile stones associated with a normal childhood. He had a very low muscle tone either from prior seizures or because of his medication. Either way, we had to start physical therapy to try to help him. The physical therapist worked nicely with Tyler. She showed us what we needed to do at home to help him and he improved somewhat, but nowhere near where he should have been in age. I was fine with that — understanding everything that was happening to him. Months later, Tyler started having trouble sucking his bottle, but was still able to eat baby food. I made an appointment with a Gastroenterologist to try and figure out what was happening and why Tyler's ability to drink was rapidly declining. Unfortunately, before we could make it to the doctor, Tyler ended up in the ER suffering from dehydration. I couldn't believe what was happening before my eyes. At one point I was reduced to giving him water through a medicine dropper – he simply could not drink from anything else. When I later spoke to the GI doctor, she asked so many questions, but I couldn't concentrate on what she was asking. I was so upset to see Tyler this way. I remember begging the GI doctor to please don't let my baby die, and asking over and over what I can could do to make him better. She explained that she needed to put a feeding tube into Tyler immediately to ensure that he received the proper amount of nutrition and hydration. I begged her to please do whatever she had to do: just don't let my baby die. She admitted him to the hospital immediately, and performed the surgery the next day. When Tyler came out of surgery I couldn't believe my eyes. I was frozen with fear. My little son was laying there with a feeding tube in his nose and another implanted in his stomach.
Due to the inflammation in Tyler's esophagus the feeding tube that was placed in his stomach couldn't be used yet. The one in his nose was temporary. Here I was standing in this hospital room alone and staring at my son in fear. A few moments later my cousin walked in the door. She looked at my son then walked over to me. I broke down in tears, screaming, "I can't do this, what am I going to do?" She said with a firm voice, "This is your son and you are his mother. You can do this." As she was calming me down the doctor came in to the room. She brought me into a private room and took time to clearly explain what was going on with Tyler. She told me I was special and that God gave me Tyler for a reason. She hugged me and told me she was proud I made the right choice by getting the feeding tube for my son.
When Tyler was sent home from the hospital, we had to have a nurse on call twenty four hours a day just in case he pulled out the feeding tube. It wasn't long before I was calling her. Tyler wasn't trilled having this in his nose. Then, the night before he had a checkup with the GI doctor, Tyler pulled the tube out of his stomach. I had just given him a bath and my mom was holding him when he pulled the tube right out. I panicked and called the doctor. She was telling me that a box I was supposed to bring to the appointment was his new feeding tube. She told me "I need you to place it in his stomach." I wasn't sure that was something I could do. How was I supposed to stick a tube into my son's stomach? What if I did it wrong? The doctor had faith in me and calmly told me that I didn't have a choice: I had to put the tube into Tyler or the hole to his stomach would close up. With the doctor's instructions over the phone, I replaced the feeding tube. The next day we went to her office and she said, "Nancy you did it!! What a great job!" I was impressed with myself. To think weeks ago I was saying, "I can't do this." Now I knew I could – and I would.
Suddenly things started becoming easier. I was used to the feeding tube and Tyler was actually improving. Unfortunately, this grace period lasted only for a few months. The day before it would mark a year that he was on his medication, Tyler had another seizure and then continued to have seizures until the doctors increased his medications. It turned out that because Tyler's weight had increased, the medications needed to be adjusted. During the next year Tyler didn't make any mile stones but at least he was happy all the time. The increased in medications also worked for a little while, but then he started having seizures again. This period of seizures continued for long enough that the neurologist felt it was a good idea to put him on a second medication, called Lamictal. The new medication made Tyler tired at first, but it turned out to be a good idea. Tyler was now 2 ½ years old and was on two major medications. I figured that I should seek help both for Tyler's therapy and his education. I had a cousin who had cerebral palsy and went to a great school a few towns away. I admit I was scared but I wanted a better future for my son, so I moved and he started Pre-K 3 in September of 2003. This was the change we needed: Tyler was doing well in school and going on a full day schedule. He was still having occasional seizures, so we had to do video EEGs pretty often to check on things. Tyler would roll all over to get what he wanted when playing with his toys, but was still in diapers and unable to sit for long periods of time. So we used a stroller, until we stared to get better equipment for Tyler, with the help of his school.
The neurologist we were seeing at the time told me one day after a regular visit that my child would be a vegetable for the rest of his life. I stepped back and said, "Are you telling me this without a diagnosis?" She replied that Tyler would always be this way. I was so angry and frustrated with that doctor that . . . well, let's just say I got kicked out of the hospital for the day. I switched to a different neurologist, but had to use one that was in the same practice as the original one due to the fact that Tyler was on state health insurance. The state insurance policy limited us to certain doctors. Anyway, this new doctor seemed very interested in helping us. She tried her best, but if you know anything about Lennox Gastaut Syndrome, you know it's a multiple seizure type syndrome. Not to mention hard to treat with medications and very rare. Most people – even doctors – simply don't know very much about this syndrome.
Over the next 1 ½ years, Tyler did well in school and with therapy but it was very up and down, like a roller coaster with many seizures and changes in his medication. The doctors took Tyler off of clozapine, left him on lamictal, and started him on phenobarbital. Tyler was once again tired and up and down. I was also having a very hard time trying to understand what was happening with my son. By the time Tyler was 3 ½, he was being fed solely through the g-tube due to aspiration phenomena. Once he started having more frequent seizures the neurologist referred us to an epileptic specialist named Dr. Sousa. I was completely hopeless at this point and was crying all the time because I just couldn't hold back how helpless I felt: no matter how much I wanted to help my son it seemed like I just couldn't do anything for him. Our first visit with Dr. Sousa was a relief. Finally, a normal, down to earth doctor. Dr. Sousa was not cocky like the other doctors I met in the past. He was actually very sympathetic and genuinely concerned with Tyler's condition. After going over Tyler's very long history of seizures he asked, "What do you want for Tyler?" I said I would like for my son to be seizure free or controlled and able to walk so he could enjoy his life a little more. Tyler deserved to have a better quality of life, even if it wasn't going to be exactly like the other children his age. Dr. Sousa said, "Ok let's see what we can do."
He ordered another MRI & EEG.
Finally, Tyler was diagnosed with Lennox Gastaut Syndrome. I had never heard of it, before. Dr. Sousa told me that LGS was a seizure disorder and we should consider a VNS. A VNS is an implant that would be put into Tyler's chest to help control his seizures. We all went home with yet another medication adjustment. Tyler now was 4 ½ years old and I was pulling my back out due to his increased weight. I had my own doctors telling me if Tyler stayed the way he was I was going to end up badly hurting myself. Being 5ft 2inches and 110lbs this wasn't something I wanted to hear, but knew it was true. With much thought of his safety, I made the decision to place my son into a nursing home. That was the hardest decision I ever made in my life. Putting Tyler into a nursing home was the last thing I ever wanted to do. It wasn't right. I was supposed to take care of my son. Not some stranger who didn't really love him. I cried all the time. Tyler still went to school and I went to see him and spent time with him every day. I remember that I wouldn't allow myself to leave his side until he fell asleep every night. I cried the whole way home. Then, when I got home I would bury myself into my husband's shoulder until I cried myself to sleep. This went on for months: at any giving moment I would cry and once it started, I couldn't stop.
My husband wasn't Tyler's biological father – but you would never know it by the way he treats him and helps me to take care of him. I met my husband when Tyler was 3 ½ years old. He always treated him like he was his own. That meant and still means the world to me. We would take Tyler home from the nursing home on weekends. I became very much like a robot. I couldn't stand what was happening to my family. I was sad and angry and frustrated all at the same time. My husband understood my mood swings. I always felt like I was taking this out on him, but he would always say, "I know you're not upset with me. You just wish things could be normal." I wanted so badly for things to be normal. This just wasn't my reality. This wasn't the way my life and my son's life were supposed to be. I was so angry at everyone and everything.
On March 14, 2007, one year after being diagnosed with Lennox Gastaut Syndrome, we had a VNS placed in Tyler's chest. Vagus nerve stimulation (VNS) is designed to prevent seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve. These pulses are supplied by a device that is similar to a pacemaker. Tyler came out of surgery giving everyone "high fives." He spent two days in the hospital following the surgery – thankfully with no issues. This was like a miracle. Tyler was having fewer seizures and when he did have one, we would use the magnet to start the VNS. It was like magic. The VNS would stop the seizure instantly. We were so happy that this was working! I finally thought we were actually going to make it. Tyler was doing wonderfully and becoming very alert and stronger every day. He was even using a walker with assistance at school. This actually lasted a few years. Tyler would have a seizure once in a while, but they weren't anything the VNS couldn't handle. I was so happy to see Tyler progressing. He was sitting up on his own for longer and longer periods of time. Tyler was saying "Mama" all the time. I kept telling my husband that Tyler was going to walk and that he was going to be able to come home. This was my dream. I dreamed that Tyler would learn to walk on his own so he could really enjoy life and able to come home.
I married my husband, Matt on November 14, 2009. Tyler, of course, was the ring bearer and both my men dressed in all white suits to match my wedding gown. Tyler was unbelievably cute and happy. At the church during an Irish Prayer Tyler vivaciously expressed himself out loud. It made me feel complete that Tyler was so happy that he had to express himself in front of a church full of people. This was a very special day not only because it was our wedding, but because it was also the beginning of our life together as a family. Matt and Tyler's relationship was strong from the beginning so I was over the moon when Tyler let us know how happy he was that we were finally, officially, a family.
Over the next nine months Tyler enjoyed additional improvements. He was in his walker at school two times a week and loving it. His teacher asked me to come to school to see how well he was doing in his walker. I couldn't wait to see, all I could think of was WOW look at my little boy becoming himself. He was so excited to show me he was walking. I kept saying, "Come give mommy a hug." He would finally get to me and I would take a few steps backward and say you almost got me, before grabbing him and enveloping him into the biggest, proudest hug I could ever give. I was cheering him on and he was taking steps. It was so nice to see my son really making progress. Dr. Sousa was happy as well. The doctor was so pleased with Tyler's progress that he even suggested that we start to wean Tyler off of his medications. The doctor explained that the VNS was designed to replace medications – or at least some of them. At this point Tyler was on phenobarbital, Lamictal and Keppra, so I told the doctor to go ahead and start the process of taking my son off of these serious medications. We were actually able to wean him completely off of Keppra without any issues. We were ecstatic and Tyler was doing awesome. He was much more alert, aware of his body, and his surroundings. Then we started to wean him off of the phenobarbital.
At first it was amazing to see what a smart and strong boy Tyler could be when he wasn't on so many debilitating medications. I could see it in his face how happy he was to be able to control himself better than ever before. His school kept telling me how wonderful it was to see him really coming into his own. Unfortunately, on August 14, 2010, I received a phone call from the nursing home. Tyler was having a lot of seizures and the VNS wasn't working. They had to give Tyler Diastat to try to stabilize him, but it wasn't having a very good effect. I couldn't believe what I was hearing! We rushed over to the nursing home to find a very heavily sedated little boy. He was in good spirits and just stared at me and fell asleep. I was on the phone with Dr. Sousa freaking out because I had never seen Tyler this bad. Dr. Sousa told me to bring Tyler to his office the next day. When I picked Tyler up in the morning he immediately started having seizures and didn't stop for two straight weeks. The first week he was home with us. We tried to get him stabilized with Dr. Sousa's help. We increased the amount of his phenobarbital, and gave Tyler Diastat, hoping it would stop the seizures. It didn't. I listened to every word the doctor said. Matt and I started logging the time, length, and body parts involved in Tyler's seizures. Tyler was having seizures every thirteen minutes.
After many phone conversations with Dr. Sousa and 3 visits to our house to check on him, Dr. Sousa finally told us that Tyler needed to go to the hospital. We all were on the fence about bringing Tyler into the hospital — at no point did I want my son intubated. Tyler had been intubated once before and it didn't turn out good. He regressed so much it was like watching him turn back into a helpless baby. But we knew he had to go, so Dr. Sousa made a few phone calls and we were off to the hospital. Once there the hospital staff hooked Tyler up to the EEG machine and were able to get him stable within a few days. By the end of this period, we realized that Tyler had managed to have one hundred seizures a day for two weeks. I was so beside myself; I didn't know what to do. I can still remember thinking on the way to the hospital that I was never letting him out of my sight, ever again. After watching everything that was happening to my son, I couldn't bear to leave his side. By that time, Tyler had spent four years in nursing care. He was now almost ten years old and enough was enough. The hospital finally stabilized him and I made arrangements to bring him home for good.
Dr. Sousa had told me that we detected focal seizures in the left rear part of his brain. Tyler could be a candidate for a resection surgery. Resective surgery is a procedure that removes an area of the brain that causes the seizures. I thought that this was great news. Finally we might be able to do something to help my son. Dr. Sousa told me let's give him a break for a while and see how he does, then we can go onto the next step toward surgery. At that point, Tyler was paralyzed on the entire right side of his body. The doctor told us that the paralysis could be temporary or it could be a permanent thing. Only time would tell. Plus Tyler was on more medications, including new addition called Triliptal, which made him appear drunk and out of it all the time.
This was crazy, but it didn't matter. I knew deep down inside that I was going to get him better. Plus, all I could think about was that I was finally bringing my baby home for good. His birthday was coming up and I wanted to make it extra special for all of us. No more nursing home and heartache. I felt alive and ready to take on anything, including resective surgery if that would finally help my son. My brother came over the day before we brought Tyler home to build a ramp up to our apartment door. With the help of my brother and my husband's friends the ramp was up and done in under two hours. Everything was falling into place, and I was feeling very blessed. God was giving me my life, and my son, back. Tyler's 10th birthday was on the way and I was so happy to invite our family and friends over for cake. He was a little sleepy during his party, but managed to stay awake the entire time. I had so many emotions going on inside me. I was happy that he was home, but nervous at the same time because I didn't know what to expect. I was doing everything in my power to get the best care for Tyler. Dr. Sousa even wrote a script for a full sized, netted and enclosed bed for Tyler to sleep in so that he would be safe when lying down. Tyler had no problem getting into a sitting position from lying down. He would sit up in a normal bed, get on his knees and then fall over. He'd do that all day long if you let him, and was not aware that if he falls off the bed he could get hurt. Trying to get the enclosed netted bed on the other hand was a complete nightmare.
Medicaid gave me a huge problem about the bed. They kept asking me why I wanted to put my son in a cage. One guy actually told me that some parents try to swoon me into getting their kids a bed. I just replied, "Listen, sir, I'm married so I have no time to swoon anyone, all I'm trying to do is keep my son safe." This ordeal took six months before we finally had a bed that was safe for Tyler. Thank God, because by now Tyler was starting to sit up and roll around again. In the meantime, Tyler's paralysis went away. In fact he was only paralyzed on his right side for 7 to 8 weeks. The therapy he receives in school is great and helps him out a lot. Tyler started having some mild seizures in the morning once he was used to his new medication. The fact that he hardly ever had a seizure in school was also a huge plus. Once in a blue moon, Tyler would have a small seizure in the evening. By now I knew this syndrome would always be difficult, I was just dreaming about him getting to the next step safely.
My mom, mother-in-law and a few other family members helped me with babysitting but they all stated they were nervous when he would have a seizure. I spoke with a case manager and she came to my house and told me about a special program thru Medicaid for children like Tyler. She was confused as to why I had been without professional care for Tyler for so long. In October 2011 we started having nurses come to our home every day for two hours in the morning to help get him ready and ride the bus to school. The nurses would also come back in the afternoon to ride the bus back home with Tyler and stay with him until 8pm every night. I was embracing all the help and once I got used to having people constantly in my home I actually allowed myself to start to take a break from all the worrying. We get to see our case manager once a month and I thank her every time I see her. Her help is always so genuine and she's always asking how we're all doing. What a God send.
We waited a year before implementing any changes to Tyler's medications or treatment routine. After a year, Dr. Sousa and I felt that Tyler was ready to take the next step that would hopefully result in successful resective surgery and the chance of a somewhat normal life for my son. This is where it got crazy. Dr. Sousa referred Tyler to New York University Hospital for an intracranial EEG. But, of course, Tyler's insurance company denied coverage for the procedure at that hospital. They did, however, refer us to Hackensack Hospital in New Jersey. I went to see the neurosurgeon and he said he would do whatever he could to help me, but I had to meet with his team. So I made an appointment with his team and told them everything I could about Tyler and his condition. After that meeting, the new doctor at Hackensack Hospital said he was happy to help Tyler. The next step was to have Tyler admitted to the hospital and have him hooked up to a regular video EEG. This process involved admitting my child into a seizure monitor unit, where they weaned him off of phenobarbital to capture seizures as Tyler experienced them to try to isolate the part of the brain where the seizures were originating. Unfortunately, taking Tyler off of the medications had a bad effect on him: he started to have grand mal seizures. After spending a week in the monitoring unit we were left with more medications, including Benzal. This didn't really make a difference for Tyler, but the doctors claimed it could be used to get him off of the phenobarbital. The doctor was saying the only thing they could do for Tyler was to put him on a ketogenic diet or to perform a corpus colostomy. A corpus colostomy involves cutting some or all of a band of nerve fibers connecting the two halves of the brain to disable communication from one side of the brain to another. The thought was that the procedure might reduce generalized and drop attack seizures. This is usually an option when no single focus for the source of the seizures can be identified.
This definitely wasn't what I was expecting to hear. Dr. Sousa and I spoke about a resective surgery. So here we have two opinions and one mother once again feeling helpless and unable to help her son. The hospital eventually stabilized Tyler and sent him home with us. Tyler seemed to have taken this testing well. I mean even after having all that happened to him, he was back to his normal self very quickly. He was still having his normal seizure or two in the morning, but otherwise he was going along just like always. I was actually pretty impressed by how well he was doing and how well he bounced back from being purposefully taken off of his medications for the monitoring. The doctor from Hackensack Hospital said he would be having a meeting about Tyler and would present for the intracranial EEG that we were looking to get at the NYU hospital, but he told us his team didn't feel it was appropriate. I didn't believe what I was hearing. Here you have a child who is now on five medications and with a VNS, and still having seizures. To top it off you must always do an intracranial before any type of brain surgery. So why wouldn't they say yes. We even tried to get an MRI done but with the VNS no one wanted to do it — it's just too risky they told me. I felt so uncomfortable with what was going on. How unorganized this process was.
We went back to Dr. Sousa. Tyler was doing well and it had been four months since our last hospital stay. Dr. Sousa and I made the choice to try to wean Tyler off of the phenobarbital again. We had already increased the Benzal. This was working out great. The old Tyler was back in action and making progress. Unfortunately, as soon as we got back down to the amount of phenobarbital we were giving Tyler in 2010, things took a major turn for the worse. All hell broke loose. On September 14, 2012, at 7:30 in the morning of Tyler's 12th birthday, when I went to wake him up with kisses and birthday wishes he was happy as always and laughing. Just as I was taking the moment in, Tyler started a seizure. I used the VNS and he went in and out of a seizure and then stopped. A few minutes later another one started and continued for 3 to 5 minutes. I immediately called Dr. Sousa and by 12pm we were in his office. Tyler had more seizures in his office and on the way home. Once home we gave him Diastat. This made him sleep, but once he woke up he immediately started to have more seizures. At 1am my husband was on the phone with Dr. Sousa and was fumbling with the Diastat box. I woke up, and said, "You're not comfortable with that are you?" He said, "No not at all." I gave the Diastat to Tyler and it helped put him to sleep. By the next afternoon, Tyler woke up and within a few hours started the seizures all over again. We went to the ER and were admitted to the EMU department.
I met a different doctor from this Hackensack group: what a nice man. He listened to everything I told him about how we got here, again. He mentioned that we were here in April, and that there was an idea of seizures in the left rear put of the brain. I felt even more confused than the first time I was told Tyler had a seizure problem. He told me the same as everyone else I've met, besides Dr. Sousa. "We'll get him stable and you'll be going home soon." I explained to him that no mother should have to pray to God to take her son because she doesn't want him to suffer any longer. He said he would present Tyler's case again for an intracranial EEG and we left the hospital on September 19th with his phenobarbital increased to 40 ml at bedtime. I still have no answers as to what direction we're going in or where to turn to help my son.
Feeling hopeless all the time is such a horrible feeling. Knowing there is a test that could tell the doctors more accurate information in a hospital that is more than equipped to perform the procedure, but either won't, can't or the insurance company refuses to cover it. This just doesn't seem fair: if it's not the insurance denying you it's another doctor saying it is a hopeless syndrome. I wish every doctor believed in Tyler the way Dr. Sousa does. He believes in finding the root of the problem and correcting it. That's what a doctor is supposed to do — not continue to medicate your son and send you away. I believe all these kids that have Lennox Gastaut Syndrome should be able to get the tests they need in order to improve their quality of life and try to relieve them from seizures.
I will continue my fight for my son and for other families in our situation. I pledge to make people aware and understand this syndrome, for it is very rare and unknown to many people. With our voices we can make a change on how most doctors look at this syndrome. I will continue to fight our way to a better life without medication for as long as I have to for Tyler. I vow not to give up hope and turn all my insecurities into positive energy for the fight on seizures. This is Tyler's story.
Tyler update: 2013
We gave Tyler a break from doctor's appointments and hospital stays. We slowly weaned him off of Benzal since it was ineffective. We utilized Tyler's VNS as his primary source of seizure management. Things were going okay for Tyler, but he was still having long, frequent seizures. We had good days and we had bad days. On the bad days Tyler would have seizures up to 10 minutes long. As Tyler's seizures progressed, I found myself not knowing what to do next, and I decided it was time for another opinion on brain surgery. We saw a new doctor from Morristown Medical Center along with a consult with a brain surgeon. The brain surgeon referred us to the new neurologist in the hospital who would complete some new testing. Tyler was placed in Morristown Medical Center for video EEG testing, which did not go well. The first night Tyler had ripped all of the EEG leads off of his head before the morning. The leads were reattached and this time, Tyler had to wear a helmet. Six hours into the EEG, a three day old, post-op screaming infant was placed in our room. The poor baby screamed for hours straight. While the baby was screaming, on the third night of our stay, Tyler jumped out of bed at 4am toward me, falling onto the floor. It was a harrowing moment, but we were able to pick Tyler up, uninjured, and place him back in the bed. After the EEG testing, we had a follow up appointment with this new neurologist. At this visit, we were faced with the challenge of the original doctor's partner, a neurologist we had never met before who handles all the outpatient visits. We talked about increasing Lamictal and getting bloodwork to start Tyler on a ketogenic diet. We went home and slowly began increasing the Lamictal. Tyler got the bloodwork done and back to the neuro we went. The neurologist had no recollection of Tyler's first visit to see her or of our conversations about medication changes and the ketogenic diet. She quickly sat me down and started speaking about brain surgery, wanting to complete a corpus callosum (a surgery in which they disconnect the brain's cerebral hemispheres). This is what the last brain surgeon suggested and is absolutely not something I was comfortable putting my son through. I became very upset because Dr. Sousa was nice enough to refer me to this new neurologist to get a second opinion since he didn't have privileges at Morristown Medical Center. This doctor actually told me that she was certain I must have too much on my mind because she was certain that she had never met Tyler before. After I reminded her that she had actually already changed the Lamictal orders, she proceeded to open the chart and found the copy of the prescription increasing Tyler's medications and started to blame her front desk staff that there was oversight. I proceeded to tell her that this was completely unprofessional, and she proceeded to refer me back to Dr. Sousa. At this point, I let her know that we were not interested in surgery and that I would schedule Tyler's next appointment with Dr. Sousa.
At my next visit with Dr. Sousa I explained what had happened with the previous doctor. He apologized profusely for her poor bedside manner and unprofessional behavior. This was when I decided to ask Dr. Sousa his opinion on medical marijuana. He said we could talk more about this on our next visit. I went home and started researching. I had been made aware of some success stories of seizure patients being treated with medical marijuana in the past, and wanted to give Tyler this opportunity to benefit from it, but first I had to be sure. I continued to research medical marijuana and spoke with Dr. Sousa several times throughout 2013. At the end of summer 2013, I watched a documentary called "Weed" with Dr. Sanjay Gupta. I was on the verge of tears while watching. My heart ached for this family, and the similarities in our lives. This child – Charlotte Figi – had Dravet syndrome, another debilitating seizure disorder that is very similar to Lennox Gastaut.
This documentary was the last bit of evidence I needed that this was the best choice for Tyler. I had made up my mind that he needed to have these benefits and nothing would stop my pursuit of helping my son. I obtained a medical marijuana doctor within weeks and proceeded with doctor visits. As some of you reading this may know, insurance does not cover palliative treatments, which medical marijuana falls under. We had to have a total of four visits, which were several hundred dollars each time we went. Thank goodness for Tyler's gofundme.com page – www.GoFundMe.com/3ritr4 – or there is no way we would have been able to afford these new and promising treatments for Tyler. I also had to obtain a phycologist, a pediatrician who was a medical marijuana supporter (Dr. Sousa) and a fingerprint and background check. This process took roughly six months from our first doctor visit until I was able to obtain medical marijuana for Tyler.
By law, I was able to purchase two ounces of medical marijuana per month in its raw form, which is anywhere from $600-$800. I did not know how to give Tyler the marijuana so I went to a smoke shop with the hope that I could use a vaporizer. The shop owner assured me that this would be possible, and I was so excited for Tyler to begin treatments that day. Once I got home, I realized that Tyler would have to perform a sucking motion in order to get the medical marijuana from the vaporizer; a motion that Tyler is unable to perform. I quickly panicked and I was once again left feeling hopeless. After my moments of hopelessness, it dawned on me that there was a way for us to get Tyler the treatments he needed. I had a CPR mask in the closet and knew that it was my job as Tyler's mother to make sure I could help him. I used to CPR mask to transfer the smoke to Tyler. After all my research, I knew that this was the most natural and effective way for Tyler to reap the benefits of medical marijuana.
After this first dose, Tyler received a dose every 24 hours. Tyler immediately went an entire 48 hours seizure free for the first time in his life. This was the first medication in thirteen years that had ever been so successful in treating Tyler's seizures. Words can't described how this made me feel. Being able to help my son for the 1st time since he was 6 months old. I made many dosing adjustments as I figured out what worked best to limit Tyler's seizure activity. Within a few months, Tyler was much more aware, alert, and oriented. His physical improvements and the decline in his seizure activity were amazing. His seizure activity used to be 8 minutes per day, frequently throughout the day and was now limited to short 3-10 seconds seizures, and he would often go 24-48 hours without any seizures. It was becoming increasingly difficult to give Tyler treatments through the CPR masks. Because at he was improving, Tyler was actively pushing me away, holding his breath, and other natural reactions of a 13 year old boy whose mother isn't giving them enough space. I found a group for parents of children who use medical marijuana. Through this group, I discovered what a Magical Butter Machine was, and quickly learned how to become a chemist. I placed half an ounce of medical marijuana and some melted coconut oil into the Magical Butter Machine and let it cook for an hour at 160 degrees, F. After It was cooked, I would filter it and seal it in a mason jar. I now had medical marijuana oil that I could easily treat my son with by putting it through his feeding tube. This seemed to be the perfect solution! I was no longer annoying him by being in his personal space, and he was still able to get the treatments that were reducing his seizure activity by an amount I had never thought possible to happen so quickly. After a few dosing adjustments, Tyler was so much more active and alert and on the road to recovery.
Most people don't know enough about marijuana based on what the government puts out and labels it as a Schedule 1 drug – in the same category as heroine and methamphetamines. Cannabis (aka Medical Marijuana) is broken into two components: CBD and THC. THC is what gives you a head high, and CBD is what gives you the calming effect. Cannabis comes in many different strands. High CBD strands have been proven to cure epilepsy and 26 other diseases. I made many trips to the medical marijuana dispensary and learned more about each of the different cannabis strands each time I went. Slowly, Tyler's seizure activity was getting more frequent and his seizures were getting longer. I mentioned to the dispensary that Tyler was not only a seizure patient, but also going through puberty. The dispensary explained that many families in a similar situation to mine were giving their children strains with high CBD, and also a low, but slightly higher THC level. I obtained this new strand, and Tyler's long, debilitating seizures stopped again! Tyler's nursing staff and I quickly noticed how much better he was getting. It was such a blessing to see my son being so into his toys and physically doing so much better than he was back in 2010. I thought ok we are going in the right direction.
In the beginning of February 2015, while we were at a visit with Dr. Sousa, Tyler's Vagal Nerve Stimulator (VNS) read 'low battery'. Dr. Sousa said we needed surgery ASAP to replace the seven year old battery in Tyler's VNS. Tyler's seizures were getting worse again and getting longer within days of receiving this news. It's been three weeks since the VNS read 'low battery', and while Tyler has been waiting to get surgery I have had to increase his medical marijuana dosage to control his seizures since the VNS is not working to its full capacity. I am thankful that it only took me a year to find a strand that really truly works for my son. I have high hopes and faith that replacing his VNS battery will bring him closer to achieving a seizure free life. I will continue with medical marijuana to try to obtain seizure freedom and eventually take my son off of all pharmaceutical medications. I can only pray to god that Tyler comes through his surgery with no complications and we continue on our road to success. To whom ever is reading this please do what you can to make people aware of Lennox Gastaut syndrome a form of epilepsy. Once again this is a 1 in a million debilitating seizure disorder. Thank you to everyone that has supported us along the way, and for those of you who have read & shared Tyler's story.


text: On the show and on the social networks I'm always giving the guys at PRO-TEK/FAB-TEK the credit for everything from helping me with my wifes BMW to setting up the #94 WRS car and making me look like a hero on the track. So after they had this cool video made to showcase what they do - I knew I had to share it. CLICK HERE TO WATCH VIDEO

subset: commoncrawl


text:
We develop and assemble locally in Præstø in Denmark and work closely with the best suppliers.
We aim to prove that it is possible to make Danish design products in Denmark. Our lamp collection is an excellent example of this as it is assembled by hand in Præstø. To ensure that we can offer the best quality at sensible prices, we source components from the best global manufacturers. Our many years' experience of purchasing in this market ensures that all our components are premium quality.
We are always curious to meet you. We view our customers as sparring partners and apply our experience and expertise so that new ideas see the light of day."


text:
Problem Solved?
We have an assignment for you. Just last week, The Dallas Morning News interviewed Sen. John McCain's healthcare advisor and co-author of his health plan, John Goodman. Here's a clip from the article:
Mr. Goodman, who helped craft Sen. John McCain's health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care.)
"So I have a solution. And it will cost not one thin dime," Mr. Goodman said. "The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American – even illegal aliens – as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care.
"So, there you have it. Voila! Problem solved."
The Huffington Post, the top news blog on the Internet, has picked up on this story and has provided a substantial rebuttal. But there is one voice that's entirely lacking in this debate: the caregiver perspective.
Lab technicians, psychologists, EMTs, nurses and others—what do you think about Goodman's proposal? How can you relate your experiences as a healthcare professional to this crackpot solution? Remember, as caregivers, we're the experts here.
I received this in my email today from a nursing alliance that I belong to. I know people hate Doctors and emergency rooms. Believe it or not we hate them too. (a lot of docs do too.)The medical community's management is all big business. (Well obviously they don't want ER's used as "insurance) but they are as political and corrupt as the people who are running this contry at this time. What they don't tell you is that they only have to give out enough medical care to rapay grants etc from government. Yes the ermergency rooms are required to treat anyone regardless of ability to pay. That's called the Hill Burton act. What he isn't taking into account is that the hospitals can and will transfer anyone that is "stable" to another hospital if they have fulfilled their repayment of this act. It doesn't take a whole lot to fulfill their obligation if they are a hospital with high traffic. They also don't tell you that in order for the bill to be paid IF that hospital still has an obligation at all, the person has to be so below the poverty level that it is almost impossible to be helped by the act, not to mention that the hospital will sue your ass as soon as you say you can't pay. It used to be you could pay 5 a month and they couldn't do anything. Not anymore they like all big business, they will require you to pay whatever amount they want a month in order for them not to take you to court.
The Republicans and admitedly some Democrats don't want you all to know what it's really like. They don't want you to know that the nurses are being worked to the point of exhaustion and that they are being stretched so thin that the nurses are working as aides, housekeeping, lab assistants etc. So while you are in the hospital the nurses you have really are trying to do their jobs and help you but they are being treated just as disrespectedly as you are. We get placed in jobs that we were not trained for and expected to meet all standards. (Training and schooling costs to much.) Like everything else, it all comes to big business.
Thought you all might be interested.
Kittie Chaos
Monday, September 8, 2008
Problem Solved?
Posted by Kittie Chaos at 7:22 PM 4 have left kittie treats Links to this post


text:
October 2017 Meeting
OCFW Welcomes Staci Mauney
OKC Christian Fiction Writers will host author and freelance editor Staci Mauney on Saturday, October 21st, from 1:00 pm to 3:00 pm. In this workshop, she will discuss how to take real-life events and use them as a springboard to create a story with a beginning, middle, and end. We want our stories to resonate with readers, and she will share a variety of techniques how to do this. Whether you are writing fiction or nonfiction, this workshop will help you discover techniques to bring your stories to life. It will include a couple of interactive exercises, so bring a pen and paper or a laptop and get ready to share!
Staci Mauney holds a Bachelor of Arts in English from Southwestern Oklahoma State University (SWOSU) and a Master of Education in Secondary Education from Cameron University. Although she lives in southwestern Oklahoma, she enjoys traveling around the United States and taking her sassy Yorkie, Lilly, for long walks in the park. Staci is active in LifeChurch and volunteers in her local community, as well as a freelance editing business, Prestige Prose, which can be found online at prestigeprose.com. She maintains a Christian devotional blog, Echoes of Joy, and has had short stories published in Chicken Soup for the Shopper's Soul; Owl Hootings, Vol. II; and Oklahoma: The Fountain of the Heartland.
Her Christmas devotional, Echoes of Joy: 30 Days of Experiencing God's Grace, will be released on Tuesday, October 24th, 2017.
OCFW meets the third Saturday of the month at 1:00 at Henderson Hills Baptist Church, located on the Corner of 15th & I-35 in Edmond. For more information, visit http://okcchristianfictionwriters.com or email JJ Johnson at email@example.com


text:
Home /
Our Sources / About Us
/ FAQs /
Advanced Search
Not what you're
looking for? Try an advanced search.
Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.
Learn more about what you receive with purchase of this case.
United States District Court, Eighth Circuit
December 20, 2013
HAROLD B. WILSON, GRACY SEDLAK, Plaintiffs,v.JOSEPH FLETCHER, ORA THOMAS FLETCHER, Defendants.
CHERYL R. ZWART, Magistrate Judge.
The court has reviewed the documentation from Joseph Fletcher, Gracy Sedlak, Harold Wilson, and Ora Thomas Fletcher produced in response to the Memorandum and Order dated September 25, 2013, (Filing No. 63).[1] During that hearing, the court agreed to review the facts reflected in those documents. The court's interpretation of those facts is outlined in the attached "Questions to Parties." The court also agreed to recommend terms for final settlement of this case. The court's proposed settlement terms are outlined in the attached "Settlement Agreement Questions, " and the explanation provided below. Although substantial documentation was provided to the court, the undersigned magistrate judge cannot track all the receipts and distributions of Harold Wilson's money by Joseph Fletcher. And the remaining questions will likely never be answered no matter how much work the parties and court invest into the project. Without substantial expenditures on expert witnesses, subpoenas, and depositions, the money trail cannot be fully understood and even then, questions will likely remain. The court therefore recommends to the parties that they settle this case under the following terms:
Joseph Fletcher and Ora T. Fletcher will jointly and severally owe to Harold Wilson the amount of $25, 000 for funds given to Ora T. Fletcher without Harold Wilson's permission. Jointly and Severally means either Joseph Fletcher and Ora T. Fletcher can pay it all back, or they can share that responsibility: But either way, they both owe Harold Wilson for the $25, 000 of Wilson's funds received and used by Ora T. Fletcher.
In addition to the $25, 000 owed for funds given to Ora T. Fletcher without Wilson's permission, Joseph Fletcher would be required to pay:
$26, 000 to Gracy Sedlak, which represents the amount of Wilson's money that Joseph Fletcher was told to give to Gracy Sedlak, but which Joseph Fletcher kept for himself instead.
$36, 300 to Harold Wilson, which represents the total amount of Wilson's money received by Joseph Fletcher through checks from the MidWestOne Bank, ($44, 516.00), plus one-half of the distributions for which there is no documentation indicating who received the money (1/2 of $13, 988.67), plus the money that is simply missing with no documentation whatsoever, ($10, 786.78), minus the $26, 000 amount Joseph Fletcher owes to Gracy Sedlak.
Based on the court's review of the documents and the parties statements, it is likely some of the money documented as distributed by Joseph Fletcher, but to unknown persons, was given out with Wilson's permission. Some was not. There is no way to figure out which of these expenditures were authorized. So in the interest of resolving the case now rather than face the same unanswered questions at trial, the parties should split that amount ($13, 988.67), with Joseph Fletcher owing half of it to Harold Wilson.
But as to the money which is simply missing, Joseph Fletcher should be required to pay all of that back. By way of explanation:
Until Joseph Fletcher opened a separate account for Wilson's money at the MidWestOne Bank, he deposited Wilson's money in his own account.
At the time the new account was set up in April 2011, there remained $34, 456.75 of Wilson's money that Joseph Fletcher had received but has no record of distributing to anyone on Wilson's behalf.
Joseph Fletcher transferred only $1800.00 of this money into the MidWestOne account when that account was opened.
&bull: Joseph Fletcher later moved money into the MidWestOne Bank account on two occasions without receiving a new institutional distribution from Wilson; on April 25, 2011 in the amount of $10, 500, and on June 9, 2011 in the amount of $10, 400. Presumably these amounts were from Wilson's money which remained in Joseph Fletcher's account even after the MidWestOne Bank account was opened.
&bull: So of the $34, 456.75 that remained in Joseph Fletcher's account when the MidWestOne Bank account was opened, it appears more than $11, 000 was never transferred out of that account to the MidWestOne Bank account, and there is no record of what happened to it. This amount likely includes the $10, 786.78 of Wilson's money that is missing. It appears Joseph Fletcher kept it and as such, he should be ordered to pay it back.
If the parties do not settle the case under the terms suggested, the court will need to decide which facts are disputed and, if any, set this case for trial. The parties will be required to respond to statements outlined in the attached Questions to Parties" so it ...
Our website includes the first part of the main text of the court's opinion.
To read the entire case, you must purchase the decision for download. With purchase,
you also receive any available docket numbers, case citations or footnotes, dissents
and concurrences that accompany the decision.
Docket numbers and/or citations allow you to research a case further or to use a case in a
legal proceeding. Footnotes (if any) include details of the court's decision. If the document contains a simple affirmation or denial without discussion,
there may not be additional text.
Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.
Learn more about what you receive with purchase of this case.
LRC, Inc. About Us


text:
Tuesday, July 12, 2011
Diamond exports soared 82 percent in May
Botswana has exported P12 billion ($1.8 billion) worth of rough and polished diamonds in the first five months of the year, according to statistics released by the Bank of Botswana (BoB).
The central bank's Financial Statistics Report for May 2011 indicates that Botswana exported US$464.1 million (P2.96 billion) worth of rough and polished diamonds during the month. The exports were 82 percent higher than the US$255.1 million (P1.6 bn) exported in the same month last year and 123.4 percent higher than April 2011's exports valued at US$207.7 million (P1.3 bn).
The bank's figures are sourced from the Central Statistics Office (CSO), the Diamond Trading Company Botswana (DTCB), and two of the 16 diamond manufacturers operating in the country. This year's diamond export revenues are likely to surpass last year's as both production and prices have been on the upswing after recovering from the 2009 freefall.
Botswana exported P20.81 billion in diamonds last year, representing an all-time high in Pula terms and signifying the industry's strong rebound from a collapse lasting approximately 15 months. In US dollar terms, Botswana exported US$3.01 billion (P19.2 bn) in diamonds for 2010.
At P20.79 billion, exports in 2008 come closest to last year's performance, with previous Pula term values ranging from P17 billion in 2005 to P20.48 billion in 2007. But in US dollar terms, last year's exports are overtaken by annual figures between 2005 and 2008, with 2006 being the highest at US$3.41 billion (P21.78 bn).
Rough diamond exports comprise mainly stock produced by Debswana, while, since last November, exports from Firestone's first independent tender in the country have also contributed to the total.After having produced 23 million carats in 2010, Debswana Diamond Company plans to cap production at around 30 million next year up from 27 million carats in 2011.
Debswana, which is jointly owned by De Beers and the Botswana government, reached peak production in 2006 at 34 million carats before producing 33 million carats in 2007 and 32 million carats in 2008 before cutting output to 17.7 million carats in 2009 due to the global economic downturn. Firestone, on the other hand, has held two tenders, which have received significant interest among international buyers.
Subscribe to: Post Comments (Atom)


text:
If you are dealing with an issue like a roof leak, you're probably stressed out, worried and perhaps even a little panicked. Many people who work in construction or any kind of industrial industry know the principle that a third of your building protects 100% of your assets, which means that only a small part of your actual structure (your roof) is the difference between keeping your assets safe or ruining them in potential damage. Just think, without a roof, your assets are completely exposed to all kinds of things like the elements, inclement weather, robbery and more. Of course, this drives the point home that roofing is a critical component of industrial businesses. If you're in the market for industrial roofing contractors, there are a few things you should look for to ensure you're getting the best service to protect your assets.
- Deep and diverse experience- When doing your research, it's important to look at a list of prior clients so you can get an idea of the contracting team's experience. A good team will have many years of experience on numerous different types of properties and projects. It also might be helpful to look for a property or project similar to yours so you can assess the results.
- Good reviews- Do a bit of digging into the reviews in order to get a sense of what real people are saying about the roofing contractors. Keep an eye out for comments about pricing, professionalism, speed and efficiency of work. You will also be able to get a sense for how popular the company is which may factor into how long you will have to wait to schedule work.
- Transparent pricing- When working with a contracting company, especially in a dire situation like a leaky roof, you don't want to be blindsided or forced to pay more in a panic. Make sure that the company you are working with is upfront about costs, not just at the beginning, but throughout the whole process.
- Good communication- Pay special attention to how well the contractors communicate with you. Do they reply to your calls or email in a timely fashion? Are they able to explain the process with you thoroughly? Do you feel like they care about you as a customer? These are all important considerations because they will make the process much easier and more pleasant for you.
- Get it in writing- Make sure than any industrial roofing services you are looking to get can be put in writing along with pricing, timeline, etc. It's extremely important that there's clarity on both ends: yours and your contractor. This will ensure that the work is done to a standard and for the price you both agree on.
There are of course many other considerations to look into when choosing a roofing contractor. Your roof is important and you should treat any work done to it with the utmost care. Roof work can be stressful and frustrating, but by working with the right team, you can be sure that a little of the stress will be removed and your roof will be back in tip top shape in no time.


text:
Trumpet Flag T Shirt TShirt
T-Shirt SKU: 679208146
Designer: Design Description:
Design Description
Trumpet Flag T Shirt TShirtSHARE it with your friends, together and . in the U.S.A – Ship to 178 countries *HOW TO ? 1. Select style and color 2. Click andquot;ADD To CARTandquot; 3. Select size and quantity 4. Enter and billing information 5. Done!


text:
Yesterday, I accompanied my aunt at the university cafeteria for some light brunch. While eating and conversing, a common family friend came in and sat at the table next to ours, also to have brunch. We exchanged the usual chit-chat, then resumed our conversation on research and technical writing, my dad, Christmas, and career. Since my aunt had a meeting at 12:00nn (and since we started and finished our meals earlier), we decided to leave our friend. As we passed by our friend's table, she suddenly called out, "O, ano? Mag-me-medicine na ba yan?" My aunt just laughed. I was not amused, but felt both embarrassed and awkward. I just said, "Ma'am, di ko po kaya and medicine." "Sus!," she retorted. "Nursing nga, nakaya mo, doctor pa kaya?" After that seemingly insignificant incident, we just walked out of the cafeteria, smiling. I wasn't actually smiling—I just put on a clown's face and lost myself in my own thoughts.
Don't you just hate it when people pressure you to take up medicine? Why, after graduating, I started getting suggestions from a lot of relatives and friends, asking me when I would continue my studies to the medical profession! Actually, even before I took up nursing, everyone was already commenting that I should take up medicine because accordingly, it suited me! Yeah, right! Do they really think that having an "MD" attached before your name would appeal to me? It's just a title. Oh sure, you get to help people—the sick, to be exact—but this is not the particular way that I would like to employ when doing charity work. There are other ways—but I definitely wouldn't think of being a doctor. It limits your scope. I actually want to reach out, not just to the sick, but to the healthy as well.
"The thought once crossed my mind," I told my aunt later. "Actually, my dad also wanted me to take up medicine, but after knowing that it took PhP50,000.00 per semester for a period of six years, he developed misgivings on it." It is essential to note that the stated semestral cost of taking up medicine here in the Philippines was that of four years ago. Now, I think the total medical school fees have risen to PhP80,000.00-PhP120,000.00. Reminder: That's for every semester. Over a six year period. Go do the math.
That's one thing people don't understand. Striving to be a doctor, like any other high-end profession, requires money. Lots and lots of it. It's actually been turned into a business—universities here and there offer medical studies and demand shocking payments in return for a diploma and certificates. Aside from the money constraints, taking up medicine will eat up a lot of your time. People just don't realize that medical students spend most of their young adult lives in the classroom, the clinic, the hospital, and in outreach programs. They spend countless hours in clinical duties. Sure, these duties may be in shifting schedules, but they can incur double or even triple shifts. Take cousin Raymund. After taking up B.S. Biology as a pre-medical course, he went on to study general medicine. It took him six years of studies and duties to finish the program. Afterwards, he had to review for the medical licensing examinations. If I'm not mistaken, licensing examinations for medical practitioners take five days! Whew! During all that time, you never saw kuya Raymund, right? He was always busy. Is that what you want to do? And don't forget—it's a highly technical area of study! Would you like to spend your 20 something years memorizing human diseases and pathology? All those essential drugs, their indications, contraindications, pharmacokinetics, side effects, adverse effects, dosages, and frequencies? How about their generic names & local and international brand names?
Uhm, no.
That's right! You already have a substantial amount of medical knowledge like human anatomy and physiology, basic pharmacology, and biochemistry. Look for other areas to study!!!
"Kulang nga eh yung 50,000. Tumaas na ngayon," observed my aunt. I asked, "Six years ba yung kinuha ni kuya Raymund?" Kuya Raymund is her second son. "Oo," she said. "Ang tagal," I replied. "Oo nga eh."
Ayoko ng ganun katagal. I couldn't stand it. Or can I? Hmm… If I did take up medicine, what area would I specialize in? Pediatrics is definitely out—I'm bad with kids. General practice is okay, but I really prefer a specialization. Obstetrics? Nah, they probably wouldn't let me—since I'm a guy, they would think I'm only in it for ogling and female genitalia handling. It's actually one of the easiest ways of collecting sexual harassment records. Geriatrics kind of appeals to me—I love being around the company of the elderly. Hey, how about being a surgeon? Yeah! Surgery is a very exciting field! Maybe cranial and spinal surgery. I still want to see an actual spinal cord—my instructors once said that it's a beautiful human organ—the smoothness, the length, and its silvery-white color.
"Kaya nga po, auntie, 'wag nalang," I added as we said our goodbyes and parted ways.


text:
Offshore Steel Structural Foreman in Europe, Netherlands
SAIPEM 7000 is urgently looking for Steel Structural Foremen for her new crew, we are looking for candidates with a valid EU residency permit to perform the following activities;
Coordinate and control the work of the dependent team based on structural Scope of Work assigned
Distribute the equipment and materials to allow the team to perform the assigned activities
Ensure that operators and all personnel belonging to the team strictly observe applicable safety standards
Ensure that the works are carried out in accordance with the project quality requirements
Analyse the drawings received from the work supervisor and give instructions to the team in order to execute the works accordingly
Coordinate and check the work carried out by the team, reporting any difficulties to the works supervisor
Organise all the means and equipment necessary to perform the work. Check that they comply with applicable provisions, report any anomalies and coordinate any corrective actions
Liaise with the works supervisor in order to optimize the use of equipment and personnel
Carry out the daily toolbox talkings
Ensure adherence to the planned time frame
Ensure that any approved modification made during the execution of the works is duly marked-up on the relevant drawings, in order to allow the issue of As Built documentation
Provide the works supervisor with data on quantities produced and/or installed for updating Progress Reports and quantities accounting
Provide the work supervisor with data on manpower, equipment, tools and material used
Implement the permit-to-work system
Liaise with other disciplines on ongoing operations
Ensure the housekeeping of the work location
If you are interested and available we will be more than happy to review your application.
Similar Job Searches
- Offshore Steel Structural Foreman
- Offshore Steel Structural Foreman in Netherlands
- Oil and Gas jobs in Netherlands
- Offshore
- Structural
- Foreman
- Steel
- Offshore Structural
- Structural Offshore
- Structural Foreman
- Structural Steel
- Steel Structural
- Offshore Foreman
- Offshore Structural Steel
- Foreman Structural
- Steel Foreman
- Foreman Steel Structural
- Offshore Steel
- Steel Structural Offshore
- Foreman Offshore


text:
A week ago. I'm looking for information on the Vintage Skull and Roses Throw Pillow, so i have to tell.
Vintage Skull and Roses Throw Pillow
Vintage Day of the Dead sugar skulls surrounded by roses. There are 2 different designs in this store so be sure to check them both out-AND view design enlarged so you can see all of the detail - Add stylish fun to any room with our roomy Throw Pillow. It measures a sprawling 18" X 18" with an 11" X 11" image area so you can lounge in comfort. It's made of ultra-soft brushed twill with a sturdy canvas image area. Ships with pillow insert. Removable zippered cover for easy laundering. Read more
Compare stores: Here
It's essential to spend less in today's financial system. We should be careful with funds, but we can easily nevertheless keep store shopping. You can find all you need for a lot less when on the web. Please read on to discover getting the very best more knowledge about thrifty shopping on the internet.
Tags: House Accessories


text:
All hail Belinda Peacock! Among all the blackmailers, alcoholics and hockey stick-wielding children terrorising Walford, one woman stands out as a breath of fresh air. Let's give it up for Belinda, 2016's most exciting addition to EastEnders. Previously played by Leanne Lakey, Belinda was a social climbing guest role providing comic relief in the early Noughties who appeared occasionally to lord it over the other Slater sisters. (She was memorably involved in the Kat/Zoe 'You ain't my muvva' reveal episodes).
Experienced theatre and television actress Carli Norris (Doctors, Hollyoaks, Holby City) recently took over the role and first arrived in January for the funeral of Belinda's father Charlie Slater. Now with her marriage over, Belinda's back on the Square permanently and Norris has already established herself as a fan favourite. Belinda Mark II is the best soap recast since Ryan Hawley arrived in Emmerdale as the new Robert Sugden.
Here's where we think Belinda could go next:
This is a woman who's been a trophy wife for two decades and is now learning to stand on her own two feet again. The look on Belinda's face when soon to be ex-husband Neville claimed that there was no money left was an arresting moment, as was the scene where she lamented that her divorce meant "20 years down the drain".
But let's not forget that Belinda is a Slater, and that means she's a fighter. So let's have no more scenes of Mick riding in on his white horse to rescue her from Big Bad Neville. It's demeaning. Instead, let's see that resourceful Slater side of Belinda emerge as she makes a new start…
She's never really had to work for a living, but she showed an entrepreneurial side with her recent lingerie party. We can totally see Belinda taking over Blades salon and making a success of it through hard graft. (Perhaps with a name change to help people forget about Dean).
Or perhaps she can take over The Albert and go head to head with the Carters as a rival business? She may not have the experience but she certainly has the chutzpah to pull it off. This would also have the added bonus of giving her a defined role in the community. We'd also love to see Belinda's relationships extend beyond the Slater/Fowler clan. Having her as a boss to the likes of Whitney or Johnny would be a great start.
One thing's for sure - Belinda needs to work somewhere glamorous. No frying fish at Beale's Plaice for her.
Belinda could fit in perfectly with Sharon and Linda's girlie gang, especially if she does buy Blades and could sort out Sharon's hair for her. (Please, somebody sort it out).
We'd also love it if she'd befriend Denise and finally give the gorgeous Diane Parish a reason to smile. Or could Belinda bond with Carmel over moving on as a divorcee? Friendships can sometimes get lost on soaps amongst the endless romantic merry go-rounds, but they're as essential as family units in making us care about these people.
Kellie Bright and Danny Dyer have repeatedly said that they don't want Mick or Linda to cheat on each other, and it seems that show bosses and fans agree. While characters being written as too saintly can be the kiss of death, there is something refreshing about knowing we have at least one stable married couple in Soapland.
But if the show did want to go down the route of a Belinda/Mick affair, they've already sown the seeds by making it clear that Belinda fancies him. And Kellie Bright's maternity leave is looming, which would be the ideal time for a heartbroken Linda to exit Walford. But we've seen all this before and it would ultimately be a lazy choice.
British telly excels at characters who have 'ideas above their station.' From Beverly in Abigail's Party to Hyacinth Bucket in Keeping Up Appearances, the snob with a lack of self-awareness is a comedy staple.
The current queen of social climbing is Corrie's Sally Webster, and Belinda could easily become Walford's equivalent. Carli Norris has the wit and the comic timing, but again we think this would be the easy option. While we all love to see a deluded character brought back down to earth, Belinda has the potential for greater depth…
Belinda's situation is tough, and also one which many women can relate to. She's put everything into a 20-year marriage which has now ended, and all her aspirational efforts to 'better herself' have landed her back at square one and living in an area she couldn't wait to escape. It would be lovely to see more heartfelt scenes of Belinda reassessing her choices and values, without falling into the easy trap of mocking her for wanting a better life.
We're still sorry that Charlie Slater had to be killed off to facilitate the reveal of Kat's secret son, and some reflections from Belinda on her relationship with her dad would be wonderful. Belinda's entire life has been upended, and that could make for a fascinating story in itself.
Seriously though, we think this could be a perfect pairing. Max appreciates an attractive woman, and we also sense that Belinda enjoys having a project to get stuck into. Rehabilitating a man who's been wrongfully imprisoned and is seeking revenge would certainly keep her busy, and these two lost souls could create sparks together. With Max having something to prove and Belinda keen to regain her lost social status, they could be a formidable pairing.
There's also the added bonus of the inevitable clashes between Belinda and Max's daughters Lauren and Abi. Throw in a surprise return from Tanya at some point and that's next year's Christmas episodes sorted!
Read all the latest EastEnders news and spoilers
Want up-to-the-minute soaps news and gossip on your social feeds? Just hit 'Like' on our Digital Spy Soaps Facebook page and 'Follow' on our @soapscoop Twitter account.
Digital Spy Soap Scoop video - hit play below for gossip on Andy being caught out in EastEnders, David being arrested in Coronation Street, Doctor Bailey getting his comeuppance in Emmerdale and Sally facing serious accusations in Hollyoaks.


text:
Home /
Our Sources / About Us
/ FAQs /
Advanced Search
Not what you're
looking for? Try an advanced search.
Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.
Learn more about what you receive with purchase of this case.
United States District Court, N.D. Alabama, Northeastern Division
March 31, 2017
UNITED GOVERNMENT SECURITY OFFICERS OF AMERICA, INTERNATIONAL UNION LOCAL 22, et al., Plaintiffs,v.TENNESSEE VALLEY AUTHORITY and WILLIAM D. JOHNSON, Defendants.
case comes before the Court on the motion to dismiss of
defendants William D. Johnson and the Tennessee Valley
Authority. (Doc. 8). The TVA operates nuclear power
facilities in Alabama and Tennessee. (Doc. 1, ¶¶ 4,
9). Mr. Johnson is the TVA's President and CEO. (Doc. 1
¶5). The plaintiffs are two nonprofit labor
organizations, United Government Security Officers of
America, International Union and United Government Security
Officers of America, International Union Local 22. (Doc. 1,
¶¶1-2). For clarity, the Court adopts the
parties' practice of referring to the labor organizations
collectively as "Plaintiffs."
their complaint, Plaintiffs assert claims against the TVA and
Mr. Johnson for breach of contract and promissory fraud.
(Doc. 1). In their motion to dismiss, the TVA and Mr. Johnson
argue that both claims are time-barred, that federal law
preempts the promissory fraud claim, and that the claims
against Mr. Johnson in his official capacity are duplicative
of the claims against TVA. For the reasons stated below, the
Court grants in part and denies in part the motion to
12(b)(6) enables a defendant to move to dismiss a complaint
for "failure to state a claim upon which relief can be
granted." Fed.R.Civ.P. 12(b)(6). A Rule 12(b)(6) motion
to dismiss tests the sufficiency of a complaint against the
"liberal pleading standards set forth by Rule
8(a)(2)." Erickson v. Pardus, 551 U.S. 89, 94
(2007). A court may grant a Rule 12(b)(6) motion to dismiss
when the allegations in a complaint "on their face . .
. show that an affirmative defense bars recovery on the
claim." Marsh v. Butler County, Ala., 268 F.3d
1014, 1022 (11th Cir. 2001) (en banc). When
evaluating a Rule 12(b)(6) motion to dismiss, a district
court accepts as true the allegations in the complaint and
construes the allegations in the light most favorable to the
plaintiff. See Brophy v. Jiangbo Pharms. Inc., 781
F.3d 1296, 1301 (11th Cir. 2015).
are the exclusive bargaining unit representatives for the
security officers who work at the TVA's nuclear power
facilities. (Doc. 1, ¶ 9). Plaintiffs and the TVA are
parties to a collective bargaining agreement. (Doc. 1, ¶
10; Doc. 9-1).
February 2012, Plaintiffs and the TVA entered into a
memorandum of understanding in which the parties
"agree[d] to discontinue the current pay structure and
progression plan (within-grade rates)" in the
collective bargaining agreement "and establish a new,
four-classification pay structure." (Doc. 1, ¶ 10;
Doc. 1-1, p. 1). Plaintiffs allege that the MOU provided that
"wages for fiscal years 2014 through 2016 would be
renegotiated in 2013, and based off of the 'salary and
wage data from utilities with comparable nuclear security
work in the nuclear regulatory commission's region 2
geographic area.'" (Doc. 1, ¶11). The parties
agreed that the collected data would "be used as the
basis for negotiations of the basic salary rate for the
Senior [Nuclear Security Officer] position." (Doc. 1-1,
p. 2). The parties also agreed that the "new overtime
rule and the new classification structure" would be
"considered to be modifications to the collective
bargaining agreement." (Doc. 1-1, p. 3).
allege that in 2013 the TVA violated the MOU when the TVA
"failed and/or refused to renegotiate wages to apply
the salary and wage data for NRC Region 2, as previously
agreed, and forced the Plaintiffs to accept wages for
security officer employees that were substantially less
[than] the wages for comparable work in NRC Region 2."
(Doc. 1 ¶ 13). Plaintiffs state that "TVA breached
[the MOU] by failing to renegotiate wages for years 2014
through 2016 based on wage data for NRC Region 2."
(Doc. 1 ¶ 16).
Plaintiffs' Official Capacity Claims Against Mr.
Johnson argues that the Court should dismiss the claims
against him in his official capacity because those claims are
duplicative of Plaintiffs' claims against the TVA. (Doc.
9, p. 9). Plaintiffs have agreed to the dismissal of the
claims against Mr. Johnson. (Doc. 17, pp. 7-8). Therefore,
the Court will dismiss those claims.
Promissory Fraud Claim
have agreed to the dismissal of their promissory fraud claim
against the TVA. (Doc. 17 at 18). Therefore, the Court ...
Our website includes the first part of the main text of the court's opinion.
To read the entire case, you must purchase the decision for download. With purchase,
you also receive any available docket numbers, case citations or footnotes, dissents
and concurrences that accompany the decision.
Docket numbers and/or citations allow you to research a case further or to use a case in a
legal proceeding. Footnotes (if any) include details of the court's decision. If the document contains a simple affirmation or denial without discussion,
there may not be additional text.
Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.
Learn more about what you receive with purchase of this case.
LRC, Inc. About Us


text:
Baltic Capitals
10 days - Escorted Tour
Riga - Tallinn - Helsinki - St. Petersburg
Inclusions: First class accommodation with breakfast, services of a multilingual Tour Director, transport by air-conditioned coach, 2nd class ferry ticket (Tallinn-Helsinki), porterage
May 24, 31
Jun 7, 14, 21, 28
Jul 5, 12, 19, 26
Aug 2, 9, 16, 23, 30
Sep 6, 14
Jul 26
Aug 2, 9,
Tour Itinerary (please click here)
Day 1 Riga
Arrive in Riga with an optional transfer to your hotel. Tonight join your fellow travellers and Tour Director at a welcome meeting.
Stay at
Hotel Radisson Blu Latvija (4 star)
Day 2 Riga
Riga, founded in 1201, is a true kaleidoscope of architectural styles. Your walking tour of the Old Town includes Riga Castle, Dome Cathedral, St. Peter's Church and Freedom Monument. In the afternoon, join an optional visit to Jurmala which is famous for its wooden architecture and sandy beaches. This evening enjoy an optional dinner at a traditional Latvian restaurant. (B)
Day 3 Riga - Tallinn
Drive along the coastal highway to the Estonian resort town of Pärnu. Enjoy a short tour before travelling through northern Estonia to Tallinn. (B)
Stay at
Hotel Radisson Blu Olympia (4 star)
Day 4 Tallinn
Explore the walled, medieval city of Tallinn on a walking tour and see Toompea Castle, Dome Cathedral and Old Town Hall. In the afternoon, take an optional excursion to Kadriorg Park with its baroque palace built for Peter the Great, and in the evening enjoy an optional medieval dinner. (B)
Day 5 Tallinn - Helsinki
Optional day excursion to Lahemaa National Park where you will visit Palmse Manor, a memorial to the von Pahlen family and Sagadi Manor. The tour ends with a visit to the charming 16th century Vihula Manor and the Vodka Museum. After lunch, you head back to Tallinn for a transfer to the ferry terminal to cross the Gulf of Finland to Helsinki. On arrival, transfer to your hotel (B)
Stay at
Hotel Glo Art (4 star)
Day 6 Helsinki
Helsinki, at the crossroads of western and eastern culture, exhibits both Swedish and Russian influences. Your sightseeing tour includes the city's lovely harbour, Parliament Building, Finlandia Hall, Sibelius Monument and the famous "Church in the Rock." In the afternoon, an optional tour is offered to Seurasaari Open-Air Museum. (B)
Day 7 Helsinki - St. Petersburg
Today, continue east to imperial St. Petersburg via the quaint town of Vyborg for a tour of its 13th century castle. Late in the afternoon, arrive in magnificent St. Petersburg. (B)
Stay at
Hotel Sokos Vasilievsky (4 star)
Day 8 St. Petersburg
During your morning tour of the "Venice of the North," become acquainted with the city's foundations at Peter and Paul Fortress, built by Peter the Great in 1703. Then travel the city's main boulevard, Nevsky Prospekt, and see Kazan Cathedral, Church of the Spilt Blood, St. Isaac's Cathedral, Alexander Nevsky Convent and much more. This afternoon offers an optional tour to Zarskoye Selo with the impressive Catherine's Palace and the Amber Room which vanished during WWII and was restored for St. Petersburg's tri-centennial celebrations. In the evening, join an optional visit to Nickolaevsky Palace for an entertaining folklore show. (B)
Day 9 St. Petersburg
This morning's optional excursion is to Peterhof, an uncontested masterpiece of the time of Peter the Great, with the impressive Gran Palace, Grand Cascade and Water Avenue and its wonderful parks. In the afternoon an optional visit to the world famous Hermitage Art Museum if offered. In the evening, enjoy an optional dinner at a traditional Russian restaurant. (B)
Day 10 St. Petersburg
Your Baltic Capitals tour concludes after breakfast with an optional departure transfer. (B)
The below Optional Tours are available to enhance your tour experience (additional charges apply).
Riga: Jurmala Excursion, Latvian dinner at Restaurant La Boheme,
Tallinn: Kadriorg Park and KUMU Art Museum, Medieval dinner at Restaurant Peppersack, Lahemaa National Park
Helsinki: Seurasaari Open-Air Museum,
St. Petersburg: Zarskoye Selo, Hermitage Museum, Folklore show at the Nikolaevsky Palace, Peterhof Palace,
Catherine Palace, Russian dinner at Restaurant Russian Kitsch
Select Your Tour
Change Details
Terms and Conditions
Please read the booking conditions.


text:
Baited – lured to a trap with the promise of a reward, or the act of having placed that reward in the trap.
Bated – diminished, reduced, basically the same thing as "abated."
So if we baited the trap with cheese, then everything about the rat is bated – its life is bated, our rat problem is bated, and its breath is definitely bated. Yes, folks, it's "waiting with bated breath" not baited. (And not "weighting," for that matter.) It means to hold your breath in excited anticipation, it doesn't mean your breath smells like cheese. Though you still might consider a mint now and then, for reals.


text:
Home /
Our Sources / About Us
/ FAQs /
Advanced Search
Not what you're
looking for? Try an advanced search.
Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.
Learn more about what you receive with purchase of this case.
August 2, 2010
DUANE HOLLOWAY, PETITIONER,v.VINCENT CULLEN, WARDEN OF SAN QUENTIN STATE PRISON, RESPONDENT.
On July 13, 2010, the parties filed a Stipulation for Status Conference and Order, informing the court of the following:
On June 21, 2010, the United States Supreme Court granted a petition for writ of certiorari filed by the California Attorney General's Office in Walker v. Martin, ___ S.Ct. ___, 2010 WL 621406 (June 21, 2010). The questions presented in the Martin case are as follows:
Under state law in California, a prisoner may be barred from collaterally attacking his conviction when the prisoner "substantially delayed" filing his habeas petition. In federal habeas corpus proceedings, is such a state law "inadequate" to support a procedural bar because (1) the federal court believes that the rule is vague and (2) that state failed to prove that its courts "consistently" exercised their discretion when applying the rule in other cases?
There is a substantial possibility that the outcome of the Martin case could alter the framework established by the Ninth Circuit for evaluating the adequacy of California's procedural bars under Bennett v. Mueller, 322 F.3rd 573 (9th Cir. 2003) and King v. Lamarque, 464 F.3d 963 (9th Cir. 2006).
Dckt. No. 61. The parties stipulated that briefing on respondent's pending motion for summary judgment, which is based on procedural defaults, be suspended until further order of the court. The court finds that this action should be administratively stayed pending the issuance of a decision in Martin.
Accordingly, IT IS HEREBY ORDERED that: 1. Briefing on the pending motion for summary judgment is stayed pending the issuance of a decision in Martin; and
2. The parties are directed to file a joint status report within 14 days after a decision in Martin is rendered.
Our website includes the first part of the main text of the court's opinion.
To read the entire case, you must purchase the decision for download. With purchase,
you also receive any available docket numbers, case citations or footnotes, dissents
and concurrences that accompany the decision.
Docket numbers and/or citations allow you to research a case further or to use a case in a
legal proceeding. Footnotes (if any) include details of the court's decision. If the document contains a simple affirmation or denial without discussion,
there may not be additional text.
Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.
Learn more about what you receive with purchase of this case.
LRC, Inc. About Us


text:
Financial Empowerment: Believe It
We've all been told or heard at some point in our lives that if you sincerely believe something – have faith that it will happen it will happen. Now I know many individuals don't completely swallow that idea and then there are those who say they practice it – but truly don't practice it – they just think they do. Then are those who sincerely practice believing and have tremendous success. Ever wonder why or how they do that? There are a number of steps involved in the believing – and you truly need to have it all in place before it can help you achieve your goals.
Let me ask you a couple of easy questions:
Do you believe, without a doubt, that you can and will have everything that you want in life and financially?
Do you believe without a doubt that you'll be guided to the right situation at the right time – regardless what you'll get to where you want to be in life?
Do you believe, without a doubt, that there's always a way to achieve your goals – you just have to discover it?
If you answered no or perhaps to any of the above questions – you don't believe – and consequently won't get to where you want to be.
Believing requires this complete trust that everything will work out. That you will do your part in finding solutions while trusting and knowing that you can and will get what you want out of life.
So how do we arrive at that level?
Firstly you have to get there by assuming small steps. Start fixing small goals – even with matters you know will happen – and then trust and relinquish – discover what happens. You could do this when you're driving – trust that you'll get to your destination on time and have a simple commute. See what happens after a week of doing this. If you lose your keys – tell yourself you know where they are then trust that you'll find them at the correct time. If you're not sure about a decision you have to make – consider all the possibilities – then tell yourself that you're making the correct decision. After a while you'll by nature consider it again – and you'll make your conclusion easily. The key is to believe and relinquish – sometimes you have to distract yourself so you don't be concerned. Worry is the opposite of believing – its saying I don't believe so I have to worry – as by worrying I can make it better – but you can't.
I advise you begin small so that you develop this practice. As when the huge decisions need to be made you'll know the process works and you won't worry – you'll believe that you can and will do what you need to do and accomplish your goals.
This procedure is so easy yet so mighty – but it takes time to acquire the habit. This practice of believing is vital to your financial success – without it everything else you do will be senseless in the end.
Leroy Ross


text:
- Units
- 62
- Floors
- 9
- Built
- 1987
- Type
- High-rise
- Active Listings
- 1 Active Sale
|Sq Ft
Building Description
101 West 87 in the Upper West Side is a fully renovated, newly constructed building offering luxury residences for rent. Located in the heart of the neighborhood, the handsome, pre-war and contemporary inspired building at 101 West 87th Street rises 12 stories and is home to 72 high-end Manhattan homes. The apartments for rent at 101 West 87th Street feature oversize windows, framing the charming scenes of the Upper West Side, while allowing for an abundance of natural light. Apartments are finished with wide-plank oak flooring, premium kitchen countertops and appliances, and marble-dressed bathrooms. Luxury amenities at 101 West 87 begin as you leave the tree-lined streets of the Upper West Side and enter the building's elegant stone, bronze, glass and marble finished lobby. Here, residents can access 101 West 87's fitness center, courtyard garden, children's playroom and garden lounge. Atop the building is the sky terrace, where residents take in sunsets with the New York City skyline as the backdrop.
Building Amenities
- bike storage
- cold storage
- concierge
- courtyard
- doorman
- elevator
- fitness center
- garden
- laundry
- lounge
- nursery
- pied-a-terre allowed
- rooftop deck
- storage room
- sublets allowed
- washer/dryer allowed


text:
No idea what I'm doing here if I'm perfectly honest, but as a mother to two young children, as gorgeous as they are, I need to be able to rant. I suppose a blog is a bit like talking to yourself- perfect for a hermit! I have no idea whether my posts will ever be read by anyone other than myself but I know it'll help me!
I say i'm a hermit but these days I'm a bit more of a 'part time' hermit. Having kids has pushed me to do more, socialise more, attend baby groups and basically get out of the house! I can't do that everyday though. I'm sure there's lots of other Mother's out there who have those days where all you want to do is stay indoors with your kids and pretend like no one else exsists, right?!
Today was a good day anyway, my Sunday Funday's are family days- do the chores, make dinner for my little family and my Dad, play with the kids, have a nap, then relax with a glass of wine whilst watching Grey's Anatomy! Bliss! However, I only have one full day left with my eldest baby before she starts nursery… Cue the tears 😢


text:
There are two basic types of insulins. There are long-acting or background insulins, and there are quick or short acting insulins. The two main long-acting insulins are Lantus and Levemir. The most widely used quick acting insulins are Humalog, Novolog, and Apidra.
Insulin can be administered in two basic ways. The first way insulin can get into you is by injection either using vials of insulin and syringes, or with insulin pens and needles. The other main way you can get insulin into you is by insulin pump, also called continuous insulin infusion. Either way, you are accomplishing the same goal of replacing the insulin that the pancreas of someone with type 1 diabetes no longer produces. Neither way is necessarily better than the other, they both have positives and both have negatives. Some people even bounce back and forth between methods of insulin delivery depending on various circumstances.
When injections are used as the primary method of insulin delivery, generally both types of insulins will be used. A long-acting insulin will be injected once or twice a day to act almost like a constant IV drip of insulin since "normal" people always have insulin working in their systems. This is called basal insulin. In addition to this basal insulin, most people who use injections also inject an extra bolus or extra burst of quick acting insulin to go side by side with foods.
Insulin pumps come in two types. The most commonly used type is a tubed pump. With this type of pump, there is a pager-looking device connected to an infusion set by tubing. The infusion set is attached to the body. With any kind of insulin pump, the device is most always attached to the wearer, but with tubed pumps, the pump can be disconnected for showers, baths, swimming, high impact sports, etc. Tubeless pumps or patch pumps have two components. There is the actual pump pod that is attached to the body with adhesive. This part holds the insulin and infuses is as needed. The other component is the PDM, controller, remote, whatever you chose to call it – it does the same thing. This part allows you to program changes to your normal basal pattern, this is also where you program in a bolus for meals or high blood sugars.
Every insulin pump is different. Please refer to the manufacturer's website or user manual as well as the primary caregiver for instructions on how to make any adjustments to the settings or insulin infusion rates.
The Basics of Insulin Administration
There are two basic types of insulins. There are long-acting or background insulins, and there are quick or short acting insulins. The two main long-acting insulins are Lantus and Levemir. The most widely used quick acting insulins are Humalog, Novolog, and Apidra.


text:
Dear All
Please find details of the NRAS group meetings taking place next week:
NRAS Group Meetings—Week Commencing 10th August 2015
Great Yarmouth NRAS Group
The Great Yarmouth & Waveney NRAS Group meet in the 'Buzz Room' of the Louise Hamilton Centre, James Paget Hospital, Gorleston, Great Yarmouth, NR31 6LA from 5:30pm-7:00pm on the second Tuesday of each month. Meetings alternate between a guest speaker and social meetings.
11th August - Guest speaker to be announced please go to nras.org.uk/groups for the most up to date information.
This is a small friendly group meeting providing the opportunity to exchange news and information. If you would like to join them you are most welcome.
Lincoln NRAS Group
Bi-monthly meetings for this group are held at The Ark, Moor Lane, North Hykeham, LN6 9AB on the second Tuesday of every other month from 7:00-9:00pm.
11th August - Guest speaker: Wanda Adams, Secretary, Coordinator and Distributor for The National Police Aid Convoys will present 'The Paper Mountain'
Banbury NRAS Group
The Banbury NRAS Group meet bi-monthly on a Wednesday in the Training Room of the Horton Hospital, Oxford Road, Banbury, OX16 9AL from 6:30pm-8:00pm.
12th August - 'Looking after your Joints' by Jackie Sherwood, Occupational Therapist
North Hampshire & Winchester NRAS Group
The following dates for group meetings are to be held at Central 40, Chineham Park, Basingstoke RG24 8WG on a Wednesday from 7:00pm-9:00pm.
12th August - Dr Ravneet Bhandel from the Pain Clinic in Winchester, will speak about living with pain and the unpredictable nature of RA as well as coping mechanisms to help manage flares
Weston-super-Mare NRAS Group
This group meets monthly on a Wednesday from 6:30pm to 8:30pm at Asda Community Centre, Asda Stores Ltd, Phillips Road, Weston-super-Mare, BS23 3UZ.
August 12th - Holistic Therapist, Mel from Samsara Beauty will be doing hand massages and talking about relaxation techniques
East Dorset NRAS Group
This group meets quarterly at the Howard Room, Christchurch Hospital, Fairmile Road, Christchurch, BH23 2JX.
13th August 7-9pm - Please bring along your gadgets that help you in your every day life and lots of hints and tips to share with the group!
You, your family, friends and healthcare professionals are all very welcome to attend and you don't have to be a member of NRAS to attend a group meeting!


text:
Visit msnbc.com for Breaking News, World News, and News about the Economy
I honestly don't understand why this type of thing continues to shock me. Huge companies are producing products in which there is absolutely zero nutrition whatsoever, and yet here we are eating this garbage! KFC's bowl mentioned in the video above has over 720 calories and contains 1 1/2 times your daily fat allowance. Grease in a bowl! I can't comprehend why we continuously insist upon killing ourselves by pouring this so called "food" down our throats, while complaining about our health. It is one of life's great mysteries.


text:
Incl. SynthaMax Dry Red Air Filter/Airbox/Hardware - w/o Intake Tube
451-181 AIRAID Cold Air Dam Air Intake System Airaid
Below is an abbreviated list of applications for the AIRAID Cold Air Dam Air Intake System.
Focus, Ford, 2017, 2016, 2015, 2014, 2013
Write the First Review!
You must login to post a review.
Just ask us! ... Use our online email form to submit details on what you are looking for. We will do our best to locate this part for you!
Covering all of your truck accessory and performance parts needs.
See it for less? Let us know! Request a price match.
See our detailed shipping rates.Easy Returns. View our policies and procedures.
Find the answers to commonly asked questions.
All transactions involving personal information are secured through SSL encryption.


text:
Like all great ideas, Solid Rock began on a simple premise. That inside every teen, there is a purpose. It all begins with hope.
A faith-based organization, Solid Rock's primary mission is to make an everlasting difference in the lives of teens by helping them meet the spiritual, economical, physical, and social needs of at-risk teens (we believe all teens are at risk) in the community by offering a safe, engaging environment during non-school hours –a time when they are most vulnerable to drugs, violence, and gangs. Maintaining "a teen's worst enemy is too much time on their hands," Solid Rock provides the music, arts, vocational programs and fellowship that challenge teens to discover their passion through music, dance, self-expression, and creativity.
In a time where public schools are cutting funding for empowering programs like music , art and dance, The Rock cultivates a love of the arts to inspire teens to embrace artistic excellence and avoid drugs, guns, and gangs.