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The American Animal Hospital Association and the American Association of Feline Practitioners would like to acknowledge and thank the members of the Pain Management Guidelines Task Force for their time and commitment to this project. The Task Force members' dedication to relieving and, when able, eliminating animal suffering is evidenced by this work.
AAHA and AAFP gratefully acknowledge the following for their sponsorship of an educational grant for the AAHA/AAFP Pain Management Guidelines for Dogs & Cats: IDEXX Laboratories, Merial Ltd., Pfizer Animal Health, Schering-Plough Animal Health Corporation and Novartis Animal Health.
Pain management in dogs and cats has undergone a dramatic evolution in the past decade. Current approaches focus on anticipation and prevention of pain, as well as both pharmacologic and nonpharmacologic management techniques. The veterinary team plays an essential role in educating pet owners about recognizing and managing pain in their pets. J Am Anim Hosp Assoc 2007; 43:235-248.
Incorporating pain management into the veterinary practice helps everyone. It benefits the patient through improved quality of life and reduced complications. It benefits clients through enhancement of the human–animal bond. It benefits the health care team through increased safety; improved morale, pride, and job satisfaction; and a less stressful environment. Contemporary approaches to pain management enable veterinarians to more effectively fulfill their responsibility to relieve animal suffering as pledged in the veterinarian's oath.
This document was developed by the American Animal Hospital Association and the American Association of Feline Practitioners through a collaborative effort between Task Force members. By their very nature as a consensus-built set of guidelines, these recommendations reflect a combination of expert opinion, personal experience, and scientific studies. They are intended to educate and inform members of the veterinary profession and should not be identified as standards of care, AAHA accreditation standards, or considered minimum guidelines, but rather as recommendations from AAHA and AAFP. These guidelines should not be construed as exclusive protocols, courses of treatment, or procedures. The Task Force recognizes that through continuing developments in research, technology, and experience, the information contained herein will be subject to change. Procedures and techniques other than those described in these guidelines may be deemed necessary based on the specific needs of the patient, available resources, and constraints due to the en-vironmental conditions.
All tissue injury, including that from elective surgery, may cause pain. Pain-induced stress responses, mediated by the endocrine system, are one of the negative consequences of pain. Increased cortisol, catecholamines, and inflammatory mediators cause tachycardia, vasoconstriction, decreased gastrointestinal motility, delayed healing, and sleep deprivation. In addition, trauma causes unseen changes in the central nervous system. Inadequate pain prevention or management can lead to magnification of pain perception and a prolonged pain state.
Although traditionally pain has been categorized as acute or chronic based on duration, a more contemporary approach considers pain as adaptive or maladaptive1 [Table 1]. Adaptive pain is a normal response to tissue damage. Adaptive pain includes inflammatory pain. Inflammation is a major component of many pain states (including acute pain following surgery or trauma) and some chronic pain states such as osteoarthritis. Inflammatory mediators sensitize neural pathways, increasing the perception of pain.
If adaptive pain is not appropriately managed, physical changes occur in the spinal cord and brain, leading to pain that is termed maladaptive. Examples of maladaptive pain are neuropathic and central pain. For instance, the thalamus typically serves as a relay station sending nerve impulses from the periphery to the cortex but may become a spontaneous pain generator if adaptive pain becomes maladaptive, central pain.
An awareness that acute and chronic pain can convert from adaptive to maladaptive pain helps veterinarians understand why pain is so difficult to control in some patients. The pain-induced changes in the nervous system cause it to become more sensitive, rather than less sensitive. The longer pain is unmanaged, the more likely the neurophysiologic processes involved will cause a switch from adaptive to maladaptive pain, which is more serious and difficult to control. When that happens, some patients require specific drug therapy—such as N-methyl-D-aspartate (NMDA) receptor antagonists (amantadine) and gabapentin —aimed at restoring normal central transmission. Patients may also require multiple therapies (pharmacological as well as nonpharmacological) to manage their pain.
"Wind-up pain" is a heightened sensitivity that results in altered pain thresholds, both peripherally and centrally, such that pain is experienced in areas unrelated to the original source. Wind-up causes a worsening of acute pain and has been used to describe the processes that result in maladaptive pain.
Allodynia is pain caused by a stimulus that does not normally result in pain and can be a component of maladaptive pain. For instance, a cat with long-standing, untreated vertebral osteoarthritis may not tolerate even light stroking across its back.
Patients may experience both adaptive and maladaptive pain. As an example, a cat undergoing onychectomy (de-clawing) experiences inflammatory pain with the potential to develop long-term neuropathic or central pain if the pain is inadequately managed during the perioperative and healing periods. Effective, early, multimodal perioperative pain management is essential to minimize the development of these events.a
An understanding of the underlying conditions that can result in pain better equips the practitioner to anticipate and potentially intervene or modulate pain development. Preventing risk factors early in life reduces the development of pain later in life. For example, providing lifelong dental care reduces the development of oral pain, and preventing obesity reduces the incidence and severity of osteoarthritis.2
Unintentional pain or discomfort associated with veterinary procedures is easily overlooked. Procedures that might cause discomfort or pain include IV catheterization, ear cleaning, manual stool evacuation, and anal sac expression (especially in cats). Evaluate in-hospital procedures where unintentional pain can occur, and reduce or eliminate those causes. If necessary, use an opioid to reduce the pain or discomfort of some procedures. If an animal must be restrained or handled excessively because of its fear, ag-gression, or preexisting pain, use anxiolytics, sedation, and/or anesthesia as needed to prevent struggling, subsequent pain or injury, and aversion.
Conditions in which it is unclear how much pain the animal experiences include some visceral, gastrointestinal, and urogenital diseases; central nervous system disorders; and dermatologic disease. Table 2 lists conditions and procedures that may be overlooked or underestimated as causes of pain. Specific management for these conditions and procedures may include pharmacologic and/or nonpharmacologic management or simply a different or more careful approach to handling the animal.
Some procedures and conditions that are commonly recognized as causing pain in dogs may be overlooked in cats. For example, osteoarthritis, intervertebral disc disease, and spondylosis are common in older cats, and yet many of the behavioral changes related to these diseases have been ascribed to "old age" rather than pain.
Cats and dogs with behavior problems often have an underlying medical condition that may be painful. For example, the cat that urinates inappropriately may have painful lower urinary tract disease. In these kinds of cases, pain management plays an important part in the animal's treatment.
The level of pain associated with surgery can be anticipated to some extent. In general, the more tissue trauma, the more pain, because pain is proportional to increasing levels of circulating cytokines.3 Abdominal surgery generally produces more pain than do superficial soft-tissue procedures, and orthopedic procedures can cause severe and prolonged pain. Keep in mind, however, that even "routine" procedures are painful. Repeat surgeries may be more painful than the original surgery due to the changes that occur in the spinal cord and brain with repetitive and prolonged stimulation (maladaptive pain). Good surgical technique and minimal tissue trauma may help alleviate pain.
Resources are available to assist in estimating the degree of pain associated with various conditions and procedures (see page 248). However, the practitioner must be aware that each individual animal will have a unique response to painful stimuli.4
To optimize pain management and improve the safety of anesthesia, use a perioperative approach to pain management. The timing of administration of medications to prevent pain is critical. For example, giving an opioid prior to a surgical procedure is much more beneficial than administering the same dose afterward. An opioid administered as an anesthetic premedication not only helps to dampen the pain response but also decreases the doses of anesthetics required for anesthetic induction and maintenance. Providing adequate intraoperative and postoperative analgesia increases patient comfort and facilitates a smoother recovery from anesthesia. It may also prevent the development of maladaptive pain.
Some opioids have a very short duration of action and have a ceiling effect (e.g., butorphanol), whereas others (e.g., buprenorphine) have a longer duration of action but a delayed onset and time to peak effect. Understanding these pharmacologic differences helps to ensure that medications are used appropriately and with the most efficacy.
Initial pain management should be followed by ongoing reassessment and revision of pain management, titrating treatments up or down to meet patient needs. Anticipate that increased signs of pain may occur following discharge from the hospital, as (for example) when residual sedation or a local anesthetic wears off after the patient has returned home. Furthermore, some animals may mask behavioral signs of pain while hospitalized, and signs of pain become evident only at home. The client should be counseled about this contingency, and pain medications should be made available. (A later section provides more information on educating clients regarding pain management in their pets.)
Analgesic drugs and/or dosages may need to be modified with the patient's changing status. If a dog with osteoarthritis is on a nonsteroidal anti-inflammatory drug (NSAID) and then undergoes intestinal surgery, a different type of drug must be prescribed if the animal becomes hypovolemic.
The practitioner should expect escalating pain management needs in animals with progressive diseases, such as osteoarthritis, cancer, intervetebral disc disease, or spondylosis, as well as in some end-of-life or hospice patients.
Although all animals experience pain, expression of pain varies with age and species, as well as among individuals. Neonates have intact neural pathways for pain transmission, but both neonates and senior animals may not express their pain as plainly as other animals. Cats and dogs also tend to hide pain as a protective mechanism. However, a lack of expression or outward evidence does not necessarily indicate that these patients are not experiencing the negative consequences of pain.
Some animals experience residual pain following a surgery or injury, whereas other animals seem to return quickly to normal function with no obvious residual pain. Responses to surgery and injury or to therapy are unique to each individual, and the differences reflect genetic variation in such factors as the number, distribution, and morphology of opioid receptors. 5,6,7
Anecdotal evidence suggests that certain breeds appear more sensitive to painful stimuli and are more easily aroused than others. Whether this reflects different communication styles, arousal patterns, or actual pain perception is not known.
Individual animals undergoing the same procedure may experience or express their pain differently. In addition, an individual animal can experience more than one type of pain at any given time. For example, the senior patient with osteoarthritis that undergoes surgery to remove a mass may experience musculoskeletal pain due to positioning during the procedure, in addition to the pain associated with the surgery itself.
Assessing behavior is an integral part of the history-taking and physical examination of any animal [Table 3]. Understanding normal behavior is essential to identifying pain and selecting an appropriate intervention.9 The input of the owner is invaluable in determining abnormal behavior that may be linked to pain.4
Behavioral signs of pain, including both loss of normal behavior and development of new and abnormal behaviors, may be subtle and easily overlooked by both owners and the veterinary health care team. A systematic and holistic approach that considers the animal as well as its environment is essential to recognizing changes in behavior and physiologic parameters. Physiologic signs such as increased respiration and heart rate, increased blood pressure, or dilated pupils may be manifestations of pain or stress but should not be relied on as the sole indicators of pain.
The line between "discomfort" and "pain" is imprecise. The practitioner must assess the conditions and procedures that cause sensations ranging from skin irritation to severe discomfort and then determine whether pain management is indicated. Tables 2 and 3 summarize often-overlooked causes of pain and signs of pain, respectively.
The decision-making process can be facilitated by the pain management algorithm shown in Figure 1, which offers a step-by-step approach to determining whether or what intervention is indicated. If a question persists regarding the presence of pain, administer an analgesic and assess the patient's response. Response to therapy is an appropriate and important tool in pain assessment. When pain management is needed, formulate a plan, note it in the medical record (and make a copy for the client), and update the plan as needed.
Differentiating dysphoria from pain can be challenging, especially in traumatic or surgical cases. Pain and dysphoria can occur simultaneously, complicating the picture. However, the observant practitioner can discern clues to differentiate between dysphoria and pain. Dysphoric animals are difficult to distract or calm by interaction or handling. Administering more opioids does not help the situation, and a source of pain is not readily identifiable. In contrast, animals in pain typically can be temporarily distracted and calmed by interaction or handling. Increased or repeated doses of opioids seem to help, and a source of pain can be identified.
Frequency of pain assessment depends on the presenting problem. In patients with surgical or traumatic pain, pain assessment is recommended at least every 2 hours. In patients with chronic pain, assessment is recommended a minimum of every 3 months or whenever control seems to be waning. All patients should be assessed for pain during their regularly scheduled wellness exams.
Scoring tools such as identification and recording of behavioral changes and responses to therapy are useful for standardizing pain assessment. No single accepted pain scale has been developed for use in dogs or cats, and scales currently in use range from simple to complex.10,11 Whatever pain scale is adopted, it is essential that it fits the practice; otherwise, the scale will go unused. The pain scoring system should be incorporated into overall patient assessment, treatment, and reassessment protocols, as well as staff and client educational materials.
The use and choice of pharmacologic agents is based on a thorough patient assessment that includes a physical exam; an evaluation of the patient's history, underlying or preexisting conditions, and presenting complaint; and a laboratory evaluation of an appropriate database. When choosing medications to send home with patients, client compliance can be enhanced by taking into account such factors as the duration of analgesic action and ease of administration.
Classes of analgesic drugs are listed in Table 4. An exhaustive list of drugs and their indications, contraindications, side effects, and doses is referenced and may be found in other sources.12,13,14 A multimodal approach to pain management takes advantage of the different modes and sites of action of various analgesic agents [Table 4]. Lower doses of each analgesic often can be used, reducing the potential for side effects and providing superior analgesia. This approach also utilizes the timing of administration of different agents.15,16
Before an elective surgery, use an opioid that also reduces the anesthetic requirement. Before or during surgery, use a local anesthetic at the incision to block the transmission of noxious stimuli. During anesthetic recovery, use an NSAID to decrease the inflammation from the surgical trauma. This combination of pharmacological agents may help prevent the evolution of maladaptive pain. Regardless of the procedure performed, opioids are anesthetic-sparing and should be used for this effect.
Pharmacological pain management must also be addressed by organizations with a high volume of surgical cases (i.e., shelters, ovariohysterectomy–neuter programs, and feral cat programs) or in situations with little to no opportunity for follow-up. Economic considerations may play a role in these circumstances. The question may be, "What is the minimally acceptable degree of analgesia that should be offered for routine surgical procedures, and how is this most economically achieved?" The answer will change as new information becomes available.
For instance, even when opioids are unavailable, other options exist. In a recent study, a single dose of carprofen given to shelter dogs undergoing ovariohysterectomy demonstrated good analgesia for up to 24 hours in most dogs.17
Local or topical anesthetics are useful for managing pain or discomfort associated with a variety of conditions such as clipper burns or urine scalding or procedures such as IV catheter placement. Opioid administration for procedures such as manual extraction of stool and anal sac expression, especially in cats, decreases pain and helps prevent fear and anxiety associated with veterinary visits. Since pain is individual for each patient, if the patient is still in pain, additional analgesia and/or anesthesia are indicated.
Because anxiety and fear can amplify pain, and physical restraint may contribute to pain, anxiolytics should be used for anxious or fearful animals undergoing hospital procedures. Alprazolam is an excellent antianxiety medication. Tricyclic antidepressants may be indicated when the practitioner suspects persistent, aberrant pain that is refractory to traditional analgesics (e.g., neuropathic pain). Recall that acepromazine is not an anxiolytic but rather a tranquilizer, causing sedation without decreasing anxiety. Acepromazine may disinhibit aggression, making the patient not only more fearful but also more dangerous. Although acepromazine is useful as part of an anesthetic protocol, it is not indicated for use to control fear or anxiety.18
A synthetic feline facial pheromone (FFP) helps reduce anxiety in unfamiliar surroundings, including the veterinary hospital. FFP diffusers can be plugged into each room and sprayed on tables, towels, and hands. Although this approach is beneficial with many cats, occasionally an individual animal may become more agitated.19,20
It is important to treat all pain for an adequate period of time. Patients receiving pain management must be monitored via reexamination and laboratory testing at prescribed intervals to assess for efficacy and adverse events.
Drug metabolism varies among species, breed, and individuals. Specific contraindications of drug classes are noted by their manufacturers (for those drugs that are approved for use in dogs and cats) as well as in many texts.
Selection of pain medication for cats requires special attention. Some opioids—such as buprenorphine, meperidine, and methadone—cause fewer behavioral side effects in cats (e.g., less excitement) than do other opioids. With respect to buprenorphine, the oral (transmucosal) route can be as effective as the intravenous route and is more convenient. Hydromorphone has been associated with hyperthermia and agitation in cats at the doses required to provide analgesia.21
There is a misunderstanding regarding the degree and duration of analgesia provided by butorphanol. Butorphanol is not as effective or long-lasting as other opioids (although there are individual variations in response to drugs that target different opioid receptors, such as the mu- and kappa receptors, which has been demonstrated in cats).22,23 Limited uses of butorphanol include anesthetic premedication and prior to minimally invasive procedures.
Pets with transdermal fentanyl patches may be easier for owners to manage, but the absorption of the drug is highly variable and may not reach analgesic levels. If the decision is made to send a cat home with transdermal fentanyl, the client should be educated about how to identify whether the cat is still in pain, such that the use of other opioids becomes necessary.24
Because vomiting increases intracranial and intraocular pressure in animals with an eye injury or intracranial mass, opioids such as morphine or hydromorphone should be avoided in these patients. Exercise caution with their use in animals that are obtunded and have an increased risk of aspiration (e.g., brachycephalics).
Appropriate use of nonpharmacologic therapy as an adjunct to pharmacologic agents can enhance pain prevention, management, and treatment. These methods of pain control typically are used for chronic pain but may also be appropriate adjuncts to treatment of acute pain.
Many basic lifestyle changes can reduce pain. For example, controlled exercise and weight management are used to decrease joint stress and improve muscular support of the joints.25,26 Although home care varies with the condition, even simple environmental accommodations can benefit the pet and prevent or reduce discomfort. These include easy access to litter boxes (no hood, ramp, or stairs and a low-entry side); soft bedding; raised food and water dishes; nonslip floor surfaces, especially in food and litter areas; baby gates to prevent access to stairs; modified access to outdoors, especially in hot or cold weather; and appropriate warm-up prior to exercise And lastly, positive, consistent interaction with the pet can improve the animal's demeanor.
Quality in-hospital care may include the use of soft padded bedding during illness or surgery to enhance comfort, warm water or air blankets to decrease pain and facilitate recovery from anesthesia, reduction of patient anxiety by minimizing the length of a hospital stay, and gentle and respectful patient handling. It is also beneficial to decrease visual and auditory stimulation and separate dogs and cats within the hospital setting. Shy or anxious cats should have a box or similar structure in their cage to provide a hiding place.
An array of medical approaches can be grouped under the umbrella of "complementary and alternative medicine." Use of some of these methods is controversial, in part because of the lack of scientific study and published evidence about them. Additional research is needed to elucidate both the benefits and uses of complementary and alternative medicine. Of all the complementary procedures used for pain management, acupuncture is most supported by evidence; its use in humans is endorsed by the National Institutes of Health.27
If alternative medical approaches are used, it is essential that the procedure or therapy be performed with the full and informed consent of the client and under applicable state laws. Where training or certification is available, the modality must be administered by individuals trained or certified in its use and limitations.b As with administration of pharmacologic agents, patients receiving alternative modalities should be periodically reassessed to determine the efficacy of treatment.
Nutrition is one of the most popular of "alternative" modalities. Nutraceuticals, such as glucosamine and chondroitin, may decrease joint inflammation and assist in cartilage repair, although a large meta-analysis conducted in human medicine indicated the need for further study.28,29,30,31,32 There is evidence that omega-3 fatty acids decrease inflammation in cartilage of dogs with osteoarthritis, and dietary intervention can improve clinical signs in osteoarthritic dogs.33,34,35 Chondroprotective agents such as polysulfated glycosaminoglycans have been demonstrated to modify the progression of osteoarthritis by maintaining chondrocyte viability via the inhibition of cartilage degradation pathways.36,37 At this time, most of the research that has been conducted to assess the roles of nutraceuticals and chondroprotective agents has been conducted in dogs. However, there are anecdotal reports of improved function in cats receiving chondroprotective agents.
Rehabilitation therapy (i.e., the application of physical therapy techniques to animals) may be used to return a patient to normal function following surgery or trauma or as a part of a long-term strategy to manage pain. Rehabilitation includes techniques such as cryotherapy, heat therapy, massage, stretching, passive range-of-motion exercise, hydro-therapy, therapeutic exercise, use of dryland or underwater treadmill, and strength-building.
Additional therapies that fall under the rehabilitation umbrella include low-level laser, ultrasound, and transcutaneous electrical nerve stimulation (TENS). Some veterinary practices have incorporated these therapies on the basis of extrapolation from human medicine and anecdotal reports of their success. Currently there is insufficient published evidence of efficacy in dogs and cats to make specific recommendations about the use of these therapies.
Although chiropractic intervention occasionally has been used to treat chronic pain, chiropractic methods potentially can cause injury through the use of inappropriate technique or excessive force. Currently there are no clear standards for when chiropractic intervention should be applied or who is qualified to use chiropractic manipulations. Practitioners who have received formal training in animal chiropractic manipulation (typically 100–140 contact hours) report positive results in their patients experiencing chronic pain. There is currently insufficient published evidence of efficacy in dogs and cats to make specific recommendations about the use of chiropractic intervention.
Pharmaceutical and nonpharmaceutical intervention can be combined for pain management. For example, a cat with osteoarthritis is given both drug therapy and a reduced calorie diet for weight loss. The cat also may benefit from acupuncture, massage, physical rehabilitation techniques, and care in handling. In the home, the pet's quality of life can be enhanced by such environmental modifications as soft bedding, ramps or steps that allow the cat to use its favorite places, nonslip floor surfaces, and food dishes raised to the height of the cat's elbow.
Due to the complex nature of many pain conditions, consultation or referral may be appropriate in some cases. Situations that warrant consultation or referral include a lack of anticipated response or an unsatisfactory response to treatments despite the use of multiple modalities. Patients may also be referred if their condition requires surgical intervention by a specialist or a procedure not provided by the primary practice, e.g., acupuncture, radiotherapy, or advanced diagnostic workups such as computed tomography (CT) or magnetic resonance imaging (MRI). Practitioners may want to seek consultation for diagnostic confirmation or help in fine-tuning pain management protocols and procedures. Referrals are also recommended for patients requiring more aggressive or complex pain management beyond the scope of most practices.
Many pet owners welcome the possibility of being able to provide hospice or palliative care for their pets when it is made available. Hospice is defined as "a system which provides compassionate comfort care to patients at the end of their lives and also supports their families in the bereavement process. Hospice care for terminally ill patients is characterized by recognition that the life expectancy is less than 6 months."38,39
Palliative care is defined as "the active total care of patients whose disease is not responsive to curative treatment. Control of pain is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families."40 Palliative care maximizes the pet's quality of life while managing pain and discomfort. Providing palliative care treats the patient but not necessarily the disease. Examples of palliative care include palliative radiation (e.g., to decrease pain related to osteosarcoma), appropriate analgesics and other pharmacologic agents, and nutritional support (e.g., esophagostomy or gastrostomy tube).
With both hospice and palliative care, regular client communication is essential. Create client support systems within the practice, using the veterinary team to assist with client education and the most appropriate means of delivery of medications or treatment modalities at home.
It is important to create reasonable expectations for the client. Clients can be helped by the use of decision-making trees and explanations of probable outcomes and by being given choices. Euthanasia can be a gift to relieve pain and suffering and should be included as a reasonable and humane option at some point. A client may not apprehend the level of suffering the pet is experiencing or have any way to gauge quality of life. Quality-of-life indices are being developed to assist pet owners in making these kinds of difficult decisions.41
At the onset of an animal's terminal condition, it is beneficial to ask the client to remember what activities the pet enjoyed and have the client compare these to the pet's current status. This process helps to clarify the client's understanding of quality of life. When possible, these issues should be discussed with the client while the pet is still healthy, before the animal is ill or in pain.
A team approach that involves the client, veterinary team, and patient reinforces the doctor–client–patient relationship and strengthens the human–animal bond. The veterinary team serves as the client's source of reliable information regarding identification and management of pain for the pet. The client plays an essential role in the ongoing assessment and success of treatment.
Education is an important component of a comprehensive veterinary practice. Both staff members and clients should be instructed on how to best handle both cats and dogs respectfully and the additional support and respect needed when animals are fearful. It is important to educate owners early in their experiences with their pets. At the first kitten or puppy visit, discuss handling, dental care, weight management, ovariohysterectomy and neuter procedures, semiannual wellness exams, and planned procedures such as ongoing dental prophylaxis, all of which can impact the future onset of pain.
Clients generally need help to recognize the subtle signs of pain and should be advised that methods for the alleviation of pain are available, effective, and generally safe. Even subtle changes in behavior are reasons to contact the veterinary clinic because these are the first signs of illness and pain.
If a pain management plan is required, the client should be given a copy of the plan as well as written, verbal, and hands-on instruction in how to administer medications. To reinforce verbal information about pain assessment, provide the client with handouts with general information about pain in pets as well as any side effects of medication. Owner compliance will be increased if the administration of the medication is tailored not only to the patient but also to the owner's abilities, with regard to both schedule and method of administration.
Many of the medications used for a variety of canine and feline conditions, including pain, are not approved for such use. For example, on the basis of its clinical performance, gabapentin is becoming more widely used to interrupt the cycle of chronic pain in arthritic dogs and cats, yet the drug is not approved by the Food and Drug Administration (FDA) for such use. Nonetheless, veterinarians should not avoid provision of pain management simply because approved drugs are not available. Legal experts advise that informed consent be obtained in these circumstances and that copies of the signed consent form be kept in the medical record. As treatments for alleviating pain continue to evolve, veterinarians can monitor the peer-reviewed literature, veterinary conferences, and appropriate associations for new information.
Team members who are involved in client interactions must be trained to effectively practice active listening. They should be willing and able to address clients' concerns and answer questions via periodic appointments, email, and/or phone support from the practice. Any discussions with clients about specific patients should be documented in the medical record. In shelters, ovariohysterectomy–neuter programs, and feral cat programs, educating veterinarians and staff members about pain management should be a part of the group's long-term strategy to raise the standard of care.
Education needs to address the various learning styles of clients and team members. Veterinarians, veterinary teams, and clients can find useful information from a variety of sources and in a variety of forms, including written, online (text and video), and video or audio recordings. Written and audio sources include journals and veterinary conference proceedings. Other educational sources include commercial companies, information-sharing groups, and government agencies. Team training resources are available for use both in the veterinary practice and home setting.
Veterinarians should be prepared to direct their clients and staff to websites that provide accurate and current information. When possible, videos, CDs, and/or DVDs should be available in the hospital for either viewing on site or loan to pet owners. Industry and FDA-approved information about medications and their adverse effects is available from each drug manufacturer and at the Center for Veterinary Medicine website at www.fda.gov/cvm/default.html. Table 5 offers a list of useful websites and the kind of information they provide.
In addition to providing extensive information about pain management, the Internet is a resource for materials related to ancillary procedures. Veterinarians can download legal forms for informed consent and refusal of recommendation, client information forms, pain management handouts, discharge instructions, and instructions on administration of medications — all useful tools for implementing a successful pain management plan.42,43,44,45,46
Offering and providing adequate pain management enhances patient quality of life, improves the human–animal bond, encourages the team, and benefits the practice. For veterinarians who wish to improve their approach to pain management, the following strategies are a good place to start.
Use the pain management algorithm [Figure 1] to aid in pain identification, prevention, and management. Develop anesthetic protocols to include pain prevention, using appropriate agents at specific times. Involve and train the whole veterinary team in pain management protocols. Discuss common case examples. Develop and provide scoring and assessment tools. Teach team members to use open-ended questions during their history-taking with clients to maximize the team's understanding of each patient's situation.
Educate pet owners as described previously, starting when the animal is young. Develop written materials for client education. Begin developing the client's awareness of the importance of identifying and treating pain whenever it occurs.
The profession's understanding of pain management is evolving with new agents and techniques and the application of evidence-based medicine. The need to be open to these changes and challenges is essential. It is hoped that this document provides a framework to approaching and managing pain and to understanding the challenges that face the profession in the future.


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If you're training to run a half marathon like I am or just want to run your first mile, this running playlist can help you get there. Having great running music is seriously one of the biggest tips I can give anyone; there's just something about a strong beat and inspirational message that keeps your feet moving! And this new and updated list includes everything from classic songs to running songs from 2016!
Before we talk about the playlist, let me tell you a story. Ten years ago my brother got engaged to my sister-in-law while we were all on a family cruise. After seeing myself in pictures from that cruise, I said that I was going to run five times a week from the day after the cruise to the day my brother got married.
And my soon to be sister-in-law laughed and said there was no way I could do it.
I'm sure you can guess how the story ended. I let my competitive side take over and ran five times a week not only until their wedding but also for months afterwards. I ran alongside my dad for the most part, and it was that summer that we decided to run our first half marathon together.
That first half marathon in Athens, Georgia was amazing. And so was the second one in Death Valley, CA almost a year later. I felt invincible. While my dad barely crossed the finish line, I could've run at least another six miles. I haven't felt that good since even though I've "run" another 13 half marathons since Death Valley. And walk/ran the Marine Corp Marathon a couple of years ago.
I want to feel like that again. And 2017 is the year that I'm going to do it.
If there's anything that can make me feel like running, it's a good song. There have been so many times that I felt like I needed to walk or like my legs just couldn't go any further. And then a song like Perfect by Pink came on, and it helped me keep going and get across that finish line. I mean, how can you start walking when the music is saying don't ever feel like you're nothing. Or how about Kelly Clarkson singing what doesn't kill you makes you stronger? Yep, a good playlist can really make the difference between an "I feel invincible" run and a run that makes you want to throw away your running shoes and just eat ice cream every day for the rest of your life.
And this my friends is the perfect running playlist. Or at least my perfect running playlist. Songs with words that remind you that you can do anything or beats that make your legs just keep moving. They aren't in any particular order because I typically just put it on shuffle so I can be surprised.
Click on the song title below to listen to a preview of the songs. And since I only listen to clean versions of songs, these are the clean versions. If you like things unedited, feel free to buy those instead.
Running Playlist
- "Bulletproof" – La Roux
- "Edge of Glory" – Lady Gaga
- Bad Romance" – Lady Gaga
- "Stronger (What Doesn't Kill You)" – Kelly Clarkson
- "My Life Would Suck Without You" – Kelly Clarkson
- "Jai Ho" – A. R. Rahman & Pussycat Dolls (from Slumdog Millionaire)
- "Roar" – Katy Perry
- "Shake It" – Metro Station
- "Girlfriend" – Avril Lavigne
- "Club Can't Handle Me" – Flo Rida
- "Raise Your Glass" – Pink
- "Perfect" – Pink
- "So What" – Pink
- "Rolling in the Deep" – Adele
- "Not Afraid" – Eminem
- "Lose Yourself" – Eminem
- "New Divide" – Linkin Park
- "Livin' on a Prayer" – Bon Jovi
- "Don't Stop Believin" – Journey
- "Raging Fire" – Phillip Philips
- "Float On" – Modest Mouse
- "Best Day of My Life" – American Authors
- "Wake Me Up" – Avicii
- "I Think We're Alone Now"- Tiffany
- "Dog Days Are Over" – Florence and the Machine
- "Shake It Out" – Florence and the Machine
- "On the Floor" – Jennifer Lopez
- Shake It Off – Taylor Swift
- What the Heck – Avril Lavigne
- I Lived – One Republic
- Marchin' On – One Republic
- Run This Town – Jay Z & Rhianna
- Flat on the Floor – Carrie Underwood
- Goodbye Earl – Dixie Chicks
- Wavin' Flag – K'naan
- Somebody Like You – Keith Urban
- Party in the USA – Miley Cyrus
- I Run to You – Lady Antebellum
- Party Rock Anthem – LMFAO
- If You're Going Through Hell – Rodney Atkins
- Can't Stop the Feelin' – Justin Timberlake
Other Running Essentials I Love:
Feetures Running Socks
Foam Roller
Garmin Forerunner
Running Shoes
Panache Sports Bra
Running Armband
No Slip Headband
Born to Run Book
Run, Fat Boy, Run Movie
If you need more great workout music ideas, make sure to check out my most recent workout playlists – 25 great workout songs for strength training and 50 awesome workout songs!

subset: commoncrawl


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10 Home Remedies To Cure Dark Spots On Your Skin
We all are familiar with the situation where a huge pimple religiously pops up on our face when we can least afford to have it. Even if, by some miracle it heals in a few days, it leaves a nasty scar which takes days, if not months to heal. Although there's nothing that can make it go in a jiffy, you can surely try some simple home remedies for dark spots on skin to accelerate healing.
Home Remedies for Black Spots on Skin
Here's how to remove black spots on skin and face:
Remedy 1:
The most effective spot removing technique is to mix a teaspoon of honey with 4-5 drops of lemon juice. You can also add a few strands of saffron to it. Apply it to the affected areas and wash off after 20 minutes. Lemon and honey work as natural bleaching agents. Honey also adds moisture. Over time it will be like that black spot on skin never even happened to you!
Remedy 2:
Mix 2 teaspoons of tomato juice with 4 teaspoons of buttermilk and apply it on the dark spots on skin. The lycopene in tomatoes is a strong lightening agent that in over time reduces the intensity of the spot and then removes it entirely.
Remedy 3:
A paste of sandalwood powder and rose water not only lightens spots but also cleanses and refreshes oily skin. This pack is a boon if you have oily skin that is prone to pimples!
Remedy 4:
Mix 3 tablespoons of oatmeal, 1 tablespoon of honey and 2 tablespoons of milk and use it as a face mask. The oatmeal is a natural exfoliating agent that will remove the dead skin cells, honey will keep your skin supple while milk will add a glorious glow to your skin!
[Read: Effective Skin Spots Treatment ]
Remedy 5:
Sour milk, cream and honey mixed together works very well on dark spots on skin as the lactic acid hastens the healing process. Lactic acid is also well known to lighten marks left behind by pimple and the moisture content along with the anti-bacterial properties in honey will improve the skin condition over all.
Remedy 6:
Olive oil, apart from adding flavor to salads, also heals spots. Apply on the affected areas at bedtime and wash off the next day. Olive oil adds moisture and but when massaged into the skin and left on for 15 to 20 minutes, it is easier to scrub the skin and remove dead cells.
Remedy 7:
Vitamin E oil is effective as an all night spot reducing treatment. Vitamin E along with being a moisturizer also has an anti-oxidant effect that curbs the free radical action on the skin that results in aging and dark spots.
Remedy 8:
Nature's very own aloe vera pulp works wonders on the skin.
[ Read: Get Rid Of White Spots On Skin ]
Remedy 9:
Mix dried orange and lemon peel powder with rose water and apply the paste on the black spot on skin. The citric acid in it will work its magic on your skin!
Remedy 10:
Grate a cucumber and squeeze out its juice and add it to curd for natural bleach.
[ Read: Vitamin E ]
These ingredients will not make your spots miraculously disappear in a day. However regular application will not only heal the spots faster, but also improve the overall texture of your skin.
Do leave us a comment if you know of any other effective solutions for black spots on skin!
Latest posts by SADIA (see all)
- 3 Effective Homemade Moisturizers For Oily Skin - July 11, 2013
- 5 Simple Homemade Conditioners For Damaged Hair - July 10, 2013
- 10 Amazing Benefits Of Ginger Juice - May 11, 2013
- 8 Eye Makeup Tips For Close Set Eyes - March 11, 2013
- Is A Short Hairstyle Right for You? - February 7, 2013


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Guide Fees & Information
To make a reservation please fill out the form here. Keep in mind payment is required to reserve a guide. A 50% non-refundable deposit is required. Should you need to change your reservation you must submit your request via our contact form and we will contact you about availability. 48 hours advanced notice will be required. Our trips are full day sessions that start in the morning and end at 4:30PM. All reservations and payments are bound by our guiding terms here.
- Rider prices= $150/day per person
- Avalanche beacons= $15/day per person
- a full day of unbelievable snowmobiling


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Dental Cast Release
Dental Cast Release provides a water-based paint that can be used to apply a thin Boron Nitride (BN) layer onto typical ceramic crucibles or molds — such as special ceramics good to 1550 °C or inserts of graphite or glassy carbon, as well as fused silica/quartz crucibles. The crucibles are generally used for vacuum melting and casting of specialty alloys such as "high fusing gold" alloys, cobalt-chrome, nickel-chrome, and other non-precious metal alloys for crowns or bridges. This new easy-to-use finger-pump sprayer allows application of BN paint onto most any surface, substrate, crucible, or mold.
- Easy to see contrasting blue color
- Ready-to-use finger-pump sprayer
- Water-based, non-flammable, non-hazardous
- Anti-stick for easy release – eliminates residues
- Extends crucible/mold lifetime
Perfect for easy release of dental alloy castings using ceramic crucibles/molds or graphite/glassy-carbon liners.
Link to the PDF datasheet: Dental Cast Release
Link to Helpful Information: Dental Cast Release Information
- Dental Cast Release Kit
- one 4-oz spray bottle
one 8-oz refill bottle
one brush
- $25.00
- Dental Cast Release Refill
- one 8-oz Nalgene bottle
- $16.00
- Dental Cast Release Kit
- case of 12 kits
- $285.00
$270.00 for 2-5
$240.00 for 6+
- Dental Cast Release Refill
- case of 12 (8 oz.) Nalgene bottles
- $183.00
$174.00 for 2-5
$153.00 for 6+


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An anonymous donor has funded the almost-terminated Hotel Program, thereby allowing families displaced by Sandy to be housed past the original end date.
The donor, later revealed as the Red Cross, donated $1 million to the city program, which was previously funded by FEMA. That federal aid was set to stop on September 30.
"Hundreds of Sandy victims remain in hotels as they repair their homes or transition into new ones," said Councilmember Donovan Richards, who fought against the termination of the program.
He said the end of the FEMA funding was "pushing these families into the homeless system."
The Department of Homeless Services created the Hotel Program shortly after the storm left hundreds of residents on the streets. City homeless shelters were without any additional room, and so various hotels took in the storm victims.
Originally, the program was set to stop by May 31. The decision was taken to court, and federal funding was extended through September. The Red Cross stepped in on October 3 with its own donation.
"Today was almost the day hundreds of Sandy victims ended up on the street, or back in their mold-filled homes," Richards said after receiving the donation. "This money gives our friends and neighbors the grace period they need to avoid homelessness."
Over 1,000 households participated in the Hotel Program since Sandy, which cost more than $70.5 million, according to court documents. As of mid-September, 179 households remain in the program.
Since FEMA could no longer provide aid, the cost would have been transferred onto the city, which does not have a place in its budget for the program, according to court documents.
"Although this money will not extend the program forever, this will aid every day New Yorkers who are in the process of transitioning into new homes," Richards said.


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No, we're not asking if they're broken… rather, have they somehow been mixed up a bit?
This week Lynn Sumida talks about what happens when we let what's really important to us shift around, and maybe get neglected. We think it's a much better way of looking at it, rather than asking "do you have your priorities straight?"
The video is just over 6 minutes long… take a look. We think you'll be glad you did.


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The Detroit Symphony Orchestra proved to be in staggering form for their second night of their first Beethoven festival in 36 years. Better weather and more familiar works ensured that the fabled 2,000 seat hall was full and abuzz with excitement. In my review of the February 8th concerts, I mentioned the excellence on display, pointing out terrific wind solos in particular. This program featured those same qualities, but with a gripping intensity that was lacking from the Third and Eighth.
Music Director Leonard Slatkin's written promise to use swift tempos and embrace modern scholarship was held up magnificently by his orchestra, who provided exciting and very clean playing all evening. While in the past – Friday's program included – the Detroit Symphony strings have taken time to find solid footing, they shot out of the opening overture with a tremendous confidence and focus. Slatkin clearly appreciates the Fidelio overture as a showpiece. While his treatment of the Leonore #3 was stunningly played but emphasized dramatic contrast, Fidelio featured sharp rhythmic attacks and a great deal of color and detail. The audience was thrilled.
As I stated previously in my review of the first installment of this series, Slakin's gifts do not show themselves in any extremes. This worked wonderfully in the Fourth, a focused and swift performance that also had a great deal of intensity. After a darkly dramatic opening, the Allegro Vivace was like sun breaking through clouds. As he had proved Friday night, Slatkin continued to be a master of dramatic shifts and Beethoven's mood changes. The first movement was followed by a lovely, flowing adagio that showed the strings and winds in very fine form. The jaunty dance of a third movement was well served by the swift approach and slightly reduced forces of the Detroit Symphony. Underneath the smiling gentleness of this oft-forgotten work, there is foreshadowing to the late symphonies, a notion Slatkin obviously agrees with. Again, tremendously clear wind solos contributed to what had been to this point as fine a performance as you could want.
Thankfully, the finale didn't disappoint. Never once allowing tempos to drag, Slatkin led his players through a tremendously satisfying final movement, where the Detroit Symphony clearly reveled in the chance to show off. Playing the early works (and Symphony #8) like they are worthy of the great canon that is the Beethoven Symphonies goes a very long way in making these admittedly smaller pieces sound important. Slashing strings, dancing winds, and spot-on playing brought a surprising amount of the hall to its feet.
I suspect however, that many patrons and first-timers alike were there to see the Fifth, and indeed the intermission was full of questions about the second half of the program living up to the first. The Detroit Symphony played the in 2011 under Louis Langrée, a very fine musician, but this performance was better still. For one, the swift tempos and sharp rhythmic attacks that made the Fourth something special carried over to the Fifth. Nothing is duller in music than this symphony's opening movement played anything less than 100%, and stellar winds and strings made it very memorable indeed. The horns of the Detroit Symphony impress me less right now, and Orchestra Hall is so sonically alluring that it seldom forgives mistakes, but here too they rang out with confidence and clarity. Clearly energized, Slatkin put the orchestra through its paces.
But one cannot forget that this iconic symphony has three other movements. Some conductors do, and the piece sages progressively as a result. Not here. Slatkin is far too good a leader to let that happen. Thus, the second movement Andante con moto shone and urged the symphony forward on its musical journey. In particular, the Detroit Symphony brass deserve a great deal of credit, their blended tones ringing through the hall. They also stood out in the third movement scherzo, their achievements outdone only by some absolutely incredible low string playing that was perhaps the highlight of the entire performance. That led effortlessly into a swift and wholly satisfying rendition of the finale. Of all the four movements, it is most in danger of sounding stop and go, but here it was majestically flowing, retaining all the tension and excitement of the previous three. Rarely, either on disc on broadcast has the conclusion sounded so easy and natural. In response to this excellence, the crowd roared its approval for several curtain calls.
I had legitimate concerns about the Detroit Symphony embarking on a Beethoven festival this year. While a successful series of webcasts have brought the group into the spotlight, the recent strike and some questionable quality of ensemble have hung over the orchestra for some time now. However, I was warmly surprised by the first installment of the series, and have no hesitation in calling this Saturday performance one of my favorite Orchestra Hall experiences. If this festival continues to rejuvenate the ensemble, the concluding concerts will be a special experience indeed. A job well done for all involved. Next!
Copyright © 2013, Brian Wigman


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The Industrial Gas Projects House (IGPH Ltd), comprises 5 world leading brands & equipment manufacturers with over 100 years combined experience dedicated to the Industrial Gases sector. Being 5 independent companies, the solutions we offer range from equipment – hoses, valves, valve manifolds, cryogenic pumps, ...View company profile
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by Heather
This didn't surprise me
I have been trying to live a normal life
and now it's a weird feeling to know
That now I'm the one that keeps this family together
It's unfortunate to see my brother without his father
Although we see my stepfather every weekend
It's not something I like
For the reason is his home is full of cigarettes and beers
I do not want to grow up and think
My brother has to live with an alcoholic father
who doesn't know who he is hurting.
And is not aware of the effects of how he is abusing his body
He thinks it is normal
No child should ever live with a father that
abuses his body in front of him/her
What will I have to tell him when his father arrives home drunk?
Should I say he's acting crazy?
What is the right term that I can use to describe this situation?
I'm truly fed up with his attitude towards my family
The worst part about my brother is that he has asthma
When my father smokes, I have to close the door
of the room that my brother is in
So he does not end up choking
I want to say something
I know that what I say
Will not change him
My mother cannot say anything
This is the biggest thing that drives me insane
Join in and write your own page! It's easy to do. How? Simply click here to return to Submit a Poem.


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All prices are in All prices are in USD
A half-dozen assorted blossoms and hearts in a wicker basket for any occasion. Approx. 33 inches tall.
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Tuesday, February 11, 2014
Traditional Pink
10 comments:
I love it! The room has the perfect touch of pink without going overboard. :)ReplyDelete
I adore those pink accents!ReplyDelete
Love that pink chair, so pretty and fun!ReplyDelete
I'm swooning over that last pic! So chic!ReplyDelete
LOVE! These were all such great inspiration!ReplyDelete
XX, SS || seersuckersass.blogspot.com
What a beautiful home! I'd love to have that pink chair in my living room!ReplyDelete
xo jen
Pearls & Lace
I really love those pink lamps. I am a sucker for funky lamps.ReplyDelete
at first i thought these were pictures of your home and i still hope they are? pink accents are my FAVORITE! are you an interior decorator?ReplyDelete
Hey lovelie!ReplyDelete
You have been nominated for the Liebster Award for your blog!!! Yay!
Here is the link to your questions and the rules:
xoxo, Ana
Amiga que linda decoração amei, belo blog;ReplyDelete
Blog: http://arrasandonobatomvermelho.blogspot.com.br
Canal de youtube: http://www.youtube.com/NekitaReis
Thank you so much for taking the time to comment. I really, truly appreciate every single comment I get and the time you put in to leave them.


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Smaller than a hardback and with enough memory to store 160 eBooks, the duo hope it'll become the iPod of the written word.
It uses e-ink technology, which means its no more eye wearying than standard black and white print - and the pages are viewable in direct sunlight, should any show up this summer.
Annoyingly for public transport users it also has an impressive viewing angle of 180 degrees, giving the person next to you a nice eyeful without them leaning over your shoulder.
Course, there is the small disadvantage of having to keep its batteries topped up, but Sony reckons one charge is good for 6,800 page turns - enough for War and Peace four times over.
Waterstones will be taking pre-orders from tomorrow. It's not said when it'll start shipping but it has said its eBook download service will be going live from early September so we'd say around then.
Sony PRS-505
Price: £200
On sale: TBA
Contact: Waterstones


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Microsoft released a new preview version of its Internet Explorer 10 browser for Windows 7 Nov. 13. With the IE10 Release Preview for Windows 7, consumers can now enjoy a "fast and fluid" Web with the updated IE10 engine on their Windows 7 devices. IE10 is the default browser on Windows 8 and is built for touch. eWEEK Senior Editor Darryl K. Taft spoke with Dean Hachamovitch, Microsoft corporate vice president for Internet Explorer, about some of the changes in IE and what to expect from Microsoft on the browser front--now that the release preview of IE10 on Windows 7 is available for download. Hachamovitch is Microsoft's lead man on IE. See what he has to say.
eWEEK: What's the primary message or theme you want to express to users about IE10? Same question for developers.
Dean Hachamovitch: IE10 is an entirely new IE, and we built it be the best way to experience the Web on Windows. IE10 on Windows 8 brings a pretty exciting new set of capabilities to the Web, such as a browsing experience that is perfect for touch, a full-screen UI, security improvements that offer the best protection against the most common threats on the Web, improved performance, and much better support for HTML5 and CSS3 standards.
The latter is particularly important from a dev perspective since we've added support for all of the standards that developers need, such as CSS 3D Transforms and CSS3 Transitions and Animations for rich visual effects and things like flexbox support for better page layouts. We've also added better storage with IndexedDB and HTML5 application cache and support for Web Sockets, HTML5 drag/drop, sand boxing and so forth. There's a lot here for developers to get excited about.
Further reading
IE has been losing market share. What in IE 10 for Windows 7 do you expect will help regain some of that loss?
Total share isn't the optimization. Gone are the days that you can meet and raise consumers' expectations by building for the lowest common denominator. The browser is really only as good as the OS it runs on. IE9 was a huge step forward for Internet Explorer and has been doing extremely well in the market. The latest numbers from Net Applications show IE as holding more than 54 percent of global market share, and that has been fueled heavily by growth of IE on Windows 7. Not only does IE10 shine on Windows 8, it brings the same powerful HTML5 engine to Windows 7 customers, so we expect it to do very well.
What has Microsoft done to improve the "Chakra" JavaScript engine in this release?
We've done a lot with Chakra in this release and that, plus additional improvements to the hardware acceleration, make IE10 really fast. We continue to focus on real-world performance as the key indicator of speed, but we're pretty consistently beating other browsers on independent third-party benchmarks now, which is a nice reflection of the work the team has put in here.
There's a very detailed blog up on IEblog that lists out all of the enhancements to Chakra, but a few things I'd call out are the substantial improvements to the JIT compiler, plus a lot of great enhancements to the memory allocator and garbage collector.


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We always have a birthday party at the beach since my husband birthday falls smack in the middle of July.
It creates a unique problem because there are no gluten-free bakeries where we vacation. Also, I don't think a homemade cake could withstand the trip.
Last year we decided to bake the cake and frost it after getting here.
This year we made our own mix. We put all the dry ingredients in a baggie and on the day of the birthday, just mixed them together and put the cake in the oven. (Purchasing a mix would work, too.)
There were no serving platters at this condo so the cake was baked in a 9 x 13-inch casserole dish. It turned out perfectly, needed less frosting, and was just all-around easier.
It would be better to premix the frosting, if possible. We used a white frosting we made here, and brought pre-made chocolate frosting to decorate.
Writing the birthday greeting and adding a border and candles were the only things we had to do. The cake was pretty and delicious, and it was nice to have only one cake for our whole crowd!
A couple of tips. Hand-mixing works but bringing a hand mixer is better. And, throwing in a decorater bag and tips also helps. It will make the cake look better and these items take up almost no room.


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It was bound to happen here, as it did in Wisconsin and other American states. First the capitalist class, or 1% if you prefer, creates a crisis, a crisis of financial capitalism which nearly brings down the world economy. It does so through its ideology, neoliberalism; which means destruction of public services by privatisation; letting the banks and corporations run riot through deregulation; and the looting of natural assets by corporations through globalisation. Then, using their tame politicians in the UK, USA and Europe, it makes the middle and working classes and unemployed, the 99%, pay to bailout the banks and save the skins of the bankers. This is privatising the gains and nationalising the losses. Socialism for the rich, capitalism for the rest of us.
So the banks get saved but there is still a big problem because much of that debt incurred by the banks has now been transferred to governments and taxpayers leading inevitably to a sovereign debt crisis, which is where we are now. The Eurozone crisis has been triggered by the sovereign debt crisis brought about by the banking crisis. Still with me? We are nearly there.
In response to the sovereign debt crisis governments in the UK and Europe implement austerity programmes, ostensibly to bailout government debt, particularly in Greece and Ireland. But its not the poor old Irish and Greek taxpayers who are being bailed out, the money is being used, once again, to bailout French, German, Spanish and Greek banks. So taxpayers have been shafted twice, first in the bank bailout and secondly by austerity - which is just another bank bailout.
To top all this the right wing politicians who are the friends of the bankers and the 1%, are now using the crisis to try and smash workers rights. In the USA, in Wisconsin, the Tea Party backed Governor Scott Walker has used the deficit to not only slash services but to try to deny unions their collective bargaining rights. Now in the UK today we hear that the government is contemplating undermining workers rights by making them easier to sack and limiting further their already limited rights to an Employment Tribunal. This crude, class war attack on workers is being carried out in the pretence that it will encourage growth.
The real irony is that the rising unemployment, increasing poverty and lack of growth in the UK are a direct result of this government's austerity programme. Economically, this government is already a complete failure and its only to be expected that it should dishonestly try to pin the blame for that failure on working people and the unemployed, that, after all, is what class war is all about.


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A Stranded Russian damsel, frisky nudibranchs, munching turtles, sleeping sharks, curious octopi. Saturdays dive had it all including a sexy blogger named Harry. If you have not already done so you need to check out Harry's thoughts on our day of diving.
Perfect conditions and an early morning start. The water in the Grotto does not get much calmer than it was on this day. What's the plan? First hole, go right, look for turtles and eels! Ok sounds good…… Hey wait a second I didn't see any eels Harry!
First check off the turtle, then the hovering barracuda (with two 4 inch cleaner wrasse doing their job), then the leaf scorpionfish, followed by a curious but cautious octopus…. and that was just the first half of the dive! By the time we had moved back into the cave it had already been one of the more interesting ones I've had at the Grotto – ever.
Once back in the darkness it got that much better. Moving in through hole two and up towards the mooring line we turned on our lights and began looking for anything that might help kill some time on the safety stop. Almost immediately I saw one, I knew what kind it was and I knew it was special because Harry and I had talked about it. This was the one that helped him get published. I had seen one a few days before at Lau Lau bay and had tried to describe it before our dive. When I saw it I got his attention as soon as possible – and so it began!
Two Halgerda guahan getting close!
Halgerda malesso
Halgerda guahan
If these guys were looking for a little privacy during their courtship then they had come to the wrong place. I'm not sure how many photos were taken of these little guys but Jenna Jamison probably would get a run for her money as titleholder for most photographed sex scene.
Lack of battery power and air left me little time with the stars of the show on the first dive. Fortunately I didn't find any resistance for a second from Harry, who, only moments after arriving at the top of the stairs, declared this was probably his best dive of the year!
New batteries, new tank, new mission another dive buddy. If it's true there are very few photos of these nudibranchs then I have to guess there is also very little video as well. I entered the water and after a brief encounter with another octopi I had no problem finding the small, slow moving, well camouflaged critters of choice. I just had to move towards the flash, and the flash and the flash. Greg and Harry were already snapping away. They had found an area with 5 or 6 Halgerda guahan so once they had moved on in search of additional subjects I settled in with the video camera. For the most part nudibranchs don't make for the most exciting video so it didn't take long before I was looking around thinking - Ok, what other angle can I get, are there others around here that might make a better subject. Then I spotted them for the first time. They had probably been hovering around for a while but I didn't notice till I took my eyes off the little nudies. What else could we add to the list for today……..
How about SHARKS!
Monday, July 23, 2007
Nudibranch sex, Sharks, Octopi.......
Posted by scubatripp at 12:33 AM
Labels: dive sites, Greg Moretti, Grotto, Halgerda guahan, Halgerda malesso, Harry, Saipan, sharks
2 comments:
- Bev said...
Great footage of the sharks Mike! We saw them yesterday but couldn't even get a clear picture of those two!
- July 23, 2007 at 5:47 AM
- Harry Blalock said...
Very awesome footage Mike. I saw them over there, but I'm so used to seeing them that I don't even think about them anymore. I loved watching them on your video though. Great blog entry by the way, keep on blogging!
- July 23, 2007 at 7:54 AM
Subscribe to: Post Comments (Atom)


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It's a two Part process
There are two procedures as part of your redefining experience, and it's crucial that you follow through with the second step. The first step is your initial appointment with your microblading specialist, where you get to design your new eyebrows. Yes! Think of this step as the creative consultation, where you get to choose the shape, colour, curve and definition of your brows (which can take some time). After this, you undergo the initial microblading procedure. The second part of the process is a follow-up consultation, completed four to six weeks after the initial session. As your skin heals and a new layer of skin forms, the original pigmentation fades significantly. The touch-up session is used to go over the penned lines and make any alterations or colour adjustments as needed. The two -part process ensures you love your new brows, and that they last!


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MLS Number: 196001
Create & Print PDF
Bookmark |
Type: Residential
Area | County: Savannah
Community | City: Skidaway Island
Neighborhood: Modena | Skidaway Island Ph 02
Location: 40 Modena Island
Savannah , GA
Beds: 4 | F. Baths: 5 | H. Baths: 1
Setting: Deep Water,Marsh,River,Tidal Creek,Woods
Style: Traditional
Built: 1998
Approx. SQFT: 6800
Pool: Heated,Hot Tub,In-Ground Pool
Fireplaces: 3
POA Fee: 1320
Elementary: Hesse
Middle School: Bartlett
High School: Jenkins
This magnificent waterfront estate boasts unparalleled views of the Intracoastal Waterway and Wilmington River. You'll enjoy the sunrise and sunset...both from your master bedroom! Outdoor living at its best with a heated infinity pool, jacuzzi, custom rock firepit and seating, surrounding decking and balconies, and exquisite landscaping. Exterior is comprised of Honduran mahogany (including garage doors) and Ipe wood. Interior flooring is also Honduran mahogany. The deepwater dock is accessed from a separate lot a short distance away. This home includes an emergency generator, hurricane shutter system, water softener/filtration system, 2 recirculating water heaters, and an energy efficient geothermal Water Furnace system as well as insulated concrete crawlspace. This incredible estate will more than exceed your expectations!
Bookcases Built-In
Ceiling; Tray
Ceilings; 9' Plus
Cove Lighting
Foyer; Entrance
Rear Stairs
Recessed Lights
Wet Bar
Fire Pit
Front Porch
Wrap Porch
Convection Oven
Double Oven
Hood Fan
Ice Maker Machine
Icemaker Connection
Indoor Grill
Instant Hot Water
Self-Clean Oven
W/D Connection
Warmer Oven
Wine Chiller
Follow hwy 204 to Spur 204 to McWhorter Rd, turn Left and follow McWhorter Rd to where road splits & stay left & follow McWhorter to Modena Gate.
»»Lat: 31.9349
»»Long: -81.0470
An amazing and history-rich island. The island where natural beauty can be found almost anywhere in the thousands of square acres of nature and adventure. Four residential communities are situated on the island: The Landings, Modena Plantation, South Harbor and The Marshes of Skidaway Island, the only on island continuing care senior living community. In addition to those residential areas, the island also has The Village, an area with shopping, library, offices, churches, gas station and financial institutions, and the Skidaway Island State Park, maintained by the Georgia Park Service (the Department of Natural Resources).


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Flair is TAPMI's Summer Placement Brochure which gives a snap shot of the college, its activities and the profiles of the first year students of the PGDM course.
Our Summer Internship or MIP (Management in Practice) is an eight week programme beginning from 2nd week of April to June 2011. The selection of the students will be done during the Summer Placement week starting from the 4th of October, 2010.
MIP provides unique opportunities to the students to get deeper insight and understanding about organizations and their management practices under the expert guidance of an industry mentor. The Association of Indian Management Schools had presented this programme the 'Best Innovation in Management Education Award'.
In case you are interested to participate in our Campus Relations Programme 2010-11 in the form of industry interactions, conclaves, workshops, projects, alumni job postings, summer placements and final placements during the year, please send a mail to firstname.lastname@example.com and our team will contact you.


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- Two weeks into the NFL season, fantasy owners face countless critical decisions. Which players top the Week 3 position rankings?
The NFL season is just two weeks old, and breakout performances and key injuries already have fantasy football owners frantically recalibrating their lineups. Among the brightest lights in mid-September: DeAngelo Williams shining in place of Le'Veon Bell in Pittsburgh, Kelvin Benjamin's triumphant return to full strength in Carolina and Matt Ryan's surprisingly consistent start in Atlanta.
Read on for the sortable Week 3 rankings by position from SI.com fantasy experts Michael Beller and Pat Fitzmaurice, which will be updated throughout the week.


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Small business owners struggle in many different ways, some of them more common and significant than others. Many entrepreneurs fight every day to keep customers happy, and that is almost always important work.
Just as many small business owners, however, consistently grapple with the challenge of attracting more clients. In many cases, turning to a digital marketing expert like Dev Chatterjee for help will put an end to such problems for good.
The Most Obvious Answers are Not Often the Best
There are countless ways for small companies today to try to drum up more business. Some of these can be so expensive or time consuming, however, that they will not often make for good places to start.
Many business owners, for instance, will have already experimented with pay-per-click advertising programs like those offered by Google and Facebook. While these can sometimes pay off, it generally takes a fair amount of expertise and commitment to make them do so.
For small business owners who have limited financial resources and schedules packed full of duties, that will not often be entirely satisfying. A better option, in many cases, will be to look into how a process known as "search engine optimization," or SEO, could pay off, instead.
A Reliable Way of Generating More Website Traffic and Therefore More Business
The search engine that is the centerpiece of the gigantic technology company Google serves billions of requests each and every day. Whenever a user enters a query into its interface, the software that powers the search engine must decide which results to return in response.
Google users are far more likely to click through to the pages that crop up first than those that appear later. With the top result for a particular search term often receiving half of all clicks, positioning is of paramount importance.
That fact can end up being one of the important and rewarding of all for the owner of a small business. Working with a small business digital marketing expert who understands how to carry out effective SEO for a website can improve its ranking significantly.
Better yet, the results that follow will not need to be paid for individually, as would visits earned through pay-per-click advertisements. Because of this, seo marketing experts often make the best partners of all for small business owners who are struggling, as so many do, to attract more attention. Simply seeking out the right such source of assistance can make running and growing almost any small business far easier.


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I *really* need help!
I get hundreds of junk mails daily like this:
"to: firstname.lastname@example.com"
I need to do the following:
(1) Send ALL such mail (whether to: or cc:) automatically to my JUNK mail folder (I check it once a day to see it doesn't contain any important / legitimate email).
(2) I also need to send all mail where I'm BCC'd to the JUNK mail folder (almost 100% of my received BCC'd email is junk).
(3) I also want to send to JUNK folder ALL mail from *@hotmail and *@yahoo where I do NOT have the sender in my main ADDRESS book.
Which ones are best handled using the BUILTIN Junk Mail tools? and which with scripts? and which with QUICK FILTERS?
Sorry but I am a total beginner when using these tools in Poco.
THANKS for any and all help!!
Maverick - drowning in many HUNDREDS of JUNK emails daily!


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If your children participate in school clubs and organizations such as band, choir, drama or other extracurricular activities, you've most likely fund raised…or it's in your future. It is inevitable that in order to have money for musical equipment, costumes, or any additional expenses, parents and students must raise money by going door-to-door selling food, coupons, t-shirts, wrapping paper or even magazine subscriptions. Here is the truth: people are tired of the overpriced catalogs of items that no one actually needs, and parents no longer want to spend their weekends washing other people's cars.
However, fundraising is a necessary evil! The majority of extracurricular activities are underfunded and in order to have money for the group's survival or participation in certain events, they must fund raise.
This type of fundraising does raise some money for the club or organization, but there are negatives to it. For one, it is a lot of work with not a lot of profit. In most cases the students don't even get to keep all of what they raise – in fact, they barely even keep half. The other half pays for the product that they had to sell. In addition, fundraising can put children at somewhat of a risk. By going door to door, there is a chance that the children will not know who is on the other side. While most try to go to people they know, some need the money badly enough that they will approach complete strangers.
Safe and trusted sites like www.MoveYourMountain.org are leading the revolution and empowering youth clubs and organizations all over the country to engage the power of the crowd. Online fundraising campaigns give the community a way to learn more about the children and the organization that is raising money. The children have an opportunity to share their love and passion by telling their story. They can explain to their supporters what they are raising money for and why the fundraiser is important to them. This is a great way for your children to demonstrate their commitment to not only their fundraiser, but to their club as well by communicating regularly with club members and supporters. Keeping everyone motivated will help raise even more money.
Online fundraising allows children a safe environment where they can promote their organization(s) and leverage the community without the potential risk of knocking on doors. Raising money through a free and easy to use online platform like Move Your Mountain takes the pressure off the children, allowing them to enjoy their team and focus on doing what they love!
Starting an online fundraising campaign is easy to do and FREE to set up!


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I started playing the guitar when I was seven years old, back in 1964. My mother had bought a Silvertone guitar at Sears that came with an amplifier in the case. It was inexpensive, and hurt your fingers.
After a few years of taking lessons that taught me everything I didn't want to know, like how to read the music, for all the tunes that my parents listened to when they were children, I just started asking my friends how to play "our music." Around the age of twelve, I learned a few chords, and by that time had a $20 guitar from Mexico that I could take with me everywhere. It was fun but not a 'real' guitar. I knew in order to play well, I needed a 'performance' level guitar. I talked to my parents about this… often… but with a large family always needing things this was of little concern.
A few years later, I was about fifteen, my parents took the family over to my uncle jack and aunt Pat's home in Escondido, California, for a few days. Much like young 'Ralphie,' played by Peter Billingsley, in the 1983 hit A Christmas Story, I saw my chance to plead my case. I explained, in front of the extended family, that I could really learn how to play the guitar if I only had a quality instrument. I could have fallen off my chair when my father said, "well son, when we get home, why don't we go shopping?" Soon I had a brand new Ovation, acoustic guitar, with a hard case.
I had two friends that I spent most of my time with, Scott Maish and Steve Pursell. Scott was a better guitar player than I was, but Steve came from a family with twelve children, most if not all could not only play well, but they could also sing. From that time forward where ever we were, there was always a guitar or two close by.
Mike and I last year at an Open Mic run by Raul Odonell in Anthem Arizona
After high-school I went to Scottsdale Community College, studying Music and Theater. That's where I met Mike Assad, who I did my first gigs with.
When Kathy and I got married in out early twenties, I put the music on the back burner. I played a little at home but was mostly trying to find my way as a husband and father of two.
And then, one day in my mid thirties, I was doing a barbecue at the local Bashas' grocery store, and a kid by the name of Ryan Hall was helping me. We decide to play a few tunes while the ribs cooked. That was the basis of my starting to play as an adult. Soon I was playing with Mike again, and a few years later I found the Open Mic at Joe's Grotto in Phoenix. From there I started playing and learning performance. I started running my own open mic and playing constantly. Mike and I have been playing out at least one day a week for most of the past sixteen years. We do a mix of acoustic blues and folk rock.
I was at home a month go when I had an idea… what about the band? I mean the band that we never had… Steve was now a great drummer and Scott was a great lead guitarist. We could play all those hard rock tunes that we loved in high-school. I called Scott, who lives in Tucson and Steve in east Chandler… they were in. I have a ton of equipment, thanks to Fender Musical Instruments. After one practice we decided to bring Mike onboard. Were tossing out all the easy listening stuff. Our motto, "More rock, less schlock!" Today we work on War Pigs!


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Western Kansas Scholastic Closing Ceremony
Joe Denoyer - February 17, 2017 10:09 am
Every year the Western Kansas Scholastic Art Association organizes an exhibit for middle school and high school art students to display their work and compete for the chance to advance to the National Scholastic Art and Writing exhibit. The Baker Arts Center in Liberal has the privilege of hosting this wonderful exhibit which showcases the artwork of young artists residing in the western third of our state.
A panel of judges reviews the works and selects which ones will be accepted into the show and the ones to receive awards. The Gold Key and American Vision Award winners are the ones that advance to the National Scholastic Exhibit and become eligible for scholarships. This exhibit began in 1923 and continues to be the best outlet for the recognition of the artistic accomplishments of the youth in our country.
The exhibit has been on display at the Baker Arts Center since January 24, and will close with a Public Closing Reception on February 26 from 2-4pm. Light refreshments will be served. The Baker Arts Center is located at 624 N. Pershing in Liberal, and is open Tuesday through Friday 9-5 and 1-3 on Sundays.


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If you are looking for a simple way to set an alarm on your computer, you might want to check out Online Music Alarm. Unlike other websites, as you may have already noticed, Online Music Alarm allows users to choose their own favorite YouTube video to play as the alarm and not some annoying sound.
The Online Music Alarm is available as a web application in the Chrome Web Store. Just download the application and click on the "Set Music Alarm" tab. You will now be required to enter the name of the video you want to set as your alarm. Select the video you want, click on the "Select Song" button, and you will then be required to enter the alarm time when the selected video clip should start playing.
When the alarm time is over, the selected video clip will be played in the browser.
- Set your favorite song as the alarm.
- Set more than one alarm timer.
- Choose from an array of YouTube videos.
- Available as web app in Chrome Store.
Check out Online Music Alarm @ https://chrome.google.com/webstore/detail/pblohfmipkhnjcgpoamnmjelcajhpcjg


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How are we compensated; we earn a success fee at closing of 1% to 5% of the funded amount, determined primarily by the loan size but also depending on the type of transaction and other factors.The initial work performed on any new account is always at our expense and involves an internal review and analysis of the loan request by our Financial Services Firm followed by further review with the specific lender selected.
The lender is selected on the basis of the borrowing company's industry type, geographic location, loan size, credit profile, type and mix of collateral etc. The lender who is approached with the transaction must express a defined interest in providing a proposal based on the representations that have been made by the borrower before they will issue a terms letter.
Access to broker/dealer firms charge for their time and efforts. These costs are paid in the form of a retainer or hourly billing.
The majority of the Financing Services Firm generally require a REFUNDABLE retainer of $3,500 or above; but only after the borrower has received and agreed to proceed with the lenders specific terms. If the transaction proceeds to closing and closes the retainer is credited against the closing fees, The retainer is non-refundable if their are material misrepresentations or omissions by the borrower or the borrower fails to proceed with the financing.
There are circumstances when a retainer can be waived and when we say waived we mean we are willing to cover up to $10,000 in hard and soft cost for the borrower.
We are providing the borrower with a specific lender who can offer financing to them based on the lenders review of the representations made by the borrower with respect to loan size, geography, credit profile type and mix of collateral etc.The retainer paid by the borrower is an engagement fee to arrange for the specific financing. We work on a non-exclusive basis and you may choose to accept other financing or pursue other available financing options.
When our borrower misrepresents collateral or cash flow
We require the retainer to protect ourselves against situations where the borrower has inadvertently misrepresented the value of collateral or the cash flow to cover debt service. It would also protect us in a case where the lender finds they cannot perfect a security interest in the collateral being offered or the borrower cannot provide the necessary documentation that the lender requires.
Private Lenders
Who are the Private Lenders or Where are the funds for your Transactions obtained?
Our Lenders are NON-BANK lenders located throughout the country that obtain their funds, not from deposits such as a bank but rather from the sale of notes and bonds on Wall Street and through private investors. They are, therefore, able to take on more risk and provide financing for tougher transactions that do not qualify for bank financing.
Pre Closing expenses are the responsibility of the borrower.
The purpose of due diligence is to allow the lender to confirm that the representations made by the borrower are true and correct so that they can close the loan.
All our lenders generally require the borrower to cover their costs of due diligence prior to loan closing. If lenders were to pay the due diligence costs they would often waste their money traveling to the borrowers company or property and performing appraisals and audits on situations where the results of that due diligence were such that the loan cannot be closed.
If the lender were willing to pay for the examination and investigation necessary to close the loan, borrowers who have problems might not disclose them in hopes that the lender would not discover these issues that may have previously caused the loan to be rejected.
Lenders due diligence may include a site inspection at your company focusing on your back office operations relative to the performance of your accounts receivable. Particularly they will want to examine the exact service or product provided, how you bill, to whom you are billing, the net collectible amount paid to you after allowances and deductions, any potential offsets due other parties or issues that could lead to offsets and the historical performance of your AR's returns.
Real Estate, Equipment and Inventory appraisals that are more than 6 months old will likely need to be updated or in some cases may need to be redone.
Character of the borrower and the Company
The lender will also be concerned with the character of the borrower (both from a company perspective as well as from the principals perspective) as it relates to previous issues of fraud or bankruptcy etc. They will also need to clearly confirm the viability of the company going forward and any legal issues that might cause them to suffer a loss with respect to the loan to be consummated.
This could include the possible inability of the lender to obtain a first lien against the collateral or the borrower's inability to cover debt service etc. The lender will be available to explain in detail what could cause them not to close the loan so that there are no surprises once you have agreed to their terms and conditions and before you pay for the due diligence.
How much time is required to Close?
The standard Time to close a transaction is 30 to 60 days
Bridge or Mezzanine Loans 7 to 21 days
All businesses proceeds on beliefs, or judgement of probabilities, and not certainties; Charles W Elliot


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a. Governing Board-engaged Faculty
Governing Board-engaged Faculty Consultants are specialists who carry out the programs of CPSC through teaching, research or such other duties as may be assigned by the Director General. They are recruited from the CPSC member countries by the Governing Board. Only one GB Faculty per member country shall be appointed by the Board at a given time. All expenses related to the appointment of a Governing Board-engaged faculty are borne under the operating budget of CPSC.
b. Seconded Faculty Consultant
The Seconded Faculty Members are academic professionals who are seconded by participating Governments or other agencies and similarly functions to carry out the academic programs of CPSC. Financial arrangements (salaries, allowance, compensation, and so on) are made between the concerned agencies of the seconding government and the seconded faculty himself.
c. Specialist
Specialists are academic professionals who carry out the programs of CPSC through teaching, research or such other duties as may be assigned by the Director General. They are appointed by the Director-General through the Academic Board. Initial period of appointment of specialists is for one year renewable on satisfactory performance. The tenure of service is fixed for a maximum period of two years and shall not be eligible for re-appointment after completion of the said contract. Monthly remuneration and other travel expenses and benefits, as per the Terms and Conditions of Service for Specialists, are borne by CPSC under its operating budget.


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ATTENTION Buyers and Sellers
Are you looking for a property to purchase or do you wish to sell an existing facility?
We Offer Consulting Services
Market Studies: Demographics, Competition, Strategies to Capture Market Share
Operational and Financial Reviews
Strategies to Improve Performance
Pre-Due Diligence Audit (for sellers)
Client Specific
Property Evaluations:
Property Management
Tell us about your particular situation. Not any of these? We may still be able to help.
Hilda W. Allen Real Estate, Inc is aware of the intricate and delicate nature of both selling and buying investment real estate. We have put together some forms to help all parties involved.
Click on the appropriate door and you will find the forms that we ask you to complete in order for us to assist you...
Buyer's Room
Seller's Room
• Confidentiality Agreement
• Questionnaire


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BraceUP Stabilizing Lumbar Lower Back Brace and Support Belt with Dual Adjustable Straps and Breathable Mesh Panels (L/XL)
The BraceUP Stabilizing Back Support provides comfortable support to your back while still allowing you full range of movement. The curved design helps minimize slipping and bunching. Eight stays give additional support to the back. Mesh panels allow for the release of excess heat and moisture. Dual adjustment straps ensure you achieve customized support for… Read More »