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Bhattacharyya N, Fried MP. Assessment of the Morbidity and Complications of Total Thyroidectomy. Arch Otolaryngol Head Neck Surg. 2002;128(4):389–392. doi:10.1001/archotol.128.4.389
© 2018
Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2002
To determine the incidence and predictive factors for complications after total thyroidectomy.
Cross-sectional analysis of a national database on total thyroidectomy cases.
The National Hospital Data Survey database was examined and all cases of total thyroidectomy performed during 1995 to 1999 were extracted. In addition to demographic information, postoperative complications including hypocalcemia, recurrent laryngeal nerve paralysis, wound complications, and medical morbidities were identified. Statistical analysis was conducted to determine potential predictive factors for postoperative complications.
A total of 517 patients were identified (mean age, 48.3 years). The most common indications for total thyroidectomy were thyroid malignancy and goiter (73.9% of cases). Eighty-one patients (15.7%) underwent an associated nodal dissection along with total thyroidectomy, and 16 patients (3.1%) underwent parathyroid reimplantation. The mean length of stay was 2.5 days (95% confidence interval, 2.3-2.8 days). The incidence of postoperative wound hematoma was 1.0%, wound infection was 0.2%, and mortality rate was 0.2%. The incidence of postoperative hypocalcemia was 6.2%. Younger age was statistically associated with an increased incidence of hypocalcemia (P = .002, t test), whereas sex (P = .48), indication for surgery (P = .32), parathyroid reimplantation (P>.99), and associated neck dissection (P = .21) were not. The mean length of stay was 2.5 days and was unaffected by occurrence of postoperative hypocalcemia. The incidences of unilateral and bilateral vocal cord paralyses were 0.77% and 0.39%, respectively.
Postoperative hypocalcemia is the most common immediate surgical complication of total thyroidectomy. Other complications, including recurrent laryngeal nerve paralysis, can be expected at rates approximating 1%.
NEOPLASTIC, inflammatory, and endocrine abnormalities of the thyroid gland are extremely common, affecting approximately 11% of the general population.1 As such, surgery for thyroid gland abnormalities is quite common, with an estimated surgical volume of more than 80 000 procedures per year in the United States.2 Total thyroidectomy is generally reserved for patients with thyroid malignancy, toxic thyroid disease (thyrotoxicosis or toxic multinodular goiter), or clinically significant goiter. Less commonly, it is performed for chronic thyroiditis or parathyroid disease. In the setting of thyroid malignancy, total thyroidectomy may be accompanied by a regional nodal dissection as clinically indicated. Despite its frequency, total thyroidectomy remains a technically demanding procedure.
The focus of modern thyroidectomy centers on potential morbidity from the procedure with emphasis on prevention of injury to closely investing structures such as the recurrent laryngeal nerves and the parathyroid glands. As opposed to unilateral thyroid lobectomy, total thyroidectomy carries potential risk to all 4 parathyroid glands and both recurrent laryngeal nerves. Whereas parathyroid injury during unilateral thyroid lobectomy is unlikely to result in hypocalcemia, postoperative hypocalcemia is a significant risk after total thyroidectomy. Similarly, although unilateral recurrent laryngeal nerve injury during thyroid lobectomy may have a significant impact on voice quality, bilateral recurrent laryngeal nerve injury during a total thyroidectomy has more serious airway consequences. Therefore, it is essential to quantify the incidences of postoperative hypoparathyroidism and recurrent laryngeal nerve injury, and to identify potential predictive clinical factors for these morbidities. Such information is important to properly counsel patients and determine preoperative risks for patients considering total thyroidectomy. We sought to examine the modern incidence of and potential risk factors for postoperative hypoparathyroidism and recurrent laryngeal nerve injury after total thyroidectomy using a national database.
The National Hospital Discharge Survey (NHDS) database for the calendar years 1995 to1999 was examined, and the records of patients undergoing total thyroidectomy as the primary surgical procedure (International Classification of Diseases, Ninth Revision [ICD-9], procedure code 6.40) were extracted. These data were imported into a SPSS database (version 10.0, SPSS Inc, Chicago, Ill) for subsequent analysis. In addition to total thyroidectomy, associated procedures such as lymph node dissection and parathyroid reimplantation were identified using corresponding ICD-9 procedure codes.
For each case, presence or absence of individual surgical complications including wound infection, postoperative hemorrhage, fistula formation, hypocalcemia, and death was determined based on corresponding ICD-9 codes. In addition, analysis for medical complications including myocardial infarction, stroke, and pneumonia was conducted. Descriptive statistics were computed for the patient population under study including demographic variables, indications for total thyroidectomy, complication rates, length of stay (LOS), and disposition.3
χ2 Analysis was conducted to determine if patient sex, surgical indication for total thyroidectomy, or lymph node dissection (in addition to the thyroidectomy or parathyroid reimplantation) had any influence on the incidence of postoperative hypocalcemia. The t test was used to determine if age impacted on incidence of postoperative hypocalcemia and also to determine if the presence of postoperative hypocalcemia significantly added to the LOS.
From 1995 to 1999, a total of 517 patients were identified with total thyroidectomy as their primary procedure in the NHDS database. The mean patient age was 48.3 years, and 81.8% of the patients were female. The indications for surgery are listed in Table 1. The most common indications for surgery were thyroid malignancy and goiter, together accounting for 73.9% of cases. Eighty-one patients (15.7%) underwent an associated nodal dissection along with total thyroidectomy, and 16 patients (3.1%) received parathyroid reimplantation. The mean LOS was 2.5 days (95% confidence interval, 2.3-2.8 days). Medical morbidities were distinctly unusual, with rates for myocardial infarction, stroke, and pneumonia determined at 0.2%, 0.6%, and 0.6%, respectively. Five patients (1.0%) encountered a postoperative hematoma or hemorrhage, 1 patient (0.2%) experienced a postoperative wound infection, and 1 patient died (mortality rate, 0.2%). Overall, 32 patients (6.2%) were identified with postoperative hypocalcemia. None of the 3 patients who underwent total thyroidectomy for parathyroid disorders had postoperative hypocalcemia. Four patients (0.77%) were diagnosed as having an associated unilateral vocal cord paralysis and 2 patients (0.39%) had bilateral vocal cord paralysis.
Results of the statistical analysis examining for associations between patient characteristics, surgical indications, and procedures performed are displayed in Table 2. No statistically significant associations between the occurrence of hypocalcemia and sex, indication for surgery, presence of a nodal dissection, or parathyroid reimplantation were identified. The mean age of patients with postoperative hypocalcemia was 40.6 years, whereas the mean age for patients without hypocalcemia was 48.8 years (P = .002, t test). Although LOS was slightly longer for patients with postoperative hypocalcemia (mean LOS, 3.1 days) than those without (mean LOS, 2.5 days), this difference was not statistically significant (P = .10, t test).
As a cross-check in the database, the diagnosis of hypocalcemia was cross-validated with the diagnosis of hypoparathyroidism to determine accuracy of coding within the database. Every patient who experienced postoperative hypocalcemia was also designated as postoperative hypoparathyroidism, indicating 100% concordance.
The NHDS is an annual survey conducted by the National Center for Health Care Statistics, which is a public agency charged with tracking health care utilization on a yearly basis across the United States. From the aggregate group of all US hospitals, representative institutions are randomly selected to provide data for the NHDS. A sample of discharge records from this national sample of nonfederal hospitals from all 50 states and the District of Columbia are reviewed; trained staff members collect data both manually and electronically. Community hospitals, teaching hospitals, and tertiary care centers are all sampled. This data set has been frequently used to determine benchmarks for incidence of disease, rates of surgery, and annual trends. In addition, it has been used to investigate mortality and morbidity in both surgical and medical patient populations.4-7
The NHDS data have been previously used to determine the incidence of various procedures, the prevalence of disease, and year to year trends in surgery.4 We have previously reported on the use of this database for assessing mortality, morbidity, and LOS for head and neck surgical procedures.3 In general, NHDS data are believed to accurately reflect disease and surgical mortality, but less accurately reflect morbidity.6 The NHDS data collection system consists of a random sampling of these institutions, carefully chosen to represent an accurate cross section of medical practice in United States. Therefore, treatment biases, selection biases, and institutional biases are less likely to play a role.3 The NHDS data extracted in this study differ significantly from the patient populations in most of the head and neck surgical literature because almost all previously published literature reflects experiences from single academic institutions. This introduces an inherent bias, since teaching hospitals have a well-documented lower mortality rate and different patient populations than community hospitals.8
Several authors have reported on institutional series of thyroid surgery for benign and malignant disease. However, to accrue significant surgical case volumes with which to study incidence and trends, the majority of the studies have been retrospective, encompassing 10- to 20-year periods at a single institution. This makes a true assessment of these incidences somewhat difficult because of variabilities in surgical technique, accuracy of medical records, and other factors that may change over time. Furthermore, many of these series include several different procedures including total thyroidectomy, subtotal thyroidectomy, completion thyroidectomy, and even unilateral thyroid lobectomy. One reason for analyzing the NHDS database was to study a large volume of procedures occurring in a short period without institutional biases.
Postoperative hypocalcemia after total thyroidectomy has been reported to range from 1% to 40%.9-13 Recently, Sasson and associates14 reported on a 9-year series of 141 thyroidectomies (69 total thyroidectomies). Not unexpectedly, total thyroidectomy was strongly associated with postoperative hypocalcemia (incidence, 13%) when compared with other forms of thyroid surgery. Interestingly, unintentional parathyroidectomy was not associated with an increased risk of postoperative hypocalcemia.14 Many of the published series regarding the incidence of hypocalcemia after thyroidectomy include several different procedures aggregating unilateral lobectomy, subtotal thyroidectomy, and total thyroidectomy. Careful review of each study is necessary to determine the incidence of hypocalcemia in the total thyroidectomy subgroups.11,14,15 Calculation of hypocalcemia rates, while including the unilateral thyroidectomies in the denominator, will tend to underestimate its overall incidence.
Controversy still exists regarding factors that are associated with postoperative hypocalcemia. Overall, the pathogenesis of postoperative hypoparathyroidism is likely to be multifactorial.16 Although patients with nodal dissection were almost twice as likely to manifest postoperative hypocalcemia, we did not find this association to be statistically significant. Other investigators have found neck dissection to be associated with higher incidences of both temporary and permanent hypoparathyroidism, and cite this risk as an argument against prophylactic neck dissection.11,17 As neck dissection may contribute to postoperative hypoparathyroidism via devascularization or other surgical trauma, it should be reserved for cases with clinically evident nodal disease.
Similarly, while some authors have identified parathyroid reimplantation as a risk factor for postoperative hypocalcemia, other authors have not found this to be the case.14,18 We failed to find an association between parathyroid reimplantation and the presence or absence of postoperative hypoparathyroidism. Therefore, it seems that parathyroid reimplantation neither protects against postoperative hypocalcemia nor predisposes to it. The decision to reimplant should be based on clinical factors at the time of surgery, retaining the parathyroid glands in situ whenever possible.19
We were somewhat surprised that the indication for total thyroidectomy was not found to influence the rate of hypocalcemia. Other smaller series have found that total thyroidectomy for malignancy is associated with higher rates of postoperative hypocalcemia.14 However, many of these studies include both hemithyroidectomy and total thyroidectomy in their patient populations, or they group patients differently.11 As patients with malignancy are more likely to also undergo total thyroidectomy, the true variable predicting hypocalcemia may be in fact the extent of surgery. Although mean LOS was slightly higher for patients with postoperative hypocalcemia than for those without, this difference was not statistically significant. This suggests that corrective measures for early postoperative hypocalcemia are able to rapidly correct serum values or that other factors (such as suction drain output) more strongly influence LOS.11,20 Since postoperative hypocalcemia generally manifests within 24 hours of surgery, delay in the diagnosis of postoperative hypoparathyroidism does not tend to contribute to an increased LOS.
Published rates of recurrent laryngeal nerve injury vary widely in the literature. This is likely due to differences in definition of palsy, diagnostic biases, and reporting biases. However, it is generally believed that recurrent laryngeal nerve injury, either temporary or permanent, is likely to occur in approximately 1% of unilateral lobectomy cases and 2% to 3% of total thyroidectomy cases.11,15 Total thyroidectomy carries an increased risk for recurrent laryngeal nerve palsy, not only because both recurrent laryngeal nerves are placed at risk, but also likely because patients undergoing total thyroidectomy often have more advanced disease. In this series, the rates of unilateral and bilateral vocal cord paralysis were too small to undergo meaningful statistical analysis for predictive factors.
Our data clearly indicate that total thyroidectomy is a safe procedure, with an expected mortality rate of only 0.2%. Medical complications such as myocardial infarction, stroke, and postoperative pneumonia are quite rare. Similarly, rates for local wound complications such as postoperative hematoma and wound infection are distinctly low. The identified morbidity and mortality rates for total thyroidectomy compare favorably with other series that include both unilateral and bilateral surgery.11 These relatively rare morbidities should not deter surgeons from performing total thyroidectomy when appropriate for the patient's level of disease.
Although analysis of the large randomly sampled national database such as the NHDS data set has distinct advantages in diminishing selection biases and reporting biases, there are several limitations in its use for the present analysis. Because the analysis is essentially retrospective, it is difficult to assess causality. Rather, we are able to compute the incidence of selected complications and identify associations between these postoperative complications and clinical factors. For example, it is possible that some patients may have had preoperative unilateral vocal cord paralysis, and therefore it would be inaccurate to list such patients as having had recurrent laryngeal nerve injury after total thyroidectomy. However, detailed review of the data indicates that 3 of the 4 patients with unilateral vocal cord paralysis underwent total thyroidectomy for benign disease. As these patients would be unlikely to have preoperative paralysis, it is fair to conclude that the vocal cord paralysis resulted from total thyroidectomy. Similarly, both patients with bilateral vocal cord paralysis underwent surgery for benign disease (goiter), and would be unlikely to have had preoperative bilateral vocal cord paralysis.
Also, the current methodology will fail to capture patients whose complications were not diagnosed during their inpatient stay, but were subsequently diagnosed in the outpatient setting.3 Given that the mean LOS approached 2.5 days, we would expect that most cases of postoperative hypoparathyroidism would be captured, since greater than 94% of cases of hypocalcemia manifest within 24 hours after total thyroidectomy.20 It is also possible that some surgeons may have administered oral calcium as part of routine postoperative management. This may mask the immediate onset of postoperative hypocalcemia, tending to deflate the overall incidence of immediately diagnosed postoperative hypoparathyroidism. In addition, it is possible that some patients experienced postoperative recurrent laryngeal nerve paralysis, but the diagnosis was not confirmed until postoperative follow-up evaluation in the outpatient setting. The best determination of the true incidence of postoperative recurrent laryngeal nerve paralysis would be obtained by examining all patients before and after thyroidectomy with laryngoscopy with electromyographic confirmation of selected cases. Understanding these limitations, our data can be interpreted as minimum values for recurrent laryngeal nerve complications in the total thyroidectomy setting since initially undetected cases may be subsequently diagnosed on an outpatient basis.
Despite the fact that total thyroidectomy is a more involved procedure that exposes more parathyroid glands and recurrent laryngeal nerves to surgical risk than unilateral thyroid lobectomy, it is an inherently safe procedure. Local complications such as recurrent laryngeal nerve paralysis and wound complications can be expected to occur at rates near 1%, while postoperative hypoparathyroidism may occur in approximately 6% of cases. Neither nodal dissection nor parathyroid reimplantation seems to affect the risk of postoperative hypocalcemia. Since few modifiable factors can be identified that predict increased surgical risk for these complications, the extent of thyroidectomy surgery should be based on patient preferences, the experience of the operating surgeon, and the overall clinical setting.
Accepted for publiction October 2, 2001.
Corresponding author: Neil Bhattacharyya, MD, Division of Otolaryngology, 333 Longwood Ave, Boston, MA 02115.


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Damian Wayne, and Grant Morrison's tendency to kill his darlings
In the swelling tide preceding Batman Incorporated #8, the promised death of the current Robin and the impending finale of Grant Morrison's six-year opus, something jumped out at me about the writer's previous work for hire: He has a propensity to kill the characters he introduces into the universes of Marvel and DC Comics before he leaves.
Think back to his first major mainstream superhero book, JLA. In it, Morrison and Howard Porter revived the team in a back-to-basics approach featuring the seven most popular and iconic members. But during that time Morrison also created (with Mark Millar and N. Steven Harris) the Mesoamerican hero Aztek. Launched in his own series — whose first issue teased his impending death — Aztek later joined Morrison's JLA and was killed in JLA #41, the writer's final issue.
Next came Morrison's acclaimed (and sometimes criticized) run on Marvel's New X-Men. In that, he created the introduced the helmeted Xorn, a Chinese mutant with a "star for a brain" who was one of the series' most popular characters outside its longtime cast. However, Xorn was famously revealed in the writer's penultimate arc to be a construct of Magneto, returning from the dead. Although Morrison effectively killed Xorn, Marvel quickly brought the character back in some conflicting stories that included twin brothers, clones and, most recently, ghost.
Not to diminish the death of Damian Wayne, but putting his death alongside Xorn's and Aztek's in a broader context of Morrison's storytelling decisions within work-for-hire superhero comics raises an interesting question: Is it a coincidence, or is Morrison consciously trying to limit the use of characters he created? Or maybe, perhaps, it's Morrison giving his creations something most work-for-hire characters never have: a genuine third act.
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Some thoughts about being healthy, getting in shape and my own path to obtaining this... A critical part of preparedness!
A very important component of preparedness is good health. Besides having the ability to hike, walk and physically do the work that will be necessary for survival in any extreme condition, If you are unhealthy, you most likely will be in need of many things that may not always be available. For instance, due to bad health, you may need various medications that could be eliminated by getting healthy and taking better care of yourself. Although this may not always be the case, most of the time it is.
So the big question is, how do you get healthy? There are so many "quick fixes" and "secret diets" out there that people are often tricked into the latest fad or extreme, and often dangerous diet. These can include harmful drugs or hormones, unhealthy herbs, starving or just eating a particular type of food while avoiding essential parts of your diet. Through the studies that have been done, many of these work... temporarily. But not without a cost. And most often, the cost is harmful to the body, permanently damaging and sometimes even deadly.
That leads us to what really does work. And not only what works, but what is long-term, healthy and effective. And surprisingly, there's no "quick-fix" to true results. Like anything that lasts, it's hard work. What's the secret? Eat healthy and exercise!
Now, to eat healthy and exercise, certain things are required that many people lack, particularly in today's society. You need self control and patience! Today, everything is now, now, now! Fast food, instant meals, video on demand, information on demand, etc. etc. If the fast food drive through doesn't have our meal waiting for us by the time we get to the window, we get mad and impatient! It's no wonder we are wanting our good health and optimal weight on demand too!
And then there's our lack of self control. Just look at our eating habits. Everything is "super-sized"... plates are bigger, soup bowls giant, sodas are quickly approaching a gallon, etc. We eat bad food and we eat huge portions of it. And it extends to all areas of our lives, not just our eating habits. For example, take a look at our financial situation. We are a society of give it to me now, give it to me big and I don't want to wait for it, even if I can't afford it or shouldn't have it. Lack of self control and lack of patience has overcome us in many areas of our lives.
So how do we overcome these problems on a personal level and obtain self control and patience? Well, sometimes it needs to be a specific moment when you stop and realize something is wrong and you need to make a change and make it now! Sometimes this can be a decision you just make on your own and sometimes it is due to a life-changing event. Either way, the decision needs to be made and the long-term commitment made.
For me, this decision was made at Thanksgiving time, 2010. On Thanksgiving night, I wasn't feeling very good. The next few days found me sick and wishing I was dead. I had a bad case of the flu, but without a fever. Not sure what was wrong, I was just sick. After a few days, I started to get really frustrated. The treadmill was in the room where I was resting, watching movies and feeling sick. Finally, I got up and got on the treadmill. I remember thinking that it was time to get healthy or die, whichever came first. I know it sounds a little dramatic, but I was frustrated and sick and tired of feeling the way I was feeling. So I started jogging (for not very long) and then walked. Then I'd jog (for only 30 seconds or so) then walk for a while and walk some more. After about 30 minutes or so, I started feeling better. It was a really strange thing. I still felt sick like I was getting over a bug, but somehow I began feeling better too.
At that moment, I made a decision that I was going to change everything. I was 100% committed to getting over the slump I'd been in and the struggle of getting in shape that had been weighing me down for so long. And best of all, it was going into the holiday season...
So from that moment on, until I reached my goals (which are pretty big), I decided that I wasn't going to drink any soda or eat any candy or deserts until I reached my goal (except for Christmas day, which was my day off to eat whatever I wanted). And I was going to avoid unhealthy carbs like white bread and other refined flour items, eat lots of vegetables, fruits and healthy meats and proteins. I was also going to focus on drinking lots of water. We made homemade wheat bread and I got a slice of that with each meal, with no butter (It's amazing how good toasted homemade wheat bread is all by itself). I ate eggs for breakfast almost every day (with a little ham, a little turkey, some salsa or whatever else I could put with it to add variety). I was going to decrease my portions and evaluate everything I ate as to whether it was good or bad for me. Amazingly, much of what I thought wasn't "that bad" was put on my bad list. I began to eat for health, not out of boredom or simply for pleasure.
Then, I committed to exercise daily. I began doing the RaceRx cardio program as well as bike, elliptical and treadmill. Many days, when I felt lazy, I'd simply walk fast at an incline on the treadmill until I felt like exercising. Sometimes this would be 5 miles. The more I exercised, the better it felt, the further I could run, the better my endurance, the more fun I had.
Christmas day came and I had been saving up many of the treats that I'd been receiving from people. I'd stick them in the freezer, fridge or wherever else so they'd be fresh and ready for me on my day off. Well, that morning after our traditional steak and eggs Christmas breakfast, I dug in. Half way through the day I felt sick and wanted to vomit. Those things I thought were so good that I was sacrificing, weren't really all that good like I'd remembered. After lunch time, I decided to go back on my healthy eating routine just because the thought of another sweet was making me sick. Three days later, I finally worked off what I'd put on during those Christmas hours of gorging myself with treats. I'd eliminated that inner craving for sweets.
Every few weeks I would also take a week and focus on higher protein, lower carb meals. This was kind of a "reset" of my system and just long enough to get me over the rut that I'd find myself in. During that time I'd focus on lots of vegetables and healthy meats, often cooked with olive oil. And during that week, the few carbs I would eat would be healthy carbs. It wasn't a "no-carb" week, but a "lower-carb" week.
Well, 12 weeks have gone by and I'm down almost 3 pant sizes and about 50 pounds! I have much more energy and feel a world of difference! I'm still not to my goal, but have hit a huge milestone. Now that a lot of my weight has been shed, I'll be adding more weight lifting and muscle strengthening to my routine. This time it's a long-term goal that I am still 100% committed to achieving and maintaining.
Now it is much more enjoyable to do the things I enjoy. Hiking, backpacking and being out in the mountains is completely different when you're in better shape. And I am already seeing how important this is in a person's preparedness plans. Get healthy! Get in shape! Strengthen your body and prepare yourself so that when stressful and demanding things are required of you, your body is better prepared to handle those tasks. And when those demands are not there, you can better enjoy the healthy new you!
As for reaching the rest of my diet and health goals, I'll keep you posted...
Enjoy the journey!
AZ Prepper


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Important: You need to post your entry to the blog with an account (leave an email address in the comment or use a username that you use on a forum like Silver Stackers or Kitcomm) or I will not be able to contact the winner.
Answer: A good question to narrow it down. Yes it is precious metals related (more info in afternoon clue).
There has been a break in the mystery... from Beer Holiday:
Number of gold mining co shares issued. On the ASX I guess. I don't follow the penny stocks, hopefully they had lots of placements this year.
As per above, I need specifics (company name)... but the above should help considerably to final answer.
The answer was guessed correctly by euphoria, it is the issued shares over a 10 year period for Gold Anomaly Limited (GOA) on the ASX. I will put up a post later tonight or over the weekend with more information.
But it's something to think about in the meantime. Some of these small cap mining stocks are better scrip printers than Bernanke himself.


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Welcome Carnival of Breastfeeding readers! This month we are writing about Nursing in Public. Please read more of the posts, found at the bottom of this post. More links will be added through Monday
Whenever I nursed my first two children in public, in the United States, I was almost always confident and sure of myself. I never used a cover-up, and I nursed just about everywhere I went. Restaurants, stores, parks, museums. Sure, in the first few months of nursing my first child, public nursing made me a little nervous. But once I got some practice, there were no worries. But here is the important point: the United States is my home country.
Nursing in public changed entirely for me once I arrived in Costa Rica. My family and I are immigrants here. Although my newest child, born in Costa Rica one month ago, is a Costa Rica citizen, my family and I are still somewhat like strangers in the culture. We may be in the process of achieving residency here, but we haven't exactly become natives. There is so much that is unfamiliar to us here, including the language. Although my goal is to become fluent in Spanish, learning has been a lot slower than I'd like simply because I'm a really busy mother. Sometimes when I walk around town, I have no idea what the people around me are saying.
You might be wondering what all this might have to do with breastfeeding. Well, ever since coming to Costa Rica, I've been really stressed about nursing in public. It's not because Costa Rica has any laws preventing public breastfeeding. It's also not due to Costa Rican breastfeeding culture. I mean, Costa Rica is a country that really values motherhood, fatherhood, and family life. Heck, I've seen teenagers here walking down the street and happily holding hands with their parents or grandparents. The reason I'm suddenly uncomfortable has a lot to do with my own sense of cultural awareness, or lack of it.
You see, in the United States, I knew that if anyone ever confronted me in public about breastfeeding in public, I would be armed with information about the law which I could share with the offended person. Or I could just tell them off. Here in Costa Rica, it's not so easy for me. Not only am I not that familiar with the laws, but I would be unable to explain myself in Spanish if I were ever confronted. This really stresses me out.
I also sometimes have trouble reading the cultural signals. For instance, when my family and I were sitting in a park one day, an older woman once gave me and my husband some very negative looks. We had no idea why she was looking at us this way. Was it because my kids were climbing on the metal fence at the park? Was it because I was wearing shorts (in some instances, shorts are not socially acceptable for adults here). Was it my nose-ring? Or maybe the woman was just having a bad day?
In a public breastfeeding situation, I fear that I won't be able to read the signals that people are giving me. For instance, are the men who avert their eyes from breastfeeding just being polite, or are they horrified to see a woman with her breasts out in public? Am I expected to using a nursing cover-up, or can I just lift my shirt with no problem? Will people be uncomfortable if I nurse my four-year-old? And what about nursing in restaurants and other public places? Will breastfeeding be OK everywhere?
Just the other day, I nursed my four-year-old for the first time in front of our maid, Olga. Even though I was nursing in my own house, I was a little nervous about what her reaction would be. Would she be shocked or embarrassed? Would it be a source of discomfort for us on the days when she was cleaning our house? When I nursed J, Olga luckily smiled right away and put me at ease. That made me feel so much better. But a few minutes later, she asked me something in Spanish about it. I didn't understand much of what she said, but I got the feeling that she was asking me if it was OK to nurse both children in tandem. She ended her questions by saying, "es bueno?" So I said, "Si! Es bueno." But I wish I had a better handle on the language so that I could have understood what her concern was, and so that I could have explained myself better (such as, "Yes, I have plenty of milk" or "Yes, I don't mind nursing both of my children", etc.). But lack of language skills prevented me from doing that.
On the other hand, maybe part of the reason I'm so stressed about nursing in public here in Costa Rica has more to do with my experiences in my home country than my new country. Even though I've never actually had anyone harass me for nursing, the stories I'd hear on the news coming from the US make it clear that there is much legal and social work to be done before all US women can fearlessly nurse in public. Regardless of our legal rights, there are occasional incidents where women are harassed in the US. In this new country of mine, it's hard to put aside my history of living in the United States. My friend W, a LLL leader here in Costa Rica, tells me she has never heard of anyone being harassed during public breastfeeding here. But still, I worry.
As a volunteer who supported mothers in their efforts to breastfeed in the United States, I admit that I really didn't even think much about the immigrant breastfeeding mother. Most of the mothers that I helped were US citizens, just like me. But now that I've put myself in this entirely new culture and country, I wonder more about how putting a woman in an unfamiliar situation affects her willingness to breastfeed, whenever and wherever. After all, many of us would be more able to be brave on our own turf than in a strange place. I'm wondering how I can better support the immigrant mother in her breastfeeding efforts. Definitely something to think about.
More posts from the Carnival of Breastfeeding on nursing in public:
- Grudgemom: Nursing in a room full of people you know
- Lucy and Ethel Have a Baby: Nursing in Public (Boobs) Out and Proud
- PhD in Parenting: Would you, could you nurse in public?
- Dirty Diaper Laundry: Breastfeeding in Public – Talents – I haz it
- Kim through the looking glass: Here? At the restaurant?
- MumUnplugged: Aww, is he sleeping?
- Massachusetts Friends of Midwives: Nursing in Public: Chinatown, the Subway, the Vatican, and More
- Mother Mary's Soapbox: June Carnival: Breastfeeding in Public
- Mommy News & Views Blog: Breastfeeding in Public
- Breastfeeding 1-2-3: To Cover or Not to Cover
- Stork Stories: Little Old Men…& Nursing in Public
- Chronicles of a Nursing Mom: Why Worry About NIP?
- Warm Hearts Happy Family: Breastfeeding and the Summertime
- Blacktating: Thank You For Nursing in Public
- Musings on Mamahood: NIP, no tuck
- Motherwear's Breastfeeding Blog: Get kicked off a bus for nursing in public? Here's how to respond.
- Mama Knows Breast: Adventures in Breastfeeding: Products That Can Help You Breastfeed in Public
- BabyREADY: A wee NIP in the park!!
- Tales of life with a girl on the go: Planes, trains and automobiles – we've breastfed in them all
- Breastfeeding Moms Unite!: Nursing in Public: A Fresh Perspective on Nurse-Ins
- Never a Dull Moment…: Breastfeeding Hats? YES! Nursing Covers? Uh… Not So Much
- Breastfeeding Mums: Nursing in Public – What's a Breastfeeding Mother to Do!!
- Hobo Mama: Easy, discreet way to breastfeed a toddler in public


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November 16, 2003, I was posted for my NYSC and Adetoun, my 'angel-turned-sister' as I fondly call her, wasn't too happy it was to one of the States in the East. But I had no choice than to serve my father land. After 3 weeks, I was officially posted to a clinic at the outskirt of one of the remote villages in the State. Bachelor's life wasn't easy though, but I had to cope. I had to struggle between work, washing, sleeping, seeing friends, and annoyingly; cooking. 'Cooking'- actually the times I didn't eat at the canteen, I cooked Indomie. I really wished I had a lady that was helping out with the cooking. May be that was what brought me to my fate.
It was a sunny Saturday and I had nothing doing. I was chronically bored. It was in this loomy mood that I heard a lady hawked pepper. The catalyst that moved me off my bed is still to this moment a mystery. I swiftly dashed out and saw the lady; may be in her twenties. I was totally in awe of her beauty and the melodies in her specially trained hawking tones. I beckoned at her and then…..actually, I ignored the sprinkles of beards that were pointing at me, even though they were somewhat competitions with my 'a-year-yet-not-grown' beards and in my tribe, only a witch has beards. I muttered quietly "that's my future wife, and that's what matters to me". I steered into her eyes for minutes and then still in the euphoria of my 'wonderland', 'ignoringly' she said "brother, why you dey look my eyes sote you con open your mouth yagada? You wan make fly enter am"
That broke the silence and startled my confidence for a while. I was left in a persistent vegetative state. Just lifeless! I had to change the 'topic-to-be-discussed' and sheepishly eulogised the redness of her pepper, as much as the tenacity she displayed while hawking it. She practically watched me displayed my unpremeditated 'madness', then she said "Oga, you wan buy pepper?!" I wittily said yes without thinking and I dipped my hand into my pockets and found nothing but a squeezed paper which I felt its hardness while my hand was still wandering about. I knew I had ridiculed myself in front of a village pepper seller.
She steered at me like a hunting ghost in search of its murderer and I had to cover up my stupidity by feigning complete ignorance of the disappearance of the money. I took the giant of faith and removed my hand with the hard paper but what I saw indeed saved my ass. It was a ₦500 note I had mistakenly washed with the trouser. It was nothing but a miracle. I confidently bought all the pepper on her tray and demanded to know where she resides to contact her whenever I need to get some pepper. She obligedly took me to her place and gave me her Econet number. My unnecessary constant visits at her place spoke loud my real intention and we could discuss any issue- and I mean any issue. It was always fun being around her and couple of times, her uncle who lived a distance away visited her. Guessed she must have explained to him how much I loved her and my marriage proposal. He suddenly became friendly and accommodating. They were fond of calling me "Docki" and she was given open permission to visit me at my rented apartment.
Oh, I forgot to tell you she didn't complete her studies at the Technical School, but I loved her the way she was.
On one of the visits, she was engrossed with my mouth-watering-tongue-licking stories of the life I live in Lagos and my utmost intention "to marry a respectful Ibo girl". Something led to something, we smooched and smooched and then……..and then nothing happened.
A month after our divinely orchestrated meeting, I completed my Youth Service program, then myself and Nkechi moved to Lagos, where I immediately got attached to a well-paying Hospital. Two months later, we walked down the aisle not minding the 'beard' and her being an orphan who incidentally was a dropped-out due to her paralysed perpetual fixation on the financial wheelchair.
The wedding was "not-too-elaborate-but-spicy" as one of my colleague once opined. Nkechi's uncle was unable to come down to Lagos for the wedding on the basis that he was sick and "bla bla bla bla bla". Anyways, that's by-gone now.
Six months later, Nkechi was delivered of a baby girl. I thought the baby came to life earlier than expected but with no complications. Nkechi's uncle sent a congratulatory letter and included the baby's proposed name Nkem, "just to honour Nkechi's deceased parents' wish"; and we actually did respected their wish.
It's been a decade now but we've been struggling with the persistent decay of Nkem's health. August 14, 2010, she was officially diagnosed a Sickle-Cell Anaemia patient. I thought through the Report and couldn't logically reconcile how the combination of 'AS' and an 'AA' could possibly result into a 'SS'. I was an 'AA' until I read Nkem's series of medical test results. "Was?"-no, I'm still.
That was our fate stormy fate until Nkem was at it again and the medical personnel requested a blood transfusion and a DNA test. Nkechi had to stay back at the Hospital and then I came home for some running-rounds. I took the test result home that night, shovelled in into our family medical file in my wife's wardrobe and then the next thing I saw was…………………………….
Nkechi's uncle's medical test report during his ailment 10 years ago was part of the documents in the file. Never knew her uncle was a Rheumatic, and he didn't look like one. I had to return the things I moved out of the wardrobe and then a paper flipped off.
It was a letter for Nkechi from her uncle congratulating her for the safe delivery of "our daughter", how it wasn't easy for him to let go of "my belle for that Docki boy" and how "he believe am say I be your uncle true true".
I was stunned but I needed more confirmation. "Wait, what more confirmation?", I inquired but since there was no one to answer my question, I rechecked the medical report belonging to her uncle, and then he was an 'AA'. That explained Nkem's mysterious genotype.
I felt like strangling myself and was unbecoming for some minutes. At least I felt like injecting Nkechi with a Mitochondrial toxin.
Don't bother about the name, it's a poison.
In the midst of the horrible 'feelings', Kelvin coughed in his room from his sleep, I rushed down there and then the thought streamed quietly in, "whose is Kelvin? Mine or Uncle's?


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Black Friday Reflection
Black Friday. Where does this day of craze and rock bottom price tags come from?
The first claim is dated way back to the 1960's when Philadelphia police officers dubbed the day after Thanksgiving "Black Friday" because of the chaos in the streets. People from all over were coming to kick off their Christmas shopping and take advantage of the good deals. Some also say that it has to do with retail stores turning a massive profit on this day, going from being in the "red" to being in the "black". (Learn more about Black Friday here.)
Either way, South Africans have adopted this day of the year, giving the silly season a proper welcome.
If you follow me or know anything about me, you'll have come to find that I am not the biggest fan of excess, fast fashion or clever marketing tactics. I was not hyped or phased by Black Friday at all, in fact, I avoided the Somerset Mall as best I could. Did my husband and I take part (and advantage) of the great deals available? Well yes, we did. But if I could explain the difference between the way we did it and the feeling I get when I see people pushing and screaming, huffing and puffing until Game's doors came cracking down.
I have decided to group the different types of consumers I have watched on phone recorded videos and news feeds to make more sense of this insane day. Bare with me…my findings are as follows.
1. Along for the ride.
These are the people who have fallen for the clever marketing and sales strategy behind this day. They get hyped up and join the crowd as people start to gather before midnight to get their hands on any deal really. They are the ones who don't plan on buying anything, they just want to check out the fuss but then walk out with deals they just could not resist. In my research I found many people confessing that if it were any other day of the year, they wouldn't dream of buying what they bought, they wouldn't be prepared to save for it. Essentially, Black Friday was the reason for their exploding shopping trolleys. Buying things they don't need, with money they don't have, as seen below.
2. The planners.
This is me and my husband. We knew exactly what we needed, and been needing for a long time. We needed a casserole pot as well as coffee mugs. Because I am all about quality over quantity, I urged my husband that we wait until we have enough money to buy a quality pot that could last generations as well as mugs that wouldn't chip and crack after a few months causing us to spend money again. He decided that "Black Friday" was a good way of getting what we needed and getting some discount on it. So he surprised me with these items and it also doubled as an early birthday present. We didn't fall for any marketing schemes that drew us closer, instead went right for what we needed and didn't buy excess while doing so.
3. The actual customer.
This person is someone who has little money, a big family to feed and support and has to make it happen somehow. They are the ones that will elbow you out of the way for a jumbo pack of diapers because they know that the little person at home is counting on them. These people are the ones who I feel buy smart because they know what they have, don't have and desperately need. Why then not save up a little for Black Friday, save some well earned money on essential items and have a joy-filled holiday season?
My conclusion…We need to be sure what in this world is leading our happiness. Are we feeling content after a massive shop where we get to bring trillions of things home that we don't need but found absolute pleasure in buying them on a great deal? Or do you also feel that sense of, "Shucks, I went overboard and allowed my eyes to feast, and my "wants" to lead me to debt and excess!"
Don't let consumerism become your trademark. Choose well and buy less, you're life will feel lighter and you'll have more space for the important things.
Happy planning, Jessica. x
Photo content by Local Truth Photography


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Wednesday, August 22, 2001
And from personal experience -- where I think there are more people who have been laid off of work now than I've ever known before in my life, it's not very surprising at all. But still scary & frustrating.
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Posts Tagged 'Nicole Gibbs'
Former Cardinals Mallory Burdette and Nicole Gibbs Continue to Impress
The qualifying rounds for the Western and Southern Open, the last big tournament in the lead up to the US Open, begin today in Mason. On the schedule are two former Stanford Cardinals who've continued to impress while making names for themselves as newcomers on the pro circuit.
Mallory Burdette, currently ranked No. 95, plays Monica Puig of Puerto Rico. Her former teammate and back-to-back NCAA champion, Nicole Gibbs, plays Johanna Larsson of Sweden. Given what I've seen from these two in Stanford the past two years, both have as good a chance as any to make it through qualifying rounds and into the main draw.
As a member of the "media", I do my best to be as objective as possible when writing and reporting on players. These two make that a difficult task, however, for many reasons. They're intelligent, well-mannered and well-spoken. They're eager to learn, and aren't afraid to "put in the hard yards" in order to get results. Moreover, they're just really nice young ladies who you can't help but root for and like.
I first met Nicole and Mallory at the 2012 Bank of the West. Both had been given wildcards into the main draw. After a first round win over a qualifier, Nicole got the unfortunate assignment of playing Serena Williams (fresh off of her Wimbledon victory) in the second round, and lost in straight sets.
Mallory got the more manageable assignment of playing Ann Keothavong (of Great Britain), and won a hard-fought 3-setter for her first main draw victory. She lost in the second round to Marion Bartoli, but still managed to do well enough through the US Open to take the big step of going pro.
Nicole stayed on at Stanford to train, get better prepared for the jump to pro tennis, and most importantly, to help her team win one last NCAA championship. She succeeded on all fronts, winning her second NCAA singles title and helping the Cardinals overcome the odds to win the team championship.
Nicole and Mallory had won the doubles title together in 2012, so it was definitely a loss for Nicole to have her friend and partner hit the road as a pro. But it also became a source of inspiration, as Mallory paved the road and showed that it was possible to translate their collegiate success to the pro tour.
"There was no doubt in my mind as soon as (Mallory) went that she was making the right decision and that she was gonna be top 100 quickly. And her success has definitely inspired me and helped me to believe that I could do the same thing with some time."
Her experiences of playing the top players has also helped her to realize that success as a pro is within reach. Though she hasn't taken many games off the top players she's played in the past (3 against Serena and 6 against Kvitova), she feels like she's not far from being able to "hang" with them.
"I can play at this level, and that's exciting for me."
If both can make it through this weekend, it will be exciting for all of us! I hope to see them both when I arrive on the grounds for the start of Monday's main draw matches.
Seeds Cibulkova, Hampton Overcome Inspired Opponents at the Bank of the West Classic
Dominika Cibulkova [3] defeats Stephanie Voegele 7-5 7-6(5)
Worries about fitness and the lingering effects of an Achilles injury fell by the wayside for Dominika Cibulkova after she overcame Stephanie Voegele of Switzerland 7-5 7-6(5) in the first match of the day on stadium court.
She showed no signs of slowness or hesitation, but did sport a layer of physio tape on her lower leg. "The tape is for prevention. My Achilles will always be tough to deal with because I have this problem with the bone. That's why my physio has to take good care of it so that I can keep playing."
Though her leg was fine, the rust in her game was another matter. She struggled to close out the first set after leading 5-2, only doing so after breaking the Voegele serve in the eleventh game to take it at 7-5.
With the first set under her belt, Dominika looked poised to close out the second in more direct fashion. Voegele had other ideas, once again working her way back into the match after Dominika had lead 5-2.
Fittingly, the second set ended in a tiebreaker that Dominika won with fearless hitting from her forehand at 5-all, before serving it out on her first match point.
When asked afterward if she'd expected such a tough match from her Swiss opponent, Dominika was very complimentary of her Voegele's abilities.
"I expected a really tough match because she's playing really well at this time. I played her long time ago but remember how she's playing close to the lines."
"I just made it tough for myself. In the end I made it, but it could be easier for me."
Jamie Hampton [4] defeats Nicole Gibbs 7-5 6-7(5) 6-3
Fourth-seed Jamie Hampton had her hands full overcoming her own "rust", as well as the inspired play of Nicole Gibbs; who was making her professional debut at this tournament after a stellar career at Stanford.
Rust on Hampton's part was understandable, since this was Hampton's first match of the tournament after receiving a first round bye as one of the top 4 seeds. "I've been here for a week now and I haven't played. And I've never done anything like that before."
The lack of sharpness in Hampton's game was less of an issue, however, than the dogged determination shown by Gibbs.
Hampton might hit a harder ball than Gibbs, but Gibbs showed no sign of intimidation as she moved her opponent from side-to-side to keep the ball out of Hampton's wheel house, and to expose any footwork weaknesses.
The first set was tightly-contested until a loose game by Gibbs at 5-all gave Hampton the crucial break, and allowed her to serve it out at 7-5.
The second set, won by Gibbs in a tiebreak, was an equally tight affair; made more so because of Hampton's mounting unforced error total as she mixed winners and unforced errors interchangeably throughout.
After the match, Hampton was asked specifically about her serving difficulties on the day when she offered this assessment of her overall play: "To be honest, I just felt like I was struggling in general today."
In spite of the efforts of her Stanford football team cheering section, Gibbs game began to unravel. The third set saw Hampton draw upon her experience as pro to serve bigger and hit bigger on shots that finally started to find their mark. There was little Gibbs could do than just say "too good".
Gibbs managed a brief comeback (after falling behind 0-4) to get back on serve at 3-4. But she couldn't sustain the momentum, and gave up one final break for 3-5. Hampton quickly closed out the match for the win.
Gibbs was remarkably upbeat after the match, and happy with the fight she showed on court. "The biggest takeaway is that I can play at this level, and that's really exciting for me!"
Other Match Notes
Daniela Hantuchova lost two straight tiebreakers to hand Urszula Radwanska a 7-6(3) 7-6(3) victory, and her second straight appearance in the Bank of the West quarterfinals. This loss is sure to stick with Hantuchova for because of the seven straight points she lost in the second set tiebreaker after leading 3-0.
Vera Dushevina beat American Madison Keys in the evening match on stadium court. Keys was unable to get any aspect of her ground game on track during the match, and was also done in by Dushevina's strong service returns.
Keys is widely touted as one of the top prospects for future US slam success. And while it's true that she has an immense amount of talent, she also still has a long way to go in terms of developing a more complete game to compliment her strong serve and ground strokes.
Young Americans Day at the Bank of the West
The Bank of the West Classic has long been known as a showcase for young American talent. Monday's lineup continued that tradition with a featured match by up-and-coming star, Madison Keys, making her Bank of the West debut against Magdalena Rybarikova. Unfortunately for Madison, it was pretty a rocky one.
Serving to start the match, she dropped that game at love with the help of three unforced errors. But once she managed to settle down, she played solid (if not spectacular) tennis to defeat Rybarikova 6-2, 6-2 in just over an hour.
When asked about her slow start, Madison attributed it to nerves and court conditions. "I think it was a little bit of nerves. And then the court was really fast. So just trying to get used to everything."
"I mean, first tournament, hard court, I think you're always a little bit nervous especially at the beginning of a tournament. Just trying to work your way into it."
And that's exactly what the teen from the Quad Cities had to do on a night where the match stats weren't great for either player. Both served in the mid-50's range with respect to their first serve percentages: not great by any measure.
Madison, however, won the battle in terms of first-serve points won (70% to 57%). She also won a greater percentage of her second serve points (48% to 26%). And though Madison double-faulted three times to offset her four aces, she still managed better than her Slovakian opponent, who hit only two aces against three double faults.
Madison's ground game, normally a strong suit, wasn't up to her usual standards. But it was more than up to the task on this night. Unforced errors on her forehand wing were offset by brilliant backhands down the line that seemed to wrong-foot Rybarikova time and again. And when needed, the forehand still mostly found its' mark.
The most important statistic of the night was the 2/4 break points that Madison saved versus the 6/12 that Rybarikova battled. It's tough to win matches when you're fighting that hard to hold serve. And on this night, Madison had the upper hand.
Still, she'll need to clean up her unforced errors and find a way to settle into her matches a lot quicker if she wants to go far in the same half of the draw that includes Jamie Hampton and Aga Radwanska. She lost to Radwanska in the third round of Wimbledon, but learned much from the experience.
"She's obviously Top Five for a reason. I think it's the big points. She played them well and I think I made a couple of dumb mistakes. And I think that was kind of the match."
With her big serve, big forehand and aggressive play the future looks bright for Madison. But she still keeps her immediate goals very simple. When asked if she has any goals that what she wants to accomplish during the summer hard court season, she said, "I want to be happy with how I'm playing. And come off the court, win or lose, and know I did my best."
Being on the Stanford campus around other students her age wasn't lost on the 18 year-old Madison, who could easily be in college herself if she weren't playing tennis on the pro tour. "As nice as (the thought of college) is, I'm pretty happy where I'm at."
The quote of the night came when she was asked what her hypothetical major would be if she were in college. After a moment of thought, the answer was an unequivocal, "Anything without math!"
Other Match Notes
It was a mixed bill for the two Stanford alums on today's schedule. Mallory Burdette lost in straight sets to Francesca Schiavone while two-time NCAA champion Nicole Gibbs bested Kiki Bertens, also in similar straight sets.
After a breakthrough performance last year, Mallory came into this year's tournament with a solid year as a pro under her belt. Unfortunately, it wasn't up to the task of Schiavone. Though not playing her best tennis these days, Francesca is a seasoned veteran who knows how to win matches with speed, spin, and guile. All of those things contributed to Mallory's undoing.
When asked about her biggest takeaway from the match, Mallory replied "You don't really see things in a match until after you get off the court and look back at it. So I'm looking forward to looking back to the match to see where those couple of points were where I got tight or she stepped it up and took it away from me."
Nicole Gibbs won in the late match on stadium court. The quick second set followed a titanic struggle in the first set that saw Gibbs down a break at 3-4. After winning three straight games to take the first set, Bertens had no answers in the second set. Gibbs win puts her on a collision course with fellow American Jamie Hampton in the second round.
The Best of 2012 from the Press Room, Part 1
It would be tempting (and easy) to do a "Best of 2012" piece with the usual cast of characters in their usual roles. But after some thought, I figured it might be better to do a "Best of" piece from my new perspective and experiences as a journalist. By doing this, I can maybe highlight and help people appreciate the things that you don't see "behind the scenes" when all you have available is crappy network TV coverage. 😉
So without further ado, here's Part 1 of my "Best" moments for 2012, in no particular order.
(Note: This will be a multi-part series so that it doesn't end up being the size of 'War and Peace')
Best Post-Match Press Conference under Adversity (WTA): Yanina Wickmayer, Bank of the West
Yanina had just lost a hard-fought (and very winnable) 3-set semifinal match against Coco Vandeweghe in the midday sun, and was pretty disconsolate. One could see that she'd cried after this one by her red eyes. With her previous back injury as an excuse, or with the heavy strapping on her thigh, she could easily have begged off for post-match treatment. But she didn't. She came to the press conference, red eyes and all, sat down, and answered questions on her loss while making no excuses her performance. I came away from that press conference with immense respect for this young lady. Her game my escape her on court, but she's sure got a lot of heart.
Best Post-Match Press Conference under Adversity (ATP): Andy Roddick, SAP Open
After yet one more injury (and another injury-related loss) to start his 2012 season, Andy came into the pressroom at the SAP Open in an understandably foul mood, trademark cap pulled down tightly on his head. It was one of those moments when you knew that if he thought there would be no fine, he would already have left the arena. The drumbeat for his retirement had been growing louder over the past year, and he himself could not deny that it was getting tougher and tougher to weather the injuries. Yet there he was, doing his best to not just walk away from it all… at least not yet. The timing wasn't right. Fast forward to the US Open, and the rest is history as he was finally able to walk away from the game on his terms.
Mr. Personality (ATP): Novak Djokovic, Western and Southern Open
The big tournaments typically use the services of a transcriber to record all player interviews. The transcriptions are then emailed almost immediately to all journalists on the official lists. When Novak sat down at the table for his pre-tournament media Q & A, he got there before the transcriber had a chance to get situated at her machine. This is what happened at that moment, as she tried desperately to jump over media to get to her machine and start typing:
This is Novak at his best. He's toned it down after criticism of his antics from other players a few years back. But Novak is what Novak will always be: a fun-loving guy who will find any opportunity to make a joke, even if he's dog-tired and just arrived on-site after winning another tournament only days beforehand. The presser started and ended with laughter, a rarity in the very serious world of pro tennis. When you see this first-hand, it's easy to understand why he is so well-liked wherever he goes.
Ms. Personality (WTA): Serena Williams, ANY TOURNAMENT
Whether you love her or hate her, there's no denying that Serena is one of the more interesting players on tour. At a time when we are treated to the same WTA talking points in interview after interview, Serena will (more often than not) toss the script on its' ear and talk about everything from her favorite TV shows to dating to fashion. Of course this is presuming that she's just won her match before she comes into the interview room…which she usually does. Some of my favorite pressroom quotables from the Bank of the West are listed here. By the time she got to the Western and Southern Open she was a little tired, so the quotables weren't as "tasty". But it doesn't matter. I'd still try to make a Serena presser over a Caroline or Aga presser (just as examples) any day.
Most Impressive College Duo (WTA): Nicole Gibbs and Mallory Burdette – Stanford University, Bank of the West
These two young players were both given wildcards into the Bank of the West draw based on their performance at the NCAA tourney, and both made good use of their opportunity by making it to the second round. Even though Nicole lost to Serena Williams and Mallory lost to Marion Bartoli, both young ladies comported themselves well and did Stanford proud. In the pressroom, both were intelligent, articulate, engaging. They're impressive young ladies, and I've become a huge fan for each. Nicole also gets a second mention in my "Best of" list…
Most Surprising Press Conference Moment (WTA): Nicole Gibbs, Bank of the West
Nicole garners a second mention in my list because of her connections with the Cleveland area. After mentioning that high school friends had told me I went to high school with her uncle, she came up to me afterward and said, "Well you must know my dad too" and motioned to him at the back of the pressroom. Sure enough, I did. It was a very odd, but great, "small world" moment in the world of professional tennis.
Stay tuned for Part 2.


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Dog Treats & Dog Bones
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Republicans showed their support and some Democrats joined them. However, many also said they are skeptical.
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You will need the corresponding product numbers, e.g. "8p13," which is below where it reads "Mix and Match." We recommend writing them down before moving to the next step, you will be prompted to select each cup by this number. Once you have selected your personalized mishmash of cups you are all set!
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In spite of the popularity of social media and internet marketing, technology cannot replace human to human communication in sales. Telemarketing and lead generation is tough work. Telemarketing is hard; it make us face rejection and challenges our very human nature. No wonder many sales people hide behind technology and avoid cold calling at all costs.
In previous blogs, I wrote that sales closing and appointment setting activities require a different set of skills.
Based on this great video by Joanne Black, I would like to repeat myself: Cold calling is not dead. It is essential to generate new prospects and fill in your prospecting pipeline. So pick up that damn phone and connect to your future customers!


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Jet Airways To Mumbai Flight Schedule
Jet Airways
12h 0m
Jet Airways
14h 50m
Jet Airways
16h 50m
Jet Airways
5h 15m
Jet Airways
18h 25m
Jet Airways
12h 50m
Jet Airways
21h 20m
Jet Airways
9h 35m
Jet Airways
15h 50m
11h 5m
About Jet Airways
Jet Airways, one of the fastest growing airlines of the country, commenced its services from the year 1993. Covering over 50 cities in India and 20 destinations abroad, Jet Airways promises to offer the best in-flight experience. Jet Airways is known for low air fare, heart-warming hospitality and excellent customer assistance in addition to ensuring schedule services between destinations. Expanding its horizons globally, Jet Airways has collaborated with some of the renowned international airlines, thereby delighting customers across the globe. Jet Airways is interline partners with over 147 airlines and is interline e-ticketing partners with 95 of them, which helps customer book tickets for two airlines on the same document. Jet Airways is the owner of the youngest fleet that not only ensures a safe and hassle free flight but also consume less fuel, resulting in low cost air tickets. Years of experience and dedicated efforts of the team have helped Jet Airways win hearts of customers in India and overseas. Online booking, web, Kiosk and SMS check-in are some of the other benefits apart from safe and secure Jet Airways Flights. The airline has won several awards that include Lonely Planet Magazine Travel Award 2012, winner for Customer & Brand Loyalty In Domestic Commercial Airlines Sector and Favourite Full-Service Airline at the Outlook Traveller Awards 2011, to name a few.
About Mumbai (BOM)
The commercial and entertainment capital of India, Mumbai, a cosmopolitan metropolis, formerly known as Bombay, is the capital city of Maharashtra. It is one of the most populated city in India and the fourth most populous city in the world. It lies on the west coast of India and has a deep natural harbour. Seven islands constitute Mumbai and were home to communities of fishing colonies. The city is symbolized with the presence of Bollywood, the centre of Film and TV Industries which has its viewers all around the globe. It is also a place for India's largest slum population. The city has been considered as a true culture melting pot because of the immigrants from the rest of the India. The city is quite liberal in comparison with the rest of the country. It is the financial and commercial capital of the country and serves as an economic hub of India. Most of the large businesses have corporate offices in this city. Public transport in Mumbai includes suburban railways, BEST buses, yellow-black taxis, auto rickshaws and ferries. There are a lot of places to visit in Mumbai such as the famous Marine Drive and the area is a home to many big organisations. The famous Taj Mahal hotel is located opposite to the Gateway of India. Chhatrapati Shivaji Maharaj Vastu Sangrahalaya formerly known as Prince of Wales Museum and National Gallery of Modern Art are some of the most famous museums and art galleries in India located in this cosmopolitan city. Girgaon Chowpathy in South Mumbai, Juhu beach in western suburbs, and Aksa beach in Malad are some of the most popular beaches in the world and people from different parts come to visit and enjoy in this place. Mumbai is a place for shoppers because of its wide street markets, the hustle of vendors and the madness of crowds. Chor Bazar, Fashion Street, Colaba Causeway, Zaveri Bazar are some of the very popular markets among shoppers. Haji Ali Dargah, Siddhivinayak temple, ISKCON temple are some of the religious places that are visited. The dining experience is more or less the same as anywhere else in the world. Since Mumbai is the most liberal city in the entire India, you will find pubs and restaurants at every corner of the city. You can easily visit this place by booking tickets of flight or of train through MakeMyTrip.com. The website offers you a host of facilities such as hotel deals, flight deals and holiday packages. The website also offers you the best of hotels to make your travel trouble-free.
About Chatrapati Shivaji International Airport
Chhatrapati Shivaji International Airport, Mumbai
Tel: +91 22 26813000


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Mark Lanegan | Union Chapel | 3 May 2016
In concert, Mark Lanegan likes to stand still. In his career, not so much. Always moving forwards, since the initial success of Screaming Trees his discography is one of solo and band recordings, collaborations, side projects, and "imitations". 'An Evening With Mark Lanegan' embraces all of it, creating a cohesive set by stripping back the music and focusing on what's important: his ragged baritone.
Backed by just two guitarists and a bass player, that voice effortlessly navigates an eclectic 30-year career, from grunge to '50s swing, without losing the spirit of the original studio recordings. So quiet set opener 'One Way Street' sounds just as tender as it did on 2001's 'Field Songs' and 'Mirrored' actually sounds even more ominous than it has before.
Even without drums, 'The Gravedigger's Song' loses none of its swampy groove thanks to the interplay between the guitarists, with one playing the bluesy riff and the other – frequent collaborator Duke Garwood – adding sonic textures. Relieved of its organ and gospel-tinged backing vocals, the hymnal 'Strange Religion' from 2004's 'Bubblegum' becomes the perfect companion piece to the shuffling Dylanesque title track of 1999's 'I'll Take Care Of You'. And while pairing two songs from current Mark Lanegan Band release 'Phantom Radio' would seem like less of a stretch, the biblical dirge 'Judgement Time' doesn't need much reworking, but 'Torn Red Heart' must survive without a wall of shimmering keys and guitars. It does and, following the makeover, sounds even more despairing.
Lanegan's renditions of 'Mack The Knife' and 'You Only Live Twice' retain the minimalist approach employed on the 'Imitations' album, 'One Hundred Days' keeps its unlikely swing, and 'On Jesus' Program' remains a chance for the singer to push his voice to breaking point, accompanied by two chiming guitars. Garwood collaborations 'Driver' and 'Mescalito' immaculately recreate the woozy, dreamlike atmosphere of 2013's 'Black Pudding', while 'I Am The Wolf' is as seductively menacing as you remember.
Most impressive though are the two songs that have been completely reimagined. Soulsavers collaboration 'Can't Catch The Train', originally all piano, strings, and brass, is performed tonight with just one guitar but all the anguish. And Screaming Trees' raging 'Hallow Of Ashes', originally performed by four men in their early 30s, sounds almost more visceral than it did 20 years ago, even though, again, it's played (with almost no restraint) on just one guitar. Lanegan himself may appear unmoved by the magic of the moment, but the Union Chapel audience clearly are not.


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GNC Preventive Nutrition® Cleansing Formula (California Only)
Write a Review
Item # 732817
Size: 120 Capsules
The product quantity for an item in your shopping cart has exceeded our Maximum Purchasing Policy. Please adjust your quantity to (12) and try again.
Your product couldn't be added to the basket because it is out of stock.
Product Information
- This combination is one of the most advanced digestive health products available.
- Supplies a premium blend of digestive enzymes, fiber and acidophilus to form a more complete digestive formula.
Enzymes facilitate digestion.*
Fiber helps food pass through the intestines faster.*
Acidophilus influences the balance of the body's natural flora and helps maintain a healthy digestive tract.*
PRODUCT DIRECTIONS / ADDITIONAl INFOAs a dietary supplement, take two capsules daily before meals.
Contains: Milk
WarningsAfter opening, keep tightly closed in refrigerator or other cool place., Consult your physician prior to using this product if you are pregnant, nursing or taking medication, or have a medical condition. Discontinue use two weeks prior to surgery. KEEP OUT OF REACH OF CHILDREN., (State of California Prop 65) This product contains a chemical known to the State of California to cause birth defects or other reproductive harm.
Other IngredientsGelatin, Cellulose
StorageStore in a cool dry place.
Distributed by;
General Nutrition Corporation
Pittsburgh, PA 15222
General Nutrition Corporation
Pittsburgh, PA 15222
Nutrition Facts
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by Neil Mackinnon
In my role as editor and writer for developerWorks Open, I post a lot of content to various social media channels. I recently posted about a new open source project we're featuring on dWO, and one of the responses to the post went something like this. "As soon as I saw it was an IBM page I stopped reading. They don't know or care about open source."
Although that kind of reaction is rare, it's not the first time a reader has responded to one of my posts with a similar sentiment. The thinking seems to be, "IBM is just boring back-end enterprise stuff, what do they know about open source? What has it ever contributed?" My answer is always the same: If you think IBM isn't committed to open source, you haven't been paying attention.
Open ecosystems
At developerWorks Open, we're helping to build vibrant ecosystems around open source projects. What does this mean in real terms? It means providing a spotlight for new open source innovations on the developerWorks Open website. It means hosting regular webcasts – "Tech Talks" – where open source innovators have the chance to peel back the covers on their projects and share their insight with an audience of thousands. It means attending industry conferences to demo our projects and meet like-minded developers and technology enthusiasts. And it means connecting people, giving open source innovators, enthusiasts, and beginners the chance to come together to talk, collaborate, and contribute to exciting new projects.
Leading-edge technology
So what kind of technology do we feature on developerWorks Open? All kinds! From cloud to Big Data, analytics to security, mobile to design, we're spotlighting and growing dynamic open source innovations. These are the technologies you dream about working on, leading-edge advancements in mobile apps, serverless computing, enterprise security, and analytics at the edge.
Take a look at some of the projects we're featuring right now:
- Apache SystemML: A scalable machine-learning language that is helping to usher in the Age of Thinking Machines.
- Node-RED: A simple tool for wiring together the Internet of Things, now pre-installed on the popular, affordable Raspberry Pi computer.
- Humix: A robot connectivity and design framework that makes it easy to build a cloud-brained robot in just a few clicks.
- Watson Developer Cloud SDKs: A set of language-specific software developer kits that make it easy to tap into services provided by Watson, IBM's cognitive computing platform.
Machine learning. Internet of Things. Robot connectivity. Cognitive computing. Artificial intelligence. These are the most compelling technologies of our time, and these are the technologies IBMers are working on right now, collaboratively and in the open.
Connecting experience with fresh thinking
We'll help introduce you to those innovators. IBM has some of the most brilliant technology minds in the world working on open source projects and developerWorks Open serves as a connection point in that hothouse of technological know-how.
Through developer stories, webcasts, communities, and collaboration environments, we help bridge the gap between our technical leaders, whose experience and skills are unmatched, and our newest employees, who come to the company brimming with fresh ideas and different viewpoints. No other company in the world can offer that kind of access to visionary technology leadership.
Open by design
So, what do I say to doubters? I'm a big sports fan, so whenever I hear people like that social media poster say that they "know" IBM doesn't do open source, it makes me think of what people used to "know" in the sports world: they knew no one could run a four-minute mile. They knew that a soccer team from Leicester couldn't win the British Premier League. They knew that the Boston Red Sox would never win the World Series. And all of these things were true – until they weren't.
If you're one of those people who thinks IBM doesn't "do" open source, it's time to think again. IBM is transforming itself, embracing a collaborative, agile, and yes, open development environment.
Is IBM committed to open source? Absolutely. The developerWorks Open initiative, which recently spotlighted its 100th open source project, stands as proof of this commitment. It's a dynamic, growing environment where innovative IBMers can shine a light on their projects, and contributors from inside and outside the company can work to move open technologies forward.
Check out the projects on developerWorks Open today. We're open by design, and we're loving every minute of it.
Neil Mackinnon is Editor and content developer for IBM Developer Works Open
If you are interested in finding out more about other technical opportunities at IBM, then follow our campaign #IBMTechTalent
To keep up to date with our Global career opportunities and other IBM news, connect with us on Facebook,Twitter, Google+ and LinkedIn.
Discover what you could do at IBM.


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Sonim XP5
Sonim XP5
Also known as the
Sonim XP5700
Reviews (5)
News (1)
User Reviews:
Read 5 Reviews
Write a Review
Bell, MTS Mobility, Rogers, Tbaytel, TELUS
AT&T, Verizon Wireless
June 2015
Ultra-rugged PTT phone
IP-68, IP-69 & MIL-810G certified
3180 mAh battery for back-to-back shifts
User Guide
Latest Reviews
Ok phone not user freindly
Reviewed on Wednesday November 23, 2016 by
Allan Robichaud
, Canada
For a basic phone,it's great. Durable and loud speaker with long battery life. The features are terrible. The predict word feature makes it impossible to add contacts. I tried typing "Al", my name, but it would auto fill with every word from altogether to alibaba but no Al. It took me 10 minutes of googling to figure out how to shut that feature off and I've had probably 6 different smart phones in the last 10 years. I almost gave it back to my current employer and said no thank you.
Dictionary isn't great
Reviewed on Monday June 27, 2016 by
, Vancouver, bc
If you want to write any words that might be even somewhat offensive or totally offensive you are SOL, (which isn't a word you can write with the xp5 btw.) sh*t fu*ck a$s? Nope. not even if you add these words to the custom dictionary will you be able to type them. Other words you won't find on an xp5? Do. Yes the word do. If you try and write the word do in the middle of a sentence do you think it will work? Do you? Nope. The dictionary and how it works is frustrating.
Reviewed on Wednesday March 23, 2016 by
, British Columbia
This phone is awesome, very loud & clear. The reception is really good. Simple easy to use. Great to use as a modem for my laptop good high speed data. Worry free very well built. Only wish Sonim would make some upgradeable apps for the XP5700.
poor sound volume
Reviewed on Wednesday January 20, 2016 by
douglas williams
, 29 Court Drive Paris Ontario Canada
very hard phone to find your way around on the directions you download from internet are very poor and inacurrate, the sound volume on the phone is very poor even when you set it to the loudest possible ,it needs to be better sound for us people that have hearing problems.I was sold a wrong bill of goods when I bought this phone very very hard to navigate your way around I would not recommend this sonim xp5 phone


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Delcam has launched a new dedicated website, for its manufacturing services subsidiary, Delcam Professional Services Ltd. This is the latest stage in the current expansion under way for its process development and prototype manufacturing activities.
The primary focus of DPS continues to be working with clients, mainly in the aerospace and power generation industries, to improve their manufacturing processes by increasing productivity, improving accuracy and shortening lead times. In particular, this is achieved through the use of adaptive machining, Delcam's unique combination of machining and inspection technology.
Services described on the web site vary from the provision of extra design and programming resources when the customer's existing staff are overloaded, through to developing completely new turn-key processes for the production of novel designs, including the manufacture of prototypes or initial production runs. These services are attracting increased demand as many companies now find that their engineering resource is needed to maintain their on-going operations, leaving them limited capacity to introduce new products and develop new processes.
For more information, visit: www.delcam-services.com


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Deadline: 29 Apr 2016
Company: Akademi
Email: firstname.lastname@example.com
Phone: 02076913210
Website: akademi.co.uk
Alchemy's YUVA in collaboration with South Asian Dance Alliance.*
YUVA returns to Alchemy for the fifth year in a vibrant showcase of the best South Asian youth dance from across the country. This year will be bigger than ever including a celebratory youth dance platform and competition.
YUVA Youth Dance Competition
Presented by Southbank Centre and Akademi
11am – 1pm
Developing last year's competition model, this year will give some of the UK's more senior students and those on the verge of professional careers (aged 16 – 25) an opportunity to perform their work in front of a panel of expert judges. Categories include: Age 16 – 20 Solos, Age 21 – 25 Solos, Age 16 – 25 Groups.
YUVA Youth Dance Competition – 16 – 25 application form
Equal Opportunities Monitoring Form
Email email@example.com for more information.
Deadline for applications is the 29th of April 2016.
YUVA Youth Dance Platform
Presented in partnership with South Asian Dance Alliance (SADAA)*
2pm – 6pm
YUVA Youth Dance Platform offers the opportunity for individuals and groups aged 15 and under to perform. Open to all dance styles with a South Asian influence, be it hip hop, contemporary or classical, YUVA 2016 welcomes applications from across the country.
Email email@example.com to request an application form and equal opportunities form.
* South Asian Dance Alliance includes Akademi, Bharatiya Vidya Bhavan, Chaturangan, Centre for Indian Dance, Kadam, Gem Arts, Kala Sangam, Milapfest, Sampad, SAA UK.


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Teeth are essential for more than chewing. Teeth allow you to speak clearly and support the structure of your face. If disease or other occurrences have caused tooth loss, you'll not only notice a difference in these areas, but you may also suffer a loss of confidence in your appearance. There are several ways to address tooth loss. Some patients may only need a bridge to fill in a gap, while others want more stability with denture implants or other denture options. Ottawa's Vranjes Denture Clinic focuses on providing dentures for patients with missing teeth. Given the different types of dentures available, our denturists can match you with the style that works best for you.
Explore Your Options
There are many reasons people lose their teeth. Some lose teeth as a result of an accident, having had the tooth knocked out. Others may have had serious dental decay that caused teeth to fall out. Sometimes certain illnesses or medications contribute to tooth decay that leads to tooth loss. Regardless of the reason, if you have had all or part of your teeth removed, consider dentures. Ottawa residents look to us for high-quality, comfortable and fitting denture options. Dentures can last for a long time if properly taken care of, often only needing replacement every five to 10 years. At Vranjes Denture Clinic, we're happy to provide a variety of dentures options at our Ottawa clinic . We invite you to learn more about each option below:
If you need to have all of the teeth removed on one or both of your arches, then denture implants may be for you. A titanium screw — also considered to be the implant — will be inserted into the bone where the missing tooth is located. Once that has happened, a denture will be attached to the screw, allowing you to have denture stability.
For those patients who don't prefer implants, conventional dentures are an excellent option. Additionally, to make matters easier with lower dentures, we offer two products at an additional cost: soft lining and the Myoloc™ System by Winder Research.
If you're only missing a portion of your teeth, the ideal treatment for you may be partial dentures. The two types we offer are cast partials and acrylic ("plastic") partials.
Talk to a Denturist to Learn if Dentures are Right for You
With the denture options available, you may be feeling overwhelmed about which type would work best for you. You may even wonder if dentures are right for you at all. For example, some individuals who have lost only one or a few teeth may only opt for denture implants, which provide a stable, artificial tooth root for a dental crown. But for others, tooth loss means dentures are necessary to ensure the right look and function for their smile. At Vranjes Denture Clinic, we can help you determine if dentures are right to address your tooth loss. If dentures are what you need, we can figure out what type will work best for you.
Contact Vranjes Denture Clinic to set up an appointment.
Find our conveniently located clinic.


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Separate names with a comma.
Discussion in 'GBAtemp & Scene News' started by Hadrian, Aug 28, 2009.
so this is just like a wheres wally game except find objects?!
It's a cheap point & click adventure.
Played it for about a nanosecond before I wrenched it back off the hard disk... I'd rather be violated with rusty claw hammers than play this game again. Rubbish, rubbish, rubbish.