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Mitt, Mormons, and the religious test that wasn't
Nov 15, 2012
Inside the First Amendment
Mitt, Mormons, and the religious test that wasn't
By Charles C. Haynes
First Amendment Center
WASHINGTON – Buried in the mountain of demographic data preoccupying political pundits this week is one historic statistic that may have far-reaching consequences for religious freedom in America:
Seventy-nine percent of white Protestant evangelicals voted for Mitt Romney, a lifelong member of the Church of Jesus Christ of Latter-day Saints – popularly known as the Mormon Church.
After a bitter Republican primary season during which many evangelical leaders supported the "anybody but Romney" effort, prominent conservative Christian ministers lined up behind Romney for the general election. A defining moment came on Oct. 11 when America's Preacher, the Rev. Billy Graham, publicly signaled support for Romney's candidacy.
One week after Graham's embrace of Romney, the Billy Graham Evangelistic Association removed from its website the reference to the Mormon Church as a "cult" – a small change in language that could have a big impact on future relations between evangelicals and Mormons.
It's very likely, of course, that conservative Protestant acceptance of Romney was largely a political marriage of convenience. Evangelical positions on social issues such as abortion and gay marriage trumped misgivings about putting a Mormon in the White House.
But however pragmatic the reasons, strong evangelical support for Romney was an unprecedented break from the long history of anti-Mormon sentiment among Protestants that dates to the founding of the Mormon faith in the 19th century.
Theological differences will no doubt continue to spark robust debates between evangelicals and Mormons. But Mitt Romney's run for the presidency appears to have shifted the tone of the disagreements, promising perhaps to usher in a new era of more-civil dialogue and – when public policy interests overlap – more common cause.
Like John Kennedy's historic breakthrough as the first Roman Catholic to win the presidency, Romney's candidacy signals another turning point in the long struggle to move beyond voter-applied religious tests for office. Although Romney fell short of winning a majority, his big numbers among evangelicals demonstrates that being identified as a Mormon is no impediment in a presidential race.
Beyond the Mormon question, is it possible that religious affiliation more broadly – for much of our history a litmus test for major party nominees – is becoming a non-issue in American presidential politics?
Consider, for example, that in 2012 no white Protestant was on either party's ticket for the first time in our history. The response of voters to this milestone appears to have been a big shrug.
But despite the apparent indifference to the religious affiliation of this year's candidates, voter surveys suggest that religion still matters in the voting booth. The range of "acceptable" affiliations may have expanded in recent elections, but the country is nowhere close to the day when either major party will nominate an avowed atheist for the presidency or vice presidency. Polls also suggest that candidates from many minority faiths, especially Muslims, would not fare well on the national stage.
Nevertheless, the demographic handwriting is on the electoral wall in an increasingly pluralistic America. Protestants are no longer in the majority for the first time in our history. And leadership of key institutions – long dominated by Protestants – is now religiously diverse. (The current U.S. Supreme Court, for example, has six Roman Catholic and three Jewish justices.)
The fact that Romney's religious affiliation played virtually no role in this election is another step – a significant step – toward the day when candidates for high office are judged primarily by their record and character, not by the place of worship they attend (or don't attend).
We still have a distance to go. But with Mitt Romney's candidacy in 2012, we moved closer to the First Amendment promise of full religious freedom – a level playing field in the public square for citizens of all faiths and none.
Charles C. Haynes is director of the Religious Freedom Education Project at the Newseum, 555 Pennsylvania Ave., N.W., Washington, D.C., 20001. Web: firstamendmentcenter.org. E-mail: firstname.lastname@example.com.


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Wisconsin Rep. Paul Ryan is Mitt Romney's choice for running mate on the 2012 Republican presidential ticket.
The official word, which began leaking overnight, came early this morning from the Romney campaign via a smartphone app and a news release.
It's something of a surprise. While Ryan was on all the lists when it came time to speculate about Romney's likely choice, the conventional wisdom had been that it was more likely to be someone such as Ohio Sen. Rob Portman or Florida Sen. Marco Rubio.
Ryan comes from a competitive state with just 10 Electoral College votes. Ohio's 18 and Florida's 29 are much more valuable prizes.
But Ryan is a favorite of conservatives across the nation for his tough talk about tax cuts, spending cuts and fiscal discipline. The two are set to formally accept their party's nominations at the Republican National Convention later this month in Tampa.
We've been following the news about the choice of Ryan, the 42-year-old chairman of the House Budget Committee who is nationally known for his championing of tax and spending cuts. Be sure to hit your "refresh" button to get our latest updates.
Update at 9:50 a.m. ET. Now, "A Different Conversation":
With the choice of Ryan, NPR's Don Gonyea says, the Republican ticket can now "start a different conversation and a conversation about what they plan on doing."
Update at 9:46 a.m. ET. And In Conclusion, Ryan Pledges To "Get This Done!":
As he wrapped up his remarks, Ryan said he is thrilled to be part of the ticket and promised that a Romney/Ryan administration would "unite America and get this done!"
Update at 9:45 a.m. ET. Reapplying The Founding Principles:
Ryan gets more strong approval when he says: "We won't duck the tough issues, we will lead. ... We won't blame others, we will take responsibility. ... And we won't replace our founding principles, we will reapply them."
Update at 9:43 a.m. ET. Strong Cheers:
Some of the biggest cheers so far for Ryan come when he says "our rights come from nature and God, not from government."
Update at 9:38 a.m. ET. This Isn't "The New Normal":
Ryan says that under President Obama, the "new normal" for many Americans has become "diminished dreams, lowered expectations, uncertain futures." That shouldn't be, he says.
Update at 9:36 a.m. ET. "Debt, Doubt And Despair":
The Obama administration, Ryan says, has compiled a "record of failure."
"We find ourselves in a nation facing debt, doubt and despair," he tells the crowd.
Update at 9:35 a.m. ET. "To Save The American Dream":
"It is our duty to save the American dream for our children and their's," says Romney.
Update at 9:33 a.m. ET. Ryan Says He's "Committed In Heart And Mind?"
"I am committed in heart and mind" to putting his experience to work in a Romney administration, Ryan says.
Update at 9:30 a.m. ET. Romney's Recovery:
Saying that every once in a while he makes a mistake (as in, referring to Ryan as "the next president of the United States"), Romney just came back to the microphone to say he didn't make a mistake in choosing Ryan.
Update at 9:28 a.m. ET. Romney Calls Ryan "The Next President Of The United States":
In the excitement of introducing his running mate, Romney just said "join me, in welcoming the next president of the United States, Paul Ryan."
Update at 9:27 a.m. ET. Obama Campaign Reaction:
As Romney continues his remarks, Obama campaign manager Jim Messina has sent reporters a statement that says, in part, that Romney has chosen "a leader of the House Republicans who shares his commitment to the flawed theory that new budget-busting tax cuts for the wealthy, while placing greater burdens on the middle class and seniors, will somehow deliver a stronger economy."
Update at 9:25 a.m. ET. Romney Promises "Positive" Ideas:
He and Ryan, Romney says, will offer a "positive governing agenda."
Update at 9:23 a.m. ET. Ryan Is In Politics For Right Reasons, Romney Says:
Ryan isn't in politicos "to advance his personal ambition," Romney says, "but to advance the ideals of freedom and justice."
Update at 9:21 a.m. ET. Romney Gets Right To The News:
"It's an honor to announce my running mate and the next vice president of the United States, Paul Ryan!" Romney just announced.
Update at 9:20 a.m. ET. Romney Arrives:
Romney just popped out of a door aboard the USS Wisconsin, jogged down to the dock, and is at the microphone. He's getting a loud welcome.
Update at 9:10 a.m. ET. Candidates To Be On Stage Shortly:
Both of the candidates' spouses are now on stage in Norfolk and Virginia Gov. Bob McDonnell is at the microphone. So it looks like Romney and Ryan will be appearing shortly.
Update at 9:05 a.m. ET. First Rule Of VP Picks Is "Do No Harm":
On NPR's broadcast, correspondent Don Gonyea just said that the first rule when selecting a running mate is "do no harm." It remains to be seen, of course, whether Romney has succeeded with his choice of Ryan.
Update at 8:57 a.m. ET. Live Streaming:
We'll be updating with highlights from the candidates' first joint appearance. Of course, it's also going to be broadcast on the cable news networks and will be streamed online by various outlets, including C-SPAN.
You can listen live on many NPR stations, and on NPR.org.
Update at 8:52 a.m. ET. From The Right Side Of The Blogosphere, Talk Of Credentials And Charm; Sighs Of Relief:
Ed Morrissey, prominent conservative blogger at HotAir.com, writes that "Ryan has solid policy credentials, but also has enough media presence and charm to make people listen. Team Obama will hang Ryan's budget on Romney, but they were going to do that anyway. Why not have the man himself as the VP to explain it?"
Another leading conservative blogger, Erick Erickson of RedState.com, says "the sighs you hear are Republicans sighing some relief. Finally, the Romney campaign has a spokesman who can do what Mitt Romney has never been capable of doing — defend success and articulate a message of why we must reform our nation's budget and support free markets."
Update at 8:50 a.m. ET. Choice Made On Aug. 1, CNN Reports:
A "senior Romney adviser" has told CNN that Romney decided Ryan would be his running mate on Aug. 1.
Update at 8:42 a.m. ET. "Controversial" Architect Of Budget Plan:
The Associated Press calls Ryan "the architect of a conservative and intensely controversial long-term budget plan to remake Medicare and cut trillions in federal spending."
Update at 8:38 a.m. ET. Ryan Is "Honored."
The first tweet at Ryan's new @PaulRyanVP Twitter page:
"I'm honored to join @ MittRomney on America's Comeback Team."
Update at 8:35 a.m. ET. Ryan To Say The GOP Team "Will Restore The Dreams And Greatness Of This Country":
The Romney/Ryan campaign just released some excerpts of the remarks Ryan is set to make in Norfolk. Among them:
"Mitt Romney is a leader with the skills, the background and the character that our country needs at a crucial time in its history. Following four years of failed leadership, the hopes of our country, which have inspired the world, are growing dim; and they need someone to revive them. Governor Romney is the man for this moment; and he and I share one commitment: we will restore the dreams and greatness of this country."
Update at 8:30 a.m. ET. Early Analyses:
-- The New York Times says the choice of Ryan "shakes up" the campaign.
-- To The Wall Street Journal, Romney's decision "puts spending" at the center of the campaign.
-- According to Politico, "Romney now has a chance to make the race about something big, rather than the petty squabbles that have dominated the general election so far."
Update at 8:20 a.m. ET. Ryan's Timeline:
Milwaukee's Journal Sentinel has and background on him. It includes a timeline of the congressman's life, from his Jan. 29, 1970, birth in Janesville, Wis.
Update at 8:10 a.m. ET. "Most Daring Decision" Of Romney's Political Career:
The New Yorker's Ryan Lizza, who this month wrote a long profile of Ryan for the magazine, calls Romney's choice of the young congressman " the most daring decision of [Romney's] political career."
And, Lizza writes, "the good thing about the Ryan pick is that the presidential campaign will instantly turn into a very clear choice between two distinct ideologies that genuinely reflect the core beliefs of the two parties."
Update at 8:04 a.m. ET. "America's Comeback Team":
The Romney campaign is touting the ticket as "America's comeback team." It says the seven-term congressman has "worked tirelessly ... to reign in federal spending and increase accountability to taxpayers."
Update at 8:02 a.m. ET. There's A New Ryan Twitter Handle.
On the Romney campaign's Twitter page, the presidential contender now says "I am proud to announce @PaulRyanVP as my VP. Stand with us today."
Update at 7:55 a.m. ET. What The 'Ryan Budget' Does:
The Wall Street Journal's Washington Wire blog runs through the key points of the much-discussed "Ryan budget plan" here. Two key points:
-- "It would spend $40.135 trillion over 10 years, compared with the $46.959 trillion the White House said its budget would spend over 10 years."
-- "[It] lowers tax rates and cuts tax breaks. But ... doesn't say which tax breaks would be targeted for new limits or elimination."
Update at 7:45 a.m. ET. Ryan On Romney.
Here's Ryan talking about Romney just before the former Massachusetts governor effectively sewed up the GOP nomination:
"I'm excited, I'm encouraged, I'm enthused, because in this man we have a person of conviction, we have a man with the right kind of experience, we have the right kind of leader we're going to need to get this country right and to get this country back on track, and I want to ask you fellow Wisconsinites to join me in welcoming who I hope becomes the next president of the United States, Governor Mitt Romney."
Update at 7:40 a.m. ET. NPR Interview:
In May 2011, Ryan sat down with NPR editors and correspondents. On The Two-Way, we led our live-blogging of that conversation with this:
One day after assailing Democrats for what he says are their "Medi-scare" political tactics, the author of the Republican plan to remake Medicare and Medicaid and cut the federal deficits and debts made the case that so far Republicans are "negotiating with ourselves" on those key issues because Democrats are the ones that won't enter the debate.
Update at 7:30 a.m. ET. Ryan Brings Risks And Rewards:
Last month, Morning Edition reported that:
"Ryan has youth and experience, he's a conservative from a swing state, and he has big ideas and the policy chops to back them up. But the chairman of the House Budget Committee would not be the safest of choices. ...
"Ryan's pedigree is strong. He worked on the staffs of Kansas Sen. Sam Brownback and the late Republican luminary Jack Kemp. He won his own seat at 28, which means that now, at 42, he's a seasoned legislator.
"But it's Ryan's ideas that first catapulted him into political stardom. The budget plan he introduced in 2010, or the 'road map,' as he called it, ignited a major debate within Congress. ...
"Ryan's budget was instantly controversial. It called for sweeping cuts to social programs, and, most troubling for seniors, would have changed Medicare from a guaranteed benefit to a voucher program.
"Still, Republicans lined up behind it and rode the plan to a sweep of the House, giving Ryan the chairmanship of the Budget Committee. Within a few months, the House passed the Ryan budget (although the Senate did not).
"That's the kind of energy a Romney candidacy could use."
Copyright 2020 NPR. To see more, visit https://www.npr.org.

subset: commoncrawl


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All of our Pro X Series Fat Sacs™ are constructed with a white water rafting material called Valmex. These sacs are unbelievably durable and no longer need the support of an outer shell. Also, our Quick Connect Valve system makes filling and draining an easy task. Furthermore, the placement of our valve holes make it possible to create the perfect automatic integrated ballast system by purchasing the fittings that we make for them separately. All Pro X Series Fat Sac™ are available in assorted colors (Yellow, Red, Blue, Black and Gray) so you can customize the look of your system.Imagine how tough a white water raft has to be when it is slamming into sharp rocks while being exposed to the water and hot sun. These rafts bounce off these jagged rocks and our Fat Sacs™ are constructed in the same way. If you built a white water river raft out of fiberglass or plastic (like some factory ballast systems), you would easily realize the fiberglass or plastic raft would not last as well as the raft made out of Valmex! Our Fat Sacs™ are more durable than factory fiberglass or plastic ballast tanks! Insider Tip: One of the awesome things about Fat Sacs™ is that It Doesn't Matter if they are the same size and shape as the compartment or space they are going in because they will conform. If you want to get the *maximum potential weight* out of a space or compartment, it is best to get a Fat Sac™ that is at least as big or bigger than the space or compartment that it is going into, so it can fill up the whole area. Some people even get Fat Sacs™ big enough to push up the seat cushions when no one is sitting in them *to make the wake even bigger*! Another great feature is the user friendly quick connect cap and chain that allows you to get the Tsunami Pump off and on quickly and easily with the cap hooked to the chain so that it will not go missing. The Tsunami Pump is *twice as fast* as any other plastic pump that is used for manually filling and emptying Fat Sacs™. You simply put the pump in the water outside the boat, attach the other end to the quick connect on the Fat Sac™, and plug it into a cigarette lighter accessory plug. Your Fat Sacs™ will be filled in minutes and you will be ready to ride! When finished, simply attach the Tsunami Pump to the Fat Sac™ quick connect, put the end of the hose outside the boat, plug it into a cigarette lighter accessory plug, push down on pump into the Fat Sac™ to create a prime, and the Tsunami Pump will empty the Fat Sac™ in minutes. In addition, you can buy any of our custom fittings for automatic (integrated) ballast systems.
No customer comments for the moment.


text:
Hewlett-Packard Company (HPQ) faced an interesting dilemma when it purchased Palm, Inc. The smartphone maker exclusively used its proprietary operating system, webOS, while HP came from a Windows background. With the tablet market exploding, the question was which option to pick -- webOS or Windows 7.
Ultimately HP chose to try both. The approach thus far hasn't worked out so great – the Windows 7-powered HP Slate has seen limited sales. But HP is hoping its fortunes will change, now that its first webOS tablet has arrived.
I. Hardware
The HP TouchPad packs a Qualcomm Inc.'s (QCOM) Snapdragon APQ8060 clocked at 1.2GHz and powered by dual Scorpion cores (ARMv7). This is the first of Qualcomm's third generation CPUs to be found in the wild. In that regard, the chip represents the successor to second generation Qualcomm chips found in tablets like the Acer Inc. (TPE:2353) Iconia. The key difference is that the clock speed has been bumped and the Adreno GPU has been substantially improved.
The company's spec page doesn't mention memory, but reportedly the design will pack 1 GB of DDR2, on par with Android designs, and better than the iPad 2. The battery though is pretty small -- a mere 6,300 mAh. By contrast, the impending Galaxy Tab 10.1" from South Korean gadget maker Samsung Electronics Co., Ltd. (SEO:005930) packs a 7,000 mAh battery.
The one saving grace in terms of battery life is that the TouchPad has a smaller screen -- 9.7 inches (1024x768 pixels) versus the titular screens size of the Galaxy Tab 10.1" (1200x800 pixels).
The tablet lacks a rear camera, putting it a step behind the iPad 2 and Galaxy Tab 10.1". However, how much customers really use a tablet's rear camera is debatable.
II. Software
The tablet is powered by webOS 3.0 "Mansion". The new OS offers some slick features. For example you can bump your webOS smart phone into the tablet to transfer web pages or more -- a rather unique idea that none of the competition has implemented yet.
Overall the OS is quite polished with slick multi-tasking and solid core apps. In that regard it's definitely on par with Apple, Inc.'s (AAPL) iOS and Google Inc.'s (GOOG) Android Honeycomb OS.
App-wise the tablet comes up a bit short. In December 2010, the webOS App Catalog hit 5,000 apps -- meanwhile Android has around 250,000 apps, and Apple has around 350,000 apps. While it's easy to argue that the number of high quality apps in Android or iOS is far lower, remember the same also applies to webOS. In other words, expect the hits to be there, but if you're constantly craving new games and connective experiences, you may find webOS's offerings a bit unsatisfying.
III. Availability
The TouchPad "launches" June 19 in the U.S., and ships by July 1 [press release]. Customers in the UK, Ireland, France, and Germany will receive their orders a few days later. Australia, Hong Kong, Italy, New Zealand, Singapore, and Spain get the tablet "later this year."
Like the Galaxy Tab 10.1 and iPad 2, the 16 GB version of the TouchPad retails for $499 USD, while the 32 GB retails for $599. The company has not announced a 3G version of the tablet, but we can expect one to land sometime in the near future. HP says AT&T, Inc (T) will be its likely carrier in the U.S.
IV. Outlook
Really, the TouchPad brings a couple unique features to the table, like tap-transfer. But at the end of the day, it's hard to use these perks to justify a purchase given the shortcomings. The iPad 2 and Galaxy Tab 10.1" both offer you more for you money -- more apps, a bigger screen, and likely better battery life.
And many will argue the best deal of all is ASUSTEK Computer Inc.'s (TPE:2357) Eee Pad Transformer, which packs a 10.1" screen, dual core CPU, 16 GB of flash, a long battery life, and a rear camera, all for a mere $400 USD.
It's far too early to count Palm out, and honestly the TouchPad is pretty impressive in terms of hardware and software. But at the end of the day, it likely will only see strong appeal among the limited numbers of webOS fans, as there's far better Android and iOS tablets on the market.


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Preventing Falls
Every year, millions of adults fall, leading to injuries and emergency room visits. Many of these falls and injuries can be prevented. Most all falls happen at home. Taking certain safety measures can prevent many falls.
Facts about falls
Here are some facts about older adults and falls:
Older adults fall because of tripping.
Falls are the most common cause of injury visits to the emergency room for older adults.
Falls cause more open wounds, fractures, and brain injuries than any other cause.
Falls are the leading cause of injury-related deaths in people older than 65.
Reducing the risk of falling
As you age, your risk of falling becomes greater. This is because of changes in vision and balance, along with other medical and physical conditions. Most people also lose bone density as they age, so the risk of broken bones from falls is a greater concern. Older adults can take steps to lower the risk of falling. Here are ideas:
Have your vision and hearing checked regularly.
Know the side effects of medicines. Some may lead to loss of balance and coordination.
Limit the amount of alcohol you drink.
Wear rubber-soled and low-heeled shoes that fit properly and support your feet. Don't wear loose-fitting slippers that could cause you to trip.
Be careful on wet or icy sidewalks.
Exercise regularly to stay flexible and keep your bones strong.
Preventing falls at home
Take safety measures at home to reduce your risk of falling as you get older. Take these steps:
Remove small rugs or use double-sided tape under small rugs to prevent slipping.
Keep clutter to a minimum. Remove things from walking areas that you could trip over.
Keep the temperature in your home at a comfortable level. This will keep you from becoming too dizzy from extreme cold or heat.
Keep items used often within reach, so you don't have to rely on a step stool.
Install handle bars next to toilets and bathtubs or showers.
Use nonslip mats in bathtubs and showers.
Improve the lighting in your home.
Remove electrical cords from the floor in walking areas.
Install handrails and lights on all staircases.
Get the Medical Equipment You Need at Home
Balance and falls in older adults
Having good balance means you're able to control your body's position. Many things can cause problems with balance.
Some medicines can cause problems with balance. For example, medicines that lower blood pressure can make you feel dizzy. Talk with your healthcare provider if you notice a balance problem while taking a medicine. He or she may be able to prescribe a smaller dose or change your medicine.
Balance disorders
A balance disorder is a problem of the inner ear. It can make you feel unsteady or like you're moving or spinning. Common balance disorders include:
Vertigo. This creates the feeling that you or the things around you are spinning.
Benign paroxysmal positional vertigo. This is a condition that makes you have a brief, intense feeling of vertigo when you move your head. This can happen when rolling over in bed or looking up.
Labyrinthitis. This is an infection or inflammation of the inner ear that causes dizziness.
Ménière's disease. This is a disorder that causes a person to have vertigo. You may also have hearing loss that comes and goes, a ringing or roaring in your ears, or a feeling of fullness in the ear.
When to call your healthcare provider
See your healthcare provider if you:
Feel unsteady
Feel as if the room is spinning around you
Feel as if you're moving when standing still
Lose your balance


text:
CRS: Alcohol Use Among Youth, January 30, 2008
From WikiLeaks
About this CRS report
This document was obtained by Wikileaks from the United States Congressional Research Service.
The CRS is a Congressional "think tank" with a staff of around 700. Reports are commissioned by members of Congress on topics relevant to current political events. Despite CRS costs to the tax payer of over $100M a year, its electronic archives are, as a matter of policy, not made available to the public.
Individual members of Congress will release specific CRS reports if they believe it to assist them politically, but CRS archives as a whole are firewalled from public access.
This report was obtained by Wikileaks staff from CRS computers accessible only from Congressional offices.
For other CRS information see: Congressional Research Service.
For press enquiries, consult our media kit.
If you have other confidential material let us know!.
For previous editions of this report, try OpenCRS.
Wikileaks release: February 2, 2009
Publisher: United States Congressional Research Service
Title: Alcohol Use Among Youth
CRS report number: RL34344
Author(s): Andrew R. Sommers and Ramya Sundararaman, Domestic Social Policy Division
Date: January 30, 2008
- Abstract
- This report describes the extent of alcohol use by youth, federal surveillance systems for monitoring underage drinking, judicial and legislative activity on this issue, and various policy implications.
- Download


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text:
Wednesday, April 23, 2008
I must admit I have a Jackson-Pratt fetish. No, it isn't as sordid as it sounds. I just love leaving these babies inside the human body (in the appropriate clinical scenario, of course). Nothing helps a frazzled general surgeon sleep better at night after a tough, dicey case than knowing you've left a drain behind.
What's a Jackson-Pratt (JP)?
A closed suction, silastic tube with multiple perforations on the flat part that resides in the body. You can attach it to a bulb which applies a constant negative pressure to the intracorporeal portion of the tubing.
What purpose do they serve?
Helps evacuate fluid/blood/pus from spaces in the body.
When do you decide to leave one?
-Lap appy for perforated/gangrenous appendicitis
-Nasty gallbladders with spillage of foul bile during a lap chole
-If there are common duct stones seen on a cholangiogram and I can't clear the duct laparoscopically; higher risk of the clips coming off from elevated ductal pressure.
-Emergency lap chole on a patient on plavix/aspirin, or even if the liver bed looks a little "oozy". Gives you an idea of any "bright red" blood loss.
-Next to low colorectal anastomoses
-Most pancreatic surgery
-Patients who present with peritonitis and massive fecal contamination
-After mastectomies/axillary dissections
-After excision of large lipomas (dead space can fill with serous fluid)
-Under the flaps after a large open ventral hernia repair
-Groin dissections
-Those cases where I just sorta feel like it.....
Now you don't want to stick a JP in the belly after every case. They provide a route for skin bacteria to enter the abdomen and cause abscesses. The closed suction design makes this less likely compared to say, the Penrose drain, but you have to be careful nonetheless. There is good literature to suggest that leaving a drain in after splenectomy will lead to higher rates of infectious complications. Also, you have to be careful leaving drains in too long around a fresh anastomosis. Sometimes the JP can erode into healing bowel and cause a fistula. I've even had a patient yank at the JP and snap it off flush at the skin surface, and have to go back in to retrieve the tip laparoscopically.
When do you take out a JP?
Depends. Breast drains I leave in until daily outputs are consistently less than 30cc a day. Most JP's left in after gallbladder surgery come out the next day unless I'm waiting for an ERCP to be done. Drains left after complicated cases of perforated appendicitis usually come out in a day or two. It's a judgment call for the most part.
Does it hurt?
A bit. Usually not much at all, and it comes out fast.
Going home with a JP happens occasionally, especially in breast and pancreatic surgery. They're not too difficult to care for; patients receive teaching from nursing staff and me prior to discharge, and are instructed to measure daily outputs. I usually send them home with a JP instruction packet, something like this.
64 comments:
- Sid Schwab said...
I love 'em, too. Used to use another reservoir, because it sucked better, but the nurses could never figure them out, even when I demonstrated many times...
I never heard the common duct stone/forcing clips off concept. Not entirely sure it makes physiological sense. And for diffuse peritonitis, I don't think random drains have much advantage; but I certainly used them with a localized process such as a gangrenous retrocecal appendix, or a pelvic infection. Some of my mentors felt -- and they might have been right -- that drains to prevent abscess don't work because they become walled off so quickly. I certainly used them whereever I was worried about leakage of one thing or another. I sent lots of women home with them after mastectomy and never had reason to regret it. - April 23, 2008 at 10:21 PM
- Devorrah said...
Love your blog--I always learn something. Thanks.
- April 24, 2008 at 12:10 AM
- Unknown said...
I love those little grenades. I've even seen one placed at the distal end of a T-tube after a choly. There's something satisfying about emptying them out into measuring containers and recompressing them.
JP is a trademark, and I can't seem to find the "generic" name for this device besides "drain to self-suction". - April 24, 2008 at 10:29 AM
- rlbates said...
My tummy tuck patients usually ask "When can we get rid of "my balls"? A little crude humor between women.
Love the post and the drains! - April 24, 2008 at 12:42 PM
- Jeffrey Parks MD FACS said...
I agree philosophically with you regards fecal peritonitis. But it seems no matter how much irrigation you use, the ascites that collects afterwards just begs to form an abscess. I leave one in the pelvis and another along the right paracolic gutter, up over the liver. As long as the fluid doesn;t look murky after a day or two, I take them out.
Re: common duct stones. If it seems likely that the patient will need a post op ERCP, I like having one in there as a safety valve. The common duct gets insufflated with all that air from the scope and I worry about clips getting dislodged. - April 24, 2008 at 12:45 PM
I have had jp drains and then I have had GD JP drains. One was after my gall bladder surgery and it came out 24 hrs later and with only a bit of pain. The others (2) were after a major abd. open surgery and they were left in until day 4 or 5. Let me tell you there was no comparrison between that GB drain being pulled out and these being pulled out. First they were so long that I swear when he pulled them out they must have been wrapped around everything. Hurt like h***. He knew it was going to also and told me far ahead of time they would. I couldn't even take a deep breathe that allowed him time to pull one completely out. The first one I took deep breathe, he pulled, I stopped, he stopped...Repeat 3 times.
- April 25, 2008 at 9:52 PM
What's the fundamental difference between JP and Blake drains? I've seen both written in op reports but every suction drain I've seen looks this way. Is is some technicality about how the tubing is on the inside?
- April 27, 2008 at 10:43 AM
- rlbates said...
Enrico, yes--the Blake drains have four channels (http://ecatalog.ethicon.com/EC_ECATALOG/ethicon/content/CAT_173.htm) and the JP is flat with holes.
- April 27, 2008 at 8:02 PM
I personally prefer Blake drains for two good reasons: first, they seem to function longer because they don't have holes to get plugged up by omentum or fibrotic debris, and two, they come out much more smoothly and with less pain than a JP with all its holes catching on everything including the fascia.
- May 1, 2008 at 6:21 AM
- Kacey said...
I had a JP left in for 24hours after a carotid endareterectomy. When the resident pulled it the next morning, he nicked something and they rushed me back to surgery at 8:00 in the evening for repair. Afterwards, I had a hard knot on that side, but it didn't seem to concern the vascular surgeon. But, it sure bothered me! This winter, after 3 1/2 years, something started bulging out of the middle of the incision. Lucky me---I was in Florida and the doctors won't see snow-birds with peculiar problems. After it broke open and small amounts of purulent drainage ensued, I wiped it off for a month with Betadine and hoped for the best. I finally saw a vascular surgeon (she came over to the Urgent Care and checked me out as a favor to the attending ) and she sent me for a CAT Scan of the neck --- then called the next day and told me to get home to Ohio as fast as possible. My surgeon opened the incision and the infection was all the way down to the carotid graft, but the samples for pathology would not grow any organisms. After a visit to an infectious disease doc, I was put on Keflex 500mg. tid for a year. I'm thinking it was there for the whole three and a half years ---- and the hard bump is still there! Dang! (P.S. ---Jackson-Pratts really hurt when pulled)
- May 8, 2008 at 11:47 PM
- Jeffrey Parks MD FACS said...
The idea of a JP left in for a carotid is puzzling. Foreign bodies next to a vascular graft is a frightening prospect indeed. Sorry to hear about your experience. - May 9, 2008 at 6:02 AM
- CaShThoMa said...
I like JP drains as well even though I'm a nephrologist; our renal transplant surgeon uses them regularly when he places a new kidney and simultaneously starts low dose heparin to prevent clotting of the allograft. They are "way cool" and usually come out in 3 days (easily).
I enjoy your blog; just found it! - May 14, 2008 at 11:21 AM
I have had a JP in for 10 days now following a hernia surgery. The PA mentioned to me that I had an empty "pocket" in my abdomen that apparently had been there as a result of previous RNY surgery 5 years ago and that they put the drain in to drain off this pocket which was filling with blood and fluid. I went back to the doctor a few days ago and they left it in because it is still draining 80-90 cc/day. There's some nasty stuff coming out of that thing including globs of fat and tissue. Now, the drainage has changed to bright red and thick and continues to come out 80-90cc/day. Should I be worried? My doc didn't seem concerned.
- June 5, 2008 at 9:06 AM
For Wendy: I had a large hernia repair on april 10 and still have one jp drain . It is ebbing away but turning darker and not lighter.. I guess we have a similar problem...
- June 9, 2008 at 6:39 PM
- Jeffrey Parks MD FACS said...
When to remove drains is a judgment call by the individual surgeon. There's no correct answer. Leave it in too long and you risk seeding the tract with an infection. Take it out too early and you can get troublesome seroma collections..... I tend to not leave them in longer than four or five days.... and I'm certainly wary to leave them in for any length of time if I've repaired the hernia with mesh. - June 9, 2008 at 7:08 PM
- Unknown said...
I too have a JP drain in. I'm also wondering when it will be too long. The last one, after abdominoplasty I removed myself. I'm not a nurse but it was very easy to do instead of waiting for my surgeon over the weekend. This time, tomorrow will be two weeks but I'm still draining around 45cc/day. Any thoughts would be appreciated. Thanks.
- June 15, 2008 at 11:59 AM
I had an open cholecystectomy 4/25 and the drain is still in. I made arrangements to get an ERCP, but just in the last couple days the drainage of bile has stopped. Now I have a minimal amount of what looks like blood draining. I don't want the ERCP now for fear it will disrupt the healing. From what I am reading, 6 weeks is too long for a drain to be in, and my surgeon should have ordered an ERCP weeks ago when the drainage didn't lessen as expected. I also have an infection around where the tube comes out, to make matters worse, but that seems to be getting better on Levaquin.
- June 17, 2008 at 7:54 AM
Oh and Diane, I feel for you, but I think you are doing OK. It's less than mine was two weeks out, and mine seems to be stopping finally.
I don't know about you, but I hate having that thing coming out of me! It's not just the inconvenience. It creeps me out. I feel like something out of a horror movie. I think having this foreign object in my body is slowing down the healing, because of my mental reaction to it. - June 17, 2008 at 8:02 AM
- Jeffrey Parks MD FACS said...
It's a judgment call. I use 30cc/day as a guide for breast cases. As I've said before, leaving them in too long risks infection. But premature removal leads to fluid collections. Be in close contact with your surgeon about the outputs and the nature of the fluid.
Not all bile leaks after cholecystectomy need ERCP. Sometimes the leak will seal just with adequate drainage. One thing to consider would be a HIDA scan or an MRCP to assess whether there is a continued leak... - June 17, 2008 at 8:12 AM
I had surgery on my bladder, right kidney and ureter because I had a duplicated collecting system on that side and reflux. I had a JP drain in for about 6 days. They took it out the day I came home from the hospital. Surprisingly, it didn't hurt coming out. At least the nurse had warned me ahead of time that it might.
- June 20, 2008 at 5:15 PM
Buckeye surgeon- I just went to the GI and they are going to do a HIDA scan. I'm glad because that seems a lot less intrusive than the ERCP. Also I am down to about 5 ml per day. so I'm pretty sure that drain will come out on my next visit! Yay!
I hope it doesn't hurt coming out...
And last but not least, thanks for this blog. A lot of these medical forums contain mostly dubious advice from people who have no medical training. I believe what you say because you are a doctor. :) - June 21, 2008 at 11:10 AM
I have 2 JP drains in for lymphoceles, following a hysterectomy and lymph node dissection. They've been in for 15 days, and the past few days, following a tube change and schlerotherapy, they're both leaking at the insertion site. Any thoughts?
- July 12, 2008 at 5:33 PM
I had a elective lap chole 16 days ago for pylops. I was diagnoised with a low grade bile leak five days after surgery. I have had a JP drain in for 10 days now. I only drain bile @ night when I sleep. During the day the drainage is the color of urine. I was told this is good and is part of the normal healing process. When should the drain come out? I am draing about 40-55ml per day now. Thedrain is red and very uncomforable where it is inserted. Thanks for any input:)
- July 16, 2008 at 6:14 PM
- Jeffrey Parks MD FACS said...
Most bile leaks will close in 1-4 weeks. Need more information for further assistance: where is the leak? has ercp been done? recent hida scan? - July 16, 2008 at 7:06 PM
Thanks for the response, I never had an ERCP. Was told I only needed one if they were going to place a stent. I have been told that since it's a low grade leak I don't need a stent. I only had the HIDE scan to diagnose the leak. Not since. The doc told me that she "thinks" its a leak on the periphery of my liver and not in the main biliary tree. She belives I was clipped during surgery. Being a nurse myself I am not a good patient and feel that someone should be held accountable. Is this a common complication of a lap chole. The drain is the worst part of all of this. If I have been draining 40-50ml a day and only half is bile can the drain come out and do I need the hide scan prior to removing the drain to make sure the leak has healed? Thanks a million for any help or suggestions:)
- July 16, 2008 at 11:59 PM
Had a hida scan today. The leak is coming from where the gallbladder was. It's a mild leak. Today I have only had 10cc out. The doctor on call would not take the drain out. He said I have to wait until Monday. It there any risks to leaving a drain in that is no longer draining? Will I need a stitch or two from where the drain was? I am considering taking the drain out myself. If the drainage stops are there any real risks in do so? Thanks.
- July 17, 2008 at 11:19 PM
- Jeffrey Parks MD FACS said...
Sounds like your surgeon has the right idea. Duct of Luschka leaks (the sort you seemed to have) are generally benign and will close spontaneously. I strongly discourage you from taking the drain out yourself. - July 19, 2008 at 6:15 AM
I had a JP drain placed in my left calf on 07-16. I had a bad laceration that did not close in Nov 2006, and my orthopedic surgeon did a skin graft to close it about 3 months after the injury. Well, I ended up with a void in my calf, and the surgery last week was the second done by my new plastic surgeon. She did not put a drain in the first time, but because of collecting fluid, she decided to put one in this time. I have 2 questions. I noticed the actual bulb can disconnect, what would be the ramifications of disconnecting this thing for a few hours ? Also, could i remove the bulb, and put a few cc's of saline in a syringe and flush the line ? I am afraid to milk it because the tubing looks awfully thin, the actual tubing being only an 1/8th of an inch or so.
- July 22, 2008 at 4:47 PM
- Jeffrey Parks MD FACS said...
Anon 7/19-
No reason for you to disconnect the bulb or to be doing any sort of flushing without explicit instructions from the surgeon who placed it. You risk seeding the wound cavity with bacteria by opening up the tubing to air.
Milking it is fine. Those tubes shouldn't break. - July 22, 2008 at 6:19 PM
I am having surgery to remove a 15cm lipoma. I will have a JP for an estimated 10 days. I will have to empty it about twice a day. I am so nervous about removing it myself. Are they difficult to use? Thanks for this blog.
- September 10, 2008 at 11:41 PM
- Jeffrey Parks MD FACS said...
All patients get explicit instructions prior to discharge. I've even admitted patients overnight if they seem uncomfortable with management of the JP after outpatient surgery. Unlikely the tube will stay in the full 10 days. Most can come out in 5-7 days after lipoma surgery. - September 11, 2008 at 4:25 PM
Thanks for the info, Buckeye (I'm a Buckeye too, by the way). Is lipoma surgery typically pretty quick?
- September 11, 2008 at 10:46 PM
AniNonymous in California
I had abdominoplasty on September 16, 2008. (I regret it!) I still have one (of originally two drains) on the left side. It is still producing about 10 cc every two hours.
What could be causing the continues flow of fluid? I do think I remember bumping that drain slightly about 6 days ago.
Could that have caused something?
I do have diabetes, though I have monitored and controlled the sugar numbers very carefully, so they have been very normal. - September 28, 2008 at 12:36 PM
Long story shortened as much as possible: 10 years ago in December had my 3rd son by 3rd c-section. Ends of scar would intermittently open and ooze and smell profane. Went to see doctors and they all said no to antibiotics and no to removing scar ("not medically necessary"), scan opens and closes at will. just all around nasty. Fast forward to spring 2008, moving furniture to paint den, later on scar popped open again, this time oozing much. went to new doctors in new region where I moved to in US and he immediately referred me to reconstructive plastic surgeon. PS ran culture: staph and strep in fluid. Scheduled surgery. Thought scar coming out only and would be back home by lunch. Nope, not so much. When PS put in blue smurf dye to see if infection contained, it snaked into my abdominal cavity toward my colon. He immediately opened my cavity and called in general surgeon. Oh, can you imagine what he found. OB/GYN has stitched my colon to my abdominal wall 10 years ago w/ very last stitch of the surgery. And, evidently, I acquired a staph infection in hospital. (Must point out first doctor told me to get off my feet and rest was my OB/GYN). But, I digress. So, abdominal wall adhered to colon and staph had eaten hole in colon. And I had 3 hernias. So, awesome PS repaired colon, 3 hernias, cut out infected scar by removing about 6 inches of my gut (which is nice) and sewed me up beautifully. Can definitely tell the difference in his techniques than the nasty staples OB/GYN used all those years ago. So, surgery on 9.22.08 and I still have the JP drain in. Averaging now about 40 ml per day give or take. PS wants to be 25 or under. Have eliminated sodium as much as possible. Did have a few nibbles of family's chinese food last night, but ate high fiber cereal as my meal. Can anyone recommend how to lower the output of this fluid. What can I do to get this little sucker (no pun intended) out of me. I actually say I went in to have something removed, but acquired a testicle. I'm ready to get neutered! This site has great, thorough discussions and after researching dozens of sites, I'm blogging here in hopes of getting some answers. I'm not looking for blame of my OB/GYN. He is a dear man and respected physician and I'm sad to say he is unfortunately dying of colon cancer. Just sad. But, I wanted to put that out there because that is not where I'm headed with this. I'm in the here and now and want to be free of the pain and go on with my life. Thanks in advance and have a great day.
- October 10, 2008 at 12:20 PM
- Jeffrey Parks MD FACS said...
Interesting history! Sounds like you've had the correct defintive procedure. Unfortunately, there's no evidence that changing your diet will do anything to help reduce seroma outputs. My stance is to remove a drain no matter what after a week or so because of infectious risks but everyone does it a little differently. Good luck. - October 10, 2008 at 4:40 PM
Thanks Buckeye,
I guess I have a few more questions about this if you don't mind. Is seroma fluid the usual abdominal fluid that is caused by the injury of the tissue (surgery). In my research, I see seromas most related to breast surgery, typically a mastectomy. Would all the infection that lived in my body for so long cause this? One more thing I forgot to point out. My PS said my colon was not "flapping about as normal colons do" and that it was seemingly crammed in post delivery/preclosing during my csection. He said the General Surgeon and he put it back how it was supposed to be. Ironically, my bm's have always been very regular, never any blood or mucus. All I had was typical premenstrual pain and tugging from what I thought was scar adhesions. When I think of how sick I really was, I literally shudder. The hernias scared me as well. I had dealt w/ pain and swelling for so long in my left leg. But, I thought needing to lose some lbs caused that. Can you explain that pain? I've seen that multiple c-sections can cause some lower limb pain. I have far less pain today. In fact, for the first 2 weeks, I was pain free in my leg. Feels like it's a little swollen again. I just want to start walking again and want the drain out and the leg swelling to decrease. - October 10, 2008 at 5:17 PM
- Jeffrey Parks MD FACS said...
Seromas can occur anywhere. Not exclusive to breast surgery. Anytime to remove tissue, the body fills in the deadspace with serum.
As for the leg pain, Im at a lost. Could be anything. Have a doc take a look. - October 12, 2008 at 8:58 PM
I have had Jackson Pratt drains 5 times in 2 years. I am a breast cancer survivor. Please look at my new drain garment at my website. I launched last week with my new company. www.surgishorts.com.
Jackie - October 16, 2008 at 5:52 PM
- Frank McGonigal said...
I had an appendectomy and had a Jackson-Pratt drain put in.
4 nurses tried to remove it after a few days,but it wouldn't budge.
The Surgeon came in and I told him about the 4 nurses who tried to remove it.
He said "Oh it'll come out and gave it a yank.
It broke off at skin level and he said it wouldn't be a problem as lots of people are walking around with things like staples in them.
4 months later the 7" broken end came through attached to a stool.
How in hell did that drain end up in my bowel ? would it cause any damage inside ?.
If it had been left in permanently would it have caused any other problems ?.
I go back to see him tomorrow and I have a few pointed questions to put to him.
I'm very angry at the moment at his cavalier attitude to this situation. - November 16, 2008 at 1:10 PM
Please visit my website and view the new garment for use with Jackson Pratt Drains.
Thank You,
Jackie Green - November 16, 2008 at 6:29 PM
How much suction power to they produce in mmg??? Cannot find info on it. Thanks to anyone that has an answer for me!
- November 20, 2008 at 1:43 AM
Enjoyed the info on the blog very much. I am a nurse of 33 years and a Doc's look at practices is a very different perspective. I came here seeking input about JP drains. I currently work in long term care although my experience is diverse. Our current Director of Nurses is just a great nurse, business woman and manager. We have been accepting admissions with higher acuity. I need some updating.
We have several problems in long term care. One is widely differing skill levels in the nursing staff. Another is that the surgeon does not follow the pt back to the nursing home. The third is the MD on call rotates through. Often I am asking for orders for my pt from a doc who knows nothing about the pt or the history. I read all H&P's, the surgical reports, review labs etc before I call the MD. I then call give a background picture and the current clinical findings I am concerned with. Also as a long term care nurse I have much more involvement with pt, and family than do most other aspects of nursing.
Given this background here is my question. I have young 30's pt who has a pineal tumor and is in a vegatative state. He has a peg tube in place and Mom is a nurse. He recently developed a gangranous gallbladder that burst during removal. He subsquently flooded his Jp with 150 cc of drainage. He was transported to a larger hospital had an ECRP done and removed a blood clot. He developed
pneumonia and has a PICC line and is receiving 3 abx's gentamycin, lyvox. He back to our facility with a JP in place that is probably 3 weeks old. Yesterday there was 15cc in the JP of rusty clear serosangious dranage. He bowel sounds are hypoactive and his lung sounds are diminshed and have ronchi. He has restarted his tube feeding also. Yesterday there was no residual for his tube feeding. Today there was no drainage in the JP drain for 24 hours. Same poor bowel sounds and lung sounds. I did get 15 cc cloudy foul smelling yellow green drainage residual before I started to give my pt his tube feeding. I called the on call doc gave him the same hx as above. I recieved orders to hold the tube feeding and restart when there was no residual. I checked again in 1 1/2 hours and there was clear yellow residual. In another 2 hours the residual had cleared. The evening nurse resumed the tube feedings etc. I felt like the pt needed to be evaluated in the ER basically due to the poor bowel sounds and no drainage in the JP, esp in light of this young mans hx. My fear was that the JP was again blocked and there was infectious material backing into the gut from the billary system. Is my understanding of the pathology and the purpose of the JP drain goofed? IF so please fill me in. I hate feeling clueless.
Thank You
firstname.lastname@example.com - January 5, 2009 at 2:57 AM
Hi, I am a 35 yr old paraplegic and have some important questions regarding these jp drains.
I have had several decubitus ulcers surgeries, including two muscle flaps and one excision & closure. recently I discovered 11cm of a drain had been left inside my body and it has caused me a world of complications. determining which surgery caused this is proving to be difficult to investigate. first of all, how long could these drains survive inside the body? my first surgery was in 1996 and a jp was used. my second surgery was in 2005 but I cannot recall if a jp was used or not. however, from xray and CT images, it appears that it showed up after the 2005 surgery. would a surgeon use the drain/strip part of the drain (the end of the jp with the plastic strip and holes) as a surgical tool during surgery? I have also had a girdle stone procedure done on my right hip due to a bone infection in my hip joint and developed a fistula to my thigh and I wonder if this was caused by the drain that was left behind. I also contracted MRSA after the 2005 surgery. any information you could provide would really help me with my investigation of this mystery. your quick response would be very greatly appreciated. thanks in advance!
Joe - February 20, 2009 at 1:21 AM
Should JP's be replaced/swaped if they are in longer than 3 weeks? Not sure if this is something done to prevent infection or if the JP just stays in until the drainage amount is low enough for removal...
- March 20, 2009 at 10:32 PM
i have a JP for about 3 week now (it supposed to be removed today) but something weird appear in it this morning , its look like a 20 cm worm or tissue i really dont know what is that ... thing? I ask my nurse this morning and she said in 36 years of my carreer i never saw that before.
Anyone have any idéa ? and i look on the site that tell after like 1 week with a JP we may have an infection or i have it for 3 week now and the last 4 days drain only like 20cc witch is like blood color do we need to take care about that or no?
Other thing i already get an other JP that will be removed like 7 day after it was put in it and the nurse tell me to get off the presure of the JP like 30 min before the extraction to release the tissue from the JP. Don't know if it work but that not really hurt when it was extract , hope this will help.
(P.S: sorry for my bad enflish) - June 9, 2009 at 10:13 AM
I just got my JP removed yesterday and the doctor said it was the fibrinous tissue that comme out the J.P. , and as i said i release the pressure like 2 HOURS before the extraction and the doctor pull it out in one shot and that just surprise me more than it hurt.
- June 10, 2009 at 7:26 PM
- Unknown said...
I hate my JPs- I just had a tummy tuck & they are SO uncomfortable- more uncomfortable than the actual surgery!!!! I am going into my doctor today hopefully to get these bad boys removed...I ABSOLUTELY HATE THEM! You doctors are HORRIBLE for making us go home with these things! UGH!
- August 10, 2009 at 3:02 PM
- Unknown said...
My husband had the Whipple Procedure done for pancreatic cancer. He has had a JP drain for 3 weeks. The stuff that comes out is vile and smells horrible and changes color day by day. Now, the drain tube is plugged up and nothing is coming out into the bulb. Fluid is leaking out of the abdomen through the stoma opening. Doctor is on vacation but PA says we may have to have a bigger tube inserted tomorrow. As of yesterday he was still draining over 200cc per day. The site is infected and pussy and is this what is pluggin up the tubing? Any suggestions? Yes, he is on antibiotics for this infection.
- August 13, 2009 at 4:09 PM
- Lindsay said...
My Dad just had a radical prostatectomy 5 days ago and was switched from a JP to a passive gravity drainage bag. I love a good Jackson Pratt, so I was a bit disappointed when we went home with this crappy drainage bag. It keeps getting clogged with stringy clots and his 24hr output is still around 250cc's. I'll be so glad to see the drain go!
- September 5, 2009 at 1:04 PM
- CC said...
I had a coccygectomy and the JP drain was removed less than 24 hrs later by the surgeon. 8 days later I returned for an emergency surgery due to infection. They found a 3 in piece of fractured JP drain inside. Have you heard of this happening?
- February 19, 2010 at 7:39 PM
I had bilateral free flap reconstruction on 1/26/10. The right breast was delayed after a mastectomy in Feb. of 07, the left was a prophylactic mastectomy with immediate reconstruction.
I have had the abdominal JP drain for 5 weeks and am still draining 40cc's average per day. The drain is now starting to get an unpleasant odor. My Plastic surgeon wants to leave it in until I am at 30cc's per day for two consecutive days. I am ok with that because I don't want to develop a seroma, but I am also concerned about the odor.
What is your opinion? - February 26, 2010 at 10:17 AM
- BRANDI said...
Wow am I glad I found this blog! I have 2 stints and a jp bag in, that has been draining about 300cc's a day. I was rushed into surgery 2 nights ago, following a gallbladder removal from 8 days prior. I have had the hida scan,ERCP, stints and jp drain, however,my fluid is still coming out red. My doctor says this is normal, although, I donot feel this is normal.I am 28 years old and very young for this kind on problem. My blood presure since all of this has been running in the 170's over 100's. My surgen has already lost my trust in him over the whole situation, that I will not mention here. Can someone please tell me to set my mind at ease that all of these things are ok? I am very scared and just want to stop hurting.
Thank you for any input! - April 3, 2010 at 1:27 AM
Had a sarcoma chemo radiation and finally extraction. Went home with 3 Jackon Pratts. 2 were removed after 4 weeks one left in for 6. Had the 3rd one pulled out and an infection developed MRSA. HAd a muscle flap operation to plug the hole and another 2 JPs inserted. Intense pain followed. Had the JPs removed and infectin was gone yet intense pain followed for the next 5 years. I always thought there was a foreign body (ie.e JP broke off inside my back) Had a thrid operation to cut 4 intercostal nerves and 7 general nerves to kill pain. It did not work. I asked the Dr. to look for a foreign body inside me. Jokingly he said no cell phones found inside. After 6 months of more pain (i.e. the pain killing operation did not work). I still suspect there is something left behind in me. After reviewing photos of the last operation I noticed the Dr. did not go back into the site of where the pain radiates but went in to cut the nerves so -- he really could not have reviewed if there was a a piece of JP left behind or not. Intense pain persists every day all day. I take a ton of pain med but to no avail. It sucks. Anyone have any advice insight or suggestions. Is it possible that a piece of JP still be inside me after all these years causing the pain???????
- July 12, 2010 at 1:51 PM
- Unknown said...
I had a ruptured appendectomy and cecum removal. When I woke up from my surgery, I had one JP drain coming out of my left groin (don't ask my why the drain was coming out of my left side when your appendix is on my right). I had 140-150ml a day for 2 weeks and then it slowly dwindled down to 50-60ml after 2 months. The doctor wouldn't remove it unless I produced less than 40ml. Two months later, I had severe pain from where the tube was coming out. The doctor finally did a CT scan and just found a swollen colon. He removed it that same night and put me on flagyl. After 2.5 months, I am finally better. I am writing this because I googled this issue for hours and didn't find anything close to what happened to me other than this site. I just wanted to let people know that this can happen after a routine surgery. I just wish they had put me on antibiotics the day after my surgery.
- November 16, 2010 at 12:29 PM
- Brooke said...
IF there are ny radiologists out there tht read thsi please advise wht tytpe of CT would you do if you were looking for a broken off piece of Jackson Pratt inside soemone. IS there a specific test you would want done to see plaastic inside someone. WIth or without contrast.
- May 6, 2011 at 10:20 AM
- Brooke said...
Radiologist what type of CT would you order to see if there ws a broken JACKSOn Pratt inside someone?
- May 6, 2011 at 10:21 AM
- Bryann not a girl said...
- This comment has been removed by the author.
- November 22, 2011 at 1:48 PM
- Shandell said...
I'm not sure if you still check this, hoping you do! I had a radical hysterectomy and lymphandectomy 6 1/2 weeks ago and I STILL have a JP Drain in, I am still getting any where between 300-500cc every day. I don't think this is normal and my dr doesn't seem concerned... Do you have ANY advice for me?
- April 7, 2012 at 11:06 PM
- Unknown said...
I hope this still gets checked too! April 11 I had a 10cmx10cm benign lipoma removed from the deep subfascial area of my lower back. I still have my JP drain. I suspected the beginnings of infection about 3 days ago and was put on druacef but it does not seem to be responding. Now I am getting small amounts of green viscous pus from the jp site and the drainage looks like orange pond water: very murky with bits of flotsam. Additionally, the site is EXTREMELY painful, with the lightest tug causing a great deal of distress. I intend to call my surgeon back on Monday, but are there any alternatives to a JP drain. Because of the infection, I'd like to have the drain pulled ASAP, but I am still draining about 100ccs a day and do not want to risk any fluid related complications. Here's hoping this forum still gets checked. - April 28, 2012 at 11:00 PM
My dad had a mass removed frm tail of pancreas and the spleen removed. He has wore the drain now for 10 days and the stuff hasn't slowed down at all. He went to doc and they are gonna check it again Tuesday. I am concerned something else may be leaking. How would u know if that was the case?
- December 14, 2012 at 9:03 PM
First and foremost, I am not a physician. I speak only from experience. I've spoke with other patients regarding their drains and recovery and have come to the conclusion that everyone will have a different draining experience. I think draining is a good sign but if you are alarmed please call the surgeons to get some
Peace of mind!
- December 15, 2012 at 10:31 AM
I had surgery on 7/26/13 for a very bad gallbladder. They left a jp drain in, and have sent me home with it. They said I had damage to one of my bile ducts, and since I had a gastric bypass several years back they were unable to do a ercp. I am draining around 300cc of bile in a 24 hour period. They didnt tell me how long my jp would be in, or how long it may take the bile duct to heal. And I cant find very many answers anywhere. As far as I can tell the drain is doing what it's supposed to do, not to much pain, and I'm keeping the site clean. Just would like to know how long it may take a bile duct to heal? Thank you, Deborah in Wise, VA
- August 1, 2013 at 3:19 PM
Hello Doctor, Came across your blog today while searching for drainage after open gb surgery. My 73 yr old mum underwent open gb surgery, after her cbd got nicked while being operated laparoscopically on 11/03/14.The operating surgeon did a hepaticojejunostomy & a jejunojenuostomy ( he is a liver transplant surgeon) and he has left a closed suction drain in situ to drain the peritoneum. Mum is afebrile on tab Ceftum 500 mg BD (Cefuroxime axetil) orally and at home since 19/03/14. The bile had been draining steadily 70 ml on 19/03/14, 90 ml on 20/03/14. In your experience how many days does it take to go below 30 cc? She is ambulant. Also do I need to give her antibiotics with the drain in situ? I thought it was advisable although its taking away her apetite. She's non diabetic, but hypertensive(on Atenolol 25 mg OD).She weighs about 45 kg. Could you care to suggest another antibiotic? and how many days? Would really appreciate your opinion.Her SGOT, PT are between 45-50 IU/L yesterday, but ALP & GGTP are raised still(218IU/L & 245 IU/L). Could not find any literature on this subject on the net.Today her USG abdomen revealed no collection of fluid. I am a practising GP based in New Delhi India, right now on leave to nurse her.
- March 21, 2014 at 1:37 PM
Had a Whipple surgery two months ago,and still have the jp drainage.and it doesn't seem to get any better.still draining a lot.its that normal ??
- January 24, 2015 at 10:18 AM


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12n PST 49ers @ Falcons
3:30p PST Ravens @ Patriots
Random rantings and ravings about the Los Angeles Dodgers, written by a small consortium of rabid Dodger fans. With occasional comments on baseball, entertainment, pop culture, and life in general.
Go, nobody!
Come on you team that I can develop a vague narrative of support for simply because you reside in the same state in which I live!
Falcons up 7-0 in the 1st.
10-0 now.
Tom Cruise is wearing a Yankees cap in the "Oblivion" commercial. Of course.
Down goes Kaepernick!
This just in: Lakers still suck.
17-7 ATL in the 2nd.
All I remember is the Niners driving the cars the gnats were riding in during their stupid parade. Sorry, Matty, but the Niners can gargle my balls.
ToGo, bishes!
TD Falcons! 24-14.
Quiznos, bishes!
Or should it be Jacquizznos?
Does Howie Long cut his hair with a Sawzall?
24-21 to start the 3rd. Bison must be happy.
I don't know about Howie Long, but I think Jimmy Johnson's hair is made of marble.
I can't believe I have to root for Atlanta here
The Falcons secondary is playing like 15 yards off...everybody's WIDE open. Bump somebody dammit!
Akers nails the wrong side of the goalpost. Still 24-21.
My hatred of the Braves doesn't extend to the Falcons--at least not like the gnats-niners connection, but that's just me.
And the Falcons turn it over. Dammit.
So much for Matty "Ice".
Falcons D picked a hell of a day to try out their Raider impression.
And the Niners give it right back!
Goal-line fumble!
Great game so far, like the other playoff games have been.
Ugh. Three and out.
Shit. TD 49ers.
Seriously, unbelievable playoff games this season. Let's just hope the Super Bowl isn't a big let-down.
I wonder if it really chaps Alex Smith's ass to see those Visa commercials.
This is the only time I don't want Matt Kemp to be happy.
Well, maybe with Rihanna too.
What a grab by Douglas!
Matt Kemp @TheRealMattKemp
Wow!!! Can't even get it right with replay!! Terrible call!!
Makeup call? 49ers on the verge of winning.
Matt Kemp @TheRealMattKemp
We going 2 the SuperBowl!!!!!!!!!!!!!!!!!!!!!!!!!!!
Is San Francisco the new Boston?
I actually like Kaepernick, but Harbaugh's a choad. Oh well. I hope Tony Gonzalez plays next year.
The Warriors and Sharks aren't gonna do shit, no worries about that. Plus, I still think it's an AFC year. Especially if it's the Patriots, but either one will likely beat the Niners.
And now I find myself rooting for Tom Brady. What the hell is going on here?
Yvonne Carrasco @yvonnecarrasco
Steve Rushin @SteveRushin
Niners in Super Bowl and Die Hard in theaters. Set your watch to 1989.
NE 13, BAL 7, 3rd.
Check that. Ravens take a 14-13 lead.
Ravens on a roll! 21-13 BAL.
Didn't see this coming. 28-13 BAL.
Man, the Pats look totally out of sync.
The best thing about this game is hearing the dismayed crowd reactions.
Both home teams in line for the loss, by the way.
Niners-Ravens Super Bowl. Yawn.
Brady throws and end-zone pick to end it. How ignominious.
Harbaugh vs. HarZZZZZZZZZZ
Sorry folks but after seeing that GT pic,Matt Kemp can suck my cock.
4/3 vs. SF (W, 5-4): Sax
4/15 vs. WSH (L, 4-6): Dusty, Orel, Sax
5/6 vs. MIA (W, 6-3): AC, Sax


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My observations:
- The non-use by the paper of the "evolutionary mutation rate" results in low age estimates and hence a "Neolithic" time frame. The authors are to be commended for going against the flow of the last 7 years of population genetics literature.
- However, the inference that a "Neolithic" TMRCA = "Neolithic" time of arrival into Europe is flawed, as I have argued elsewhere. In short: a particular TMRCA is consistent with either the arrival of the lineage long before and long after the TMRCA in a particular geographical area.
- Equally flawed is the inference that R1b1b2 is clinal (Figure 2A). Microsatellite variance is not significantly higher in Turkey than in Europe -- even if one makes the questionable questionable assumption that modern Anatolian Turks are patrilineal descendants of Neolithic Anatolians. The significance of the regression line disappears if 1 or 2 data points are excluded, and the plot has a quite visible "gap" between Turkey and Italy corresponding to the entirety of eastern Europe and the Balkans, i.e. the routes that any putative Neolithic lineages would have entered Europe
Related: Migrationism Strikes Back in which I argue in favor of Neolithic (or later) replacement of most European mtDNA.
PLoS Biology doi:10.1371/journal.pbio.1000285
A Predominantly Neolithic Origin for European Paternal Lineages
Patricia Balaresque et al.
The relative contributions to modern European populations of Paleolithic hunter-gatherers and Neolithic farmers from the Near East have been intensely debated. Haplogroup R1b1b2 (R-M269) is the commonest European Y-chromosomal lineage, increasing in frequency from east to west, and carried by 110 million European men. Previous studies suggested a Paleolithic origin, but here we show that the geographical distribution of its microsatellite diversity is best explained by spread from a single source in the Near East via Anatolia during the Neolithic. Taken with evidence on the origins of other haplogroups, this indicates that most European Y chromosomes originate in the Neolithic expansion. This reinterpretation makes Europe a prime example of how technological and cultural change is linked with the expansion of a Y-chromosomal lineage, and the contrast of this pattern with that shown by maternally inherited mitochondrial DNA suggests a unique role for males in the transition.


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I am a big Chocoholic myself and can never say no to a Chocolate Dessert.When it comes to cakes,no prizes for guessing that I am fond of chocolate cakes over anything else.I have,from personal experience,found that a slice of decadent chocolate cake can shoo away your worries and tension,at least temporarily.Yes,chocolate has that power to transport you entirely into a chocolate heaven!!!
So it was no wonder that when I decided to host my first event on Easycooking,Chocolate cake was my first choice.Though I have baked quite a few chocolate cakes myself,I madly collect recipes of the same hoping to try it out next.
I got 34 wonderful entries from 25 bloggers and one non-blogger[my co-sis] and 4 entries from me.Thank you all for making this event a grand success.
As promised,the winner for the giveaway was chosen by a special guest.By special,I mean REALLY special as I've known him since sometime now and now he is a rockstar.Yes,I am talking about the latest IPL sensation-M.Vijay.
And the winner is...
Aliena of What's Cooking today wins the book 1 mix,50 cakes.Please get in touch with me at email@example.com to claim your prize.Congrats!!
[entries in random order]
Chocolate Cake by Nayna Kanabar
5 minute Magic Chocolate Cake by Smitha
3 minute Chocolate Cake by Daisy
Chocolicious Chocolate Cake by Chaitra
Marble Cake by Chaitra
Chocolate Cake by Ann
Rich Chocolate Moist Cupcakes by Sudha
Eggless Dark Chocolate Cake by Parita
My Entries
Deep Dark Chocolate Cake
Whole Orange and Chocolate Cupcakes
Hope you enjoyed the Chocolatey round-up!!
P.S-If I have missed any entries,please shoot me a mail and I will include it in the round-up!!


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First Blood "Silence is Betrayal" CD
First Blood is not an unknown band by any means, featuring ex-Terror bassist Carl Schwartz on vocals, First Blood formed in early 2002 from the ashes of Sworn Vengeance. Previously releasing material on Division36 Records (Bridge 9) and Deathwish Inc., First Blood impressed many for their brutal delivery and in-your-face lyrics dealing with both social and political issues. Having toured throughout the USA, Canada, Europe, Japan and Mexico while sharing the stage with notable bands such as Comeback Kid, Ignite, This Is Hell, Sick Of It All, Stretch Arm Strong, Agnostic Front, Hatebreed, Exodus, Napalm Death, The Black Dahlia Murder and Despised Icon, First Blood is ready to hit the road again in support of "Silence Is Betrayal." Deluxe edition CD includes four additional tracks.
- Intro
- Silence
- Preamble
- Enemy
- Resist
- Truth
- Detach
- Enslaved
- Confront
- Fascism
- Lies
- Survive


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New Record - Life And Times - Sums Up 30 Years of Work with Reflection while Never Easing up on the Aural Assault
With bands like the Silversun Pickups and No Age drawing big crowds at this year's Coachella music festival, it was a midday set on Saturday from Husker Du/Sugar veteran frontman Bob Mould that schooled the young audience on the real power of loud guitars and moody lyrics.
The 48 year old Mould played a 45 minute, career-spanning set that kicked off with Sugar's "The Act We Act" and included favorites like Husker Du's "New Day Rising" along with songs from Mould's expansive solo material, including two songs from his latest Life And Times. Backed by a full band that gave the eager crowd the wall-of-guitar sound that Mould popularized way back in the 80s, the Coachella performance was noted as one of the weekend's best by fans and critics alike:
- "Mould's most recent release, Life and Times, is about reflection. His Coachella set was more about asserting some dominance. There's nary a younger act on the bill that doesn't owe some debt to Mould's work in Husker Du and Sugar, ranging from the fuzz-laced assault of the Silversun Pickups to the hearty heartland rock of the Hold Steady." --LA Times
- "Marrying ear-candy melodies to noisy and snarling punk-kissed sonics and creating a muscular, nerve-flayed detonation of classic punk and rock that felt like rhythmic slabs of concrete being shockwaved from the stage and into the crowd. Skipping from the slam-bang kinetics of minute-and-a-half Dü-styled speed-punk to the melodic slow-burn edge of a track like "Life and Times" (from his 2009 album of same name), the Bob Mould Band illustrated the possibilities of melody and songcraft within a serrated guitar thunderstorm, and did so without compromise or sacrifice of vision. And while Sunday performers No Age may be the current gatekeepers of the noise-rock genre, Mould noisily reminded everyone within bloody earshot that he was still in charge." -Paste Magazine
- "He plays straightforward grownup rock, combining new material like "Life and Times" with old band hits like "If I Can't Change Your Mind" and Mould himself not doing anything at all out of the norm while still keeping the crowd thrilled." -Entertainment Weekly
- "No act rocked Saturday's concert better than Mould, who, at 48, proved that there is no age limit for creating exciting new music." --Live Daily